My season is going to complete crap
Plan for 2014 was Texas 70.3, Kemah Olympic Triathlon, IMCdA and IMMT.
TMI ALERT: In January I started having some pain in my groin area. Went to the doc in early-February. I had three issues: a hernia, pulled/strained ab muscles and epididymitis.
The hernia is not surgery worthy yet so that's not going to impede anything.
The ab muscle problem healed itself in a couple of weeks. I'm certain the Tour of Sufferlandria caused this issue as I wasn't in the kind of shape I needed to be in to do it. Did it anyway and planned to use that to really kickstart my training.
The epididymitis was the big problem. If you don't know what it is feel free to look it up. Basically, it's an infection of one of your testicles. It hurts. A lot. Needless to say biking and running are just not an option when one of your boys feels like someone is squeezing it all the time. I took a 10 day dose of antibiotics. By the time I could get around to training, Texas 70.3 was six weeks away so I had to scrap that since I basically hadn't trained. The Oly was three weeks after the 70.3 so I figured I'd still do that since nine weeks is plenty of time for me to prep well for an Oly.
The naughty bits felt fine after the antibiotics. I got two or three weeks of training in and then my nut started hurting again. Tried to grind it out for a few more days but it was just too uncomfortable. I went back to the doc today and he explained that epididymitis often needs more than one round of antibiotics to knock it out. He gave me a more thorough exam this time. Nothing like having some dude fondle your junk for several minutes. He thought he felt something hard in my right nut, didn't think it was anything to be concerned about but felt it was best to have an ultrasound. So off I went to radiology to have an ultrasound on my bag (I'm running out of euphemisms). So I had some female ultrasound tech messing around down there for 15 minutes. Nothing awkward about that.
Anyhoo... hopefully nothing major and it's "just" the infection. Now I have a 21 day supply of antibiotics that I have to take twice per day. Of course no more training for another three weeks.
So now the Oly race is a goner. IMCdA is 14 weeks away. Now that's in jeopardy as I'd have maybe 10 weeks to train for that.
Operating under the assumption I don't have ball cancer, I think my best option is to transfer my CdA registration to Whistler and do IMC again. That gives me another four week buffer. That will prove a much costlier option as I will have to:
- Pay Ironman a $50 transfer fee.
- Change my flight reservations. I'm assuming United is going to charge me $100+ to do that.
- I was using my Marriott points for a free stay in CdA. Now I will have to pay for a room in Whistler. That's probably an extra $1,500+.
- I had a free bike transport to CdA via TriBike Transport's frequent user program. That only can be used for domestic transports, so now I will have to shell out $300 to ship my bike.
I was contemplating switching to Whistler anyway but now it's almost a forgone conclusion.
Sorry had to vent! 
Comments
Bob - Thanks for sharing. Seriously. That's some scary sh$t even if the US turns out OK. I dealt with the first two of your three problems around the same time frame, thankfully not the last (although its hard to avoid some issues there with all the biking we do.)
Why not consider IM Tahoe? I guess summer time training is the issue? It is such a scary course, that it's never going to fill, and it may not attract the heavy hitter to the extent that IMC does. You'd have another couple of months to train, AND, you could use your $300 TBT bonus. If I don't make it to Hawaii @ IM CDA, I'm planning on going back there for another shot at the race; I went down in flames (actually, it was freezing) the first time I tried it.
@Bob, sorry to hear all that. Not too long ago I went to a urologist because of numbness when biking and nothing worse than dropping the pants and having another guy examining it a little too close up. If you switch to IM Canada, welcome to the IMC team. Might wanna look at Airbnb. My wife and I found a nice place just outside Whistler for half the cost of the hotels.
@ Bob...I am a urologist (pediatric to be exact), but I see a lot of epididymitis in kids/teenagers. Most of the time, it is not bacterial (I'm assuming you did not have a UTI). The etiology is not known in most cases, but the key to treatment is just like any other inflammatory process (eg...sprained ankle, tendonitis, bursitis, etc.)....rest, ice, elevation, and NSAIDs. My personal experience treating this is that the NSAIDs are the key. There is a tremendous amount of inflammation, edema/swelling, increased blood flow, noxious inflammatory mediators, etc....that respond nicely to NSAIDS. I put patients on scheduled NSAIDs (ibuprofen, naproxen, whatever) for 3-5-7 days, then as needed thereafter. Bed rest for bad cases for 3-5 days, ice (pack of frozen peas works great) acutely. No strenuous activity/lifting/CYCLING/RUNNING until pain completely gone. For cycling, I would think also you should hold off until the swelling is all gone, or at least avoid the aero position.
Assuming you don't have any gastritis/ulcers, sensitive gut for NSAIDs, I would stay on them all the time....like you would treat a strained back/herniated disk, etc.
You might find you recover faster than you think if you can handle the NSAIDs. Hope that helps. If you have more questions, feel free to PM me (or just keep sharing your nutsack status with all of us!)
