A twist in the road

Before the operation I wasn’t planning to write this blog post. Better to keep what had happened secret I thought - save myself the embarrassment and ridicule. As I lay on my back watching clouds passing by outside the hospital window I tried to digest what the doctor had told me that morning. I’d never heard of this condition before. How had it had happened to me?

‘Very rare for a man your age,’ he’d said. Well that day of cycling was no different from hundreds of others on the road. No twists, turns, falls or knocks. Were all those thousands of hours I’ve spent on a saddle building up to this? I’m still puzzled as to how it happened.

Before going to theatre.

I was in Mozambique when the pain started. In fact I’d only entered the country the previous day on a 3-day transit visa from Malawi. I had 250km to cover in that time, so needed to make steady progress in order to reach the Zimbabwean border before facing an overstay fine. There was no need to push myself though. The ‘Tete corridor’, as the road is often dubbed, links Malawi with Zimbabwe and passes through a western branch of Mozambique. There were no big climbs and the road was pretty well paved.

The night before I’d memorably camped on the banks of the River Zambezi as it passes through the city of Tete. Lights lit up the city skyline and the enormous suspension bridge spanning the river. With the Cahora Bassa dam not far upstream, responsible for powering most of Mozambique and a number of other countries, it was no surprise that this was probably one of the most well-lit cities I’ve been in on the continent.

Sunset beside the Zambezi in Tete

The next night was very different though. There had been a gradual climb out of the Zambezi valley earlier that day, passing small mud-hut villages selling bags of charcoal on the roadside, and the heat had been of an intensity I’m now familiar with. The rains I’d been cycling through in Malawi had now been replaced by blue skies, and once I’d seen the condition of the budget rooms available in the last Mozambican town before the border I decided I’d camp again.

Most nights in my tent in Africa are spent beside a village school, church or within the compound of the village chief, but it was clear from my surroundings that on this night I would be wild camping. I filled my water bottles plus a 10-litre water bladder before leaving the last town on a gradual climb towards the border, recording this video as I went.

It was whilst showering under an acacia tree that I first felt the pain. It started with a stitch in my lower right abdomen, then moved to what I felt was my bladder. By this time I’d abandoned plans to cook pasta and lay down in my tent hoping the pain would subside. But it continued to intensify. Was it my appendix I wondered? But which side was my appendix? Maybe it was those two beers I’d taken mid-afternoon? I never drink alcohol in the middle of a cycling day, but I was leaving Mozambique and this was going to be one of the last opportunities to drink Manica, a far superior beer to the Carslberg I’d been drinking in Malawi. Perhaps that litre of beer in my system was causing the stitch and pain in my bladder?

I found my first-aid kit, swallowed 2 paracetamol, then started drinking water in the belief that peeing was going to flush this pain and alcohol out of my system. It didn’t. I took another 2 paracetamol and continued to drink, but the water just seemed to sit in my stomach, and before long I was vomiting it back up. Lying down was more painful than standing up, and I spent most of the night pacing around my tent in agony. The road was several hundred metres away, but what little traffic had been on it during the daytime had now almost ceased, apart from a very occasional truck. Of all the places I could have been this was one of the worst. There was no-one around and my cries of pain were lost in the surrounding bush. I took another 2 paracetamol and finally managed to produce a trickle of urine before sleeping for perhaps an hour.

The intensity of pain had subsided a little when I started to pack up my tent early the next morning. The sun quickly rose and energetic flies buzzed irritatingly around my face as I went about repairing a puncture on my rear tyre before wheeling the bike onto the road. I cycled slowly. The border was only 30km away and I was there well before midday.

I had little appetite, but hadn’t eaten the night before nor taken any breakfast so used my remaining Mozambican metacais on a plate of chicken and rice. I only managed to finish half of it before lying down in the shade outside to wait for the worst of the midday heat to pass. What had been agony in my bladder during the night was now a dull pain.

Border crossing formalities passed without incident. Too many white faces had come this way before to make my presence be of any particular significance. A Zimbabwean official gave me a 30-day visa in exchange for $55, although there was some disbelief when I said I’d cycled from Malawi and was proceeding to Harare, about 240km away. “All that way, by bicycle?”  

It was only later that night that I noticed the swelling. I’d pitched my tent on the veranda of a primary school, then taken a shower under a nearby tree. My right testicle was hard, raised and swollen. No pain unless I moved or touched it, but this wasn’t normal. Surely it had something to do with that stitch and pain in my bladder?

Well I slept like a log that night, hoping the swelling would go down by the morning. It didn't. I cycled on slowly, greeting school children with what little enthusiasm I had to be on the road, but the discomfort and pain was increasing.

It needs a really good reason for me to abandon ship, quit as it were and take motorised transport to reach my destination. Well by mid-morning I decided to throw the towel in; it was time to flag a lift to Harare.

I waited some 40 minutes under the shade of an acacia tree before a mini-bus with a trailer passed by. Sitting squeezed in the back amongst vociferous Zimbabweans was no more comfortable than being on the bike, and what would have been a 2 hour journey in a private vehicle took more like 4 hours with the never-ending police check-posts.

In downtown Harare I wheeled my bike around looking for a bank that would accept an international visa card. I had no map or information about the city. People seemed busy going places. I felt lost and had no idea where to stay that night. I had the contact number of a friend of a friend who lived somewhere in or on the outskirts of Harare, but that number was buried in an old facebook message. Why hadn’t I written it down? More than anything else I needed to see a doctor, but I didn’t know who to ask.

