Family Jewels or Fried Eggs?

Q. When I was in spinal cord rehab one of the nurses told a story about a quad who spent the day in his chair sitting on his “family jewels.” By late afternoon they were so severely damaged that they were reduced to “fried eggs.”  The story made an impact on me. I’m a T9 para and I always do a quick adjustment and check when I get in my chair. But over the years I’ve wondered if this can really happen or if it’s just an urban rehab legend.

— Matt

A. Matt, when I was in rehab I heard a similar story. To this day I automatically do a quick check and adjustment when I get dressed and anytime I do a transfer. My paralysis level is complete at T10, and there have been a few times when my testicles got slightly squished — especially back when I wore tight jeans. I’d lean forward to reach something, then feel slightly nauseous and get a pain in my mid stomach—a duller version of what any nondisabled male painfully experiences from an errant baseball, failed bicycle stunt or groin kick. It caused me to straighten up and do an adjustment really fast!

I asked a physical medicine and rehabilitation doctor if there was any truth to the fried eggs story. He said the “reduced to fried eggs” part is going a bit far, but he does occasionally see a man with a spinal cord injury come in with a swollen or discolored testicle due to trauma. He says it is important for males to add testicle adjustment to the checklist of what to do if they start experiencing unexplained spasticity or dysreflexia. Also, any swelling or discoloration of the testicles should be checked out by a doctor, as well as any dull pain or ache in the abdomen.

Paula Wagner, a urology nurse practitioner at U.C. Davis Medical Center in Sacramento, Calif., says, “You see nondisabled men positioning themselves all the time. This is even more important for men with SCI, since they won’t be able to feel if a testicle is getting traumatized.” For higher-level quads that have no hand movement, Wagner suggests having a personal care attendant make “check and adjustment” part of the standard dressing and transfer routine.

While on the subject, Wagner says all men should do testicular self-exams on a regular basis. When you do this, your testicles should feel like rubber balls with no unusual lumps or bumps. Quads that don’t have the ability to do a self-exam should ask a personal care attendant or significant other to do it for them. There is a good description on how to do an exam at the Testicular Cancer Resource Center website.

According to the Mayo Clinic, testicular cancer is the most common cancer in the SCI target demographic — males between the ages of 15 and 34. Testicular cancer is highly treatable, but only if it is caught early. So an exam of the testicles should also be part of a routine physical. However, like getting checked for prostate cancer (discussed in February Bladder Matters), this is often overlooked due to dealing with myriad SCI issues.

To reiterate, if you notice an unusual lump or swelling, ask your doctor. An abstract in the February 2008 issue of Scientific World Journal says that orchitis — swelling in a testicle — is common in adult men with SCI. This is often due to cathing and urinary tract infections and is usually treated with antibiotics. However the abstract describes a 37-year-old male paraplegic that developed swelling of the right testicle. He was prescribed ciprofloxacin, assuming the swelling was due to an infection. Four weeks later, the swelling hadn’t receded and an ultrasound was done, revealing a tumor, which required an orchidectomy (removal of the testicle). A pathology exam showed seminoma — a slow growing form of testicular cancer. The article’s findings point out the importance of self-examination, seeing a doctor if there is any swelling of the testicle, and getting an ultrasound scan if the physician’s exam reveals hard swelling of the testicle but no signs of an infection.

When it comes to doing self-checks and seeking medical advice, the Testicular Cancer Resource Center website says it best, “Embarrassment is a poor excuse for not having any problem examined by a doctor!”

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