Varicocele Healing

THE COMPLETE GUIDE TO NATURAL HEALING OF VARICOCELE BY DANIEL JOHNSON

CONTENTS CHAPTER I CHAPTER II CHAPTER III CHAPTER IV CHAPTER V CHAPTER VI CHAPTER VII

INTRO COOLING AND PAIN RELIEF LIFESTYLE CHANGES HEALING FERTILITY AND HORMONES DIET AND NUTRITION FITNESS AND EXERCISES

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CHAPTER I

INTRO

WHAT IS A VARICOCELE? Varicocele is an incidence of venous insufficiency. This means that it is the results of the failure of the veins to circulate blood. More specifically, veins have valves that prevent backward blood flow. When these valves do not close properly, blood does not circulate well and pools. Pooled blood causes excess pressure on the vein wall, forcing it to stretch. These stretched veins are called varicose veins. More specifically, we refer to the varicose veins that affect the pampiniform plexus in the spermatic cord of the testis as a varicocele.

HOW DOES A VARICOCELE AFFECT YOU? WHAT ARE THE SIDE EFFECTS? When blood pools in the varicocele, it causes excess heat, hyper-hydration, oxidation, toxin build up, and a lack of nutrition, resulting in many negative side effects. The major side effects are pain, decreased fertility, scrotal sag, testicular shrinkage, and decreased testosterone. Many people experience some of the following symptoms as well: Embarrassment, gynecomastia, erectile dysfunction, weak or quickly lost erections, low sex drive, decreased masculinity, low motivation, decreased muscle tone, infertility, and increased estrogen.

WHAT IS THE CAUSE OF VARICOCELE? LIKELY NOT GENETICS OR FAULTY VALVES The popular belief is that faulty valves disrupt normal blood flow and pool blood in the pampiniform plexus veins, stretching them and causing varicocele to develop. However, this is a very old and out dated theory. Scientific advancement has found many other explanations. These explanations mainly involve increased blood pressure and impairment of blood flow. Contrary to the popular belief, varicocele is a complex and multidimensional disorder, and there are many risk-increasing factors. Do not buy in to the belief that the varicocele is a genetic disorder! You are not born with malfunctioning valves. Rather, when normal blood flow does not occur, valves malfunction and blood pools within the veins. The pooled blood burdens the veins. Burdening weakens the vein walls and leads to bodily responses that increase the vein’s diameter. Furthermore, impairment of blood flow increases stagnant blood that has toxic and oxidizing agents that damage the valves. This damage over a period of months to years causes makes the valves malfunction. For most people, this is a reversible process. Even though faulty valves are found in about 70% of those with varicocele, this merely implies correlation and not causation. A genetic disorder is not likely to be the cause of faulty valves. Faulty valves are more a symptom of, than the cause of, varicocele development. Furthermore, scientific evidence suggests that grade and bilaterality are not heritable. The implication is that nurture factors are critical for development of the varicocele.

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THE MAJOR CONTRIBUTORS TO VARICOCELE DEVELOPMENT As mentioned, varicocele is a complex and multidimensional disorder. There are many contributing factors to its development. One major contributing factor is due to the entry angle of the left spermatic vein into the renal vein. There is a large discrepancy between the incidence of left and right-sided varicocele because the left spermatic vein drains into the renal vein at a right angle, while the right spermatic vein drains into the inferior vena cava obliquely. The right angle entry puts excess pressure on the left spermatic vein, which in turn increases pressure on the left testicular pampiniform plexus. As well, the insertion of the left spermatic vein is 8-10 cm higher than that of the right spermatic vein, resulting in 8-10 cm greater pressure on the veins as the blood flows up through them. This indicates that increased blood pressure and not faulty valves per se is the major cause of varicocele development. Another major reason for varicocele development is the “Nutcracker” effect. The term Nutcracker refers to how the aorta and the superior mesenteric artery compress the spermatic vein between them. This compression restricts blood flow and increases fluid pressure. Notably is it only present on the left side. This explains why those who have experienced bowel problems are more likely to develop varicocele and typically experience more severe symptoms. Studies have found many risk factors for why varicocele develops and why it its symptoms are more severe in some. These factors include but not limited to: Obesity, height (taller is worse), high Nitrous Oxide expression, scrotal sag, chronic cough, constipation, bowel problems (e.g., irritable bowel syndrome and inflammatory bowel disease), abdominal bloating, stress, improper lymph drainage, improper nutrition, lack of exercise, long distance running and biking, high exertion during exercise, postural imbalances, and prolonged standing. Notice how most of these factors contribute to the increase of blood pressure in the pampiniform plexus. Some rare medical conditions may also cause the development of a varicocele, I recommend consulting a medical practitioner just in case. These conditions include renal cell carcinoma (tumour), retroperitoneal tumour, retroperitoneal fibrosis, and liver cirrhosis (cause by portal hypertension). These are rare cases, but should not necessarily be ruled out.

HOW IS VARICOCELE DIAGNOSED? Due to advances in diagnostic techniques, the current belief is that varicocele may affect as much as 25% of people. The diagnostic criteria fall under the four categories of subclinical, grade I, grade II, and grade III. SUBCLINICAL Ultrasound analysis but not physical exam detects presence of varicocele.

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GRADE I The varicocele is only palpable during or after Valsalva maneuver. GRADE II The varicocele is palpable without Valsava maneuver.

GRADE III The varicocele is normally visible through skin to the eyes (seen as a “bag of worms”).

WHY THIS GUIDE? This is The Complete Guide to Natural Healing of Varicocele. No guide like it exists. This guide is the result of thorough research and proven results. It has information from over 150 recent scientific publications. There are over 70 exercises in this guide. Every exercise comes with detail on its anatomical significance. Furthermore, there are in detail instructions on how to perform every exercise effectively. This is the most comprehensive guide on natural varicocele healing. You will not find most of this material by searching online and some of the material you will not find anywhere else. After reading this guide, you will not need to review any other material; it is complete. I highly recommend reading the whole guide to get fuller understanding of the multidimensionality of the varicocele. To heal your varicocele and to prevent its reoccurrence, you must make lifestyle changes. The great news is that these lifestyle changes are mainly easy and accompany with them many other positive life-changing benefits.

THIS IS THE RIGHT GUIDE FOR YOU IF YOU WANT TO: INDUCE HEALING OF VARICOSE VEINS UNDO TESTICULAR SHRINKAGE RELIEVE PAIN REDUCE SCROTAL SAG IMPROVE FERTILITY INCREASE TESTOSTERONE AND NORMALIZE HORMONES IMPROVE SEXUAL PERFORMANCE POST-SURGERY MAINTENANCE INDUCE HEALING OF VARICOSE VEINS Healing your varicocele involves reducing venous pressure, stimulating the growth of normal tissue, creating an ideal healing environment, and providing proper nutrients that will stimulate the strengthening of your veins. Ever ask yourself why so many people develop varicose veins next to their testicles? Well, there are several anatomical reasons why. Caring for these will do wonders for the healing of your varicocele. Copy Right Daniel Johnson 2014

The healing process requires removal of stress factors and the provision of a more nurturing environment for the varicose veins. Healing is the point of this guide, and every exercise presented is relevant to it. UNDO TESTICULAR SHRINKAGE Blood pooling causes damage to the testicle on the affected side. It deprives the testis of nutrients, exposes it to excess toxins, and causes heat stress. Overtime, it causes damage and testicular shrinkage follows. However, testicular shrinkage usually occurs on both the affected side as well as the non-varicose side. Shrinkage is seen on both sides because damage to one testicle disrupts normal testosterone production, which in healthy individuals is responsible for growth and development of both testicles. Decreased testicular volumes of 43%, 53%, and 73% occur in individuals with varicocele grades I, II, and III, respectively. Most of the exercises in this book aim at minimizing blood pooling, and stimulating both testicular healing and growth. RELIEVE PAIN Pain sensation arises from the testicles and/or the varicose veins, relative to the causal stressor. Both short and long-term stressors can cause pain. Short-term pain is short-lasting (hours to days) and may be is caused by: 1) Heavy blood pooling and little drainage for prolonged periods 2) Prolonged heat stress 3) Masturbation (physical stress) 4) Penis enlargement exercises Etc. Long term pain can be felt for up to weeks and is typically caused by: 1) Years of bad habits (life style changes are required) 2) Unhealthy testicles 3) Excess body weight 4) Chronic constipation or improper digestion/bowel movements Etc. Remedies for both short and long-term pain are provided in this guide. REDUCE SCROTAL SAG The testicles need to be 1-3°C below normal body temperature to function properly. That is why they are located on the outside of the body in the scrotum, which effectively regulates their temperature. The scrotum sags away from the body to cool the testicles and tightens against the body to warm them. Copy Right Daniel Johnson 2014

