Last Updated February 2007
February 1998 Hernia:
In late February of 1998 I had surgery for a left inguinal hernia. The surgery went well in the sense that my hernia was fixed. Unfortunately, some other problems began. After the surgery I had a reduced sense of touch in my upper and lower left pelvic area. My left buttock would occasionally feel as though it was waking up after it had "gone to sleep." Although annoying, these symptoms were not very problematic.
One symptom that was considerably inconvenient was that I lost the ability to discern when I needed to urinate. I would have a sudden and rather severe pain, like a muscle cramp, and this would be my signal to use the restroom. It felt like the part of my body near the old surgery site had suddenly clenched internally. The pain would build in intensity until I was able to urinate, which felt like a sudden release of some incredibly cramped muscles, after which I would feel fine again. There was never any danger of incontinence, just a horrible feeling of an aching cramped pain until I could urinate. The feeling of relief was overwhelming, like rusted bolt in my groin had suddenly released and a dam had broke open. Once that happened the pain vanished in a few seconds, even if I had to urinate for a very long time. Standing seemed to mildly alleviate the pain, while walking intensified it, although limping helped somewhat. So Iíd suddenly feel the pain, limp to the restroom, then walk normally back to work.
February 1998 - March 2004:
Over time some symptoms diminished, some remained unchanged, and some increased. For example, I regained the ability to tell when I needed to urinate, although my old pain symptoms still appear from time to time. The deadened sense of touch around my pelvis is roughly the same as it was three days after the surgery, and I still have the odd tingling sensations. I suppose in many ways I grew accustomed to these inconveniences. I haven't grown accustomed to the pain I began experiencing related to running.
Before the surgery in February 1998 I jogged on a treadmill every morning for 20-40 minutes. After the surgery I began to have problems doing this. I could not jog or run without pain. Any pace faster than a brisk walk would create a dull aching pain around the old surgery site, like there was some sort of bruise there or maybe a hole of some kind, or maybe there was a muscle that just didnít want to exert itself. Pain eventually spread to my general left groin, and then eventually to my knees and calves, but I think that was mostly related to how my gait changed in an attempt to compensate for the groin problem. I also found that intense exercise, such as biking or using a stairmaster, usually exacerbated my more general symptoms.
I talked with a few doctors and a few personal trainers at my health club and they all recommended yoga and stretching. They said this should relieve the tightness around my pelvic muscles and help get my body and my stride back in alignment. A sports trainer/ physical therapist at the University of Oregon recommended the same thing in October 2001. Yoga and stretching do seem to alleviate some of the pain, and I started engaging in yoga regularly. However, I still couldnít run for more than a few blocks without pain forcing me to stop.
Within a year after the surgery I began to wake up in the middle of the night with an urgency to urinate. Sometimes more than once. Over time I began waking up more and more often, and these days I never sleep all the way through the night.
Also during the same period I began to have significant discomfort from hemorrhoids, not surprising I guess since now I always seem to need to strain my muscles whenever I defecate. That's stayed the same ever the surgery since too. I've learned to control that partially through a fiber rich diet. This may or may not be related, but I also acquired a strong sensivity to sugars and starches about 6 months after the surgery.
Around the middle of March of 2004 I was on all fours and I shifted my weight from left to my right leg. I felt an odd tearing or burning in my groin and thereafter I had some problems. My groin hurt and ached, with sensations similar to what I felt after I gave myself the hernia back in 1998.
Shortly afterwards I began having pain during ejaculation and during urination. The feeling was very similar to the ache I sometimes felt when I needed to urinate. In both cases it was a sensation of a clenching, a cramping. As though I had a strong muscle cramp deep inside my groin.
April & May 2004:
In late April and early May I saw Dr. Kevin McEvoy (Urologist), who diagnosed my ejaculation problems and tenderness as an infection. He prescribed some Cipro, which after three days had almost completely killed the pain during ejaculation and during urination. However, it also made me sick to my stomach, so they switched me to Levaquin. That didnít seem to improve me too much more, but it didnít make me sick. Neither had any effect on the pain I still experienced during running and the occasional ache when I needed to urinate, and of course from time to time I still felt tingling in my left buttock and other strange sensations. I still had mild aches from time to time during urination and ejaculation.
