Pain Drain

“We just don’t seem to be making progress. You seem to be in too much pain when I try to release your trigger points. I’m going to release you back to Dr. Fontenot,” expressed Dr. Fingers.

I left my sixth and final physical therapy appointment. I was supposed to go twice weekly, but my work schedule only allowed once per week. I wondered if the less-than-ideal frequency of my visits was why I wasn’t getting better.

Then again, could I really take two visits per week of someone putting her fingers up my butt?

“I’m afraid we’ve exhausted our options. I could surgically cut the muscle inside, and that would surely do the trick... but then you wouldn’t be able to have kids. I could send you the Baylor, and they could probably give you a shot. Or we can just wait and watch,” explained Dr. Fontenot.

At that moment, I realized that this was a pain that I could deal with. And if I had to deal with it the rest of my life, so be it. 

Oh, it hurts a little bit to pee? Big whoop.

This was the first time I ever had that thought. I had finally come to terms with my condition 3 years after the onset of the symptoms (Onset: 2009-- now it was 2012). Finding out what was causing the pain, as I previously stated, was 75% of the battle. I could deal with this 25%, even if for the rest of my days on Earth.

Also, I want to have kids one day! And I don’t want any needles in the vicinity of... ya know...

There are people in so much more pain than I.

I chose to wait and watch.

With the pain no longer being on the forefront of my mind, and the anxiety that came with the unknown diagnosis squashed, my brain freed up space for me... to do me.

I could finally do me again.

A vision

The first thing on the agenda? Get the fuck out of Eunice, Louisiana. As you may recall, I had moved here right out of optometry school. The job I had taken required me to drive two days per week to Kinder, LA, work one day per week in Eunice, LA, and then drive one day per week to Oakdale, LA.

The driving got old fast. The not-knowing-anyone-in-these-towns got old fast. I just wasn’t happy.

I sat at my dining room table one evening in my rent home in Eunice, and I suddenly had a vision.

I remembered what a professor I had while doing my rotations in Dallas had once said about starting a practice right out of school:

“Why not start a practice right out of school? There is no better time. You’ll never have enough time, experience, or wisdom. You’re used to being broke. What’s another couple of years of being broke?”

I grabbed a pen, a paper, and I began to draw.

The result:

Fast forward to June 10, 2013, and I opened Scott Eye Care in my hometown of Scott, Louisiana. I saw 7 patients on my first day, and I had a staff of two: a technician and an optician.

Fast forward to present day 2019: Scott Eye Care now employs 8 staff, has 2 full-time doctors, and did $1 million in revenue in 2018. We have a dataase of nearly 13,000 patients. I am also in the very early stages of building our own building.

The pain is now not an obstacle.

Love

Now that I was done with the rigorous studies of optometry school, and now that the pain was behind me, perhaps I could finally find a girlfriend. It’s important to me to be married someday and start a family, but I couldn’t do that with the putrid dating life I had had so far.

My cousin Erin ended up setting me up with a friend of hers. She set us up because we “post the same kinda stuff on Facebook.” Looking back on that, that’s so weird! haha.

One fun memory I had with her is that on one of our first dates, it was near Easter. I had learned that she was very quirky, and she really like drinking Blue Moon and Dr. Pepper (not together! but those were two of her favorite things to drink.) So I made her an Easter basket with bottles of Blue Moon and Dr. Pepper in it.

I dated this gal for almost a year. At that point, it was my longest relationship. It didn’t work out in the end, but it provided me an experience that I could grow from and learn from.

A year or so later, I met a young lady at a local event called Clash of the Cocktails, where bartenders square off to make the best drinks. We had mutual friends, and I thought she was very cute. We talked a little, and after the event, I learned that she was interested!

I dated this lady for a year and a half. It came to an end because we were not on the same page at the same time in life--she was very ready to be married, whereas I was still getting my career and practice off the ground. Though I had picked out a ring for her, I could not commit to someone who did not see the bigger picture of why I made the investment in my practice and the sacrifice of moving back in with my parents.

Again, it was an experience that I could build off of for the future.

Fast forward to present day, and I’m still single at the age of 34. Sure, it can be frustrating to see that the friends you grew up with have found love, and perhaps marriage. A lot of my friends have started families.

Social media makes the thought of, “Wait, he has a girlfriend, and I don’t???” possible, which is totally unhealthy. But it’s the reality of my thinking.

I have yet to be able to find someone who can appreciate what I bring to the table. I’m on a streak of 3 years of rejection. It’s really wearing me down, but I know God has a plan for me, and I just have to be patient and trust in Him.

I remain very hopeful, especially now that the pain is now not an obstacle.

Debt Be Gone

I graduated optometry school in 2011 with a total debt of approximately $175,000.

Yup.

I read Dave Ramsey’s book “Total Money Makeover,” and I was immediatey inspired to get this debt out of my life.

I began making extra payments towards my debt.

But then I had this wonderful idea to take out a $210,000 SBA loan to start Scott Eye Care.

It turns out, however, that the advice given to me by my Dallas professor was 100% dead on. I could live with being broke for a couple more years if it meant building an investment that would eventually make me a great salary and fund my retirement.

In 2017, I bought my 2017 Nissan Frontier with cash, and in 2018, I paid off my student loans in their entirety.

I now own my first home and was able to move out of my parents when I purchased it in 2018. (And, no, I did not buy that in cash!)

Read my story on how I got out of debt here: http://mexicajun.tumblr.com/post/175195264171/debt-bitch-u-prob-make-double-what-i-make-in-a

Debt is now not an obstacle because my pain is now not an obstacle.

Lafayette Community M.I.Brary

My involvement with the local community has helped me to raise my awareness of events taking place. I seem to be in-the-know when it comes to concerts and festivals, voting issues, and various charity events.

Through a young leaders group I am in called the705, I heard of an event called the 24 Hour Citizen Project that was having its 2nd annual event in 2017. This is an event where community visionaries pair up with non-profit organizations and pitch their ideas to investors. The investors then donate to the non-profit of their favorite pitches to make the ideas come to life.

The 24HCP was having a pre-event called “Idea Speed Dating,” where people with ideas to improve their communities would gather at tables, exchange ideas, and then move on to another person to exchange ideas with.

I had heard of the first 24HCP a year ago where a couple of ideas were funded, such as lighting a dark bike path and funding covered bus stops throughout the city.

2 hours before the Idea Speed Dating event, I came up with an idea.

“What if we had a library where we could check out musical instruments?”

I ended up winning Idea Speed Dating. The founder of 24HCP, Butch, encouraged me to enter the big event, which was to take place in a couple of months.

I gathered a team of my good friends, Kassie and Chris, and we got to work.

My initial idea of having a place to check out an instrument for an hour or two, go to a room where you could play it, and then return the instrument afterwards eventually evolved into being able to check out the musical instrument from the local public library for four weeks. We brought the idea to a local arts organization, Acadiana Center for the Arts, and to the Lafayette Public Library. Luckily, both organizations were on board.

On July 27, 2017, I gave my pitch to the community investors, and I asked for $5000. The pitch can be watched here: https://www.facebook.com/24hourcitizenproject/videos/1507206406023912/

Along with projects to create rain gardens in the city, to create a new walking Mardi Gras parade, and to create pop-up theatres for children, The Lafayette Community Musical Instrument Library, a.k.a. M.I.Brary, was funded in full!

This was one of the happiest moments of my life.

I launched the M.I.Brary approximately 1 year later in the summer of 2018. It has been a resounding success.

This was all possible because pain was no longer an obstacle.

Recognition

In 2018,  I was recognized for my hard work by the705 and by the local newspaper during their joint annual awards ceremony called Top 20 Under 40. I had been nominated the previous 5 years, and I finally pulled through and was recognized in 2018! I was lucky to be recognized along with 19 incredible individuals, most of whom I was lucky enough to call friends.

That night in November was one I will never forget. I bought two tables to share with friends and family. I had so, so much fun that evening.

I achieved because the pain was no longer an obstacle.

These are just a few of my accomplishments over the years since I have gotten over my pain. If I were still in pain and still had the anxiety of not knowing what was causing it, I don’t know that I could have done any of this. Not one damn thing.

But I persisted. And I hope you do, too.

I still have many aspirations. I am not yet satisfied. I hope you are not satisfied, either.