However contrary to popular belief, it is not the mere pooling of warm blood that is the major contributor to overheating. The major contributor is the varicocele itself. The varicocele effectively destroys the cooling mechanism of the pampiniform plexus. The pampiniform plexus is a meshwork of veins that run counter to arteries which bring warm blood from the heart. This meshwork absorbs heat from the arteries and releases them when the testicles sag. A varicocele is defined by pooling of blood in the pampiniform plexus. This abolishes the counter current cooling mechanism. Therefore, the scrotum constantly hangs low since it cannot alleviate the heat. Scrotal sagging also occurs because the varicose veins weigh down the scrotum. Over years, the varicocele causes the muscles that keep the scrotum tight against the body to loosen and the skin to stretch. Thus, one testicle usually hangs lower than the other. This guide has exercises for both improving scrotal muscle tone and improving blood circulation and cooling testicles, without damaging them. IMPROVE FERTILITY About one in four people diagnosed with varicocele experience fertility problems. That is about 5-6% of the population. Parameters used to assess male fertility including sperm count, volume, morphology, and motility, as well as sperm DNA damage and testicular volume. Those with varicocele who have fertility issues typically experience several of these factors. Commonly, both varicocele severity and fertility worsen as the affected person ages. So it is important to stop the disease or mitigate its side effects as early as possible. You can do many things to improve fertility. However, the exercises provided in this guide are mainly varicocele specific. These exercises include ways to minimize negative symptoms, stop further oxidative damage (which is a major way thorough which varicocele damages your DNA), and exercises specific for those with varicocele to improve their fertility. INCREASE TESTOSTERONE NORMALIZE HORMONES Varicocele disrupts normal testosterone production. This causes a whole array of symptoms, including gynecomastia (enlargement of male breast tissue), erectile dysfunction, lower sex drive, decreased masculinity, low motivation, testicular shrinkage, lower muscle tone, and excess fat, just to name a few. Luckily, normalizing hormone levels, as long as your varicocele has not progressed too far is relatively easy and the negative symptoms (with partial exception to gynecomastia) are reversible by restoring normal hormone balance. Normalizing hormone levels is a bi-product of most exercises in this book. However, I have provided specific exercises for it as well, for completeness purposes. Copy Right Daniel Johnson 2014

ENHANCE SEXUAL PERFORMANCE Erectile dysfunction, weak or quickly lost erections, and poor sexual performance are all associated with varicocele. Again, luckily correcting this is relatively easy (similar to normalizing hormones) and will come while you follow this. Specific exercises targeting sexual performance are also provided, for completeness purposes. POST-SURGERY ENHANCEMENT Surgery, though effective at treating varicocele, comes with several risks. Aside from the possibility of losing a testicle and the scarring from the incision, varicocele can re-develop (up to 30% of cases), in many cases there is no testicular hypertrophy (size regain) and at much of the time, normal fertility does not resume. That is not to mention that surgery involves killing your veins. Do you want to understand varicocele better? Do you want to know what to do to reduce the chances of redeveloping a varicocele post-surgery? Do you want to stimulate testicular growth and normalize fertility? This guide is the best place to go for a complete guide for what to do and not to do when it comes to caring for your testicles and vein health.

BENEFITS OF THIS GUIDE This book is a complete guide on how to reverse the negative side effects of your varicocele. There are six sections in this book. They are not presented in any particular order. Here is a list these sections and their focus. COOLING AND PAIN RELIEF Keeping your testicles cool is the first step in the healing process. You cannot induce healing when your testicles are suffering from genital heat stress. There are right and wrong ways of cooling, you will find both in this section. LIFESTYLE CHANGES There are many changes you can make that will make a significant positive impact on the state of your varicocele as well as your fertility. This section contains many things you should do and should avoid doing during the healing process. HEALING Healing is possible. This section contains exercises that are specifically effective for healing varicocele. FERTILITY AND HORMONES Do you want plump testicles, rock hard erections, high testosterone levels, and to increase your sperm count and ejaculate volume? The exercises in this section are designed to improve all these and at the same time aid in the healing process. Copy Right Daniel Johnson 2014

DIET AND NUTRITION There are many dietary changes and supplements that will make a significant impact on improving the status of your varicocele. FITNESS AND EXERCISES This section is very important because it teaches the specific exercises needed for reducing the excess pressure that causes varicocele. It also contains the top yoga and tai-chi exercises I have specifically selected for their effectiveness in reducing venous stress and improving digestive health.

HOW LONG DOES HEALING TAKE? How long will each improvement take? Well, that depends on what variable you are considering. Remember that best results come with time. You cannot build Michelangelo’s David in one day, nor can you fix years of bad habits in a month. But, you can be well on your way to greatness in a month. Take your time, there is no rush. If you follow this guide, here is how long you should expect healing to take:

SHORT TERM PAIN LONG TERM PAIN SUBCLINICAL VARICOCELE GRADE I VARICOCELE GRADE II VARICOCELE GRADE III VARICOCELE SCROTAL SAG TESTICULAR SHRINKAGE REDUCED FERTILITY INFERTILITY

MINIMUM 5 MIN 1 DAY 1 MONTH 1 MONTH 6 MONTHS 8 MONTHS 1 MONTH 1 MONTH 2 MONTHS 3 MONTHS

MAXIMUM 1 DAY 1 MONTH 3 MONTHS 6 MONTHS 1 YEAR 1.5 YEARS 4 MONTHS 4 MONTHS 1.5 YEARS NEVER

If you consistently follow this guide, you should see a noticeable difference in as little as three days to a week. These results will appear to come and go for the first few months. They are the result of removing the stress that was previously on your veins. Consider these short-term results to mean that you are on the right track. They will become more and more consistent with time. Varicocele grade and the rigor with which you follow this guide will determine how long the healing process will take. An effective approach is to follow the simple and easy exercises. Make the simple life-style changes, and just forget about your varicocele. Doing so will reduce stress and make sure you continue the long-term process that is required for healing. From there, one day, not today, not tomorrow, but a few months down the road, you will look down in the mirror and notice amazing results. Copy Right Daniel Johnson 2014

CHAPTER II

COOLING AND PAIN RELIEF

PAIN AND HEAT STRESS WHAT CAUSES PAIN As explained in the intro, the spermatic veins that leave the testicles form a meshwork of veins called the pampiniform plexus. The pampiniform plexus encircle the arteries that bring blood to the testicles. This creates a counter current heat exchange mechanism that cools the warm arterial blood entering the testicles. Varicocele abolishes this mechanism, causing elevated scrotal temperatures. Higher temperatures increase metabolic activity, deplete nutrients, cause oxidative and hypotonic stress, and come with a whole array of other symptoms that result in testicular injury. Despite varicocele grade, or even the presence of a varicocele; sperm concentration, motility, and testosterone are deteriorated with increase of scrotal temperature. Higher temperatures also have negative effects because the testicles have enzymes that are only active at lower temperatures. These enzymes work optimally at 1-3°C below normal body temperature (normal body temperature is 37°C). Sperm density decreases by 40% for every one degree Celsius increase in average daily scrotal temperatures. In fact, testicle temperatures above 36.5°C completely halt sperm production. Severity of varicocele typically increases with age. This results in an increase in the rate of injury through positive feedback mechanisms. For this reason, most people do not experience pain at early onset. However, when the varicocele progresses, they begin experiencing more and more regular and intense pain. Pain attributed to the testicles is very common. This pain is occurs during exposure of the testicles to excess stress (i.e. excess heat, poor blood flow, low nutrients, etc.) throughout the day or over longer periods of time. So, the best thing to do is remove the stressor, normalize blood flow and rest. Next time prevent or minimize the stressor to minimize pain. Pain can also originate from varicose veins. This type of pain occurs when enlarged varicose veins are tugged around, squeezed tight, or exposed to excess pressure. The sensation comes directly from the veins or from any tissue around the veins, including at times the testis. COOLING FOR PAIN RELIEF In every case, the idea for quick pain relief is to improve blood circulation, normalize the temperature of your testicles and rest. Cooling alone has been shown time and time again to greatly improve semen quality in about 70% of people (leading to improvements in fertility). Keeping your testicles cool is something you should always be working toward if you want plump testicles (higher sperm count and improved testosterone production). Copy Right Daniel Johnson 2014

You know that your testicles are too hot when they feel warm or hot to the touch of your hands. Normally, they should feel slightly cool (unless you have abnormally cold hands). Scrotal sagging is another sign that your testicles may be too hot. Sagging means that your testicles are too hot and your body is trying to cool them by distancing them from your body. However this sign is not always accurate, so feel your testicles every time if you can. Also, keep in mind that your testicles do not always have to be cool. Their temperature naturally fluctuates throughout the day. Your goal is to prevent excessive and prolonged heat stress, not to constantly and always keep them cool. Just a cautionary note for when you perform these exercises: Do not over-cool your testicles. 37°C is your normal body temperature. 34-36°C is an ideal temperature for your testicles. This is only 1-3°C lower than your normal body temperature! Your goal is to normalize, not to cause testicular hypothermia! You should also not worry about getting in a hot tub once in a while or over cooling your testicles once in a while or even taking hot showers. Your testicles are not delicate snowflakes. I cannot stress enough that your goal is long-term prevention.

