Guitar Capo-Or as my mother used to say, ” Necessity is the mother of invention.”
When I was a urology resident I had to do a research paper on Fournier’s gangrene. I got somehow the original article on the subject by Mr. Fournier himself. It was in French and much to the chagrin of the chairman of the Dept. of Urology, it cost something like 500 dollars to translate it. Fournier’s is an interesting and devastating disease process. Two things are remarkable about it: one it can start as a small scratch on the scrotum and in hours infection can devour tissue from the scrotum and then up onto the abdominal tissue and skin (an infection that gallops) and despite all the destruction, the testicles themselves are spared. Why? The skin of the scrotum and that of the testicles are different so the testicles are unaffected. Think of a forest fire and one species of tree is left alone. The only treatment is wide and radical debridement of dead tissue, often times just leaving the testicles hanging there alive but with no covering. I saw about five cases of this in my time as a resident and hence the paper.
Now about the scrotum, I had a saying as a resident, “The scrotum is your friend, the urethra your enemy.” The scrotum is very forgiving usually, ” John, you only need a postage stamp of scrotal skin alive to cover testicles. An amazing organ indeed,” Dr. Witherington used to say. The least amount of trauma to the urethra and you’ve got issues forever.
As men age small little clusters of blood vessels develop on the scrotum. The are asymptomatic and really don’t mean anything or amount to anything…usually. Scrotal petechia or specifically Angiokeratoma of Fordyce– little things that look like a blood vessel pimple.
Anyway, on Thursday of this past week I was on my way out the door to work and my wife asks, “John did you cut something. There is blood in the bathroom and it leads into the living room.” We go back to look and sure enough there is fresh blood from the bathroom to the living room hard wood floor and then it mysteriously stopped. Nothing anywhere else.
“It must be Penelope or Chloe,” I say. But after checking the two of them and their sleeping area (our bed) no blood there. Since the blood was in front of my sink, I became the suspect. I check my nose, hair, ears and arms and stuff. No blood. I check other places…nothing. “I don’t know Karen, I don’t think its me. Maybe I cut something opening the orange juice this morning. (The orange juice has a serrated top that you have to pull off to open.)
I go to work and no other issues are noted by me, our dogs or Karen. “I was never at your sink John. It can’t be me.”
So the next morning, I turn the shower on to let the water get warm, and as I step in, I see blood swirling around down the drain. (I reminded me of the Alfred Hitchcock movie where the lady is stabbed in the shower, Psycho I believe. We saw a reanactment of that at Disney World. That scene ha been rated on of the best ever in movie making annals.) I start to look around on my body to see where it is coming from and you guessed it…my friend the scrotum. I put pressure on the area and notice that I have the little blood vessel bumps in other surrounding areas that I’ve told my patients about over the years. I figure I must have popped one of them and now it was bleeding.
Over the years patients have come in to my office with bloody pants where blood had soaked through their underwear and pants because on of these things rupturing. “Doc, I think I am bleeding to death. Where is this coming from? Why won’t it stop?”
There are two reasons why this little known issue of the male scrotum is not easy to stop. For starters, patients won’t hold pressure for the time it takes to achieve clotting. They want to peek every two to three minutes, see it bleed and then repeat that process. They never do the full 7-10 minutes. The other is that is not like a scratch, this is an issue where the top of a blood vessel is scraped off. There is a larger area to coap and then stop bleeding…like a whole in a small blood vessel that can’t close.
Well I am in the shower and am pinching the area to keep it from bleeding and switching hands in order to “scrub both sides of my body” and with each switch the bleeding continues. This process continued through the time I dried off, shaved and dressed. It wasn’t until I got my socks on that I could “practice what I preached about holding pressure without looking.”
It was then about 8:55 a.m. and I already had a text from my nurse that, “three waiting.” What to do?
As I am holding the area between my fingers I ask, ” Do I hold this all the way to work? What if it’s still bleeding when I get there?” I had already tried putting a bunch of toilet paper and pulled up my underwear real tight…not enough pressure. The degree of bleeding, just as my patients had told me, was impressive.
Then I had an idea, “Karen, do we have any of those clips we use to keep potato chips fresh?”
“John are you kidding? Ouch!”
“I think it will work,” I say and she begins looking through drawers. She finds one but it was about 8 inches long. I found one that was about 3 inches and wadded toilet paper up over the area and put on the clip. The problem was that the pressure exerted was too broad so the area just kept on bleeding. “This won’t work,” I say dejectedly.
“Here’s a guitar tuner. Will this work?” I look up and she has a guitar capo. A glorified clothes pin I think. Later my wife said she offered up the capo as a joke, but it looked like to me that it just might do the trick. “Perfect,” I say. “Pin point pressure right to the area I need and “it’s hand free.”
I fold up toilet paper again in tight bundle, pinch out scrotal skin away from the testicle, and put the capo on. It stayed in place, and it stopped the bleeding. Except for the intense pinching sensation, I thought it would be fine for me to drive to work and once I get there see if it did the trick. The drive satisfies the requisite 15 minutes of holding pressure. “John, you are crazy,” I heard my wife say as I went off to work.
At work I go into the bathroom to take the capo off and see if the bleeding had stopped. When I go to take off the capo, the back side of it (which some family musician had put tape on-see picture) had impressed and attached itself to the scrotal skin. So when I went to take it off it got stuck on the back side, very painful, and the effort to get that off disturbed the front side and it started bleeding again. I get a bunch of paper towels and press that up against the scrotum and pull the underwear again, but to no help. I decide to try the capo again. This time I folded a paper towel so that it protected the skin on the front and back and put the capo back on. “Dr. McHugh, Line One,” I hear as I am flushing bloody paper towels down the toilet and washing my “hands free of blood.”
Lab jackets are very forgiving. They cover wrinkled shirts, an ever-increasing waist line and the rigid silhouette of a capo in one’s britches to stop scrotal bleeding. I see about five patients over about the next 25 minutes and then make my way to the bathroom again. I carefully remove the capo…and no bleeding. It was done.
In scouts…starting a fire for a scout is not usually a big deal. But if you tell a scout, “start a fire…and you have three matches and two minutes,” well that is a different story. In this case the bleeding alone was not that big a deal but add the other stresses…well I was concerned. I knew I’d be alright and that there would be a “story in it.”
All day I carried the capo in my lab pocket. I told the story (yes I did) about ten times to certain fun-loving patients and to my all female staff. “This is the thing right here,” as every time everyone cringed. It was a great Friday afternoon pick-me-up of sorts.
Everyone thought it must have been very painful to wear a capo,(especially when I used the capo to pick up a book of about 100 pages to show how strong the pressure was) but they did not know what I knew and that was that, ” One’s scrotum is one’s friend.”
One other thing…I anticipated one day one of my son’s sitting down to strum the guitar and beginning to use the now famous medicinal capo and me saying quickly, ” I don’t think I’d use that one my friend.”
Finally, why the capo story. It intensely reminded me of my prostate cancer journey during the time I worked with a condom catheter on daily for three months. Each day in that recovery to continence and potency was an uncomfortable adventure…ahh… the memories….