Dr. Fontenot helped me feel so, so much better, all by just illustrating to me exactly what was wrong with me and by educating me on my condition. As I stated in the previous entry, I felt an immediate decrease in my pain by 75%.

Could 75% of this disease be mental?

Also, how do I get rid of the remaining 25%?

As you may recall, Dr. Fontenot also mentioned to me that what I really needed was physical therapy. But we also tried other things:

-Steroids didn’t help.

-alpha-blockers, no matter the brand, didn’t help.

-He prescribed a TENS unit. No, I didn’t have to put it on my pisser. I would stick it to my leg and foot, which was supposed to electrically stimulate a certain nerve to help relax my pelvic muscles. Didn’t help. (It just made my toes do weird things).

During this trial and error, I scheduled my first physical therapy appointment. Luckily, there was a pelvic physical therapist near where I’m from. 

Though ideally I would go twice per week as prescribed by Dr. Fontenot, my current work schedule only allowed me to go on Thursdays--my day off.

What exactly would physical therapy entail? Would I have to do a bunch of stretches? Would this envolve back massages? Would the PT do anything to my wiener?

The day of my first PT appointment came. I felt at ease knowing that the majority of my pain was relieved. Hell, I felt excited, because hopefully this physical therapy could put an end to it all.

I met a physical therapist assistant near the entrance to the clinic. After I filled out some paperwork and handed over my referral, she handed me a gown and had me change into that in a special room in the clinic. The main room in the clinic was full of people doing regular physical therapy things like lifting light weights and stretching.

I went into the special room, changed out of my clothes and into the gown, and sat on the doctor table waiting on the therapist. It was interesting but understandable that this room was isolated from the rest of the clinic. The room had a fancy computer, a bathroom attached, and on the wall some gloves and...

...some lubricant.

Dude. Dude! What did I get myself into?

A faint knock is heard. “Hello, I’m Dr. Fingers!” (This was definitely not her real name). “So nice to meet you,” she says as she walks into the room.

I nervously greeted the doctor and shared with her my story. She had seen several men with similar issues, some not able to enjoy things they used to do like ride bikes or even sit down without pain.

I was starting to feel at ease after seeing that lubricant in the room. Maybe Dr. Fingers could help me out.

The first thing we did was strange to say the least. She hooked up some electrodes near my perineal area. She had me walk over to the adjacent restroom and urinate into the toilet. The electrodes measured the tension in my muscles.The tension was shown as a line on a graph. She showed me that even as I “relaxed” my pelvic floor to release the urine from my bladder, the “relaxed’ state of my bladder was still more tense than a normal person not urinating.

We went back to the table and practiced relaxing the pelvic floor. 

“Make as if you are going to pass a little bit of gas.”

Um... ok? But she was right--this was a way to relax the pelvic floor. She had me watch the graph and try to get my muscle tension below a certain line on the graph. This was a technique called biofeedback.

It was really difficult for me to get the muscles to relax. We hoped to get the muscles to be less tense over the next few weeks and by the end of therapy.

As she puts on a new pair of gloves, she explains to me, “Biofeedback is one way to help relax the muscles. The other way is through massage.”

Cool! I’m going to get a massage. My favorite!

“Though some of the pelvic muscles can be reached externally, most of the trigger points have to be reached internally. This is much easier to do on a woman through the vagina. On a man, we have to go through the rectum.”

So............. that explains the lube.

She had me lie on my back with my knees bent up a bit.

“Ready?”

I mean.... no.

She tooks a lubricated finger (or fingers???) towards my anus.

Ok... so this really wasn’t so bad. I thought that this would be very painful, and she would meet a lot of resistance, and I would be so miserable and...

YOWZA!!!

Once she broke through the sphincter, my body was like, “Nuh uh, girl. Get out of here!” I could feel the muscles trying to push her out. It was very... unpleasant.

I relaxed after a minute or so, and she explained to me that she would press on certain trigger points on certain pelvic muscles and try to release the tension.

“Whateva, bitch, do what ya gotta do, and hurry the fuck up!”

Ok, so I didn’t say that. But that’s what I thought.

The very first muscle she tried to release was very painful. I could tell it should not have been as tense as it was, and by lord did it hurt so very much. Plus, I mean, a finger (or fingers???) was up my butt, so that didn’t help the cause.

She explored many different muscles in the pelvic floor and named them as she massaged them.

“Goddamn lady, how many pelvic muscles do we have? A billion???”

Ok, so I didn’t say that, either.

As she went deeper and deeper, the pain was worse and worse. She could tell how excruitiating it was, so she seemed to cut the massage short.

“Maybe next time, now that you know what to expect, we can work a little longer on your muscles.”

“A little longer??? Bitch, you cray!!!”

You’re right... I didn’t say that. Just thought it. Thought it very loudly.

So for the next 6 weeks, every Thursday, I had to look forward to getting a finger (or fingers???) up my asshole to get a “massage.”

“Hi, I’m Dr. Fontenot,” says the doctor wearing bowtie.

I was sitting in my FIFTH urologist’s examination room. In walks Dr. Fontenot with a young lady in a lab coat--his intern. 

I had been referred to Dr. Fontenot by my new PCP, Dr. Kelly Cahill. He had nothing but great things to say about Dr. Fontenot. I had hoped that he would be different from the previous doctors. I absolutely needed answers. Although I recently had gotten my anxiety under better control after starting Effexor XR again, I knew that I could not keep up with the stressors of having a new job and living in a new city with the huge weight of the unknown urinary condition sitting on my shoulders, heavy as hell.

It was as if I was holding Shaq and Yao Ming on my shoulders.

Dr. Fontenot interviewed me, and I went through the entire story. The onset. The pain. The frequency. The misdiagnoses. The antibiotics. The cystoscopies. The failed urodynamics test. 

It seemed like before I could finish, Dr. Fontenot had me bent over the exam table with a gloved finger up my butt.

I had had my prostate checked before, but not like this. He was massaging it.

AND IT HURT LIKE A MOTHAFUCKA.

Like, nevermind that a person is putting a finger up my butt. The pain from the pressure on the prostate was nearly unbearable.

He casually slipped a microscope slide under my penis and collected some fluid. Why hadn’t any of my previous doctors checked this?

As Dr. Fontenot and his intern walk out of the room to examine the specimen, I had to lie down on the exam table. The prostate massage hurt so badly that I felt very faint. 

Here lies Ryan. He died of a prostate massage. May he forever rest in peace.

So, I wasn’t dying, but I thought I was. My life flashing before my eyes was interrupted by Dr. Fontenot and his intern walking back into the room, seeing me lying on the exam table.

“Everything ok?”

“Yeah... I just got a little faint from the pain.”

Dr. Fontenot went on the explain that the specimen showed a lot of pus. His intern looked at me wide-eyed, as if she had never seen an inflammatory specimen as such before.

“I know that this was attempted before, but we really need to do urodynamics.”

Well shit.

If you’ve been an avid reader of this blog, you’ll know that the first time I had this done did not exactly go so well. 

As much as I wanted to refuse, more of me wanted a goddamn answer. 

And for once, I felt like we were on to something. Because not a damn one of my previous four urologists even thought to examine a prostatic secretion. That, and this dude was wearing a bowtie. As much as I absolutely hate bowties, I’ve observed over the years that people who wear them on a regular basis are different. Different... sometimes in a bad way, but sometimes in a good way. I had a feeling it would be the latter.

The dreaded day came. For the fourth time, I was about to have a tube up my tool.

I had super awkwardly asked my boss for the day off, and now here I was, in a surgical center, wearing the ever amazing hospital gown, straddling the weird looking chair that was going to collect my urine.

I warned the nurse that last time this was attempted on me, I went into vasovagal syncope. She understood and said that they would be ready for it if it were to happen again.

Then she began to slide the tube in.

Just like the previous three times something was slid into the snake, it felt like an eternity for it to reach its destination. Can this be over with already?

Just like the previous three times, the tube breaches the bladder sphincter, and the pain is excrutiating.

I begin to feel faint.

Before I could give the nurse a heads up, she was already abandoning ship and calling for help. She had seen how pale I looked and knew what was going on.

I don’t remember much after that, but I remember being put on a hospital bed and Dr. Fontenot and another doctor coming in to assist. I believe I was hooked up to an IV.

In my mind I was on a TV hospital drama, flatlining, the doctor rubbing the defibrillators together--CLEAR!!!--shocking me multiple times to no avail, and my wife beside me weeping as I move into the afterlife.