EXERCISE 1: QUICK COOLING AND PAIN RELIEF You should always take a mental note of what you think caused you to experience pain. Maybe you were wearing tight underwear all day, maybe you exercised with pants and underwear that over-heated your testicles, maybe you were very constipated, or maybe you masturbated multiple times over the past few days. Figure out what might have caused you the pain and try to avoid it. Of course, you may just have chronic pain from long-term damage that needs time to recover. This section relevant if you want to quickly minimizing acute or chronic pain. LAY DOWN Being vertical (e.g., standing or sitting) builds up a lot of pressure in your varicocele, since the blood has to move vertically up, against the force of gravity, from the scrotum to the heart. Being horizontal (e.g., lying down) in general decreases your blood pressure because your heart does not have to pump blood against the force of gravity. Lying down is good enough to drain, improve circulation and cool down your testicles. It is a great way to drain your varicocele and quickly cool and relieve pressure that could be causing pain. To allow your testicles to cool down adequately, lay down without pants or underwear. However, you should aim for comfort at the same time, as being relaxed and stress-free is healthy and better than freezing your body to cool your testicles. Just a further note, lying down is also a good way of relaxing and changing the gravitational directional pull on your digestive tract. It allows gas to pass easily, and can stimulate a bowel movement. Gas passage and bowel movements decrease bloating and abdominal pressure. Copy Right Daniel Johnson 2014

When lying down, you can further stimulate gas passage and bowel movements by rolling onto your sides and by stretching. NAPPING If you are experiencing pain or your testicles are not feeling optimal, napping is a great way of helping them recover. Again, since you are lying down horizontally when you sleep, your blood pressure is much lower. In contrast to lying down, napping also stimulates healing, helps decrease inflammation, and drops the body’s temperature by about one degree Celsius, all of which are good for pain relief and recovery. Generally, symptoms are lowest when waking and worsen as the day progresses. Napping is therefore a great way to re-set the veins to how they were when waking. I recommend sleeping bottomless when possible. At most, only wear loose fitting underwear or just a thin pajama pants (without underwear). You can wear as much as you like on your upper body, but let your testicles get some air! Also, remember not to stress yourself when doing this. If you want to be comfortable and sleep well, a good night’s rest is better than killing yourself to cool your testicles. I recommend taking your time to set up your bed so you can be comfortable while keeping your testicles cool. FEET UP ON WALL When just lying down is not enough to drain or cool your varicocele, you can perform inversion exercises. Inversion exercises elevate the pelvis above the heart, draining pooled blood and improving blood circulation to cool the testicles. Inversion works because the varicocele is not a problem of the arteries, but of the veins that travel from the pelvis back to the heart. So turning upside down makes blood flow naturally with the force of gravity. If anything, remember this exercise only. It is my favourite exercise. It is the easiest and best exercise for long term healing. It is great for quick cooling and pain relief, and is more easy and effective than the bridge pose. This exercise is super effective because it is easy to keep your feet up on a wall for several minutes. This exercise is also very important because with your varicocele drained, you can perform exercises that would have otherwise been painful (will be noted later). Furthermore, the advantage of inversion and lying down exercises is that you do not have to worry about over-cooling your testicles. That is because these exercises work by draining and normalizing blood circulation, therefore your testicles will naturally approach their optimal temperature. To perform this exercise, begin by sitting next to the wall, with the wall on your side. Get in close, so that the side of your hip is almost touching the wall. Then lay back perpendicular to the wall as you extend your legs up. It is important to bring your hip close to the wall as doing Copy Right Daniel Johnson 2014

so will force your pelvis to tilt upwards and make your legs more straight (improving blood circulation). To enhance this exercise, consider raising your butt higher by placing a pillow underneath it. This exercise is ideal at night in bed, before sleeping. It is a relaxing exercise, so with a blanket on top of you, you can keep your feet up on the wall for a few minutes and then easily fall asleep. You can also perform this exercise at the gym or anywhere in the house. Just lay down a mat if you use the floor. I recommend performing this exercise every day. COOL SHOWER The cold shower is the most common thing that people think of when they want to cool their testicles and contract their varicose veins for better blood flow. It is quick, easy and effective, but most people do it wrong. A lot of time, people make the mistake of taking a cold shower and stressing their whole body. Instead, try cooling only your testicles, not your entire body. Your body needs to be at its normal temperature and your testicles at their normal temperature. Notice that the exercise name is not “cold” but “cool” shower. The water should feel lightly cool against your body and just normal on your testicles. There really is no need for super cooling your testicles, and you will not notice faster results from doing so. Remember to normalize not thermo frost. Unlike lying down to drain your varicocele, cold causes constriction of superficial veins, and therefore can help improve the muscle tone of the smooth muscles lining the vessels of your varicocele. This makes it an important exercise for long-term healing. So, you want to cool both your varicose veins and your testicles. The other benefit is that a cooling shower can be effective at toning your cremaster muscle (the smooth muscle lining your scrotum). This is important for both long term healing and making aesthetic gains (reducing scrotal sag, and increasing testicle size). The side affected with varicocele usually hangs lower. This actually increases the volume of blood that is able to pool. Therefore strengthening your cremaster muscle will tuck your varicose veins closer to your body and is helpful in the long-term for healing. Perform this exercise at most once every other day. Cool under running water for maximum of 60 seconds. EXERCISE 2: DAYTIME PROPER UNDERWEAR Just switching from tighter underwear to boxers improves fertility. So, first, get rid of your boxer briefs and all other tight underwear. Tight underwear prevents your testicles from Copy Right Daniel Johnson 2014

sagging to cool when they are overheated and puts unnecessary pressure on your varicocele. If it is a hot summer day, you are better off going out without any underwear. I recommend purchasing cotton boxers (not briefs). Boxers allow the natural decent of your testicles and cotton is great because it breaths better than most other fabrics. You also want to make sure to buy boxers that fit nice and loose around your waist. Tight underwear around the waist puts unnecessary pressure around your abdomen and reduces the room your organs have (including your veins). PROPER PANTS Now I know odds are that no one told you, but tight fitting pants are bad because they constrict natural blood circulation and put unnecessary pressure on your body. Ideally, you should wear breathable and well fitted pants. Your pants should not be tight around your hips or waist, but should have a light and comfortable feel. This also includes any belt as well. Do not make your best excessively tight around your waist! Give your veins and bowel room to flow! BEWARE THE CUSHIONY CHAIR Cushiony chairs trap heat and have been shown elevate scrotal temperature by 3-4°C! Saddle chairs are more ideal, but less comfortable. Try to avoid cushiony chairs when you can, whether at home, in the car, or at work. However, if you do sit on cushiony chairs, you should try some of the following: Be comfortable—but sit more with your legs spread than crossed, get up once in a while to allow the heat to dissipate, have a fan pointing toward your crotch, or put an ice pack near your crotch to keep the general area cool (which is actually very effective). SITTING You want to put your legs up on something when possible as it will lower the blood pressure on your varicocele. Also, instead of sitting slouched into your chair, sit up tall, with good posture. Try performing a mild version of the axial extension I mention in a later chapter. Slouching collapses your ribs into your stomach, disables full breath and disables the muscular support of your torso. Do not sit for more than two hours at a time without getting up to take a break and stretch. If you do sit for prolonged periods, perform hip stretches and abdominal exercises to counteract the negative impact. LAPTOP ON LEGS This one should go without explaining. A Laptop can heat up—a lot! You do not want to spend hours with it on your legs. EXERCISE 3: NIGHT TIME Nocturnal cooling of only one degree Celsius (bellow the personal norm) is enough to improve sperm density, total sperm count, percentage of progressive motile spermatozoa and percentage of normally shaped spermatozoa after several weeks of treatment. Copy Right Daniel Johnson 2014

SLEEP The most inflamed, swollen or painful days are the ones you should just go to sleep. If nothing you do works, it is probably time to wave the white flag. Just go to bed. Sleeping for the night will relieve the pain, almost every time. Just make sure the next day you do your best to keep your testicles cool and stress free. The most important thing is to have a good night’s sleep. Do not worry about all the details in this section because getting a good night’s sleep by itself will usually induce more healing, cooling and pain relief than the details. Do your best to make yourself have a good night’s sleep. Take a nice warm shower, drink camomile tea, wear an eye mask, stretch, etc. Scrotal temperatures can elevate at night it not taken care of, so I do highly recommend that you make sure you drain and cool your varicose veins before going to sleep. And, as noted in the napping section, it is important to sleep bottomless, or in thin and breathable pajama pants or underwear. Consider these as the basics that you must practice daily. At night, scrotal temperatures during lying on the side or front are higher than during lying on the back. Therefore, ideally, you want to sleep lying on your back. This is relatively hard to do for most people, so I just recommend not caring. NOCTURNAL SCROTAL COOLING In contrast to having a good night’s sleep, I should also say that nocturnal scrotal cooling is an effective treatment for varicocele fertility issues. Studies have shown that nocturnal cooling can cause a twofold increase in sperm count, increase sperm density, and motility as compared to pre-treatment values, in those with varicocele. Perform this by using a liquid cooling pack that you can purchase at a local pharmacy market. Apply it for about 15 minutes in bed, before going to sleep. The cooling pack should not be too cold; it should just feel mildly cool to the touch. Apply the cooling pack at most five days per month. EXERCISE 4: BE CAREFUL EXCESSIVE HOT TUB, SAUNA, HOT SHOWERS, ETC. Like I said earlier, there is nothing wrong with going to a hot tub or sauna. However excessive or prolonged elevation of scrotal temperatures, can have negative implications on fertility and also on pain. You should however aim to relax and not stress it, whenever possible. So, if relaxing in the hot tub for 30 minutes daily is very relaxing for you, then so be it. It is better to be relaxed, because stress can cause an array of symptoms that are bad for your varicocele (discussed further in a later section).

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TESTICULAR HYPOTHERMIA Do not cause testicular hypothermia! You do not want to stress out your testicles! I cannot keep emphasizing this enough. Your testicles are smaller than a golf-ball, and therefore their temperature can change very rapidly. The best idea is to provide an optimal environment for them and allow them to regulate their own temperature. COLD AND HOT WATER ALTERNATIONS Sometimes you find crap on the internet. Don’t stress yourself out with cold and hot water alternations. Don’t do anything that feels stressful. Healing should feel natural and easy. EXERCISE 5: REVERSAL Warming up your testicles can be healthy too! Your goal is not to constantly have cold testicles. You do not want to cool them every hour of the day. You should not cool your testicles for more than fifteen minutes a day. If your testicles do not cool when provided breathable space, do not force them to. Moreover, in contrast to this entire chapter, heating can be very healing and can even reduce pain. WARM OIL MASSAGE A warm oil massage can be very nurturing for the testicles and can alleviate pain. The oils that work best are sesame oil and olive oil. Begin by warming up the oil until it feels warm to the touch. I recommend performing the massage while lying on your back. Once oil is heated, proceed to gently massage your testicles with the oil. Try not to tug on your varicocele while massaging. Continue for 2-5 minutes or until feeling satisfied. The benefit of the warm oil massage is that it can help improve scrotal skin tone and stimulate healthy blood flow to the testicles, both of which are necessary for long-term healing. SIT WITH YOUR LEGS CROSSED I do not know where the nonsense to avoid crossing your legs at all costs started. I guess it makes some sense if you think that crossing your legs traps enough heat to hard-boil your testicles. Nevertheless, the reality is that crossing your legs can be both relaxing and nurturing. Crossing your legs can reduce blood flow and pressure to the lower extremities. Furthermore, it is natural. It will not kill your testicles. You may want to not cross your legs if you are sitting on a cushiony chair, however, I recommend comfort over paranoia.

