Where have I been?

As you may have noticed, I haven't posted in over a week.
To make a long story short, my wife had a baby! I was hoping to get my full 3 weeks of heating in before the bundle of joy arrived, but he was a little bit early. Mother and baby are both doing perfectly!

I haven't been able to continue to the experiment, 1) because we have been busy and 2) my mother-in-law is staying over.

I plan on restarting things in about 2 weeks. You can check back then.

The last day of my experiment was Day 15. Here is what the sperm looked like then: (The first one is at 40x and the second is at 10x)

I can't do a true sperm count, but things aren't grossly different.

Day 13: Back to Sci Fi

Now I'm reading Old Man's War by John Scalzi. I think it's going to be a standard space marine story, but with 75 year-olds in regenerated bodies.

The balls have been aching a bit more today. Although that may have more to do with my 10 mile bike ride in jeans. (Bike shorts tend to be more comfortable)

Day 11

I need a new book now. Overdiagnosed was brilliant. I think I have some sci-fi lined up. I should probably make a slide this weekend.

I read today (again) that a semen analysis is a standard part of the workup for low testosterone. I'm not really sure if that's necessary for a man that's over 40 and not trying to conceive. Especially if he has successfully conceived in the past. I have never ordered it.

Day 10: Hot!

I was able to keep the water temperature above 105 for the entire bath this time.
What do I do while I'm on the pot for 45 minutes? Currently, I'm reading Overdiagnosed by Gilbert Welch. It is about the harms of turning well people into sick people by over-aggressive screening.

My favorite (and most clinically relevant) chapter so far is on incidentalomas. This is a cheeky bit of medical slang for incidental lesions found on imaging studies, when you were looking for something else. For example, you order a CAT scan to rule out appendicitis. The appendix looks fine, but there's a cyst in the liver! Then as a doctor you have to decide what to do with that information.

I had a wonderful example of an incidentaloma yesterday. A patient had a MRI of her low back because of back pain. The study showed stuff wrong with her lumbar disks (not surprising). But it also showed something in her pelvis. The radiologist said it was either a cystic ovarian mass, or fluid in a loop of bowel. He recommended an ultrasound.

As Overdiagnosed would point out, there is no proven benefit to screening for ovarian cancer. There's a lot of potential harm here. An incidentaloma is not screening. It has even less value. At least with screening, you started out purposefully looking for cancer.

What if I get an ultrasound, it finds a mass, she gets surgery for it, has complications like an abdominal infection? And the mass could still turn out to be benign.

So do I take the patient down this very dangerous road, with high chance of harm, and low chance of benefit, for something that may be a loop of bowel?

Day 7, 8, 9. Inconsistent

I was on call this weekend. My day 7 treatment was cut short and not very hot. I didn't do day 8 at all, as I had to rush in for a delivery.

Tonight was day 9, and I kept the temperature over 100F the whole time. I will make some slides later this week.

Day 6: is aching a good sign?

My goal temperature is 116F. Yesterday the tap water was 118, but today it was only 114. I wish I knew why. The difference in those two temps is quite dramatic. 114 is quite soothing, while 118 is difficult to take.



Yesterday, I had a slight ache in my testicles but wasn't sure if it was for real. Today, it is definitely not my imagination. If this ache continues at this level for the whole 3 weeks of soaks, it's not a big deal. If it aches like this for the entire 6 month cycle I might not try it again. If the achiness continues to worsen as my spermatogenesis shuts down... We'll try not to think about that.

Day 5: not much to report

I did a little better titrating the temperature. I kept it above 102F the entire time. But my left leg went numb again.

I have a bit of a stomach ache, but that's probably because of the pizza buffet lunch and large Mediterranean dinner.

It's local standard of care to get 2 semen analyses after a vasectomy. Today I called a patient with lab results. His test showed no sperm. He sounded excited to be able to have sex without fear of pregnancy. His procedure and first test were almost a year ago.

In this 2005 study, 233 (42%) men did not return for 6-week, 3-month, or 1-year post-vasectomy semen analysis (PVSA). Of 551 men, 318 (58%) returned for 6-week PVSA, and 138 (25%) returned for 3-month PVSA. Only 44 (8%) of the 551 eligible for a 1-year analysis returned for PVSA.

Day 4: everything's just ducky

I am getting a little more used to the process. I'm not sloshing water around everywhere. Sitting is not as uncomfortable, and my leg didn't go numb.

I'm still working on the water temperature. Today I ended at about 97-98 degrees, but I probably had a higher average temperature throughout the bath.

It is always important for a researcher to describe his methods, so how am I measuring the temperature anyway?

I picked up this little guy at the local mega-mart. The bath thermometers were either ducks or frogs. The duck was obviously cooler because of the sunglasses. Also ducks reproduce by copulation, while frogs participate in amplexus (an external form of pseudocopulation). So I thought the duck would be more appropriate for my task.

Day 2: Turn up the heat!

To better interfere with the production of my spermatogonia I slightly adjusted my hot water heater to get something closer to 116F. When I filled up my sitz bath, this time the water was steaming at 118F.

As I settled in, this water was noticeably hotter but not scalding. I tried my best to titrate in flow from the bag as it cooled. At the end of the 45 minutes, the water was somewhere between 97 and 98 degrees. I was hoping it would be above 99. Maybe I can improve this with better control of the water flow.

About 30 minutes in, I developed pretty dense numbness in the left L4-L5 dermatome. It improved with shifting my weight, but positioning is going to be a challenge.

After I was done, my scrotum felt noticeably warmer than usual. I suppose this is a good sign.