Only I didn’t have a wife, and it wasn’t that serious. And did you know that defibrillators aren’t used when someone is flatlining? That’s just some made up TV bullshit.

Anyways. The vasovagal spell passes, and I’m actually ready to do this.

The nurse gets the catheter where it needs to go, and I felt much more relaxed. Usually after a spell as such, I feel fine and at ease.

But now came the hard part.

I had to actually pee with this sensor up my pee tube.

It was extremely difficult. I remember it taking probably at least 30 seconds for me to feel the pee break through my bladder sphincter.

AND IT HURT LIKE A MUTHAFUCKA.

The pee trickled down the catheter into the collection contraption.

It was over. I did it!

Now could I get some answers???

The nurse pulled the catheter out, and I sat there awaiting Dr. Fontenot’s assessment.

A few mintues later, Dr. Fontenot walks in and shows me the images and the pressure readings generated by the urodynamics study.

He pointed to an area of my bladder near the bladder sphincter. This area showed distention, indicating my bladder having difficulty voiding its urine.

“Your external bladder sphincter is not completely opening, causing a build up of pressure. This can cause the prostate to become inflamed, which can cause more difficulty with urination, and so on and so forth!”

So the problem was that I had a malfunctioning external bladder sphincter. The difficulty in voiding created a vicious cycle that caused prostate inflammation, which caused more difficulty in voiding, which then caused more prostate inflammation, etc.

I had an answer.

I felt incredible. I felt like I had a breakthrough.

I felt like I had been running a 3 year long marathon, and I finally tore through the finish tape.

I literally felt like the weight of Shaq and Yao Ming was lifted off my shoulders.

Even better than that was the fact that after getting a tried and true diagnosis that I understood and could visualize... my pain decreased about 75%. Sure, it would still be painful to pee, and there was still the hesistancy, but it’s like I didn’t care anymore. 

Nearly 3 years after that fateful Phoenix Suns vs. Houston Rockets game... the day the pain went away was finally here.

I almost felt like my old self again.

All because of the man with the bowtie.

It was September 2011, and I was walking into Kinder Eye Care for the first time as the provider at that office. I was nervous, as I believe there were 16 patients on the books. Throughout school, I had never seen that many patients in one day.

It turned out to be not so bad. Not all of the patients showed, but the ones that did weren’t too bad.

The problem was that I was in the middle of nowhere. There is literally a casino in that town, and that’s about it. 

The cool part about practicing in a small town far away from civilization is that you will likely get to see lots of pathology, as you are the only provider around. And I certainly did see that.

One of the very first patients I had in the first few weeks in Kinder, LA, walked in with an eye completely closed. His chief complaint was something along the lines of, “I think I have pink eye.”

I opened the eye with my fingers. It showed no swelling. However, he could not move that eye except in one direction; the other eye moved just fine.

It certainly was not pink eye.

My training told me this man needed an MRI. Being in the middle of nowhere, I could not find a place nearby who could do it for him. He did not have the finances nor the insurance to pay for such a test. I sent him to nearest charity hospital in Lake Charles, LA. I lost track of him afterwards.

Months later, I randomly ran into an old friend from college named David. He was doing his M.D. residency at that same Lake Charles charity hospital. I mentioned to him that I recently sent someone to that hospital with what was called a “third nerve palsy.”

“Dude... we had a case just like that in grand rounds,” he said.

It turns out a fellow resident presented the exact case to his colleagues at their grand rounds. It was my patient.

I was able to obtain a copy of the MRI. The MRI showed a cavernous sinus meiningioma. The growth was pressing on the man’s third cranial nerve, the oculomotor nerve, which is responsible for pupil control, eye movement (in most directions), and opening the eyelid. The man eventually had the growth removed, but I later learned he lost the vision in that eye.

It quickly put things into perspective. Maybe my painful pisser wasn’t that bad after all.

Or maybe it was.

I still had difficulty getting it off of my mind. I would temporarily forget about it while seeing patients, but when it came time to pee, I was reminded that I still had a problem that needed to be solved.

It was time to get established with doctors in Louisiana.

Though I now lived in Eunice, Louisiana, I still considered the Lafayette area to be home. Through Facebook recommendations, I decided to see a doctor in Lafayette by the name of Kelly Cahill, MD. 

Dr. Cahill was great. He was thorough and listened to my problems. He set me up to do bloodwork to make sure my cholesterol was in check--I have a history of familial hypercholesterolemia. Thanks, dad! Just kidding. 

Dr. Cahill also refilled my Effexor XR, as I was not going back to that old man psychiatrist from the last blog entry.

I told the doctor about my pelvic history. I told him everything I went through I asked him if he had any recommendations on what steps to take next.

“There’s a great urologist in town that I send my patients to: Dr. Chris Fontenot. He’ll be sure to take care of you.”

It was only natural to be skeptical after everything I had been through. All those tubes down my peter. False diagnoses (interstitial cystitis). False accusations (”You need to be tested for STDs!”). Pain. Blood. More pain.

But it turned out that Dr. Cahill was right. Dr. Fontenot took care of me.

My whole life, I was a student. I studied. I took a test. I studied some more. I took another test. Rinse, repeat.

Suddenly, I was no longer a student.

Life was suddenly real at age 26.

You spend your whole life preparing to be an adult, and I finally reached that point. Was I prepared after 21 years of schooling?

The answer in a word: no.

Imagine taking someone with uncontrolled anxiety and changing everything he ever knew and felt comfortable with. No more studying. No more tests. No more 100+ classmates to relate to and share experiences with. Thrown into the real world suddenly, now with bills, now living alone, and now with real responsibilities.

And with a painful pisser.

I should have been excited to be at this point. I had worked so hard. So, so, so, so hard. But instead, I felt absolutely intimidated by life. All because of my uncontrolled anxiety and my strange physical ailment, instead of looking forward to what I’ve been prepared for, I was dreading it.

How could I ever face a stranger and be held with the huge responsibility of investigating his ocular ailments? The future of his or her vision depended all on me. How could I do that 15+ times per day? And how would I deal with my pain during this?

This wasn’t right. I had to get help for my nerves, and I had to get help fast.

Right out of school, I had a job lined up out of Eunice, Louisiana working for two doctors. I would travel to Kinder, LA twice per week (where the doctors jointly owned a practice), work at one doctor’s Eunice office once per week, and once per week in Oakdale, LA at the other doctor’s office. Despite the travel, it was a good gig because I would get to practice the medical optometry that I loved, and I would have Thursdays off to do what I want, whether that be fill-in somewhere else, work on my new music project, or just... sleep.

I instead decided I would use Thursdays to get better.

But before I could refocus any efforts on getting my pelvis healthy again, I had to get my mind healthy again. 

I decided to look for psychiatric help for the first time in my life. I needed to get my mind right before turning to this new page in my life.

There was one problem: pre-existing conditions. This was before the nation’s healthcare overhaul, so I had extreme difficulty getting my own health insurance. I got denial after denial because of all of the testing I had done over the past couple of years and because of my history of anxiety. I was only on one medication at this time (Lexapro), but insurance companies didn’t want me.

After I turned 26 earlier in the year, I was on my parents’ COBRA plan, meaning they were paying out of their butts to keep me insured.

I looked through the providers of my insurance for mental health services. There wasn’t much to choose from. 

I came across a mental health facility that had the word “addiction” in it, but their services included help for those with general depression and anxiety--not just for those addicted to alcohol or substances. Although I didn’t feel great about walking into a building with a sign saying “addiction” on it, help was essential at this time, and they accepted my insurance plan. I made an appointment.

My first appointment was pretty good. The therapist there listened to how I was feeling. She helped me realize that a lot of my stress and anxiety was from the pressure I put on myself to be perfect.

I was a perfectionist, and I never realized it. 

Perfectionism forces unnecessary expectations on the perfectionist. She helped me realize that nothing ever needed to be perfect. I didn’t need to be perfect. I needed to accept things as they are, and it wasn’t up to me to make things perfect.

She followed the discussion with a meditative session. She guided me as I closed my eyes and imagined myself in a calm place.

Is this what relaxation feels like??? If so, it was a good feeling.

I left the appointment looking forward to the next one. The therapist set my appointment up with the psychiatrist on staff. I was looking forward to talking with him. I had decided to bring up to him that I remembered the best medication that had ever worked for me was Effexor XR, which I was previously on in high school and college. The Lexapro I was currently on was not effective whatsoever on me.