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CHAPTER III

LIFESTYLE CHANGES

In caring for your varicocele, you might have to make some lifestyle changes. These changes are simple, but they can have a profound impact on the status of your varicocele and the healing process. It also is important to take a holistic approach to improve your entire health and not only focus the varicocele.

EXERCISE 1: STOP CIGARETTE SMOKING, DRINKING ALCOHOL AND DRINKING COFFEE CIGARETTES Over and over again, studies show that cigarette smoking reduces sperm count, density and motility, and leads to higher abnormalities in sperm shape and function. It is also relates to higher rates of hormonal issues and erectile dysfunction. Cigarettes also make blood stickier and less able to flow smoothly. Since your varicocele impedes the blood circulation to your testis, it is important to optimize blood circulation and quality. Studies have found improvements of all fertility parameters in those who stop cigarette smoking. ALCOHOL Alcohol is actually a leading cause of erectile dysfunction. It lowers testosterone levels, libido, and negatively effects many of the same parameters as smoking. Related to the varicocele, alcohol over-loads the liver (which is responsible for filtering blood), making your blood more viscous (thick), and increases the cardiac output (causing hear to pump more blood). Pumping more and thicker blood increase the amount of pooled blood in the varicocele. COFFEE As for coffee (or caffeine), the scientific literature has mixed results on the effects of caffeine on fertility. However, since there is controversy around the topic, and since it is not mandatory for you to be drinking coffee, I recommend staying away from it. I especially recommend staying away from coffee if you are a smoker or drinker since evidence suggests that comorbidity is higher in mixed users. Relative to your varicocele though, caffeine may be making your symptoms worse. Caffeine causes a mildly anxious state that lasts for hours, until it filters out of your system. The half-life for caffeine in your body is six hours. This means if you drink a cup of coffee with 140 mg of caffeine at 10 AM, by 4 PM your body still has 70 mg of caffeine. By 10 PM you still have 35 mg of caffeine in your system. Meaning that by the time you go to bed at 10 PM, you still have a quarter of a cup of coffee in your body. So the mildly-anxious state lasts almost as long as you have caffeine in your system. Caffeine is a drug that acts directly on the brain by stimulating the sympathetic pathway (fight or flight response). The sympathetic pathway is bad for both digestion and sleep! Now, consider that Copy Right Daniel Johnson 2014

caffeine causes thinning of the stomach mucus lining, irritable bowel syndrome, insomnia, and relates to lymphatic swelling. It is up to you to make the changes necessary for improving your health. EXERCISE 2: HEALTHY MASTURBATION Recent research has shown that Excess Nitrous Oxide (NO) is released from the testicular veins. Excess NO is toxic. It impairs fertility and increases total vein diameter and is associated with higher grade varicocele and disease progression with age. Excess masturbation can lead to excess NO production in surrounding tissue. What is excess? More than twice or times a day is excessive. Even after masturbating once, varicose veins typically swell, the testicles heat up and the cremaster muscle relaxes. Pooling of blood in this case is not the cause of faulty valves but of excessive NO production and induced increase in blood circulation to the testicles. This is not to mention that your testicles heat up after masturbation, to recover. You should especially minimize masturbation if you are trying to have kids. It takes about sixty days for sperm to mature and you want to have as much mature seaman as possible during conception. Overall, I am definitely not saying stop masturbating, but I am saying excess is not good for your varicocele. Tugging on your skin while masturbating (especially if you are circumcised) can irritate your veins and cause pain. For similar reasons you should also definitely refrain from masturbating fast and strong like a jackhammer. Also excessive and hard masturbation (especially without lubrication) irritates the skin and reduces penile sensitivity. Reduced sensitivity leads to easily lost erections, less enjoyment of sex, and a condition you might have heard about from a bragging friend, where he lasts hours without being able to climax. Squeezing your hand around your shaft when you masturbate (masturbating hard) causes excess pressure that can irritate your varicocele. So masturbate softly and use lubrication. Off-topic note: Stop all natural penis enlargement exercises, as these often significantly contribute to varicocele development.

EXERCISE 3: CONSTIPATION AND BOWES Interestingly, there is a difference in the occurrence of varicosities (including varicocele) in developed countries versus developing countries. Developing countries have much lower rates of varicosities. This discrepancy is largely due to the difference in diets and lifestyle.

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Chronic constipation is one of the most common functional gastrointestinal disorders, affecting up to 27% of the North American population. Chronic constipation can cause varicocele. Since constipation requires pushing hard to have a bowel movement, it severely increases the pressure in your hips. This, in the long term contributes to both varicocele development and severity. Constipation also typically comes with irregular bowel movements, which mean that the Nutcracker effect (squeezing of your internal veins) is further exacerbated because of the build-up of excrements in your intestines. For optimal bowel movements, you have to manage your stress, diet, activity level, and maybe try a few supplements. Stress can cause many negative bodily symptoms, including irregular bowel movements, constipation, inflammatory bowel syndrome, and irritable bowel syndrome. It is a major factor you have to get under control, see the section on stress for further details. You really have to take a look at your stool in the toilet. If it is too hard, maybe you need more indigestible fibre from vegetables. If it is not smooth enough it might need more volume as in from legumes (e.g. beans, lentils, chickpeas, etc.). If it is falls apart too easily, maybe you need more sticky foods like oats in your diet and less acidic and hard to digest foods. If your food just does not digest well, maybe you should have more yogurt or other foods with probiotics. Consider taking vitamin D supplement if you do not get at least 15 minutes of direct sunlight daily, as it is important for proper digestion and relieving inflammation. You could also try digestive enzymes and probiotics supplements. You need to move to stimulate bowel movement. Exercising in general, especially inversions, twist and some of the ones recommended later in this guide are very helpful. Even going out for a walk can be very stimulating for a bowel movement. Dehydration is also a major cause of dry, hard stools. As your food passes through your intestines, the moisture from it is soaked up. This is even more pronounced when you are dehydrated, since the body wants to retain as much water as possible. BLOATING, DIGESTION AND CIRCULATION Overall digestive health is vitally important, not only for your varicocele, but for your general health. Bloating is a digestive problem that is very common. The main cause of bloating is stress. You have to get your life handled, and manage your stress better. Other major contributors are lack of exercise, poor diet, and eating on the go. Exercise is important for your bowels to move (will be discussed in much more detail later). A diet low in probiotics, high in processed foods and sugar tends to cause bloating. Eating too quickly, then exercising or running for the day’s tasks can irritate the digestive system, leading to bloating. Take more time when it comes to food, eat a bit slower, and make your diet more wholesome. Copy Right Daniel Johnson 2014

Did you know that the human body contains 10 times more bacterial cells than human cells? So, from that it is not hard to understand why upsetting the bacterial balance can cause many disorders. Our focus is on digestion, and probiotics are vitally important. You need to have some fermented food as a regular part of your diet. I am not talking about artificially sweetened yogurt, what I mean is fermented food like plain white yogurt, pickled food (e.g., pickled cucumber, hot peppers, and cauliflower), soaked nuts (e.g. almonds, walnuts, sunflower seeds), miso, tempeh, kimchi, etc. Improving blood and lymph circulation are also critically important. Best advice is to exercise daily. Aside from exercising regularly, to further enhance blood circulation you can try supplementing with grape seed extract, horse chestnut seed extract, Butcher’s Broom, bioflavonoids, and bilberry. These will be further discussed in the diet and nutrition section. LYMPH Disturbances in the lymphatic system may also contribute to or be the cause of some cases of varicocele. Specifically, we are concerned with the enlargement of the groin lymph nodes (in the retroperitoneum space) and inadequate lymph drainage. Enlargement of these lymph nodes impede the blow flow of the spermatic veins and causes the development of varicocele. Improper lymph drainage leads to immune and digestive problems. The lymphatic system is an intricate system much like the venous system. It branches and reaches almost your entire body. Its major functions are cleaning out waste products and fighting invading bacteria or viruses. Therefore, swelling of the lymph typically is indicative of high levels of toxicity or foreign invaders. Unlike the venous system, the lymphatic system does not have the heart to pump it throughout your body. Instead, it relies mainly on the flexion and relaxation of surrounding muscular tissue to flow. Therefore, it is important to breathe deeply through your stomach and to have an active lifestyle. Overall, the idea is to have an active lifestyle and keep your immune system strong.

EXERCISE 4: CHRONIC COUGH Chronic cough can affect your varicocele negatively. Coughing increases pressure in the torso and can irritate your varicocele. Some cough you can control. For example, if you live in a city that has particularly dry air that irritates your airway, you can purchase a humidifier for your home and moisturize your nostrils with a cream. Since the causes of chronic cough vary greatly, I recommend consulting a qualified physician for more information.