About the same time I also saw Dr. Susan Strom (Chiropractor) who suggested I have X-rays taken of my pelvis and lumbar spine. Based upon those, and her examination of me, she concluded that further chiropractor treatment from her would not be of great benefit. She believes that my current joint and muscle problems are related to either nerve damage in the pelvis, or muscle damage creating poor body mechanics. She recommended that I see a neurologist or a sports Chiropractor.
In late May I saw Dr. Robert Grimm (Neurologist). He suggested my overall problems could be the result of a trapped nerve. When Dr. Jutton opened me up in 1998 she found that the ilioinguinal nerve was rather small and noted to be cut. Dr. Grimm postulates that the nerve began to regenerate at about the same time that scar tissue began to form from the surgery repair. It is possible that the two "collided," meaning the regenerating nerve ran into the developing scar tissue. The scar tissue then trapped the nerve, forming a nueroma. As time went on I naturally altered my gait in order to avoid the pain from the nueroma, creating improper mechanics. The improper mechanics put additional stress on my knees and calves, creating pain there. The general idea is that if I remove the nueroma, and fix my body mechanics, much of these problems will go away.
Summer of 2004:
Dr. Grimm referred me to a surgeon (Dr. Schumann) who examined me, ordered an MRI, and then reviewed the MRI. He found nothing, or at least nothing he thought he could help with. He said I didnít have a neuroma, and sent me back to Dr. Grimm for further investigation. Dr. Grimm wasnít sure what else he could do at this point, and referred me to the pain management clinic in North Portland.
About this time I started using an exercise bike a lot. I found that the exercise bike seemed to alleviate some of the pain in my groin, but it also helped to increase pain in my knees, ankles, and butt.
Fall of 2004:
I went to the pain management clinic and met with two people, Dr. Stephens, an accupuncturist, and Dr. Chiu, a regular doctor. Dr. Chiu said that he could try a nerve block injection. Given that Iíve lost a lot of sensitivity in my groin, I felt hesitant about perhaps increasing that loss. So I decided to try accupuncture.
Around this time the pain during ejaculation returned, except it usually opened only when my legs were pressed close together or spread wide apart. If they were in a loose open stance I didnít feel the pain, or at least not very much.
December of 2004 to January of 2006:
When I first saw Dr. Stephens I had lots of tenderness, pain, and/or tension in my left thigh, left buttock, general left groin area, both knees, and both calves. Over the course of the yearís treatment he pretty much eliminated the tenderness and tension except for a right at where my left inner thigh meets my groin. The pain during ejaculation lessened too. I also discovered that if I warmed up for a long time on a exercise bike first I could jog on a treadmill afterwards with little pain.
In the last couple of treatments Dr. Stephens started focusing on the point where my left inner thigh joins my groin. The last few times he did that it felt like he jabbed something, like there was something buzzing in there he was poking.
After that I started having some odd symptoms. The pain during ejaculation began to return in intensity, but I discovered an odd way to alleviate that almost totally. If I press hard down on the spot where my left inner thigh meets my groin, the pain during ejaculation almost totally goes away. Also, one day while standing up I had the oddest sensation of an intense burning radiating from that spot in an almost perfect circle. It covered most of my left testicle, the left side of my penis, and about half way down my left thigh. Itís as though I was stung by a bee near where my left thigh meets my groin.
The pain during urination returned too, except this time I found that whenever I sit down on a toilet seat to urinate or defecate I would often have to urinate some more once I stood up again. I never have this problem when I use one of the urinals, but when I use one of the urinals I sometimes have the odd clenching sensations just after I finish urinating.
Around late April of this year I switched to a different exercise bike, one with a narrower and shorter seat. It feels like my groin is supporting more of my weight than it did before, and this has created some clenching and tingling sensations around the old surgery site if I sit on the bike for a while. I'm trying to find a seat just like the one I used to use.
In May 2006 I began seeing Dr. Rosencratz, who suspected that I might have a prostate infection or something similar. So he prescribed Levaquin and I began a 4 week treatment.