The time came for my second appointment. I was called to the back, and I walked into the doctor’s office. Sitting behind the desk was an elderly man. He was probably in his 70s. It wasn’t what I was picturing in my head as the psychiatrist, but I was pleased after my first visit and expected to have the same result after meeting with the doctor.

Let’s call this doctor, “Dr. Geezer.” (I feel bad about that, but perhaps not after what I’m about to say.)

Dr. Geezer opened up my patient chart. I took a seat in front of him, ready to discuss my history of anxiety, ready to ask to be switched to Effexor XR, and ready to get my mind right to begin my adult working life. 

The first words out of Dr. Geezer’s mouth after introducing himself:

“So, Ryan... what are you hooked on?”

.............

If you’ve read my blog up to this point, you know when I say that I’ve had some shitty luck with doctors that I am short-changing myself with that understatement.

I have had some SHITTY luck with doctors. All caps, underlined, italicized, and boldfaced.

I didn’t enjoy being judged by doctor after doctor after doctor. Do you guys even read the goddamn charts you’re given, or do you just waltz through every exam like each person has the same exact problem?

I somehow maintained my composure and told him, “Nothing. I’m just here for my anxiety.”

I made it through the appointment with his old judgemental ass and walked out with a prescription for Effexor XR.

I remembered running some errands after the appointment. At the end of my to-do list was a trip to the pharmacy to fill my medication. I made it there... only to find that...

... I couldn’t find my prescription.

I dropped it somewhere.

GREAT. This will go over well when I call the ADDICTION place and tell them I dropped my prescription and couldn’t find it.

I called the mental health center the next day, and just as I knew would happen: “You’ll have to see the doctor again.”

“I just need another copy.”

“You’ll have to see the doctor again.”

The mental health center that served addicts and non-addicts continued to treat everyone the same.

I had to waste more hours of another day to see Dr. Geezer and convince him again that I am not addicted to anything, that I didn’t just want more pills, and that I was just trying to get my mind right.

He ended up writing a new prescription without hesitation, but I was annoyed that I had to go through that bullshit again.

I finally filled my medication. I started feeling better within a week. 

And I never went back there.

To be continued...

Fast forward to present day. I post this entry at a time of anxiety, depression, and burnout. I’ve worked myself to burnout, and with that came a new wave of anxiety and depression. I haven’t felt myself in a few months-- I haven’t felt like the hard-working, hard-rocking individual that I usually am. I wake up and don’t want to move. After 20 minutes of convincing myself to get out of bed, I go to work and don’t get much accomplished. I go home after work and just want to go to bed.

I’ve been getting help from my PCP and at a fantastic facility in Lafayette called Acadiana Medical Psychological Services. I’m on the mend, and I’ll be taking a couple of vacations coming up that I’m very much looking forward to.

I write this in hope that if you feel similiarly, there is no shame in getting help. You shouldn’t feel any different seeking help for anxiety, depression, or any mental health issues than you should feel about asking for help for a sinus infection. Live life in the pursuit of happiness, not in the dark and lonely closet of depression. For every person who has a problem on this Earth, there is another out there who can help.

Ask for help. You will thank yourself later.

With love,

My new record came out last week, which has very relevant artwork:

The cover of the album symbolizes not only the pain I’ve had for the past 9 years, but the difficulties I’ve had with relationships. There’s so much the artwork symbolizes.

As for the music, I couldn’t be prouder of the work that was put in.

Listen at http://bit.ly/HexesSpotify

The final thing you should do to chop down this goddamn tree is get healthy. Eat better, seek physical therapy, stretch, and work out!

Diet

The American diet is super pro-inflammatory. Meats are processed, carbs are super processed, and so on and so forth. 

Your body needs inflammation to heal itself. But when it has too many pro-inflammatory influences, you can go into inflammation overdrive. Why do you think we have such trouble with obesity, cholesterol, and high blood pressure?

Omega-6 fatty acids are important to consume for inflammation, but the amount of omega-6s we consume far outweight the anti-inflammatory omega-3s.

A great start to change your dietary ways would be to read The Brain Fog Fix as mentioned in previous posts. (Amazon Link). Author Dr. Mike Dow gives a great blueprint on how to start eating more anti-inflammatory foods to balance the omega fatty acids.

Perhaps more relatable would be the dietary tips provided in Heal Pelvic Pain by Amy Stein. Stein talks about avoiding foods that can irriate the pelvic muscles and urinary tract. (Amazon Link).

Another place to look would be to read my dietitian’s blog. Daphne Olivier is an incredible “unconventional” dietitian. She is so up-to-date on nutrition and research. She stresses eating real food. Putting me on a non-processed foods diet, she helped me lower my cholesterol by 40 points. Reducing inflammation is key.

Check out her blog: http://www.theunconventionaldietitian.com/blog/

Physical Therapy

I can’t stress enough how much physical therapy can help your pelvic pain. I truly believe that a pelvic physical therapist is the best healthcare professional to coordinate your care, as is argued in Pelvic Pain Explained, a fantastic book previously mentioned in my blog. (Amazon Link).

The pelvic muscles are exactly that: muscles. When your muscles ache, what better way to treat them than physical therapy and massage? To find a skilled pelvic physical therapist, start with this CPPS therapist directory.

While I am not a physical therapist, I would like to share with you the stretches that have helped me most.

Malasana

This pose is also known as the yogi squat. This pose does a great job of stretching the groin and pelvic floor.

 Warning: it took me months to even accomplish this pose. For the first several weeks, consider placing yoga blogs under your booty. Otherwise, you may find yourself on your tippy toes, which does not give nearly the same stretch as the full-on pose.

Upward-Facing Dog

I was supremely surpised to find out how tight my abdomen was prior to initiating my stretching routine. It turns out that the abdomen plays a big role in pelvic floor function, as the abs are an adjacent group of muscles. 

Only last week did I notice that on the days that it is most diffcult to urinate, I actually contract my abs to aid the push. I’ve got to relax and try and let my bladder sphincters do their duties, but in the meantime, upward-facing dog really helps me stretch out my abs.

Hamstring and illiotibial band stretch

For this stretch, you’ll need a yoga strap. Place the yoga strap on the bottom of your foot and extend your leg straight up into the air. Pull until you feel the stretch.

To get to the illiotibial band (IT band), pull the band towards the inner side of the leg you are stretching (2nd picture above). Warning: this stretch hurts–at least to me! My IT bands are tight.

Pigeon pose

Pigeon pose targets the hip flexors. Kneel on one knee. Turn your front leg inward. Lean forward as pictured above.

Foam roller: piriformis

Dude, the first time I did this foam roller exercise, I wanted to cry for my mama.

Sit on the foam roller. Cross your legs as pictured above. Roll onto the butt cheek of the crossed leg. Rock back and forth until the discomfort you feel in your piriformis muscle melts away.

Foam roller: IT band

That damn IT band can use some work. This easy-to-do foam roller exercise can help a ton. Lie on your side on the foam roller, and roll up and down that IT band as pictured above.

Foam roller: groin

Place the foam roller at the groin. Rock side to side until you feel the groin stretch out. 

The above are only a few stretches taught to me mostly by Dr. Susie Gronski during the course I took with her. Her book, full of illustrations, can help guide you through more stretches: Pelvic Pain: The Ultimate Cock Block (Amazon Link).

There are many more advanced techniques that I perform, including myofascial rolls, using myofascial balls, andusing  the Pelviwand. I personally would recommend you seek the guidance of a physical therapist for these advanced techniques.

Exercise

A common misconception about pelvic pain: exercise will make it worse.

While exercise may exacerbate symptoms temporarily, it is important to know that your muscles want to be muscles. They want to be exercised! And it is in your best interest for your long-term health to do justice to your incredible muscles.

Do you feel like you don’t have time to work out? I’ve recently learned that you don’t need a lot of time. Check out this absolutely incredible book, backed by a ton of science, on how to create the most efficient workout possible: Body by Science by Dr. Doug McGuff (Amazon Link).

Guys, you now have the tools necessary to chop down the tree. Fuck that tree. 

Timber, mothafucka!!!!

In all seriousness, I will mention that my tree has not been chopped down. However, I have made peace with it living in my yard, and I feel that I have the tools necessary to make it come down. It’s just a matter of time!

