Trust Your Brother
The case of the month is an actual patient of The Turek Clinic
Do you trust your gut? With 1.1 zettabytes of internet holding 1 billion websites and 1 million emails sent every second, our lives are rife with trifle; so how do you even find that gut to trust? Well you should, because heuristics research has shown that decisions made based on hunches can be very effective ones. You just have to know when to use it.
Infertile and Hurting
The young man travelled across the country to see me. He asked a simple question: “Do I have a varicocele?”
“I should be able to answer that,” I thought to myself.
In his early 30’s, he was having difficulty conceiving his second child. His son was 3 years old. But after a year of trying again, he had his sperm count checked and, lo and behold, sperm were present, but only in single digit numbers. He had an extremely low sperm count, termed cryptozoospermia. Probably the cause of the infertility.
But then it really got interesting: He was also a testis cancer survivor. A dozen years before, he had one testicle removed and received radiation therapy to secure the cure. Not only that, his one and only testicle was hurting him off and on for a year, and this concerned him.
So, he honkered down and did some research. He reasoned that something happened between 4 years ago (when he last conceived) and now to lower his sperm count. The testis cancer escapade was 12 years ago, so this was an unlikely culprit. And, having survived cancer, he has taken great care of himself ever since, so lifestyle risk was not on the table either. And then there’s the pain. After thinking this through and examining himself, he concluded that he had a varicocele, a bag of dilated veins in the scrotum. It lowers sperm counts and it causes pain. The 14th century logician, Friar William of Ockham, father of Occam’s razor, would be proud.
To confirm his hunch, he saw several doctors, including his primary care physician and a urologist. But neither confirmed his suspicions. Frustrated, he sought me out.
After hearing his story (which by the way was not told before, simply because of the limited time spent with other providers), I examined him. Yessirree, there it was, a large varicocele surrounding his only family jewel. You could almost see it from across the room. He was right, and we repaired it. All gone. I am expecting a healthy return of sperm over the next several months. And no more pain.
So, what happened here? Well, a lot. He was a young man who knew his body, and was deeply invested in taking great care of himself. He also researched his condition well, and being an ace at “content curation,” he accurately sifted and weighed medical information. On top of all this, he had a gut feeling and he listened to it. Alas, he met up with a health care system that is simply not used to empowered young men. And one that certainly doesn’t have enough time for a good story. As a consequence, this man’s care came to a screeching halt.
Is this how we should approach the health care of young men, one of the most medically underserved populations in the U.S? Hardly. During his visit, I congratulated him on a job well done, and I also apologized that it took so long to learn the truth.