Government Health Care in action--or inaction as the case may be

Okay, now see how government health care works. My son is sitting on a medical time bomb. He has had two episodes of intermittent testicular torsion. He has to always be within six hours of a facility that can perform emergency surgery. The doctor who saw my son in the DeWitt Army hospital emergency room did not initiate a referral to a urologist until I requested it. He was going to discharge my son with no specific follow-up instructions. Because I am a doctor and demanded the referral he complied. It took one month to get the referral approved and an appointment scheduled. He saw the urologist who agreed that my son needed to have the minor procedure of orchiopexy done in a timely fashion to prevent emergent surgery in the future. However, when he went to schedule the surgery he found out that the doctor in the emergency room had checked the wrong box on the referral request. A request for a second opinion was submitted instead of a referral for evaluation and treatment. Because of this, I have to schedule an appointment with my son’s primary care manager. This primary care manager has to submit a referral for evaluation and treatment. Once that referral is approved—another one month process—the urologist can schedule the necessary surgery. Everyone in this governmental process is concerned about making sure the paperwork is correct and no one has any concern about the well being of the patient—my son.

Here is an article I wrote on testicular torsion:

Self-examination of the testicles as a screening procedure for cancer is one of the many topics covered in today’s high school health classes. As valuable as this prevention technique is, it might be even more important for the schools to educate high school boys about testicular torsion, a true medical emergency.

Testicular torsion occurs when the spermatic cord twists itself inside the scrotal sac and cuts off the blood supply to the testicle. Once the blood supply is cut off, you only have six hours to restore blood supply before the testicle is irreparably damaged and has to be removed. Torsion occurs spontaneously. Only 4 to 8 percent of cases are associated with trauma. The peak age for this condition is 14 with most cases occurring between ages 12 and 18. Every year, one out of every 4000 males under the age of 25 will suffer testicular torsion.

This happened to one of my sons when he was fifteen years old. He was playing a computer game when he suddenly cried out in pain. He said it felt like he had been kicked in the groin. Having practiced emergency medicine for several years, the sudden onset of scrotal pain was a red flag for me. I immediately told him to get his shoes on, because we were heading for the emergency room. He was surprised by my swift response, since I am known for my reluctance to seek care in an emergency room unless something is broken or bleeding. Once I explained the possible problem and the time constraint for preventing dire consequences, I could not drive fast enough for him.

Upon arrival at the emergency room, it is important to effectively communicate to the front desk personnel that this is a true medical emergency. When I took my son to the DeWitt Army hospital emergency room, the intake clerk handed us a pager like they give you at restaurants and directed us to the waiting room for triage. She looked skeptical when I told her that scrotal pain was a real emergency. However, she communicated the problem to the medical staff and they leapt into action. The primary diagnostic procedure is an ultrasound examination to assess blood flow. A urologist should be called in immediately. If torsion exists, the ultrasound will show compromised blood flow and the urologist must perform immediate surgery to untwist the spermatic cord. As I said, there is only a six-hour window from the time the cord twists until the time it is corrected in which the testicle can be saved. The surgery also includes a procedure to both testicles called orchiopexy. This involves placing small stitches in each testicle to tack them down and prevent them from twisting in the future. This is done to both testicles, because if torsion occurs in one testicle, there is a significant chance that the other testicle is predisposed to it as well.

After my son’s episode, I realized the need for better education of teenage boys and their parents about this medical emergency. I was surprised to hear my son say that he had experienced a similar pain two months prior to his emergency room visit but it had resolved spontaneously after a couple of hours. He had no idea that such pain could be a sign of something serious and needed immediate attention. More than likely, he had experienced an episode of torsion that untwisted by itself. This is called intermittent testicular torsion. Such pain should not be ignored. Even though the pain resolves, the underlying anatomical problem that predisposes to torsion remains. It is advisable to electively undergo the minor surgical procedure of orchiopexy to prevent subsequent emergency surgery for a persistent torsion.

I spoke to several mothers of my son’s friends. None of them had ever heard of testicular torsion or knew that scrotal pain was a medical emergency. Because there is so little time to surgically correct the twisted spermatic cord and save the testicle, it is critical that boys and their parents are made aware of this condition and the need to act quickly.

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