While I work on the final “Chopping Down the Tree” entry, here’s a mini-post.

The local newspaper, The Daily Advertiser, recently wrote an article on me! I was so honored to be featured in the “Be You” section.

Check out the link below, where I talk about my ambitions and even give a shout out to my pelvic therapist:

http://www.theadvertiser.com/story/entertainment/2017/12/11/how-eye-doctor-does-all/934608001/

If you’re a man with pelvic pain, I bet that at this moment, you are worried about something. And if you’re not worrying about your pain, it’s probably about something trivial. You’re probably worrying about if you can afford your future kids’ college… or why that person won’t text you back… is it something you said? Maybe you came off too bold. Maybe you are cringing about that one speech you made in high school in front of all your classmates 15 years ago. Maybe that mole you found on your chest is cancer. Maybe you’re gonna die tomorrow from that mole. Or when you get into your vehicle tomorrow and that prospective driver behind you will wreck into you because they are texting.

Now that I’ve put it in writing, doesn’t it sound silly? But admit it, you’ve had similar thoughts on a daily basis.

You not only have pelvic pain, but you have anxiety disorder.

One thing I’ve noticed when talking to other men with pelvic pain and after all of the books I’ve read is that most sufferers have anxiety and/or depression. Both anxiety and depression are common in everyone’s life at some time or another. In fact, anxiety may help us at times: it’ll help us prepare for that big exam next week, or get us to put more effort into that date tomorrow night. Depression is normal after losing a loved one, or maybe a bad breakup. But neither are normal to have long-term.

Coping mechanisms? Ha. You and I both know that your only coping mechanism is to tighten your pelvic muscles.

The thing that sucks about your anxiety the most? It will feed your pelvic pain, and your pelvic pain will feed your anxiety. You’re anxious about your job interview tomorrow, and that causes your pelvic floor to tense up. The added tension causes pain. The pain causes you to worry. The new anxiety causes your pain to flare even more, which causes more concern. It’s a never-ending cycle, a continuously growing avalanching snowball.

It’s time to break the cycle! Melt that big ass snowball!

But… mental health is taboo in this country. How do I do this?

Dude. Life is too short to worry about tomorrow. Live in and appreciate the present moment!

Also, I bet that if you ask 10 of your closest friends, 5 of them would be on anxiolytics or antidepressants. And 4 of them would be happy to talk to you about it.

First of all, I am an eye doctor. I am not giving you medical advice in mental health, as I am not credentialed in that area–but I am giving you advice based on my life experience.

That said, the first thing you should do is schedule a physical exam with your primary care physician. Make sure to get blood work done. If something is out of whack, you may feel out of whack.

Be sure to tell your PCP about your anxiety, depression, and pelvic pain! They have heard it all–trust me on this. Don’t be bashful.

Your doctor may prescribe medication for you. There are a ton of anxiolytics and antidepressants on the market. According to my therapist, to eliminate trial and error, there are DNA tests you can take to see what medication would work best on you.

Know that all medications have side effects. Because of this, ideally you will want to be on medication short-term. In some cases (like mine), you may need to be on medication for a long time until you can develop good coping mechanisms. It’s possible you’ll be on medication for a very long time if your brain chemicals are just not balanced. I have been on anxiety medication for many years, and I unfortunately don’t see myself coming off of them. I deal with the side effects because in my opinion, the few side effects I experience are much less serious than the effects anxiety could have on my life: high blood pressure, heart disease, stroke, etc. And just a lack of happiness! That’s not a way to live.

Remember that once you come off of medications, unless you’ve made some serious changes, your symptoms will come right back. Medication is simply a crutch. That’s why the next step should be to educate yourself.

The book I am currently reading is fantastic. It deals with the topics of brain fog, anxiety, and depression: The Brain Fog Fix by Dr. Mike Dow. Dr. Dow warns of the dangers of taking medication, but admits that anxiolytics and antidepressants are necessary. He offers alternative–and life-changing–ways to battle the fog in your brain: increasing intake of omega-3 fatty acids (through seafood or supplementation), staying active, and practicing mindfulness. I won’t ruin the read; check it out on Amazon: http://a.co/5NHqzVQ

Your next step should be to try and increase your mindfulness. What exactly is that? It’s focusing on the here and now… not worrying about tomorrow or the day after tomorrow or the day after the day after tomorrow. How can you do this? I do this through yoga and meditation.

Believe me, I felt really stupid when I started both practices. “Yoga is for stinky hippies!” “Meditation is some weird ass shit, yo.” But with practice, you’ll believe.

Warning: both of these are hard if you have anxiety. Your mind is so used to running and running and running. It’s chaos in your cranium! But with practice, you’ll get better.

I’m sure you can find a yoga class around you. As for meditation, check out the app Insight Timer. It offers free guided meditation. I love it! Other great apps include Calm and Headspace, but both require subscriptions.

The best book on mindfulness isn’t really a book about mindfulness– or at least it doesn’t claim to be. It’s called The One Thing by Gary Keller. The book talks about how to be more productive by getting rid of the bullshit that keeps you from moving forward. It coaches you on how to schedule time blocks to get shit done. It talks about how multitasking is a myth, and how to accomplish a work-life balance. I feel like it is a must-read for anyone wanting to accomplish anything. One of my all-time favorite reads.

Amazon link: http://a.co/deprEcm

The last thing you should do is set an appointment with a mental health therapist. I am a 32-year old man who was diagnosed with generalized anxiety disorder in high school, but thinking back to even earlier, I think I’ve had it my whole life. I’ve waited until now to seek therapy, and after only 3 sessions, I feel a major breakthrough–like I am about to turn over a big, heavy leaf in my life. Like a 3-ton leaf.

My pelvic physical therapist recommended that I seek out a therapist certified in EMDR, or eye movement desensitization and reprocessing. In a nutshell, my counselor brings up a negative thought that I have or a negative experience I’ve lived through. She then asks me to look at it in a different light. For example, at my last session, I was concerned about how I recently had to fire an employee during a time in which another employee is leaving for maternity leave. I couldn’t imagine getting through this burden. My counselor had me think about how I can use this as an opportunity for a rebirth of my eye clinic….

…And then she has me follow her fingers with my eyes.

The theory is that it mimics REM sleep (rapid eye movement sleep), the phase of your nightly nap in which your brain processes and stores information–like defragmenting your computer. EMDR helps you process these experiences and store them away.

I know what you’re thinking–that sounds wacky as fuck. What kind of witchcraft you into, boy???

I admit: I’ve had serious doubts. But it’s working. So I no longer question it. Google EMDR… it has been shown to work on soliders with PTSD.

Your therapist need not be EMDR-certified. It’s just an extra perk I sought. Just having someone to talk to and to teach you coping mechanisms will be well worth your time and money. I cannot stress enough how much help this has been to me. I wish I had done it many, many years ago. But I cannot go back in time, so I won’t worry about that ;-)

In conclusion, strengthen your tree-chopping muscles by getting help for your brain. It’s easier than you think, and you will thank yourself for all eternity.

Stop worrying about that pesky tree growing in your yard that you believe is threatening your house and livelihood. It’s not– you’re gonna chop it down.

You’ve got a giant tree (AKA pelvic pain) growing in your yard, threatening to fall over onto your house with the next spell of bad weather. Instead of leaving it to fate, you decide to become proactive in getting rid of the tree. You’ve got a dull axe that you need to sharpen, muscles that you need to build, and poison to feed to the tree.

You’ve tried to get help from a few doctors. Antibiotics didn’t help. More antibiotics didn’t help. Probing and prodding your orifices have led to no answers.

You’ve decided to take matters into your own hands.

My advice is to learn, learn, learn. And by that, I don’t mean WebMD your symptoms. Watch a few videos, read a few blogs, and read books! For as many scary black holes as there are on the internet, there are some great resources available as well.

Learn About Pain

First of all, what do you know about pain? One thing I’ve taken for granted: I know pain. I have a degree in biology. And I’m a doctor. For as lame as it is to have persistant pelvic pain, I am lucky to know how pain works. 

In a nutshell, pain is the body’s way of protecting itself from harm. Think about accidentally touching a hot stove. The extreme heat can cause harm to the skin on your hand. The nerves from you hand send a signal to the brain, saying, “Yo! This shit hot, bruh! Help me out here!” The brain gets the message, create a pain signal, and send it back to your hand. You feel the burning sensation and immediately withdraw your hand from the heat. The pain is the brain’s way of saving you from harm and for teaching you that you probably should try and not do that again.

