“I heard that you’re a palm reader,” he blurted as he sat down across from me during my office visit with him. Sure, as a physician I examine men’s hands, as they can tell you a lot about his life and work. But beyond that, any closer reading I leave to others.
But the comment was interesting nonetheless. To gain more information about what this might mean I asked my 9-year old daughter her opinion on this matter. “I think it’s because you always look at their hands to see if they are injured or healthy” was her response.
Injured or Healthy
Great point dear daughter! I seek to determine whether the infertile man in front of me is healthy or not. I get loads of good information from their symptoms, medical history, and the semen analysis and also from the physical exam. The health’s the thing, and the “palm” is the way to decipher it.
A Telling Story
In my office visits, I try to figure out each man’s story: How did he arrive where he is with infertility? Some call it root cause analysis but I think of it more as the fine art of medicine. One of the simplest stories is that of a previously fertile man who is no longer fertile due to the progressive thermal effects of a bag of scrotal veins called a varicocele. Funny how such an innocent anatomical anomaly that arises at puberty can so profoundly affect fertility years later. Even more basic is the man with a “natural vasectomy” who has no sperm conducting tubes and therefore no ejaculated sperm. Nothing else going on. ‘Tis genetics, my friends, and it holds the trump card in the fertility game. A story nonetheless.
Or, how about the man with zero sperm count because of a single painful infection he had years earlier that hurt like hell for a week and burned like fire when he urinated. Although cured with a week or two of antibiotics, but it left behind microscopic scar tissue that now blocks the flow of sperm out of the epididymis and into the ejaculate. Thank God for microsurgery that can restore this like new!
But let’s also take the infertile man who smokes weed, is overweight, hypertensive and eats and sleeps terribly. His low sperm count simply reflects his overall health. And, I believe these hits to health are not additive (1+1+1=3) but compounded (1+1+1=5). The fertility as a biomarker of health concept rings loud and clear here. Nothing more is needed to explain his story, just a lot of work to be done.
Surely the picture of the man with infertility is the “palm” that I read. So, I guess I really am sort of a palm reader. But the power in my palm readings is that I use what I learn about biology and behavior to not only read but also to change, the fortunes of my clients.