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EXERCISE 5: SQUATTING ON THE TOILET Toilets are unnatural for bowel movement. They force a posture that pinches and hinders the natural flow of the stool. This means excess pressure as you push and force the stool out and only partial emptying of the bowels. This is a very important and easy change to make. Correcting this is equivalent to for controlling one of the stress factors that contribute to varicocele development. I cannot emphasize how big of a difference this makes. You will also instantly notice the difference in the ease of your bowel movements! The idea is to raise your knees up so that your body is in more of a squatting position. Similar to the position used for Eastern squatting toilets. To further enhance the ease of flow of the stool, bend over your legs (do not sit up straight), raise your chest up slightly and spread your butt cheeks. To raise your knees up into a more squat position, you could buy a squatting stool, but I recommend buying yoga foam blocks instead because they are less embarrassing to keep around the washroom. However, you can really use anything to prop up your legs. If you do not have access to anything to prop up your legs bend over closer to your knees; do not sit up straight.

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CHAPTER IV

HEALING

As mentioned earlier, a complex of factors cause the development of varicocele. Therefore, you cannot merely follow this section and expect healing to occur. The chapters of this book are merely for organization and referencing purposes. No single exercise will heal your varicocele. You cannot heal your varicocele without removing the stresses that accompany genital hyperthermia. Nor can you heal your varicocele without making several the lifestyle changes that accompany you daily. It is also of critical importance to improve digestive health and to have a more active lifestyle. Without these, you cannot heal your varicocele, as you have not removed the stress factors responsible for causing and stabilizing the varicocele.

EXERCISE 1: BREATHING Generally, you want to breathe deeply through your stomach. When you inhale, your stomach should come out and when you exhale, it should go in. This movement naturally massages your internal organs improving lymph movement, digestive health, and enhancing blood circulation. Breathing deeply also nourishes the whole body with extra supply of oxygen, removes toxins from the blood and purifies it. It normalizes the phlegm and bile balance in the body. Deep breathing also reduces stress and anxiety, putting the body into a healing state. Breathing up in the lungs is very shallow. It also does not come with the same benefits of deep breathing. I recommend practicing at least five minutes of deep breathing daily; it is very helpful healing the varicocele.

EXERCISE 2: SLEEP Sleep is so valuable for healing that it is worth the reiteration. Having a set-bedtime and a night-time routine have been shown again and again to be the most effective ways of falling asleep quickly and getting a good night’s rest. You may also want to try exercising intensely throughout the day, having a banana or milk before bed, taking time to wind-down, or any other remedies that work well for you. However, none of this is as important as having a set time for sleep. Sleeping well decrease risk of heart related disorders, fights weight gain, and improves ability to cope with stress. As noted earlier, do not have caffeine at night. If you are going to have caffeine, have it in the morning so that it is mostly out of your system before going to sleep.

EXERCISE 3:

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SCROTAL TUCK As mentioned earlier, strengthening the cremaster muscle is important for long term healing. Furthermore, their strengthening is critical for reducing the embarrassing scrotal sag. Sagging occurs because the varicocele weighs down and over time, stretches the cremaster muscles of the affected side. As the testicles hang lower, more blood is able to pool and a feedback mechanism initiates that increases the severity of the varicocele over time. Hanging low with pooled blood also tugs on your varicose veins and can be the cause of pain. Therefore, it is important to strengthen this muscle to aid in long-term healing and pain relief. I highly recommend that you perform this exercise while lying down, before bed or with your legs up on the wall, to minimize the pressure accompanied by exercise. To get the feel for the exercise, begin by contracting your anus muscle (your butt hole) as if you are holding back gas. As you do this, try to feel as if you are pulling your testicles up and toward your body. With experience, you will become more and more able to tense your scrotal muscles and relax your anus. Hold the tension for a few seconds and then slowly release the muscle. It is important to have high time under tension with little rest since the cremaster muscle is a smooth muscle that requires long time under tension to strengthen. Like any exercise, this may not be easy to do at first and you may only be able to tighten the muscle for a few seconds, but aim to have the muscle under at least two minutes of tension total. You want to hold the tension for either 5 or 10 seconds and then slowly release the muscle. Rest at most for 5 seconds and then tense again. Repeat this (contract and release) until you have a total time under tension of 2 minutes (e.g., repeat 12 times if you are holding the tension for 10 seconds). Perform this exercise every day before bed. STRETCHING THE CREMASTER MUSCLE Both sides of your cremaster muscle strengthen when you perform scrotal tuck exercise. Therefore, it is ideal that you stretch the cremaster muscle of the unaffected side, so that it does not become excessively tight. Perform this exercise only when lying down or with your feet up on the wall. Simply grab the scrotum of the unaffected side at the bottom and stretch it out and away from the body. Hold this for at least 20 seconds to induce an effective stretch. Do not stretch too hard. A gentle stretch is enough. Furthermore, make sure not to tug on the varicose veins, as this might irritate them and cause pain. Perform this exercise every other time you perform the scrotal tuck exercise.

EXERCISE 4: STRENGTHEN VEINS Improving tone of the muscle surrounding veins is critical for healing. Strengthening these muscles will reduce the diameter of the blood vessels and make them more resistant to pressure.

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COOLING FOR VENOUS TONE Cooling is an effective way of contracting and strengthening veins. When you begin the healing process, you should do some sort of cooling a two or three times per week to strengthen your veins. As you progress however, you should not cool as often, but aim for normalizing scrotal temperatures instead (see chapter on cooling). NUTRITION FOR VENOUS TONE Nutrition can be very effective for improving venous tone. Of note are bilberries, bioflavonoids, Butcher’s Broom, gotu kola, horse chestnut seed, and vitamins B, C and E. These contain specific chemical that act as anti-oxidants (oxidative damage prevents healing of varicose veins), alleviate venous inflammation, increases vein elasticity, protect venous connective tissue, tighten blood vessels, repair and maintain veins, enhance venous emptying, and have blood-thinning effects. See the chapter on nutrition for further details. EXERCISING FOR VENOUS TONE Aerobic exercises are particularly important for stimulating venous strengthening and improving circulatory health. See the chapter on fitness and exercises for more details.

EXERCISE 5: CREATING SPACE IN ABDOMINAL CAVITY This exercise is one of the most important exercises you must perform for healing. It is so effective that you should be able to note improvements in your varicocele right after performing it. It works by increasing space in the abdominal cavity and shifts around your internal organs, effectively alleviating the Nutcracker effect. For long-term healing, you must perform this exercise, as it will relieve the Nutcracker effect. This exercise has two variations. You should perform both. REACHING UP AND TO THE SIDES To perform this exercise, begin standing. Exhale fully, and then reach up as high as you can with your arms. Keep your lungs empty of air, and raise your chest up as you reach straight up or to either side. You should note that as you raise your chest up, your navel pulls in and your digestive organs move upward. Hold the stretch for a moment, then inhale slowly, and relax down. Repeat five times upwards, and to each side. BENT REACHING FORWARD AND TO THE SIDES Perform this exercise when standing. You want bend and turn at your hip until your body is parallel with the ground. Exhale all of the air out of your lungs. Perform an axial extension with your upper body in this position by reaching forward with the crown of your head and reach forward, or to either side with your head. You can also perform this by reaching forward with your arms instead of the crown of the head. Hold the stretch for a second, then inhale slowly and relax to center. Repeat five times each side.

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CHAPTER V

FERTILITY AND HORMONES

About one in four people with varicocele experience fertility problems. That is about 2-4% of the population. The main parameters used for assessing fertility are sperm count, volume, morphology, and motility, as well as sperm DNA damage and testicular volume. Varicocele negatively effects all these parameters. Varicocele can also cause a decrease in testosterone levels, leading to decreased sexual performance and slight feminization of the body and mind (e.g., enlargement of breast tissue, erectile dysfunction, passivity and decrease assertiveness). To improve fertility, you must relieve testicular hyperthermia, improve testicular blood flow (to reduce reactive oxygen species and remove toxins), improve your diet, and normalize your hormones. Fertility and hormones are very interrelated; the testis need to be healthy to stimulate testosterone release and testosterone release is required for testicular health and sperm development. Lower testicular volume is common in those diagnosed with a varicocele. Normal volume is normally greater than 15 cm3. Varicocele causes an average decrease of 5 cm3 in volume on the affected side. Notably the unaffected side may also shrink because of the disrupted hormones of the effected side. Higher grade or bilateral varicocele causes the biggest decrease in volume. This section has exercises specifically selected for improving fertility and stimulating testicular growth. However, do not neglect the other sections of the book, since they are varicocele specific and will contribute to recovery. Your testicles have a particular firmness to them when they are healthy. Notice that they have a nice healthy feel when you take care of them and in contrast, a soggy and droopy feel when stressed. As you following this guide, you will notice that the affected side’s firmness returns very quickly.

EXERCISE 1: TESTICLE MASSAGE Testicle Massage is a great exercise for increasing blood flow to your testicles, stimulating their growth and improving fertility and testosterone levels. I do not recommend this exercise if your varicocele is inflamed or hurting, since it may aggravate your condition. However, when practiced properly, this is the best exercise for improving fertility, returning firmness to your testicles and increasing their size. It can also bring pain relief if your pain originates from the testis and not your varicocele. Size and firmness are clear indicators of how healthy your testicles are. You can feel when your testicles healthy. When you squeeze them lightly, you can tell that they have a nice firm and plump feeling to them. The same is true about the scrotum; when it is healthy, it has a nice leathery texture rather than a saggy and droopy one. Copy Right Daniel Johnson 2014

Only perform this exercise while lying on your back with your legs on the wall. Doing so will drain your varicose veins, and protect them from light tugging that the exercise may accompany. I recommend performing this exercise in the morning when your varicocele is least irritable. However, it can also perform it at night in bed before going to sleep. Begin by grabbing your testis in one hand, and lightly moving it away from your body. Only pull so far away as you need to perform the exercise. This is the starting position. Then, using both palms, roll your testicle as if you are making a ball out of Playdough (or clays). Perform this exercise every other day for about 1 to 2 minutes. Note: Do not perform this exercise when in pain or when your varicose veins are extra inflamed. Also, do not tug on your varicose veins, as this will irritate them and cause pain.