So that’s acute pain... but what about chronic pain? Why does chronic pain exist, especially when tissues in the body heal within a few weeks? Well, chronic pain shouldn’t exist. 

It’s a case of your nervous system being a little out of whack.

Watch this fantastic video, “Understanding Pain in Less Than 5 Minutes,” and you’ll understand. 

Learn About Pelvic Pain

Now that you understand how pain works and why chronic pain exists, let’s get a little more specific. Learn about pelvic pain!

The best overall book on pelvic pain, in my opinion, is Pelvic Pain Explained by Stephanie A. Prendergrast and Elizabeth H. Rummer. It does exactly as its title promises. The book talks about what can cause pelvic pain to plague your life, why a physical therapist may be the best person to lead your plan of attack, and what to do about it all.

The best part of the book is the chapter entitled “The Perfect Storm.” It explains how your pain was probably not brought on by one thing, but by several things at once. Think back to the onset of your pelvic pain. What was going on in your life? In my life, I was stressed more than I had ever been (poorly managed general anxiety disorder plus optometry school), I was sitting more than I had ever sat in my life (class and studying), and I had some longterm anatomical issues. 

Read this book immediately.

Clearly, you’ve already found paindrainblog.com. I really appreciate you reading my entries. I hope that my decision to be vulnerable has led to helping at least one person.

...But when it comes to blogs and social media, one physical therapist rules them all: Dr. Susie Gronski. You’ve already read about her in my first few blog entries. Social media is the way I discovered her.

You should visit her website at drsusieg.com (make sure to read her awesome blog!), and make sure to follow her on Facebook and Instagram.

The best thing about Dr. Gronski is that nothing is taboo to her. You’ll feel comfortable reading her material. In my case, I was lucky enough to get the chance to be comfortable in conversation with her!

If you can’t make your way to North Carolina to visit Dr. Gronski, make sure to read her book Pelvic Pain: The Ultimate Cock Block. It’s a quick, easy read, and it’s basically an instruction manual especially for men with pelvic pain.

Now that you’ve read about pain, you’re better equipped to handle it! Your axe is a little bit sharper!

To summarize, here are some essentials for learning about pain and pelvic pain:

Understanding Pain in Less than 5 Minutes (video): https://youtu.be/C_3phB93rvI Pelvic Pain Explained (book): http://a.co/2OrcZLO Pelvic Pain: The Ultimate Cock Block (book): http://a.co/dAv47Jz Dr. Susie Gronski: facebook.com/drsusieg ; instagram.com/dr.susieg

I had a conversation with a reader of this blog. He mentioned that he skimmed through it, looking to find what has helped me, but came up with nothing. I realized that I have posted mostly the negative situations and the invasive procedures that come with having pelvic pain and having no clue and no direction. That’s the opposite of what I want to accomplish with this blog.

So, I’m going to take a break from my story for a few weeks so that I can talk to you about what I call “chopping down the tree.”

Pelvic pain is a tree. A big ass tree growing somewhere you don’t want it to grow. You’ve got to chop it down before it falls over itself, destroying your house and livelihood.

The tree can grow uncontrollably. With each year that passes, the tree fattens an additional ring in width. Each stressor in your life waters the tree, helping it grow taller.

All you’ve got is an itty bitty axe that’s duller than a turd. 

But what if you could sharpen this axe? Maybe you could get started on the tree. It’s better than nothing, right?

What if you could grow stronger yourself? That could add a little somethin’ somethin’ to your swing.

What if you could stop the tree from growing? Maybe it would be difficult to kill, but keeping it from getting any bigger would help your cause.

Maybe I haven’t chopped my tree down yet, but it’s so very close. I’ve definitely stopped it from growing and from threatening my house and livelihood.

Keep posted to Pain Drain for entries on how to sharpen that axe, how to grow stronger, and how to stunt that tree’s growth. You’ll be reading entries on pain education, physical therapy, stretching/yoga, mental health, and nutrition.

Follow my new Facebook Page: Pain Drain

Urodynamics was a complete failure, and I was very disappointed in myself. It was even more disappointing that the failure was something that I could not help. It would be one thing if the procedure failed because I chose not to show up or chose to forego it, but to be so, so close to finding some answers and your body just failing you just completely sucked. 

I went to what was supposed to be my urodynamics follow-up. Dr. French completely understood why the procedure failed. After all, you’re watching someone shove a snake down your snake, and it doesn’t feel good.

I warned Dr. French that soon enough, I would be graduating and then moving back to Louisiana. Dr. French explained that if we were unable to do a urodynamics study, then he would at least like to look at my bladder.

Surprise!

I would have flat out refused to let another doctor probe my pickle (this would be my third cystoscopy!), but Dr. French wanted to get a biopsy of the tissue at my external bladder sphincter. I appreciated that he actually listened to me when I had explained to him that during my first cystoscopy in Houston, the pain was when the doctor reached that area of the urethra.

So I gave Dr. French my permission, and off we went...

I don’t know why I never experienced syncope during cystoscopy. It was basically the same thing: getting a medical device rammed into your penis. Perhaps the anesthesia played a part in it, and probably the fact that you don’t really see anything--just a doctor and a nurse looking at your junk.

It was the same experience as before, but this time, they scraped the tissue at the bladder sphincter. Dude... it felt like they stuck a tiny little crawfish down my wiener and asked him to pinch me in the most painful place imaginable. My goodness. 

The cystoscopy was clean, but they would have to call me with the results of the biopsy. I said my goodbyes to Dr. French, as this would likely be the final time I would see him, and I left the office awaiting the results.

I was called a few days later, and the nurse explained to me that there were inflammatory cells found in my biopsy, but nothing of huge concern. It was a relief, but it was still disappointing to still not have any answers.

What was not disappointing was that it was now time to graduate.

On May 14, 2011, my class was set to graduate. It was an awesome feeling, but also bittersweet. The reason is because I had spent the past 4 years growing very close to these 100 people. We shared the same struggles and rode the same boat for those 4 long years. And suddenly, we would graduate and disperse throughout the country, some of us never seeing each other again.

The heartbreak of leaving my friends ended up being trumped by becoming a doctor. I don’t know if I can put into words how hard we worked to get that degree. But I guess when that stress results in pelvic pain, you can get an idea.

My family drove in to Houston to see me walk across the stage. My mom, dad, sister, and aunt / Godmother were in the audience.

And I didn’t know what they had in store for me:

Surprise!

They were sitting in the crowd with giant print-out heads of me. Only my family...

The diploma made it to my hands. I was now Dr. Ryan Cazares.

I've had many questions arise after posting this contraption in prior blog entries:

The answer to your questions:

-This is called a Pelviwand. This is prescribed by both of my therapists, Dr. Susie Gronski and Dr. Amber Anderson.

-Yes, that is where it goes.

As gross, intimidating, and cringeworthy as it looks, this is the one piece of therapy that provides me the most relief, be it temporary. And besides, if you're up to date on my blog, you know I've had things go into my thing! So this therapy is nothing compared to that.

When one has aching muscles, a massage does wonders. It helps to release tense muscles.

But what if said muscles are internal?

What if my sore muscles are the iliocoecygeus and the pubocoecygeus? The Pelviwand is used to reach those unreachable muscles.

From pelvictherapies.com:

Using the Pelviwand® to Treat Male Pelvic Floor Muscle DysfunctionBy Dr. Pamela Morrison Wiles, PT, MS, DPT, BCB-PMD, IMTC

The curved design of the Pelviwand® is perfect for ease of use intrarectally to treat pelvic floor muscle dysfunction. Because of the brilliant design it has been employed as a massage tool by physical therapists and patients for those suffering with pelvic pain or sexual pain.

The Pelviwand® for transrectal use is narrower and tapered on one end allowing for easier anal insertion. Once inserted, the user can easily manipulate the Pelviwand® with the elongated handle to gently massage pelvic floor muscles that are tender, tight, or have myofascial trigger points. Users should use gentle strokes or sustained hold stretching with the Pelviwand® to perform the massage and pain relieving techniques to the pelvic floor muscles. Massaging scar tissue in the perineum or anus may also be beneficial to alleviate scar pain, sensitivity, or tightness.