I'm doing IMMT regardless of what I do with the IMCdA registration so I'll be training throughout most of the summer anyway. The bike course at IMLT itself doesn't concern me. There's just no way I can deal well with the weather and altitude issues there. I'll be coming from 100 degrees and sea level. Temps in the 30's to 50's with 7,000 feet of elevation just isn't an option I'm willing to entertain. One of my buddies from here did the race last year and he said it was the worst experience of his entire life. He did IMCdA, IMC, IMLT and IMFL last year. IMCdA in 10:30, IMC in 10:40, IMLT 13:48, IMFL 9:50. That near 14:00 is all that needs to be said.
Thanks for the response. UA tests done back in February were negative for STD causes (my wife would've had some 'splainin to do if it were anything but negative
 
and the urine culture reported no infection, no growth. Am I to assume that would include UTI?
I should have mentioned that I also got a prescription for some NSAIDs.
Doc said it was most likely due to urine reflux back into the epididymis. Which is often caused by strenuous physical activity.
Am I looking at a reoccurring issue?
Bob,
Yes, that means you probably (would need to have tested your urine with first episode, prior to antibiotics to be sure) did not have a UTI. UTI in men is pretty rare, until you're really old and having prostate problems. You would probably have had fever, burning with urination, etc., as well.
If your gut can handle NSAIDs, recommend you take them regularly/scheduled. Ibuprofen, naproxen, etc....doesn't matter which one, just use them! If you have sensitive stomach, h/o ulcers/gastritis, etc., then be careful and/or take a proton pump inhibitor (prevacid, nexium, etc.) or H2 blockers (prevacid, etc) and take NSAID with food.
Reflux of urine down the vas to the epididymis is one of the theories. This would presumably happen due to straining with a full bladder (lifting piano with full bladder, hammering along in Z4/5 with a full bladder
, etc.). So, simple recommendations are to void frequently, esp before strenuous activity, lifting, etc.
Re recurrence....you are probably at an increased risk of recurrence, but it's not a huge risk or common to see recurrent epididymitis (with an anatomically normal urinary tract). I.e...not common enough that I know a "recurrence rate" from memory.
I have always wondered how LA delayed seeking treatment as long as he says he did, given that he wore spandex every day
I will take them diligently.
My dad is an ER doc. Nothing quite like having your father's personal friend give you that exam... They decided to admit me. I was on IV antibiotics and morphine for a day and night and then another day and night with just IV meds. I was there two nights! The scary thing was that they brought in an infectious disease specialist. He ran me through the ringer of testing. Everything from HIV to the clap and all points in between. Scary. Everything came back negative. The even did DNA tests looking for STDs I may have had years ago. Nothing there either.
In the end, they said it was just "one of those things".....
And I thought my OS and spring racing was in the crapper with a stress fracture and all the mental stuff of not being able to do what we do, sorry to hear of all your going through. And I thought I had it bad phewwww. Some MOJO headed your way....
The reason I went with CdA over Whistler this year was IMMT. Three weeks between compared to seven weeks. I'm not as much concerned about that now as I was last year.
Yikes, Dino! Glad mine isn't that bad. I had a friend who got it post-vasectomy and he was on antibiotics and NSAIDs for eight weeks, half of which with a nut the size of a racquet ball.
I would just concentrate on mt. Similar vibe to the other canada.
Wish you a speedy recovery and thatnks for posting this!
I do have fluid backed up into the epididymis.
Jeff,
The doc said the bigger concern was my left nut. He said I have nice case of varicocele going on there. He described a few symptoms and I was like "Yep, got all that going on." He wondered how I had been dealing with that as it makes everything super sensitive and I just told him that's what I thought nuts felt like all the time. Guess not.
So now I have a date with the urologist on Tuesday to discuss this issue.
What are your thoughts on varicocele?
I have a lot of experience with varicocele management, as lots of adolescent boys have them. I'm going to assume that you are done having children? If so, then the ONLY reason to have your varicocele fixed is if it is causing you pain. 15% of men have a varicocele (very common), 95% of them are left sided. The most common reason for varicocele surgery is infertility problems or the risk of infertility (thus my first comment). Most varicoceles are not symptomatic and do not require surgery unless infertility is an issue/concern. The usual symptoms (when present, which again, is not common) is a dull ache (worse at the end of the day or after prolonged standing, etc.) or dull pain.
Don't have it fixed just because it's there. I have one, no symptoms, and have fathered 3 children!
That said, if you have those symptoms mentioned (on the left) and a varicocele, then fixing it will probably eliminate the symptoms. It is not usually related to epididymitis.
Hope that helps. Ask or PM me if you have other questions. Hope the other side is getting better.
We're in our mid-40's so we're definitely done with having kids. Infertility is a non-issue.
The dull ache/pain you described is definitely what's going on and it does bother me. At least now I know why. I wouldn't mind getting it fixed but that will have to wait until end of the year as I have two Ironman races and a marathon this season.
What's the recovery from the varicocele surgery?
Thanks for all the help!
@ Bob....There are several ways to fix a varicocele. There is one non-surgical way and several outpatient surgical approaches. None of them are very invasive and I'd ask your urologist when you can get back to training postop.
