July 1, 2014 PDI Newsletter
Greetings to all PDI and DCI Warriors,
Welcome to this July 2014 PD Institute newsletter. Hope all is well and moving in the right direction in your world.
This month our discussion will be one simple question from someone who obviously needed to get another opinion about PD surgery, and my reply. Those with Dupuytren’s contracture should also be especially interested in this discussion about Peyronie’s disease surgery. Even though this specific question is about the effect and response of surgery on Peyronie’s disease, everything that is mentioned applies just as easily to the consequences of Dupuytren’s surgery. Lastly, I will make a few additional comments after the two emails you will see.
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The email from DXXXXXX is in black, and my response to him is below in red:
Sent: Sunday, March 02, 2014 5:45 AM
Subject: second surgery
I’m 40. I had the nesbit procedure for Peyronies disease in 2007. I was told that was the best procedure for me that would correct my curvature. but I later learned that it was simply the safest due to the doctors inexperience with this issue because he had not done much with Peyronies in the past. he admitted he operated on me with this method more because of the method that he felt comfortable with rather than the one that was best for me. right after my surgery I developed two more new problems. I cannot get hard like I did before, and I am too soft and weak to enter her. And I have lost a lot of feeling in the head area so that I do not feel anything if I masterbate. The surgeon said these things happen sometimes because of all the scar tissue build up I had where I was cut on.
Is it possible to get a second surgery to restore my length and remove these now large inner lumps from the sutures?
You are asking a question that should be posed to a more highly qualified surgeon than the first who operated on you, the best you can find who has special training in this area who does this specific type of surgery often. Please take more time and effort to find a better surgeon than the first one you used.
No surgery can ever restore lost length. It is my opinion that a second surgery could actually reduce your length even more, based on common sense and what I am often told by the large number of men I communicate with who have had this type of surgery. It is further my opinion that a second surgery to remove the scars you developed as result of the first surgery could result in a worse scar problem than you now have.
Here is an article I wrote a few years ago that has been helpful to many people who are contemplating surgery. Finding a surgeon for your Peyronie’s surgery.
You are facing a slippery slope that could result in more complications. For this reason I caution you to go very slowly to assure you do not make a bad situation worse.
Theodore Herazy, DC, LAc
So, there you have it; a simple and direct question and a reply. Believe me; I get several letters about bad DC and PD surgeries like this every month. This kind of inquiry is so tragically common.
This fellow was operated upon many years ago, thinking that his problem would be “cured.” He soon learned that he had new and larger problems after he surgically stimulated tissue that easily tended to develop scar tissue. As a result he is now thinking about getting a second surgery. It is a common saying in health care that surgery often leads to more surgery. In regards to Peyronie’s disease and Dupuytren’s contracture this is especially true because surgery on the shaft or hand of those individuals also tends to make excessive fibrous tissue in response to the extensive tissue incisions during surgery.
Everyone of you who is only half-heartedly using his PDI therapy – playing around with taking just a few supplements every now and then, getting the smallest plan because of false economy, substituting cheap vitamins to save a few dollars, forgetting to do what he is supposed to do, please take this fellow’s situation seriously. Many of you must think, “Well, I’ll just try this vitamin stuff for a little while and see what happens. I don’t want to spend too much money on it, because, you know, my medical expert says there is nothing you can really do for PD except surgery. But I will try this for a few weeks and see what happens. That’s it. I will get one order of vitamins from this Herazy guy. If nothing happens then I will get some surgery to get that know of tissue cut out and I will be as good as new. Yep, just like my doctor said, I can always have surgery if the problem gets to be too bad..” that kind of thinking can result in a bad situation being made worse.
Here are a few thoughts that come to mind as I think about this fellow’s situation:
1. Even though the surgeon who operated on this fellow apparently did not have a lot of experience with PD, his lack of familiarity is not the only reason for this fellow’s current sad situation. The best and most experienced surgeon in the world can get poor results like this because of the nature of the tissue we have that produces too much collagen after injury – leading to a disappointing and tragic ending to surgery for PD or DC. That is why surgery for Peyronie’s disease and Dupuytren’s contracture is always so risky: We who have PD and DC do not respond the way other people respond to surgery (or any kind of injury) t the shaft or hand – that is why we have these problems in the first place. To cut on an area that produces too much fibrous tissue in response to injury is always a risk. Sometimes a surgeon and the patient can get lucky, but other times the results can range from not good to tragic.
2. The surgeon who operated on this fellow probably did not tell him everything he should have before surgery. Maybe he even lied to him. Imagine that! Surgeons have been known to down-play or distort certain information if it possibly could cause a patient to refuse surgery. They will do this either because they think they must encourage or guide the patient’s discussion to go in a particular direction, or because they need to do surgery to make a living. The fact is that ALL Peyronie’s disease corrective surgery results in loss of length and girth/diameter, period. Many surgeries for PD result in complications like lost sensation and numbness, erectile dysfunction (ED), worsening of curvature, and so on. Yet only a few men I have spoken to who have had PD surgery in the last 12 years have told me they were fully warned about all the problems that developed as a result of their surgery. Only a few thought they were given all the information they needed to make a good decision or really understand what they were getting into; most men tell me they were given limited or basic information only about successful operations – the perfect operations – but only slight or vague information about what could go wrong.