The Pelviwand® is an excellent tool to treat pelvic floor dysfunction in men. Its design is what makes it effective and useful to alleviate pain. Its tapered end allows easy insertion. Once it is inserted the user can easily manipulate the wand using the elongated handle to gently massage pelvic floor muscles that are tight, tender and have myofascial trigger points.

Useful for men with:

Pelvic floor muscle dysfunction (i.e. pain, overactivity, shortening, trigger points)

Rectal Pain

Prostatitis

Painful Scar Tissue

Sexual Pain

Anismus

Chronic Pelvic Pain

Apply a generous amount of lubricant on the tapered end tip of the Pelviwand®.

Assume a comfortable semi-reclined position with your knees bent. An alternative position may be standing with one leg raised on a footstool.

Find your rectal opening.

Gently insert the tapered end into the rectum.

Orient yourself to the rectal opening and pelvic floor muscles as a clock to identify painful or tight muscles.

Turn the Pelviwand® to the 9 or 3 o’clock position to begin strokes.

Since the pelvic floor muscles surround the rectum, strokes are best performed from 11 to 7 o’clock and 1 to 5 o’clock.

Avoid applying strokes to 12 or 6 o’clock due to sensitive structures such as the urethra and rectum unless otherwise directed by your practitioner.

Perform gentle strokes for several minutes on each side until relief is felt.

Trigger point release and lengthening can be achieved by holding sustained pressure on the painful pelvic floor muscle(s) with the tapered end of the Pelviwand®.

Always use with caution and consult with a physical therapist that specializes in pelvic floor rehabilitation prior to use.

Use daily or how prescribed by your health care provider.

So far, through the first 30 entries of Pain Drain, you’ve read about

1. Foreshadowing on how I had to travel 788 miles to find true help for my condition (Entry #1)

2. How Shaq made my tee tee hurt (Entry #4)

3. How they probed my pickle (Entry #10)

4. How I went on a date with Flomax girl (Entry #13)

5. How I was wrongly accused of having an STD (Entry #14)

6. How my dog ate Metallica (Entry #18)

7. How blood came out my pee pee (Entry #23)

But none of it… NONE of it… could have possibly prepared me for what I was about to experience.

I was wrapping up my 4 years of optometry school. It was a long, very difficult journey, but my friends, family, and dog helped me along the way.

As if the curriculum weren’t difficult enough, I had to endure the trying times with a wounded wiener.

I believe it was fate that I picked the two externship sites that I did for my final year of optometry school: Bridgebuilders in Dallas, TX; and Plano Eye Associates in Plano, Tx. And not only because they gave me wonderful learning experiences, but they gave me FRIDAYS OFF! (Bridgebuilders was a half work day on Fridays, Plano was full day off.)

While you may be thinking, “Hell yeah! Fridays off! I’d kill for that gig!” I was thinking, “Thank you, God, for leading me to choose these Friday-free sites so that I can tend to my pelvis.”

I really, really don’t know what I would have done if I did not have Fridays off.

The Friday came around that I was scheduled at Dallas Center for Pelvic Medicine. Dr. Dan French got the privilege to hear my entire story. He was happy that Dr. Gottesman picked up on the unneccesary Elmiron prescription, and he agreed that I needed a urodynamics test done.

From Urology Care Foundation:

Urodynamic studies (UDS) test how well the bladder, sphincters, and urethra hold and release urine. These tests can show how well the bladder works and why there could be leaks or blockages.

There are many types of urodynamic tests. A health care provider may recommend one or more based on your symptoms, but they are typically performed together as one test.

Dr. French wanted to see if I indeed had a bladder obstruction. The urodynamics would show if the pressure in my bladder was abnormally high when voiding. It sounded very invasive, but what hasn’t been?

We scheduled the procedure for a Friday, and in the meantime, Dr. French wanted me to try a bladder relaxant and an alpha-blocker other than Flomax (since Flomax was at one time promising).

The bladder relaxant and alpha-blocker were unsuccessful, but I had faith in Dr. French for several reasons: 1.) He listened to me, 2.) Dr. Gottesman highly recommended Dallas Center for Pelvic Medicine, and 3.) No physician had approached me with the urodynamics test, which seemed like a no-brainer. Why did I not know of its existence until 2 years after the onset of my symptoms? Why was this test not yet performed on me?

The Friday of urodynamics came around. I was dreading yet another tube penetrating my pecker, but I was excited to finally find out what was pestering my peter.

I was called to the back by the nurse who was to perform my urodynamics test. I had to change into a hospital gown, and I had to sit in a funky-looking fancy chair that looked like the stuff of nightmares:

I was to have a catheter inserted into my urethra and bladder. The nurse was going to fill up my bladder with some saline, and I was to piss it out. The scary-looking-chair-machine was going to measure the pressure necessary for a successful tinkle to take place.

The diagram at the top of this blog post also shows some kinda rod in the booty. I don’t remember having to do this. This is either because A.) it wasn’t necessary, or B.) when you have something stuck up your penis, something stuck up your butt is NOTHING.

“Ok, now I’m going to insert the catheter.”

The nurse began to snake the tube down the length of my urethra, a process that seemed to forever.

My heart skipped a beat, and then another.

“Are you ok?” asked the nurse. “You’re really pale.”

It was happening. Vasovagal syncope overcame me again (See Entry #23).

From Mayo Clinic:

Vasovagal syncope (vay-zoh-VAY-gul SING-kuh-pee) occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope.

The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.

When I experience vasovagal syncope, I don’t ever pass out, but I get heart palpatations, I get very pale, and I almost pass out. It’s one of the worst feelings in the world. I can’t justify how horrible it is with simple words.

The nurse immediately withdrew the catheter, and she lay the chair back until I was feeling like my blood pressure, heart, and overall well-being was back to normal.

I couldn’t quit. I was so, so close. I had to go through with this. C’mon, body. Cooperate here. We are going to find some answers today!

After I gave her permission, the nurse began to feed the tube through my tube. Usually, after a vasovagal episode, I feel much better, and can endure whatever is thrown at me.

I could not endure this.

My heart started skipping again, I turned pale, and needed to lay back again.

It is then that the nurse and I agreed that this was not happening today.

The catheter was withdrawn, this time for good, and I was released.

Released with no answers.

One of the most powerful lessons presented during Dr. Susie Gronski’s 6 day Hands-On Training Program in Asheville, NC was the one about “The Brain On Pain.” At the end of the day, Dr. Gronski introduced a concept brand new to me: “DIMs and SIMs.”

DIMs and SIMs (danger in me and safety in me) originate from Protectometer, a handbook meant to accompany Dr. David Butler and Prof. G. Lorimer Moseley’s book Explain Pain.

To read a thorough explanation of DIMs and SIMs, please visit: https://noijam.com/2015/03/12/dim-sims/

In a nutshell, DIMs can influence an individual to construct a pain experience, whereas SIMs can lessen pain. In a future blog post, you’ll read about the time I came across a SIM that improved my quality of life onehundredfold.

For now, I want to sit down and really get at the DIMs and SIMs that I currently have.

If you read the above linked NOI blog post, you’ll see that DIMs and SIMs can be organized into seven categories: 1.) Things You Hear, See, Smell, Taste, and Touch (HSSTT), 2.) Things You Do, 3.) Things You Say, 4.) Things You Think and Believe, 5.) Places You Go, 6.) People In Your Life, 7.) Things Happening in Your Body.

Here goes nothing!

1.) Things You Hear, See, Smell, Taste, and Touch (HSSTT) DIMs: The smell of seafood The taste of seafood Nickelback music Boy band music Dog poop (I hate the feel of it even though I use a poop bag. Oh and it smells bad, too) Seeing awkward situations, even on TV (sometimes I have to change the channel if a cringe-worthy scene is aired)

SIMs: The smell of pizza, gumbo, or tacos The taste of pizza, gumbo, or tacos Awesome guitar music (Rage Against the Machine, Pearl Jam, Gary Clark Jr., Hendrix, Zeppelin, I could go on and on) Petting my dog Watching my niece play Seeing the faces of children who put on glasses for the first time

2.) Things You Do DIMs: Cooking (I think I can turn this back into a SIM someday. Someone in my life made me hate cooking) Yoga (I hate doing it, but the feeling afterwards is definitely a SIM) Cleaning stuff Signing medical records that I’m behind on Dating Being forced to watch a Lifetime Movie

SIMs: Eating, especially pizza, gumbo, and tacos Exercise other than yoga Sports (watching and playing) Helping people see better A night out with friends A night in with friends Going to concerts

3.) Things You Say DIMs: “I have chronic pelvic pain syndrome.” “I’ve got a bum shoulder.” “I’m absolutely burnt out.” “I have familial hypercholesterolemia.”