EXERCISE 2: PENIS STRETCH, PERINEAL MASSAGE AND PROSTATE STIMULATION The perineum refers to the area below the abdomen and between the thighs and anus. These exercises are gentle self-stretching and massage, targeting the small muscles of perineum and stimulating the prostate gland. The prostate gland is located deep of the perineum and can be stimulated by massaging the perineum. It is responsible for producing prostatic fluid, which is the part of the ejaculate that helps semen motility. Stretching and massaging these areas improves blood circulation to the entire genitals, relieves tension (by reducing excess tightness and improving mobility of legs and hips), and greatly enhances testosterone release, sex drive and causes rock hard and lasting erections. These exercises are well suited for erectile dysfunctions and improving seaman parameters. They are some of the best exercises to perform for sedentary or over-active lifestyles (especially if you bike a lot). They also help maintain and strengthen the ligaments and tendons of the pelvic floor by relieving excess tension and pressure built by knots and stiffness in the tissue. PENIS STRETCHING For this first exercise, begin by lying on your back, with your legs spread slightly and knees bent. Make sure that your varicose veins are drained. Start by grabbing your penis on the upper part of the shaft, close to the penis head. Pull your penis up toward your abdomen, until you feel a light stretch. Hold this for 5 to 10 seconds. Then follow up by stretching your penis to the left, right, down and straight out. Switch hands and repeat the sequence one more time. Remember that a light stretch is good enough. Make sure to not to tug on your varicose veins. If you have to, hold your scrotum in one place while performing the stretches. You can perform this exercise as regularly as you like. It is especially effective after long hours of sitting, standing, running or biking. The stretching should last about two minutes. Copy Right Daniel Johnson 2014

PERINEAL MASSAGE The area between your scrotum and your anus and between your thighs is the perinium. Down the center of the perineum, you will feel a rope or rod like structure (which is the continuation of your urethra and penal glans). While lying down, gently massage either side of this rod. Massage with several fingers at once, slightly digging your fingers into the tissue while stroking. Note that the varicocele veins enter your body along the side of this rod. Make sure not to touch them! Massaging this area is great for relieving tension built up after prolonged sitting or biking. Perform this exercise at most three times per week for about 30 seconds. PROSTATE STIMULATION To stimulate the prostate, follow the rod down to the area just before your anus. If you poke in to this area, you should to feel a soft area roughly the circumference of your finger. Mildly poke into and rub this area. This exercise produces rock hard erections and increase ejaculate volume. Perform it maximum twice a week for 30 seconds. EXERCISE 3: HEALTHY WEIGHT You probably knew that this section was coming. Being overweight and obese have been shown to decrease testosterone, increase estrogens, and have detrimental effects on almost all sperm parameters. Obese individuals report more varicocele symptoms such as aching and throbbing. Obesity can cause insulin resistance and diabetes. Diabetes comes with an array of negative effects, including digestive and fertility issues. The Body Mass Index (BMI) is a commonly used to define weight categories of underweight, normal weight, overweight, obese and severely obese. The BMI is dependent on both weight and height. You can calculate your BMI by using a BMI calculator found online with the key words “BMI calculator”. BMI is a good predictor of both varicocele and fertility. Those with above normal weight generally have a higher chance of developing varicocele and have a 24% lower sperm count on average than those in the normal BMI range. For every three-point increase in BMI, above normal weight, male infertility decreases by about 10%. Waist circumference is actually a better predictor of varicocele development than BMI. Excess fat around the waist puts pressure on the renal and spermatic veins and impairs their blood flow, increasing the likelihood of developing varicocele. Furthermore, taller individuals with normal BMI are also at increased risk since the spermatic vein has to travel further to reach the renal vein (having a higher incidence of pressure built on it).

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The solution is obvious. If you are overweight, lose the weight! The best advice I can give you is to eat healthy and exercise frequently. Cut out the fast food, junk food, artificially sweetened food, and overly processed food. Make your diet balanced and wholesome. Do a bit of research on what foods are good and bad for you. If you do not have a gym membership, get one. Go to the gym at least five days a week, consistently for at least three months. Do a bit of research on what exercises are most effective. Follow this simple advice (exercise frequently and eat healthy) and you will lose weight in no time.

EXERCISE 4: REDUCE STRESS So you might think, “Stress, I could have just Googled that…” However, stress can have a huge negative global impact on the body. Relevant to the varicocele, it can impair healthy blood flow, reduce the effectiveness of digestion and bowel movements, and has a direct negative impact on fertility. Stress messes up healthy blood flow at multiple levels: It reduces the amount of nutrients in the blood, increases the acidity of the blood, may causes high blood pressure, and decreases blood flow to digestive and reproductive organs. All of these create an environment that is not healthy for healing and optimal function for your testicles. More relevant to the varicocele, stress suppresses normal digestion, increases inflammation and bloating, reduces the number of bowel movements (suppresses the urge to go to move bowels), increases bowel irregularly, and is associated with irritable bowel syndrome. This is all bad because irregular and less frequent bowel movements and increased inflammation of the gut and increase pressure in the mid-section and therefore contribute significantly to varicocele development and severity. Stress can also directly decrease fertility because it reduces testosterone production which is required for normal spermatogenesis. Moderate to severe stress is associated with a 40-50% decrease in sperm count and total number of motile sperm. If you follow the rest of this guide but you are not handling your stress, you will greatly reduce the effectiveness of all the exercises. So, reduce your stress, improve your internal control, selfesteem, optimism, coping strategies, take more action and seek emotional support and social contacts if needed.

EXERCISE 5: KEGEL One of the most well recognized exercises for naturally enhancing penile performance is the kegel (also known as the pelvic floor exercise). Over the past 60 years, it has been shown repeatedly to be effective at improving erections and enhancing sexual performance. It is also beneficial for the prostate gland, testicles and is effective for reducing varicocele related pain.

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Be cautioned, this exercise will give you rock-hard erections. If you cannot control the impulse to masturbate, then do not perform this exercise too often. To perform a kegel, tense the same muscles you use when you stop urinating. These are the muscles of the pelvic floor, including the pubococcygeus muscle (commonly referred to as the PC muscle). Perform either 10 repetitions of 10-second holds, with brief rests, or 100 repetitions of one-second holds (both are effective). Those without varicocele can perform this exercise anywhere. However, for those with varicocele, I highly recommend performing this exercise while lying down or with your legs on the wall, as it increases pressure in the lower abdomen and pelvic region. I recommend performing this exercise five days a week for three months, then slowly winding down to once a week.

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CHAPTER VI

DIET AND NUTRITION

A good diet with proper nutrition will make a big difference in healing and reducing negative symptoms. Relevant to healing and optimizing fertility, a good diet consists of foods that improve circulatory health, are high in antioxidants, optimize testosterone production, and aid in digestion. I highly recommend trying out a few different supplements. These supplements are inexpensive and have scientifically proven efficacy. So, I highly recommend testing them out. Many of the recommended supplements are anti-inflammatory, help strengthen connective tissue that support veins, contain vascular tonifying agents and have chemicals that help develop and support good vascular and circulatory health. Caution: These supplements may interact with certain medications. They may cause negative side effects. Make sure to ask a qualified healthcare practitioner before trying any supplement.

EXERCISE 1: BLOOD, CIRCULATION, AND VENOUS HEALTH BILBERRY (VACCINIUM ERICACEAE) Bilberry extract reduces lymph node hyper-activity, has anti-oxidative effects, reduces diabetic symptoms, alleviates symptoms of inflammatory bowel disease and irritable bowel syndrome, and reduces negative symptoms associated with diarrhea. It has also been shown to help circulatory conditions and is used as a treatment for varicose veins because it reduces oxidative damage and venous inflammation. There is a lot of scientific literature supporting the effectiveness of bilberry extract. I also vouch for its effectiveness. BIOFLAVONOIDS (GRAPE SEED AND PINE BARK) The most effective bioflavonoids are diosmin, oligomeric proanthocyanidin complexes, and hesperidin. Grape seed and pine bark extract are high these bioflavonoids. Bioflavonoid supplementation is effective for treatment of venous insufficiency (varicosities). Bioflavonoids are vasculoprotective (because of their anti-oxidant properties), reduce inflammation and pain, improve venous tone and elasticity, protect connective tissue structure, increase vascular permeability, vascular function, and improve capillary strength and function. Foods high in bioflavonoids include oranges, apples, apricots, blueberries, tomatoes pears raspberries, strawberries, cherries, white, yellow and orange vegetables, parsley, tomatoes, onions, peppers, and buckwheat. You should include some of these as a regular part of your diet.

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BUTCHER’S BROOM (RUSCUS ACULEATUS) Burtcher’s Broom has a long history of use in folk medicine for treatment of inflammation and varicosities. Now, scientific evidence also backs its efficacy. Butcher’s Broom maintains venous tone, enhances venous emptying and improves blood circulation. It also is effective at relieving constipation and abnormal water retention. Overall, Butcher’s Broom is effective for improving blood circulation and increasing blood vessel tightness and strength. GOTU KOLA (CENTELLA ASIATICA) Gotu kola is a plant supplement with lots of scientific backing for its effectiveness at treating varicosities. It greatly enhances connective tissue integrity, elevates antioxidant levels in wound healing, and is generally important for vascular integrity. horse chestnut SEED (Aesculus Hippocastanum) Hourse chestnut seed extract is also very effective at treating varicosities. It has vasculoprotective properties, is anti-inflammatory, and a strong antioxidant. It is great for strengthening venous connective tissue and vein walls. As well, it tightens tissue surrounding veins, helping increase vascular tone.

