Wrecking Ball(s): Dr. Jacomides On the Causes Of and Treatments For Testicular Pain
Speaker 1:
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Donna Lee:
Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee. And Dr. Mistry stepped away, so I brought in our fabulous friend and partner, Dr. Lucas Jacomides. Hello, Dr. J.
Dr. Jacomides:
Hi, Donna Lee, how are you today?
Donna Lee:
I’m fabulous. How is your weekend going?
Dr. Jacomides:
My weekend is fantastic. I try and just stay cool in this horrible weather, or if it’s winter and we’re taping an old rerun, man, is it cold outside! I’m so happy to be indoors.
Donna Lee:
You know, the heat index the other day was 110.
Dr. Jacomides:
That’s really hot. That’s really no good.
Donna Lee:
I’m sure it’s not comfortable for you guys and all your parts.
Dr. Jacomides:
Well, that is a very, very relevant question, I would say. You know, it’s not comfortable for anybody’s parts, but these parts are getting chafe-e. Yes, it’s really hard.
Donna Lee:
Really? That’s funny. Well, before we get into all the parts discussion, you can call us during the week at (512) 238-0762. You can ask us all about your parts and we’ll make an appointment to see your parts. Our website is, now it’s changed, it’s northaustinurology.com, and you have to click on “podcasts” so you can see our smiling faces and check out the podcast there. Or you can listen to our podcasts wherever you listen to podcasts. We’re going through some marketing changes, Dr. J, with all of this growth we’re having.
Dr. Jacomides:
Yes, our parts are not part of this clicking a button, no…not available on the podcast.
Donna Lee:
We’ll keep your parts private, but we want to address your parts as the patients. We joke a lot about jokes on this show, and I had an interesting discussion with my husband–every time I say rectum, he always says, “Damn near killed him!” And I never understood. So I reached out to our amazing listeners and one person already responded. I have a second response from a patient and he wrote into our website, “Little Johnny’s teacher asked the class about their summer vacations. Little Johnny said, ‘Horrible. My dog got hit right in the ass by a car.’ And the teacher corrected little Johnny and told him to say ‘rectum’ instead. And little Johnny responded, ‘Rectum? Damn near killed him!'” Okay. There’s our joke!
Dr. Jacomides:
There you go! Too bad I have no high hat in here to ring that joke in.
Donna Lee:
We need sound effects, for sure.
Dr. Jacomides:
By the way, we are allowed to say ass in the donkey way. Right? That’s what you meant. Right?
Donna Lee:
Yes! And Daniel, our KLBJ guy will bleep out anything.
Dr. Jacomides:
Well, that’s good.
Donna Lee:
Yeah. My mom has a good story. She’s Asian and she taught, she has a donkey. One’s named Jenny and the other one’s Michelle Obama. Oh, Michelle Obama–for real in real life. Yes. She always talks about the donkey. She loves them and she always, she’ll call me and say, “Donna, I talk about how cute my ass is.” And I’m like, they’re donkeys.
Dr. Jacomides:
By the way, that reminds me, I just want to shout out to my wife, Jenny, by the way. So I just please bleep that part out.
Donna Lee:
Dr. J’s not married to Michelle Obama, but he is married to Jenny.
Dr. Jacomides:
Yes, yes.
Donna Lee:
So, there you go. I wanted to talk a lot about, or some about ball pain. We’ve had some of your patients, I answer the phones quite a bit cause we’re a little short-staffed but I’ve had a couple of patients that I’ve talked to you for you, and one of them was a younger guy. He’s got a pea-size bump he felt on his testicle. Super great guy, getting an ultrasound. Tell us all about these cases that are coming in. I feel like there’s more than usual right now.
Dr. Jacomides:
You know, I I’ve had a run of a couple of guys that had this weird ball pain and they both happen to have COVID. And I said, “I wonder if this is even related,” but I’ve, this is completely anecdotal. And so I don’t want everyone out there to get covered, tested if we have ball pain or we’ll have many more negative tests.
Donna Lee:
Right, but get ball pain tested.
Dr. Jacomides:
Yes. Yeah. I think it depends on the ball pain and the age. You know, certainly I just took out a testicle on a guy in his, you know, fifties to sixties, you know, and fortunately it turned out to be fairly, not aggressive, but you do see that rarely in older populations. A couple of things there, you worry about the mass, that a mass is testicular cancer until proven otherwise what people worry about. But I think it’s very important for listeners and, you know, to know specifically, you know, where it is and sometimes masses and most masses are outside the testicle itself, and they’re in the epididymis behind the testicle. And those are usually benign. It could be an infection, but it’s usually a benign tumor.
Donna Lee:
Interesting. Well, we have a question. It’s along these lines. From a patient the other day, and I did reach out to him and he did have a followup with his urologist, because it was a little scary. “I often wake up in the morning with a very sore right testicle. It’s very painful. For some reason, about one hour or two hours later, the pain goes away. I had a hernia mesh surgery in 2009. The surgery was on the same side as the sore testicle on the lower abdomen. I have no pain or discomfort due to the mesh surgery. What could be causing this kind of pain? It doesn’t bother me when I sleep only when I stand up in the morning. Please advise.”
