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CASE REPORTSCase No. 2PPOD symptoms: pelvic pain; testicular pain; chronic constipation; impotence; loss of libido. A 54 year old male was referred to the author for treatment of chronic low back and left leg pain of many years duration. He reported that he initially injured his back at age 16, while shoveling snow. Rest and activity limitation gradually resolved his complaints. While in his 30s, he reinjured his low back and experience to the onset of left hip and leg pain. Chiropractic treatment at that time was initially helpful, but gradually, his symptoms became progressively worse. When medication and exercises failed to improve his condition, he was referred for neurosurgical evaluation. After extensive diagnostic testing, a laminectomy was performed. As his operation failed to improve him of his symptoms, he underwent additional testing and treatment without relief. Finally, do to a lack or response, his symptoms were judged to be of a "functional" nature, and he was referred for supportive treatment. Upon being seen by the author however, careful historical evaluation revealed that about 18 years earlier, during a time of increasing low back and left leg pain, he had developed sharp left inguinal (front of pelvis) pain. This pain had been diagnosed as being due to a developing inguinal hernia, and as a result, he underwent a left hernioplasty (hernia repair). Unfortunately however, this procedure failed to relieve him of his pain, and a second operation, with the implantation of a supportive mesh was performed. However, in addition to being left with continued left inguinal pain, he had awakened from his second hernioplasty with persistent left testicular pain. This pain was attributed to an "atrophic" (a wasting away) left testicle. After further diagnostic testing, and because of continued pain, the left testicle was removed. Unfortunately however, following this surgery, persistent phantom left testicular pain remained. These symptoms were judged to be due to poor prosthetic placement and additional surgery had been planned. During this same period of time, he recalled experiencing the onset of deep suprapubic pain, and a progressive loss of genital sensitivity and erectile strength. Orgasm could only be achieved after extended periods of coitus (intercourse), and when it did occur, it was of a diminished intensity. In addition, when ejaculation occurred it was accompanied by intense phantom left testicular pain. Gradually, he lost all sexual desire and noticed that bowel function had slowed to one evacuation every three-four days. Clinical evaluation revealed the characteristic features of a Type I mechanically induced PPOD syndrome with secondary left inguinodynia (anterior pelvic pain), left orchialgia (testicular pain), depressed libido (sexual drive), impotence (inability to achieve or sustain erection), cystalgia (deep supra pubic/bladder pain) and constipation. Treatment following the Type I PPOD protocol resulted in a gradual resolution of his complaints. After two weeks of care, he was aware of improved libido. In addition, bowel function had improved so that evacuation was occurring at least one time per day without difficulty. After four weeks of care, suprapubic pain had resolved. Inguinal and phantom left testicular pain had all but completely disappeared and bowel function had returned to normal. As this individual had been divorced and not sexually active, he was unable to provide detailed information about sexual performance. However, he did report that libido had improved and he was experiencing intermittent spontaneous erections. |
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