Stop self-diagnosing, people

I would say, in a typical patient week, the most commonly presented problem in my office is varicocele. This is basically an enlarged "varicose" vein in the scrotum, which, depending on the size of the varicocele (which range from subclinical to the largest, grade III), can impede sperm production, sperm quality, and testosterone production.

When a man comes in to our office for an evaluation, my boss will take a detailed medical history, examine him and order any further testing he deems necessary for the evaluation. Sometimes one of these tests is a scrotal ultrasound, which will confirm the varicoceles felt on examination.

One of the biggest pet peeves of my office is when a patient gets an ultrasound and then the technician tells them "yes you have a varicocele" or "i see you have a cyst" or "oh, I see here you have calcifications." Why is this a pet peeve? BECAUSE TECHNICIANS ARE NOT QUALIFIED TO INTERPRET WHAT IS ON THE SCREEN. THEY ARE ONLY QUALIFIED TO OPERATE THE MACHINE. I'm not saying that technicians are unnecessary, or trying to diminish their role in the diagnostic process, but they need to not tell patients what they think they see. They are not doctors. Period.

I say all this because I just read a blog entry about varicocele on this guy's site. I'm not going to link to it because it irritated the living hell out of me. Apparently his wife is in ultrasound school, so she thought she'd do a sonogram on his nuts. Let me reiterate: she is in school to be a technician. She's not currently a technician; she's learning to be a technician. So, she did an ultrasound on her husband's testicles, and lo! Diagnosed him with varicoceles, hydroceles (a bag of fluid that sometimes happens concurrently with varicocele), epididymitis (an infection of the epididymis - usually very painful; how any man had epididymitis and didn't realize it I'm not entirely certain) and my favorite: microlithiasis (small calcifications in the testicles that can be a predictor of an increased chance of getting testicular cancer in the future).

This poor guy must be convinced that his balls are about to fall off. I hope he goes to a good urologist who will evaluate him and tell him his wife is completely off her rocker. I hope she learns a lesson in this that when she's performing an ultrasound, she NEEDS TO SHUT HER MOUTH.

This made me snicker

Male Reproductive Medicine, where I work, is a pioneering facility where we're constantly developing new ways to treat male infertility. One of the main causes of male infertility is what's known as a varicocele. Those varicose vein women get the the backs of their legs? Men get those in their scrotums. The increased blood flow to the testicles raises testicular temperature. The whole point of keeping the testes in the scrotum is to keep them lower than body temperature. Having varicoceles defeats that purpose. My boss developed what's known as microsurgical varicocelectomy. It's the best way to get rid of varicoceles; it has the least complication rate and the least chance of recurrance

Of course training to perform microsurgical varicocelectomy isn't done directly on humans; you can only operate on humans once you've mastered the technique. For the past twenty five years or so, training has been done on rats. However, our office has recently developed a varicocele model in mice. Mice are better than rats. They just are.

So today they are operating on mice. I was emailed the itinerary for the operation. It amused me, so I thought I'd share it.


1. Anesthetize mouse.
2. Weigh mouse.
3. Measure ambient temperature.
4. Measure mouse rectal temperature.
5. Measure mouse intratesticular temperature with needle probe for both testes.
6. Shave mouse.
7. Laparotomy, expose previous surgery site.
8. Inspect for varicocele induction.
9. Measure testicular vein diameter.
10. Deliver testes.
11. Measure testicular dimensions.
12. Photograph and videotape representative mouse.
13. Cardiac puncture to collect blood sample.
14. Harvest testes.
15. Freeze blood and testes specimen.

My favorite: "Shave Mouse".

It made me snicker.