I would personally (if you live in a metropolitan area) look for a urologist who specialized in infertility or does a lot of varicocele/infertility work. It is a small part of urology overall, and some urologists don't do much of it. There are fellowship-trained infertility specialists in most big groups or metropolitan areas. That is the first suggestion.
The non-surgical approach is transvenous embolization (sort of like a cardiac cath/angiogram, but it's all done on the venous side, with less risk or pseudoaneurysm/mishaps/etc.). Outpatient procedure, IV sedation, small puncture in groin. The radiologist threads a catheter into the left renal vein, into the gonadal vein and then injects stuff to clot off the gonadal vein. Very easy, superquick recovery, but lower success rate (depends on the radiologists experience mainly), but in the ~70-80% range. No risk of hydrocele or losing the testicle.
Surgical options, all outpatient (all of this hierarchy really reflects success at correcting infertility (not an issue for you) with least chance of adverse things (this IS an issue for you....if you want to get back to training quickly).:
Gold standard/standard of care is microscopic subinguinal varicocelectomy. Small incision just above scrotum on left, isolate spermatic cord (all the plumbing to the testicle!), ligate all veins using microscope (to allow identification of the things you DON'T want to ligate....artery, vas deferens, lymphatics). High success rate (95-98%), low complication rate (hydrocele - fluid accumulation in scrotum that can be quite annoying, not good for spandex lifestyle, occasionally require surgery to fix the hydrocele; loss of testicle (very rare). I would not let you run/swim/bike for 2 weeks. At that point, provided your pain is all gone, I'd let you slowly start back up. There is no risk of a hernia if sub-inguinal approach is taken. Once skin is healed and pain is gone, you should be able to start back up. Note....I treat kids for a living...they heal fast and don't do things that hurt (ie....they actually listen to their bodies
). An adult surgeon may be more cautious restrictive. Do what your surgeon tells you please.
Another common option, is laparoscopic varicocelectomy. Small umbilical incision (10mm at most, I use a 5mm..camera goes here), one or two other small incisions (5mm usually) to insert instruments. Abdomen insufflated with CO2, everything to testicle except vas deferens is ligated/clipped. Incisions closed with absorbably suture/glue. High success rate (98%) at correcting varicocele (in your case, resolution of discomfort). Much higher hydrocele rate though. This is the main downside to this approach. Hydrocele rates vary from 5-35%, depending on studies, definition of hydrocele, etc. In my experience, most boys do get a little fluid for a month or so, but then it usually resolves. I have not had to operate to fix a hydrocele, but I do most of mine microscopic inguinal or subinguinal. Recovery for laparoscopic approach would be similar to microscopic...perhaps a little longer/more restrictive though, as there is a risk of umbilical hernia if you strain too early. Avoid deadlifts for at least a month!
I don't want to tell you what to do, because there are pros/cons of each approach, and your surgeon will have his/her own success rates, opinion/comfort with these. Trust your instincts. Find a good urologist who does a lot of this stuff and you'll be back to training pretty fast. Be as specific and accurate with your discriptions of your symptoms to the urologist too. The last thing you want is to have surgery....only to still have the same symptoms.
Hope that helps....sorry for the length. Ask more anytime. Good luck. If you need help finding a urologist in your area, let me know where your nearest med center/metro area is and I'll look for you.
@ Bob....ahhh....I see that you live in Cypress? One of the most widely known infertility urologists in the country is in the Houston area with Baylor College of Medicine, Larry Lipshultz. He RUNS an infertility fellowship (he trains 1-2 urologists/year in infertility stuff). He has been doing this forever and does a crapload of microscopic varicocelectomies. I don't know what he would tell a man beyond his child-bearing years with a symptomatic varicocele, though. I suspect he's still recommend microscopic, but don't know that for sure (just my instinct/best-guess). I also don't know if he sees any patients in any satellite clinics closer to you, like Katy?
Lipshultz' website (he has his own website!): http://www.larrylipshultz.com/
I found another fellowship-trained specialist, Russell Williams. Looks like he sees patients in two offices....not sure if either of these is more convenient to you either. His website is:
http://www.maleinfertilityhouston.com/
Bob...if at any point you want to move this conversation to regular email, my email address is: jaleslie72@gmail.com. Makes more difference to me though....it's your junk in a forum of ~800 people!
Yeah, but now it's just funny. My privates are not private.
I was on the shelf until April 7th. Did some running that week and completely jacked up a muscle in my neck from sleeping on it weird. So I haven't worked out since April 11th. It feels okay now so I'll get back at it tomorrow.
So here's how my season has gone...
Took off two months after IMFL for the holidays and all that. I do that every year. Did some light running and cycling in January. Did the Tour of Sufferlandria end of Jan & beginning of Feb. Aforementioned ball problems had me sidelined until April. Worked out for three days and off for another week+ with a neck issue.
So I'm 14 weeks from IMC and basically haven't started training and haven't trained since IMFL. Granted, 14 weeks (and 17 to IMMT) are plenty of time but it's just been frustrating as hell.
This has not been my year so far.
Bob....Sorry to hear about what has happened to you, but hope you're well now and can get back to doing what you love without any major problems.
Work back into it slowly.
Pool running part of the plan?