Cliffnotes-esque summary: I clearly have some varicose veins in my scrotum; it’s known as a varicocele. It causes a dull ache, and the medical literature strongly suggests that it lowers testosterone levels. I’ve studied it in depth for months, from legitimate sources.
My GP referred me to a radiologist for an ultrasound. Though by all accounts the radiologist was a nice guy, he didn’t know anything about the link between varicoceles and low testosterone, and he said not to worry that varicoceles are harmless. I disagree. Without throwing credentials around, I want to establish that I’m educated in medical literature and statistics and research and I know more than this man about the condition.
I can clearly see it, and my left testicle appears to have gotten slightly smaller since the varicocele first appeared. But he said it was nothing to be concerned with, that it’s barely noticeable (its size varies day to day and on this day, unfortunately, it wasn’t as inflamed-looking as most days), and he wrote a letter to my doc saying that everything was cosure. It goddamn isn’t.
Now, my doc doesn’t seem to know much about varicoceles either. How on earth do I approach him about this? I don’t want to appear arrogant, like I’m telling him what he doesn’t know, and I don’t want to sound confrontational about the radiologist who was very biased and on the ignorant side. I want this taken care of (there’s a minimally invasive surgery that’s very effective and very low risk), and I don’t know what to do. How do I approach my doc, and how do I convey that the radiologist wasn’t up to scratch on this topic? I don’t want to come across as a hypochondriac or arrogant ass, but if I’m not persistent enough I risk being fobbed off.
I took photos of the varicocele and am planning to bring them in, and perhaps I should bring in some research showing the importance of treating them early?
(Clearly I’m not looking for medical advice). Many thanks for reading.
if you dropped dead in their office that would show them.
tell your doc that you have read some medical journal articles if that is what you’ve done.
there is a lot of medical literature. if every doctor read every article there would be no time to see patients.
i’ve had doctors say that they know what your symptoms are, they have a vague memory of something that could lead to those symptoms, they need to do some reading and will get back to you with a potential diagnosis.
Consider the possibility that you are wrong. For some reason, it’s really difficult to diagnose yourself using the internet. Perhaps part of it is that pretty much every symptom can be caused by something benign or something serious.
Get your testosterone level tested a few times by a reputable lab. If your levels are seriously out of whack, then show the lab report to your doctor and ask what he thinks.
Tell your doctor the fellow was dismissive of your symptoms, and concerns. Tell him this doctor wasn’t a good fit for you, ask if he knows someone else you can see.
I’ve had a similar issue with a doctor my primary care physician sent me to. I returned to her, and in very few words conveyed precisely what I wrote above. I didn’t question his knowledge, or reveal my own researches, only to say I’d been reading and needed someone who would seriously address my questions.
She was nothing but sweet about it, admitting that not every patient-doctor combo works. Then she set up an appointment with another Dr, who did address all of my concerns. For me it was as easy as speaking up. So, of course, it’s what I recommend. Good Luck!
First, print off the scholarly article that resulted in your concern about T-levels. Then bring it to your next doctor’s appointment and ask to have your testosterone levels checked and/or to have it removed. If that doesn’t work, get a second radiologist’s opinion or a new GP (depending how seriously your GP appears to take you).
I think bringing a printed article (and maybe a list of other sources) to your primary care doctor is a great step: you can tell him what you understand it to mean, and ask the doc to review it. This establishes that you’re really doing research using respected sources, not from energycrystalcleansing.com or thingsmymanicuristtoldme.tumbler.com or whatever. It also lets there be a dialogue between you.
Take the attitude that doctors can’t know everything in their head all the time, so no discredit to him if he didn’t know the answer immediately, but also that you’re not medically trained and you well could be misunderstanding something about the article, so the end result may well be him explaining to you how you were mistaken (or, possibly something like him explaining that, yes, the research is solid, but in the real world the testosterone decline isn’t enough to worry about, medically).
These seem to me like issues that should be addressed by a urologist, not a family/general practice doctor, especially since your current doctor apparently is not an expert in the symptom you’re concerned about.
And a radiologist is an expert in interpreting the test results, not necessarily in providing treatment.
Take your pictures, and a precis of the articles with links and how they pertain to your concerns exactly, and I tend to include the actual article/s as an appendix/ices. If he doesn’t respond with an answer you like, request a second opinion/consult with a urologist who deals with male gonads.
Whip out your balls to 10 people and see if at least half of them agree with you. Pass pictures of them around at work at to your friends and family and get a survey of your ball veins. That’s what I would do
The urologist can do an exam, order a blood test for testosterone levels and discuss results with you. And being surgeons, urologists will likely not hesitate to recommend a procedure if indicated.
I ran into a similar situation about 2 years ago with my girfriend. She had a chest ex ray done and based on the x ray determined that she had a large tumor in her left lung. I saw the picture and it was plain as daylight.
I thought I better explain something that happened recently as it might be of importance. I told them that several months earlier she had a horrible cough and a smell comming out of her lungs like rotten garbage. The smell lasted about two weeks and the coffing subsided after about 3 or 4 weeks. They said it is very rare for something to go down the left windpipe and only happens to severe alcoholics. I explained she was a periodic but severe alchoholic.
They did 4 biopsies all negative but decided to remove the lower left lobe and part of the upper left. The pathology showed only scar tissue as I suggested to at least 5 doctors who ignored me before surgery. It really pissed me off.
Your collection of articles and claims of great knowledge will carry less weight than a current practice guideline. Generally published expert guidelines, which are usually based on review of all the evidence by a panel of experts, will be deferred to by both generalists and specialists (and those deciding about what gets covered). In this case the current guideline states:
So you are on easy grounds to expect a semen analysis and of course to request the opinion of a urologist. All the more so if there is decreased testicular volume on the side of the varicocele.
It must however be noted that the Cochrane Review is a bit more conservative.
The data on varicoceles and testosterone levels has apparently not yet been of sufficient magnitude to convince the guideline producers to advise it for that indication. I make no claims of urologic expertise and defer to your review of the primary literature. The point is that practice will be driven most by these guidelines as few will defer to their own or your review over the expert committee.
The bolding I added above highlights a conflict in your intentions. No matter how much you believe the first statement, keep it to yourself and act on the second one.
Bring copies of the pertinent journal articles with the important areas highlighted. Do not bring a huge sheaf of papers or highlight more than a few sentences, or you will trigger the idea that there is too much to look at on the spot. Say something like “I’m still not sure that I should not have surgery on this” or “I still have some questions,” and show him the pertinent journal section.
It does sound like you should ask for a referral to a urologist.
Another vote for talking to a Urologist (and not a radiologist) and keeping in mind that it’s still possible for you to be wrong. They’ve had years for formal and real world training and you’ve had hours of internet research.
I was convinced my daughter had lyme disease…FOUR doctors said it was a normal reaction to mosquito bites. When she gets bitten she gets huge welts with bulls eye shaped marks that are about 3 inches across. It took a lot to convince me that I was wrong.
OTOH when I started having problems swallowing I asked my ENT, he said I was probably find but ordered a barium swallow. The radiologist said I was totally fine, but I think he rushed the exam. The ENT read the results and told me everything was fine and that I just need to be careful swallowing. I told him something is wrong so he put a camera up my nose and into my throat and still said everything looks good.
So, I made an appointment with a GI doctor who did an endoscopy…turns out my esophagus was so strictured and inflamed they couldn’t even get the scope down more then a few inches. Yeah, I wasn’t ‘fine’. So, case in point, sometimes doctors are wrong.