In the end a travel agent directed, then decided to escort me to a nearby clinic. “I want to be a good Samaritan. We Africans have a duty to help.”

The Doctor was female and at first I wanted to ask if she had a male colleague before dropping my pants. “Don’t worry, I’ve seen everything here in Zimbabwe” she remarked puling on some surgical gloves.

She took the right testicle in her hand and looked up at me gravely. “This is serious and you need urgent medical assistance. This looks like testicular torsion”.

I’d never heard of testicular torsion before, and explained that the pain was never really in my testicle, but my lower abdomen. She put her fists together then twisted them as she explained how the testes, the right one in my case, had twisted upon itself and cut blood supply to the testicle.

The Congolese urologist confirmed what the female GP had said, but was surprised that a man of 33 was experiencing torsion. “It’s usually young boys and teenagers who I see this with. Unless it’s Orchitis (an infection) this testicle is now dead”

Dead!? I exclaimed in shock. I later did what research I could with limited Internet access, and read what the urologist had said. Unless operated upon within 6 hours from the onset of pain the testicle dies from lack of blood supply and soon goes gangrenous.

Coming to terms with the news that you are going to lose a testicle isn’t an easy thing for any man to deal with, particularly when you are alone in a hospital in a foreign country. I should have acted quicker, but there was no way I could have got to hospital within 6 hours.

I did a lot of crying in the hours before being taken to theatre. “Don’t worry. You can still have 20 children”, said the urologist. “It’s a simple operation and I’ll fix the left testicle so it can never become twisted”. The nurse smiled at me. “God gave you two and you only need one to function.” But one testicle I thought to myself. What was it going to look like? How was it going to feel? When could I ride my bike again? Was it going to affect getting an erection and performing? How was I going to tell people? Maybe I should keep it a secret? Girls would think I’m abnormal and have no sex drive. Why had this happened to me now and not when I first started cycle touring years ago? Was it even connected to the cycling? The doctor had said this could suddenly happen. “A bump or pothole in the road is all it needs sometimes.”

A scan some hours before going under the knife confirmed that it was torsion and not orchitis, and that the left testicle was still healthy. By this time I’d made contact with those friends of friends, who asked why the hell I hadn’t called them when I first arrived, and probably shuddered when I said I was in the government hospital.

I panicked when I came round from the anaesthetic. “Where is my bike and bags?” I asked the theatre nurse. They were in fact still with that travel agent. I expected to be in some pain as I looked down at a large bundle of bandaging around my scrotum, and the tube which was draining out from where I guessed there to be a number of stitches. It was that numb discomfort again though. The cocktail of antibiotics and painkillers I’d been on before the operation were no doubt at work.

I was discharged from hospital 2 days later, wheeled out on a wheelchair that used a white plastic garden chair as the seating component. How resourceful Africans can be I thought.

“This hospital has changed a lot in the last few years”, remarked my hosts. “You wouldn’t want to have been here in the real crisis years”.

The wheelchair

 At first the urologist had said no cycling for 3 months, but when I revisited his consultation room several days later and questioned him on this whilst the bandaging was removed he said at least 1 month, 2 would be better** (see below). I guessed he’d never operated on a guy who was cycling across the continent. Apart from 6 ugly looking stitches and a little bit of loose skin my manhood looks no different from before. The stitches will fall out within a week or two I’m told.

And so here I am recovering in one of Harare’s leafy suburbs, wondering when to get back on the bike, at least for a casual ride around the shady jacaranda-lined streets?

Other than the fact that it makes for an interesting, if somewhat wincing read, I decided to blog about this experience for two reasons. Firstly I want to hear from readers, cyclists or non-cyclists, as to what they know or don’t know about testicular torsion and the recovery from such an operation. Were all those hours I’ve spent on the bicycle leading up to this happening? Perhaps it was the heat that day and the added load I was carrying for the last 10km? Did the beer in my system have an affect?  Can I blame my brooks saddle even though I’ve done 30,000km on it now? I’m basically asking whether testicular torsion is an occupational hazard for cycle tourers?

In my mind I’d like to be heading out of Harare in about 1 month, but I clearly don’t want to end up again in a hospital bed in Zimbabwe, or somewhere else between here and Cape Town.

The second reason I decided to announce that I now only have one testicle is to pre-warn my cycling brethren, particularly those younger than me. I don’t think many people know what testicular torsion is, and I wonder how many guys have found themselves climbing a mountain, sailing an ocean or possibly wild camping after a day on the bicycle and thought to themselves, as I did, let me see how this pain feels tomorrow. Maybe it will go away. Well the next day is unfortunately too late in the case of testicular torsion. The moment you feel any kind of unusual pain or discomfort in any region of your lower abdomen or genital area don’t hesitate to get yourself, if you can, to the nearest hospital. When I think of all the places I’ve cycled and camped, unfortunately 6 hours would never have been long enough. But to ignore the pain and continue with the discomfort, which the Doctor said would also pass over time, is even more dangerous. That dead testicle will infect the other. Well if I’d lost both testicles I really don’t think I’d have easily found the balls to tell you this.

** I am as of now back on the road, cycling out of Harare some 32 days the operation date. I wrote this blog post about 1 week after the operation, but delayed posting it for reasons I'll write about in a forthcoming post.