I've seen Dr. Rosencratz three times now. I'm almost finished now with the Levaquin, and so far there has been no improvement. He did a rectal exam when he saw me the first time. He checked my prostate, and I began to feel better almost immediately after that, but the Levaquin hasn't done anything. So on the third visit he tried massaging my prostate. When he did that I felt the old pain again. This time it made the surgery scar ache, tingle, buzz, everything at once. I also had an overwhelming urgency to urinate, although I'd emptied my bladder only 20 minutes earlier. He gave me a plastic cup in case I had to go, but I didn't actually need to do so. It occurs to me that when I saw Dr. McEvoy he gave me a rectal exam before starting me on Cipro. It's possible that the exam is what improved my symptoms and not the antibiotics.
Well, it's been eight and 1/2 years, at least 12 doctors, and many diagnoses since my hernia surgery, but the quest marches on. Dr. Rosenblum at the Emannuel Pain Management Clinic says my injury is indicate of "reflex sympathetic dystrophy" involving the ilioinguinal nerve. He believes that I had a nerve injury shortly after the surgery that is causing my problem. It wasn't the surgery itself.
He's recommending pain relieving patches first, and then trying a new drug called "pregabalin." He's made me promise to do two things over the next 6 months. First, I am to use my exercise bike for 45 minutes each day. And I am to walk for 45 minutes to an hour each day. This will be hard to keep.
Anyway, the patches or the pills should reduce the pain, which will allow me to stretch and use the relevant muscles, which will hopefully rehab them a little. This plan hasn't worked in the past, but then I haven't tried these new medicines before either. If this doesn't work out we may try a nerve block injection. If that doesn't work, then it's corrective surgery at the North Penn Hernia Institute. Corrective surgery has about a 25% chance of "fixing" things, a 50% chance of not changing things much, and a 25% chance of making things worse. I'm keeping my fingers crossed.
I've also made an interesting discovery. A lot of my more acute symptoms lessened when I stopped riding my exercise bike. I think the bicycle seat on the new bike I bought has been aggravating my condition. So I bought an "Easy Saddle," which has definitely taken the pressure of my groin, but it makes my butt hurt. Gotta try something else.
The lidocaine patches have been moderately helpful. They are like putting a soothing cool bag of ice cubes on a bad burn. It helps, but doesn't get at the heat under your skin. It also deadens the skin on top. It does help a little though.
I just got the paperwork straightened out for pregabalin. I took the first pill today. So far, my groin is really tingling, like a funny bone that's almost finished waking up. I suppose I'll find out if it works.
I also found wikipedia's entry on Pregabalin.
I found something called "The Pump Seat" for my spinner bike. It seems to help a little, but the pedaling is forcing my knees out, which is causing problems there now too.
There's got to be a solution to all this someday. If I can't bike because of my knees, and I can't run because of my groin, how will I stay healthy? I've waited 8 years, maybe I'll have to wait another 8 years. . . .
This pregabalin (brand name "Lyrica") is fantastic stuff! I jogged the morning of March 15th for 15 minutes with almost no groin pain at all. I had some problems with my ankles and knees, but nothing too bad.
The combination of the patches and the pills has been eye-popping. I'd prefer not to take these pills forever, they are very very expensive for example, but the results cannot be denied. Only in the last few weeks have I started to realize just how much the injury has affected almost every aspect of my body below my waist. I'm moving and walking in a way I only dreamed of years ago.
I see Dr. Rosenblum sometime in April and then we'll see what's what.
20 minutes of jogging on March 20th and no real pain. I was sore at the surgery site, and my knees hurt, and a few other things. The main problem I was having is just how out of shape I mean. No jogging for almost 9 years has definitely taken its toll. And how my body has altered its motions to accomodate the old injury has also caused some problems too. From now on it's jogging for at least 20 minutes every day until I get the problems worked out.
I can't believe this is actually working. These pills are fucking magic!!
The pills are starting to wear off. The pain has returned. Dr. Rosenblum seemed to almost expect this. He said my body had gotten used to them. So I need to double the dosage. That does seem to take me back to the old "no pain" situation. But I'm now having some sexual side effects that were unexpected. And the double dosage sometimes makes me feel a little inebriated. I'm not sure if this is worth it. The patches are only moderately successful, but they do help. However, I'm getting a rash there now which is annoying.