VITAMINS VITAMIN B There are no real benefits of vitamin B complex for varicose veins. VITAMIN C Vitamin C is important for repairing veins and keeping them flexible and strong. Food high in vitamin C includes peppers, guavas, parsley, kale, watercress, broccoli, Brussels sprouts, kiwi fruits, papaya, and oranges. VITAMIN E There are no real benefits of vitamin E for varicose veins. VITAMIN K Vitamin K may boost testosterone. Food high in vitamin K includes beef, dairy, eggs, spinach, kale, green peas, watercress cabbage, basil, sage, thyme, cayenne pepper, chilli powder and paprika.

EXERCISE 2: BOWEL MOVEMENTS Ideally you want soft, well-formed, regular bowel movements, the idea being to minimize the time spent in forceful Valsalva (holding breath and pushing). A well-formed stool is one that literally slides out of the anus.

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Having a set time for bowel movements is very important. For example, try to have a bowel movement every morning when you wake up, after breakfast. Your body will get used to this, making the bowel movements much more effective and easy. Even when following this section on improving bowel movements, please remember that a balanced and healthy diet is very important. If you have further questions or concerns, consult your healthcare practitioner. STOOL VOLUME Increasing stool volume is important for smoothing and moistening bowels, may normalize stickiness of stools and is crucial for making bowel movements more regular and timely (normalizes transit time of bowel movements). As mentioned earlier, if your stool is lacking volume, you should eat more vegetables, fruits, legumes, nuts and seeds. For volume, you generally want to have foods with high insoluble fibre that are also non-acidic. Here are some foods that I highly recommend for increasing volume: Bananas, avocados, green beans, turnip, sweet potatoes, yams, beans, chickpeas, lentils, rice, and spaghetti. These are great foods for increasing volume because they are easy on the digestive system and are mainly alkaline, therefore you can eat a lot of them. STOOL STICKINESS Stool stickiness can go two ways. First your stools may be too sticky, as indicated by overly hard and tight stools. Second your stools may be not sticky enough as indicated by stools that easily fall apart and do not form together. The treatment for excessively sticky stools is to reduce dairy and meat intake (if excessive) and increase moisture and volume of your stools. To do this, drink more water and follow the guidelines in the stool volume section. The treatment for non-sticky stools is to increase intake of foods that are easy to digest and that contain probiotics. Here is a list of foods you should consider: Easy to digest foods like bananas, rice, spaghetti, cooked vegetables, eggs, oats and white bread, as well as fermented foods like kimchi, miso, pickled foods, sauerkraut, yogurt, and chutneys. Furthermore, it is likely that your stools fall apart easily if your diet consists of mainly raw fruits and vegetables. If this is the case for you, I recommend reducing the amount of raw fruits and vegetables that you consume. Once your stools begin forming well again, you can find a middle ground with your ideal diet and well-formed stools.

EXERCISE 3: CAUTION Now, notice that I am only cautioning you about certain foods, I am not saying never to eat them again. Copy Right Daniel Johnson 2014

I recommend staying away from soy products and omega 3 supplements since there is controversy around their impact on male fertility. Now also notice that I did also recommend miso, which is fermented soy. What I am not saying is “never touch soy products”. I am merely cautioning excessive use. I do also recommend having fish in your diet as a source of omega 3 fatty acids. However, you probably do not need to supplement with omega 3. I do highly recommend reducing meat intake to at most two or three times a week. However, you will have to make many dietary changes to accommodate this. Note that I am not here to endorse vegetarianism, and I think that having meat occasionally is healthy. However, relevant to the varicocele, meat products, especially red meat, take a long time to digest and are slow to move through the digestive system. I do endorse substituting regular meat intake with alternatives like: Legumes (including chickpeas, hummus, beans, lentils, etc.), eggs, nuts, seeds, mushrooms, fish, grain products, root vegetables like turnips, beats, sweet potatoes, yam, and high protein vegetables like green peas, broccoli, asparagus, spinach, kale and watercress. Note that some of these foods may be bloating; therefore you have to find the right balance for yourself.

EXERCISE 4: DIET AND HORMONES BOOST TESTOSTERONE Fat is good for you. Do not subscribe to diets that are low in fat. At least 30-50% of your calorie intake should consist of fat. Generally, monounsaturated and saturated fats boost testosterone, while polyunsaturated fats decrease testosterone. Foods that I recommend are olives, olive oil, coconut oil, nuts, eggs (with yolk), avocados, peanut butter, dairy products, and red meat. It might sound contradictory to say to eat dairy and red meat, since they may have a negative impact on bowel movement, but every-body is different and you have to find the right balance for yourself. Zinc also boosts testosterone levels. Instead of supplementing with zinc, I recommend just consuming food high in zinc, including beef, poultry, liver, shell-fish, rice, wheat, spinach, nuts, seeds, and legumes. Quinoa, garlic and vitamin D also notably boost testosterone levels. NORMALIZE ESTROGEN Foods shown to decrease estrogen levels include broccoli, cauliflower, cabbage, and mustards, brussels sprouts, turnips, kale, bok choy, and green tea. Vitamin B6 is also note-worthy for normalizing estrogen levels.

EXERCISE 5: NORMAL AMOUNT OF SALT High salt levels cause many symptoms that are bad for your varicocele. For example, high salt levels cause bacteria in the stomach to deteriorate the stomach lining, leading to inflammation. Copy Right Daniel Johnson 2014

Salt also slows down digestion by interfering with digestive enzyme secretion. It can also dehydrate stools, causing constipation. Furthermore, high salt levels increase blood pressure and blood viscosity. Note: I am not saying stop having salt in your diet. Salt is critical for bodily function. I am saying normalize your salt intake. For example, if today you ate some food with high salt content, do not add extra salt to the food that you cook.

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CHAPTER VII

FITNESS AND EXERCISES

As mentioned earlier, this entire book is important for healing. I do not want to miss direct you into thinking that the chapter for cooling is only for improving fertility, or that the healing section is all you need to follow. No, I want to embark upon you the sense that healing involves a change in life-style. It is not just a matter of cooling your testicles, but a matter of making the critical lifestyle changes, performing healing exercises, improving your nutritional intake and strengthening your body’s immune, digestive, vascular and muscular systems. Overall the idea is to live a healthy lifestyle. I have provided you with the tools proven effective for this lifestyle. You are responsible for healing your varicocele and optimizing your fertility. You need to take action! Note: I highly recommend doing a video search for each of these exercises, using the exercise name as the search keywords. The exercises will make much more sense when accompanied with visuals. Caution: Please consult a qualified healthcare practitioner before attempting any of these exercises, especially if you have heart, circulatory, spinal or joint conditions.

EXERCISE 1: TRANSVERSE ABDOMINAL During exercise, you usually want to exhale when you push against gravity and inhale when working with gravity. You can also think of it as exhale when exerting and inhale while working passively (i.e., moving with gravity). As well, you want to exhale when you do forward bends (flexing at the hips or abdominals), and inhale when unbending or stretching backwards (extending at the hips or abdominals). The idea behind these breathing patterns is to strengthen your abs (mainly the transverse abdominis), prevent unnecessary stress on your internal organs, and to reduce pressure built up in the lower torso when exercising. They also ensure that your internal organs move out of the way when you bend forward and are secure during exercise.

EXERCISE 2: AXIAL EXTENSION Axial extension is a very important exercise for relieving stress from your varicocele. It is practiced in almost every sport and yoga. The exercise lengthens your torso, shifting the weight from the varicocele and digestive organs on to the core muscles. It also opens up space in your torso and aligns your digestive organs, making space for more optimal blood flow. This exercise is one of my favourite exercises because it can be performed at any time. You can do it while lying, sitting, walking, running or exercising.

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Simply put, the axial extension exercise is a lengthening of the torso and neck. To perform it, reach for the ceiling with crown of your head and for the floor with your hips. You should feel a stretch in your torso and neck and your chin retracting and tucking in slightly. It is critically important to perform an axial extension when carrying heavy loads (e.g., when wearing a heavy backpack, lifting weights at the gym, carrying groceries, etc.). Note: The goal is not to cancel out the natural arcs of your spine, but to correct posture by merely lengthening the spine up.

EXERCISE 3: SWIMMING Swimming is one of the best exercises for varicose veins. It is cooling therefore improves venous tone and fertility. Furthermore, when swimming the body is horizontal, and therefore less blood pressure is on the varicocele. Swimming is also good for lowering stress and for stimulating bowel movements (because it requires axial extension and compression, as well as twisting of core muscles). I highly recommend swimming. I cannot emphasize enough how much it will help with healing. Do not wear a tight swimsuit.