Dr. Jacomides:
Well, a couple of things, it’s a good, good email. There are certain things I tell people in healthcare, we want to find out what’s common and what could kill you or kill an organ. Cancer certainly something we want to diagnose, because it could be very aggressive, but the organ killer is torsion. So if you have, the key for this patient makes me less worried acutely is that it went away. If you have pain that is not going away over hours and it’s a twisted testicle that could compromise the testicle and you can lose the testical within 6 to 12 hours. So we worry more in the adolescent population, and this is the boys who never want to talk about their parts, at least to their parents, you know. Or yeah, maybe to each other and maybe yes, if it’s trauma or something that caused it, but, but a torsion is a, is a testicle, a risky event. And, and by that we mean, you know, I look at testicles like Christmas tree ornaments and maybe we’ll type this during the Christmas tree season, but they hang down and they can twist. And if it twists 180 degrees, it can completely twist off the blood supply and you have about 6 to 12 to untwist it. So, the fact that this pain went away in an hour, hour and a half is good. He mentioned the previous hernia surgery, and a lot of times it’s unfortunately not much that can be done acutely with a entrapped nerve, especially that sounds like it was over 10 years ago. You have to do just palliative ways either anti-inflammatories that we can offer or even [inaudible] blocks injections that we can do. But nothing, no magic pill, pouch, potion will make it go away. It’s something you just have to manage. Finally, I think what’s interesting, and what I tell a lot of folks too, is that his pain went away when he stood up or maybe hurt more when he stood up. I forget what you said, but it was positional, right?
Donna Lee:
Right, it doesn’t bother him when he sleeps only when he stands up.
Dr. Jacomides:
Right. So when you’re moving around and things change, and if it’s a positional dependence, I often think it’s a back issue or nerve issue. I tell everybody, any pain you have from neck down could either be, say sciatic nerve pain–most people know sciatica. If it’s pain in the back of your thigh, it’s not your thigh that’s the problem. It’s the nerve that’s in your back that’s pinched from a disk. Keep that in mind, if you have positional pain and it gets better or worse with certain positions, it’s probably going to be something nerve related.
Donna Lee:
Oh wow. I never thought about that.
Dr. Jacomides:
That’s why we’re here.
Donna Lee:
That’s why I’m talking to you.
Dr. Jacomides:
It’s ball pain, why would you?
Donna Lee:
I don’t think about my ball pain. It never happens. Well, that’s interesting. We had another patient, I know that we kind of talked about the other day, but a young patient, 30 something, had that little pea-size lump. So his concern was how soon as he supposed to get a call. I was just wondering about protocols. How soon should they get a call from the imaging center? Right away, right?
Dr. Jacomides:
Yeah. I mean, if we’re worried about it, I mean, the adage we’re told if you’re worried about cancer specifically, and chances are, if I felt this was definite and malignancy–say the patient I just mentioned to you that had, you know, the older patient that had the disease. We saw him on Tuesday, got the ultrasound. I didn’t even think it was in the testicle, but sure enough, the ultrasound showed it was, he got the ultrasound Thursday. They called us. He was on the, or table the next day. So if we’re worried about a clearcut guy in his twenties and thirties with an asymmetric, like the whole testicle feels completely different than the other one, then yes, that’s usually us calling the imaging place and saying, “We need to get this guy done or you need to go to the emergency room to get it done that day or the next.”
Donna Lee:
And so should men, or we kind of talked about this, can men get their, they do self checks like women do their breasts?
Dr. Jacomides:
I’d have to know more details.
Donna Lee:
Like shouldn’t they check their testicles once a month? Once a few months?
Dr. Jacomides:
At least. That seems like very easy to get to for most men. But do they? But you’re right. I mean, is it something that you’re going to get there and actually…The nice thing is, as with breasts, we’re going down a very dark rabbit hole here for our listeners, but we are our own control. Right? You have one that’s theoretically normal and one that’s directly something’s not right. And something asymmetric about it. So you say “That feels different than this one. I should get that checked out.” It can be very subtle. And then most of the times the guy’s like, “Well now I didn’t, I didn’t know how long it’s been there. I don’t know that I ever checked back there.” Or maybe they were told by their spouse, you know. But yeah, I think they should check it once a month, and sometimes for folks it’s hourly, you know, some you just have to cut them off at once a month.
Donna Lee:
Stop checking your testicle so much. Is that, that’s a problem?
Dr. Jacomides:
That’s right.
Donna Lee:
Is it true that the pea-size bump will actually feel like a little stone or does it vary in size or does it always start like a pea-size? Cause that’s what you always hear, right?
Dr. Jacomides:
Right. No, I mean, let, let’s say that’s about testicular cancer. Testicular cancer in some cases can double in size in a matter of weeks.
Donna Lee:
Weeks?
Dr. Jacomides:
Weeks. So when someone says I’ve had this problem for a year, A) I’m not worried about torsion and B) I’m not worried about cancer. So if it’s kind of coming and going, it could potentially be a torsion/detorsion situation, but testicular cancer is not going to be there for a year. You know, it’s going to be something really bad. So yes, everything starts small and gets bigger, and you know, we just have to be careful that today’s pea is tomorrow’s princess. Is that the right story? Princess and the pea.
Donna Lee:
That’s right. There’s a mattress involved.
Dr. Jacomides:
That’s right.
Donna Lee:
Well, if you have any questions about this for Dr. Jacmides, Dr. Yang, Dr. Mistry, or Dr. Ong with our group, you can email us at armormenshealth@gmail.com, and we will answer all of your questions. And what is next month?
Dr. Jacomides:
Next month is prostate cancer awareness month.
Donna Lee:
Prostate cancer awareness month. We’re going to have lots of information about prostates for the month of September, for sure. You can find us in the Austin area in Round Rock, North Austin, South Austin, and Dripping Springs–super cute Dripping Springs. And Dr. Jacomides is sometimes in Lakeway and all over the world, Georgetown…
Dr. Jacomides:
Sometimes in Dripping Springs, sometimes [inaudible].
Donna Lee:
You can call us at (512) 238-0762. And thank you so much for listening. Thanks Dr. Jacomides.
Dr. Jacomides:
Thank you.
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The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.