Expert: Stephen W. Leslie, MD - 10/30/2006

Question
As a means of introducing myself, I am a 49 year old male, married, four (4) children.  At the present I am in the Appeals Process with SSA Disability. I am not able to be gainfully employed due to chronic genital, knee and back pain.  My hearing date is set for 11.21.06.

In May, 2000 I suffered severe trauma to the groin.  The trauma that I sustained caused epididymitis (infection of the epididymis) which enlarged my scrotum to something the size of a large grapefruit or a small cantaloupe.  The first treating doctor gave me a mild anti-biotic and I had to lay flat for several (8-10) weeks. Once the swelling went away I never really felt right. I would describe the way I was feeling as "germ sick" with symptoms such as: lack of energy, inability to exercise, not really wanting to go anywhere, constant pain and so on.

The infection either was dormant or returned about a year later and to make a long story short and before the Urologist would consider surgery I had to try Pain Management injections to the back. Needless to say, that didn't work.  A very costly medical procedure which I underwent three different times.  I believe the total costs were in excess of $20,000.

I then had three (3) invasive surgeries which removed the epididymis, then the testicle and repair of a hernia and then an incision and drain due from blood clots and infection.

The consensus of all my doctors (Primary Care Physician, Medical Doctor with Certification in Acupuncture, six (6) Urologists, two (2) Pain Management Medical Doctors and a Psychologist) was that I was under treated in the beginning. The anti-biotic that was first prescribed was in the family of penicillin (ampicillin sp). Within a few days I went to Levaquin 500mg twice a day and daily 1 gm injections of Rochephan (sp).

The present diagnosis is neuralgia in the distribution of ilioinguinal nerve (entrapment) and chronic pain in the genital area.

The methods that I used and now use to lessen my chronic pain are the following:

Before
Stay in a supine position as often as possible. I am unable to sit upright for more than 5 - 15 minutes at a time.
Apply heat packs directly to the right side of my scrotum (eight to twelve times daily).
Take six, eight or ten Lortab 10/500 daily.
Activity level was nil.  I am unable to stand or walk for any appreciable amount of time or distance.
After
I've noticed that I spend less time in the recliner.
Application of the heat packs are down, and some days as few as three - four.
The patches, Duragesic 100 mcg (Fentanyl Transdermal System) does relieve the pain considerably better than taking six, eight to ten Lortabs daily.
I'm gaining on adaptation to the side effects; such as: vivid dreams, nodding off, and dry mouth.
On average, the use of Lortab 10/500 is two per day.
I can get up and down to do light housework tasks with minimal pain.
I have two questions:
Is there medical literature that I could read, match up my symptoms to, provide support for my SSA Disability Claim?
Would one of the experts address my case and offer suggestions as to other medical treatments to investigate for the purpose of curing or at least lessening my chronic genital pain?
Respectfully Submitted,

Paul

Answer
I don't know if it will support your claim or not, but the best way to research your problem is use www.pubmed.com.  This is a free medical research database supported by the NIH and National Library of Medicine.  Essentially, any research on your issues will be listed.

The purpose of this forum is more in the area of generaly knowledge rather than specific consultations.  With a very complicated case like yours, a second opinion from a university based Tertiary care center like Mayo or Cleveland Clinic would be a very reasonable idea and could prove to be helpful.