SIMs: “I am an advocate for pelvic pain awareness, especially in men.” “I’ll get this shoulder better sooner or later.” “All of this hard work is finally paying off in more ways than one.” “I do my best to eat nutritious food.” “I refuse to live paycheck to paycheck.”

4.) Things You Think and Believe DIMs: “l’ll never get over this pelvic pain.” “I’m a loser for living with my parents at age 32.” “I’m running out of time to find that special someone.” “I’ll never get out of this funk.” “I hate seafood.” “I hate that I hate seafood.” “I hate that people hate that I hate seafood.”

SIMs: “I will get over this pelvic pain, and I’ll live to tell the tale and to spread the word.” “I’m smart for saving my money, paying off my student loans, and saving for a house down payment all while building my business.” “I’m taking my time and making sure to marry the right person.” “A funk is a temporary thing. I got this.” “There is no bite too big to chew.” “Maybe, one day, I’ll enjoy seafood. But for now, it doesn’t matter.”

5.) Places You Go DIMs: The MF’n urologist (Have you read any of my blog posts??) A seafood restaurant Baton Rouge

SIMs: Masseuse A pizza or Mexican restaurant (Deano’s, La Pagua, Tampico) New Orleans Austin Hiking Red’s Health Club A concert or festival A sporting event Networking events and socials

6.) People In Your Life DIMs: The MF’n urologist Those patients/customers that cannot be pleased That Negative Nancy friend Those people who put you down to feel better about themselves Doubters

SIMs: My physical therapists, Dr. Susie Gronski and Dr. Amber Anderson The patients who are thankful for our services, and those who leave 5-star reviews My supportive, encouraging friends My family My hard-working employees

7.) Things Happening In Your Body DIMs: Depression Anxiety Random pelvic muscle spasms Painful urination

SIMs: A sense of pride for my accomplishments A positive outlook on life Losing body fat Improved pelvic pain symptoms since beginning physical therapy

“So how are you feeling after the bladder distention?”

“Everything feels the same.”

“So the Elmiron isn’t working either?”

“Nope.”

Dr. Icee seemed dumbfounded that the bladder hydrodistention showed no signs of interstitial cystitis, nor did it provide me with any relief. The Elmiron medication he had put me on also did not do a damn thing.

I reminded Dr. Icee of something he mentioned at one of my first visits: “Doc, what about the possibility of deferred pain from a kidney stone? Didn’t you say it could be that?”

Dr. Icee looked at me like I was stupid. “I suppose we could order an ultrasound.” Did he not remember saying that to me?

By this time, I had started my final semester of optometry school. My final rotation was at a private practice in Plano, Texas. I had Fridays completely off, so I had the entire day to focus on my health, finding answers, and getting better.

One Friday, I made it to the hospital to get my ultrasound. A nurse performed the procedure, and I was sent on my way.

A few days later, I received a call from the staff of Dr. Icee’s office. The nurse said something very ambigious: “It looks like there could possibly be a stone, but we aren’t sure.”

So much for that bullshit. They couldn’t even tell if I had a kidney stone???

I was so sick of this shitty (or pissy?) situation. I feared that all of this anxiety from the unanswered questions was causing new symptoms, as I started having lower abdominal pain (as mentioned in previous entries), indigestion, loose stools, lower back pain, and foot pain.

I guess you could say everything hurt: my peck, my back, my stomach, and my crack.

I felt as though optometry school aged me 50 years. I was a 25-year old man in a 75-year old’s body. If I could only make it 5 more months, I could live to see the day that I walk the stage and get my doctorate.

I was so miserable. I would wake up in the morning, and it would hurt to get out of bed. My feet would ache. My back was stiff. I literally was 75 years old, y’all.

And, of course, when I could mentally get past those achy feet and that stiff back and walk to the bathroom to pee, my prostate and pisser hurt.

75 years old, y’all.

For the first time in my life, I visited a chiropractor. I remember her telling me, “You’re too young to be here!” Even though I felt 75.

She adjusted my spine and did some really weird shit to my back. It felt as if she put a power sander on my back. She had some interesting contraptions, to say the least.

After leaving the chiro, I felt 25 again.

...until the next morning. 75-year old geezer Ryan returned.

I only went back to the chiro a couple more times because I felt like what she did only helped for a few hours. She also kept reminding me how I was too young to be there. Ok, no copay for you!

I did some internet research, and I found a place that specifically treated pelvic issues. I was excited to give this place a shot. It was the first time I found a facility that specifically treated the issues I was having: pain in the pelvis and problems with urination.

I visited the facility on a Friday, and I left the first visit underwhelmed. All they really did was chiropractic stuff. They adjusted my spine, put some warm compresses on my back, and stretched me out a little bit. They explained that pelvic pain stemmed from back issues. I gave it a visit or two more, but felt like they weren’t addressing my problem.

My anxiety was at an all-time high. I just could not uncover the answers that I was looking for. What if I never would? And would these new symptoms keep coming up?

Am I falling apart?

The stomach issues started to take precedence over the pelvic pain. It seemed as if there was a constant, slight burn in my belly. When I would go #2, the product was no longer solid. I didn’t have diarrhea, but everything was loose. So now, every trip to the bathroom was more miserable than ever.

I decided to seek medical help, despite my discouragement with all of the professionals I had seen over this time period.

I somehow came upon Dr. Andrew Gottesman, gastroenterologist. And little did I know that a butt & gut doctor would help pave my way to a clearer future.

Dr. Gottesman was the most intelligent doctor I had ever come across, and it probably still holds true. He blew me away with how personable he was and how much knowledge he had. I talked to him about my stomach symptoms. I had no intention of mentioning my pelvic issues, but Dr. Gottesman brought it up himself:

“Now, looking at your medication list, I see you are on Elmiron, which is a drug... an expensive drug... that is primarily used on women with interstitial cystitis. Could you tell me more about that?”

Whoa. Not only did he know what the Elmiron was for off the top of his head, but he even knew that the drug was mostly used on females.

I told him about the painful piss and the difficulty starting the stream. I told him about the misery that was the bladder distention procedure. And I told him that apparently I had interstitial cystitis, according to my last urologist. He shook his head.

“You don’t have interstitial cystitis. What you need is a urodynamics test. This test will give you a lot of answers to your problems. I know a great group of doctors that can help you.”

So I went to the doctor for my poo but got a bonus for my pee!!!

We went along with the exam, and Dr. Gottesman concluded that I may have irritable bowel syndrome. However, this is a diagnosis of exclusion, so I would have to go through some tests to rule out more serious conditions.

The first test I had to do was a barium swallow test. This involves drinking a disgusting liquid (think mixing chalk with Maalox) and then taking X-rays of the esophagus and upper digestive tract. That test only showed minimal reflux.

I then went to a lab to have blood work done. At this lab, I also had to drink another substance and then blow into a balloon. This tested for Helicobacter pylori, a stomach bacterium that can cause problems in some people. These tests were both negative.

At a follow-up, Dr. Gottesman concluded that I likely had irritable bowel syndrome. While there were treatments, he suggested that my symptoms seemed mild, and I could elect for him to just monitor my issues. I agreed with that, and I felt like I could live with the stomach problems, especialy since I felt more at ease that the stomach issues were nothing serious.

(I ended up finding out the cause of my irritable bowel syndrome with the help of my mom. I had recently switched from Dr. Pepper to Diet Dr. Pepper. My mom told me that she once had a co-worker with similar problems. When he stopped drinking diet sodas, his symptoms went away. The same ended up true with me. Mom knows best! Damn you, aspartame!)

In the meantime, Dr. Gottesman sent me home with another recommendation: to vist Dr. Brian Feagins at the Dallas Center for Pelvic Medicine. He truly believed they could help me.

I made an appointment at Dallas Center for Pelvic Medicine. Dr. Feagins, unfortunately, was unavailable for several weeks. Being that my time in Dallas was limited, I went ahead and scheduled with his partner, Dr. Dan French. I was excited that Dr. Gottesman, the most remarkable doctor of any kind that I had ever been do, had so much faith in this place.

But what was that urodynamics test he spoke of?