3. DXXXXXXX mentions he now has “large inner lumps from the sutures.” This means that he now has masses of hard internal scar tissue where the sutures were placed on the shaft. In addition to his lost length, ED, and numbness around the head of the male organ, it is likely that these lumps are also painful. He is thinking about undergoing a second surgery to remove those lumps without ever considering that additional surgery to cut off those lumps of scar tissue could easily cause even more lumps of scar tissue.
4. DXXXXX did not mention his PD curvature; I take this to indicate that his curvature might be better than before the surgery. This brings up an interesting aspect of this discussion: The surgeon’s mindset about a patient who has new complaints as a result of surgery. I had often wondered how a doctor could perform surgery this kind of surgery when it is fairly common for bad reactions to occur. Over the years I have heard bits and pieces of comments and explanations from doctors and patients that answers that question. Based on what I know doctors say to defend bad surgical results, or what men have reported they were told by their surgeons, I will guess that when this fellow first complained about the results of his surgery this is what the surgeon might have said: “Look, you had a curvature because of your Peyronie’s disease, and you wanted me to straighten you out. I operated on you, and now you have less curvature. That means the surgery was a success. I fixed what you wanted me to fix. No jury would find I did anything wrong. You should be happy, and you should be grateful to me. I am sorry that you lost length, but that is what happens when large sections of tissue are removed from the shaft to reduce curvature. When you cut away tissue, you can’t expect things to be the same. I am sorry that these additional scars developed where I had to cut your tissue. Your body tends to make excess scar tissue when your shaft is injured – that is why you had the scars in the first place. As far as your numbness is concerned, there is no way to cut on tissue without cutting nerves; there are loads of tiny nerves over every part of the body, especially the shaft and head. No surgeon can prevent cutting nerves during PD surgery, so you just have to accept what you have. Maybe in a few years you will get some feeling back if the nerves grow back together. I can only say I did my best. Look, you had a curve, and now you do not. The surgery was a success. There are always trade-offs and side-effects in these cases, everybody knows that. No jury would find I did anything wrong. You will just have to learn to live with it, or let me operate again to see if I can remove the new scars, and we can hope you do not get more scars to replace the scars I cut out. You think about it. Call me for another appointment if you want to talk about more surgery. I have to go now because I am late for the patient in the next room.”
5. Even though DXXXXXX might have more scars, lost length, loss of feeling and erectile dysfunction (ED), he is actually pretty lucky. I get emails and phone calls from men who say that after having the Nesbit procedure their curvature and distortion is the same or worse, on top of having more scars, lost length, loss of feeling and ED. It all comes down to how bad the new scars are that develop as a result of the surgery. Sometimes the new scars that develop only cause minor problems, and sometime they cause problems that are greater than the original issues of the Peyronie’s disease. In fact, a few months ago I mentioned in one of the PDI Newsletters that I talked to a man a few years ago who was going to have his male organ amputated – cut off – because the three PD surgeries that he had were all failures. After each PD surgery he got progressively worse. He finally got to the point he was so distorted that the only way he could urinate was to pee on himself. He was in constant pain, his wife left him long ago, and amputation was the only option the good surgeons could offer him.
The same can happen after DC surgery. I have spoken to many men and women who already had finger amputation or were told the next step was removal of part of the hand since no more corrective surgery could be done. Doctors do not talk about these things happening when they first mention the subject of hand surgery. We know why. But patients should be told these things so they know how serious the results can be, and they do not so lightly enter into surgery without first trying other less extreme and dangerous options.
6. If DXXXXXX goes to a second surgeon for another opinion, it is possible the second surgeon will tell him about some procedure in which plastic or silicone material can be inserted in the shaft to restore his lost length. Perhaps he will be told a graft of some kind can be done to restore him to his prior size. I suspect our hopeful friend would like to hear that kind of response, and I further suspect he might be desperate enough to have that second surgery. Desperate people do desperate things. The more cutting and alteration you do in this area, the worse things tend to become.
The position that PDI and DCI has taken for the last 12 years is to exhaust all possible non-surgical options because the bad results that can occur after PD and DC surgery can be tragic.
7. Am I saying that all PD surgery is bad and they all result in failure, with no surgical successes for men with PD? No, of course not. I am sure there are positive outcomes to PD surgery. I just never get to hear about them. I hear the horror stories, and you should too, so that you can keep things in perspective. Surgery is not always the fast, easy or sure success the surgeon would like for you to believe. All too many surgeons paint a rosy picture before surgery, and then when the complaints start after surgery they back away from responsibility by blaming the patient for unreasonable expectations or not understanding what they were told before surgery.
8. All people with PD and DC need to go into surgery with great reluctance AFTER doing all they possibly can to avoid surgery. Only when they have taken a very long time to exhaust all non-surgical options should they consider surgery.
9. Follow your PDI and DCI treatment plan faithfully and aggressively so that you do not have to consider surgery. I want you to be successful in your Alternative Medicine treatment. Please let me know what I can do to assist your effort to cure your problem.
Talk to you next month.