EXERCISE 4: CORE EXERCISES Bending forward, backward and to the sides, twisting, axially extending, pulling in your navel and letting it out (as in breathing) are all the motions you can perform with your core muscles. Relevant to the varicocele, you want to strengthen your core so that it takes excess load off your internal organs. You want to perform bends, twists and extensions to massage your internal organs and induce movement of your bowels. Ideally, you should not exercise for a time after eating. This time is shorter what you ate is easy to digest (e.g., juice or bread) and longer for food that takes more time to digest (e.g., large meals or meals high in fat). CRUNCHES Crunches are a straightforward and important exercise. They squeeze your navel area and are a good exercise for increasing abdominal strength and massaging your digestive organs. Begin by lying on your back with your knees bent. Your feet should be about as wide as your hips. Place your hands behind your head so your thumps are underneath your ears and your fingers are on top of your ears. Inhale, curl up and forward, using your abdominal muscles, so that your head, neck and shoulder blades lift off the floor. Pause at the top for a moment for Copy Right Daniel Johnson 2014

further contraction of your abdominal muscles. Slowly exhale and uncurl, lowering back to the ground. That is one repetition. This is a simple and easy exercise to perform. Anyone can do it. I recommend performing at least 25 repetitions daily. Caution: Make sure you do not pull your head forward with your hands. This is not a neck exercise; your neck should remain neutral throughout the motion and should not touch your chest. LEG RAISES To fully massage and tone your digestive organs, you need to target both the upper and lower abdominals. While crunches target your upper abdominals, leg raises target the lower abdominals. Therefore, you should perform both leg raises and crunches. Begin this exercise by lying flat on your back. Then place both hands underneath the middle part of your buttocks, with the palms facing the ground, the fingers straight and making a triangle shape with your thumb and fingers. This is the starting position. Your hands are there to help remove tension from your lower back by serving as a pivot. From the starting position, keep your legs straight and raise them to about 45 degrees. This is the end of the motion. From here return to the starting position, but do not touch the ground with your legs. Repeat the sequence. I recommend performing at least 25 repetitions every day. If you need to make the exercise easier, you can bend your knees or not raise your legs as high. LOWER BACK EXTENSIONS The lower back extension exercise is almost the opposite of the crunch exercise. If you are performing crunches or leg raises, you must also perform this exercise as a counter, or you will develop muscular imbalances. This exercise also has benefits for the varicocele. Place your hands behind your head so your thumps are underneath your ears and your fingers are on top of your ears. Begin the exercise by lying on your front. Put your hands behind your head, with your palms facing the ground and the tips of your thumbs touching just behind your ears. Do not shrug up your shoulders, instead keep them down and relaxed. Inhale and lift your head and chest off the ground. Bend up as far as you can. Hold the top position of a second and then exhale and come down slowly. That is one repetition. Do not over exert yourself. Do not strain your neck; keep it in a neutral position. Your goal is to get a good extension through the abdominals and tone your digestive tract. I recommend performing at least 25 repetitions daily. Copy Right Daniel Johnson 2014

STANDING TWISTS It is easy to change the intensity of the standing twist exercise. It good as both a mind exercise for warming up in the mornings and a as an intense exercise for strengthening your core muscles (specifically the external and internal oblique muscles). Begin by standing with the heels of your feet out at shoulder length or slightly wider, with your feet not pointing straight but about 30 ° out. Have a slight bend at the knees. This is the stance. Begin the exercise by twisting your torso to the left and the right. This exercise more easy if your arms are closer to your body and if your twist more slowly. To increase the intensity of this exercise, fan your arms out more wide and twist more quickly. Note: Keep an axial extension throughout the exercise. It does not matter how intense the exercise is, your goal is not six pack abs, but to massage your internal organs. I recommend performing minimum 25 repetitions (twists both left and right side equals one repetition) of this exercise daily. You have three options for breathing, I recommend alternating through them. You can inhale when turning left, exhale when turning right and vice versa, or inhale as you begin to turn and exhale as your finish the turn. REACHING UP Everyone is familiar with this exercise. It is the same as yawning and stretching up. The exercise is an axial extension that also involves a deep breathing (diaphragm). It is good for reliving build up tension and stress and important for shifting around your internal organs and making room for venous drainage. Therefore, it is an important exercise for long-term healing. Perform this exercise anytime, while lying, sitting, or standing. Reach up toward the ceiling as you inhale. When you reach as far as you can, reach a bit more and then relax and exhale. You can also reverse the breathing (very important for healing, as outlined in the chapter on healing). This is a very simple and effective exercise. Perform it several times per day at your convenience. REACHING UP AND TO THE SIDE This is essentially the same exercise as reaching up, but you reach up and then at an angle. The angle is at about 10 to 15 degrees off center (about 11 or 1 on the clock hand). This exercise stretches and strengthens the oblique abdominal muscles and more particularly stimulates the digestive organs that are on either side of your core. Perform this exercise in the morning or throughout the day at your convenience.

EXERCISE 5:

DIGESTIVE EXERCISES Copy Right Daniel Johnson 2014

Technically all of the core exercises are also digestive exercises. However, the core exercises I presented are more for strengthening your core muscles and these digestive exercises are more for improving the health of your digestive organs. RUBBING BELLY When you wake up in the morning, rubbing your belly can be very stimulating for bowel movements. This is an important exercise setting a bowel movement schedule and is good for passing gas. Perform this exercise when standing. Begin with the palms of both hands facing down, with sides of your index fingers and the tips of your thumbs touching, forming a diamond shape. Then place your palms on your belly, with your navel inside the diamond (your hands do not touch your navel). Then gently rub your belly in circles with the palms of your hands. Perform at least ten circles clockwise and at least ten counter clockwise. This is a gentle exercise, do not press into your abdomen, it is more rubbing then pushing in. Your goal is to heat up, gently massage and stimulate blood flow to the area, not to irritate your intestines. Perform this exercise every morning. STANDING FORWARD BENDS Inversion exercises, including the standing forward bend, are generally very good for massaging and toning digestive organs and alleviating flatulence and constipation. To perform this exercise, begin with your heels just a bit narrower than your shoulders. Stretch up in an axial extension and then bend forward. You want to turn at the hips and keep your a neutral arc in your spine as far into the range as possible, until you are fully bent over. Your legs should be straight throughout the range. However, you can bend your knees if you lack the flexibility to bend over fully. You can hold the bottom position for either a moment or a few seconds. Rise back up the same way you went down. Perform at least 10 repetitions every morning or night before sleep. SPHINX POSE The Sphinx pose is a great exercise for improving posture, and increasing blood flow to the digestive and reproductive organs. It is also an easy pose to hold for a few minutes. Start by lying on your front. Place your elbows underneath your shoulders, push yourself up, bending backwards by raising your chest up, and forward. Your elbows should be directly underneath your shoulders and your lower arm on the floor with your palms facing down or in fists. Hold yourself up at the top of this range. Keep the tension in your chest and back muscles by pushing down your arms firmly onto the ground. Do not allow your shoulders to shrug up. Keep the top of your feet flat on the floor and diffuse the tension evenly along your spine (i.e., do not put all the tension on your lower back). Copy Right Daniel Johnson 2014

I recommend performing this exercise every morning and holding it for at least 1 minute. JUMPING Do not underestimate jumping. It is critically important for digestive health (massages internal organs and is great for constipation), hormonal balance, and drainage of stagnant mucus and lymph. Simply stand in one spot and jump up and down. You do not have to jump high; even one or two inches is okay. Use your feet and only a bit of your knees for jumping. Keep the exercise light. Jump at least 25 times in one spot every morning.

EXERCISE 6: LOOSEN UP HIPS HAPPY BABY POSE Happy baby pose is also one of my favourite exercises. It is very easy to perform and hold for long periods and has great benefits. It is an inversion exercise and therefore drains the varicocele. It stretches and tones the pelvic floor, reducing muscular tension and improving blood circulation of the lower torso. Perform this exercise by lying on your back with your knees bent. Then draw your knees into your chest. Then take a hold of the outsides of your feet with your hands. Slowly draw your legs down with your arms until you attain a mild stretch in the muscles between your thighs. You do not want to roll up your lower back when performing this exercise. Instead, try keeping your lower back relatively flat (if you have the flexibility). This exercise is especially important for bikers, runners and anyone who sits or stands for prolonged periods. I recommend performing it every night for at least 30 seconds before sleep. BRIDGE POSE The bridge pose is an inversion exercise that allows your varicocele to drain, and has benefits for both posture and digestion. Begin by lying on your back, with your feet parallel with one another, hip width apart. Your arms should be next to your sides. Bend your legs so that they are about a hand’s length away from your butt. This is the starting position. From here, exhale and rise your hip straight up, as high as you can. Push your hip and chest up and away from your body. This is the end of the pose. Hold this position for at least 3 seconds and then return to the starting position. I recommend performing at least 10 repetitions of this exercise daily, at any time of the day.

EXERCISE 7:

AEROBIC FITNESS (AKA CARDIOVASCULAR FITNESS)

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BIKING Long distance biking is associated with increased incidence and poorer varicocele health. I recommend not biking if you have a varicocele. Biking causes microtrauma to the testicles and veins, tightens up the hip area, creates many muscle imbalances that are difficulty to correct, is associated with genital heat stress and is one of very few exercises that puts very high pressure in the lower hip for long periods of time. If you want to continue biking, I have several recommendations. Do not bike for excessively long periods (e.g., over 30 minutes per day). Do your best to bike on even ground to minimize vibrations that cause trauma. Do not wear underwear when biking, instead wear only breathable shorts. Bike standing once in a while; do not bike sitting for prolonged periods. Perform axial while biking to reduce pressure on your lower torso. Do not bike on a full stomach. Stretch your hips and pelvic floor after biking. RUNNING Most upright exercises are non-ideal for varicocele! People that are more active have a higher chance of developing varicocele. It is therefore not hard to understand why, like biking, long distance running is associated with increased incidence and poorer varicocele health. I recommend not running excessive periods (anything over an hour) if you have a varicocele. However, I do recommend running for improving aerobic fitness. Aerobic exercises are very healthy for improving outcomes of varicocele when performed properly. Exercise in general does improve health and fertility. However, prolonged exercise may be nonideal. I therefore recommend shorter durations of activity, adequate stretching of the hips, and allotted time for draining and relaxing the stress induced on the varicocele (e.g., by putting your legs up on a wall for a few minutes after running for 30 minutes). Instead of wearing tight pants or underwear, wear clothing that is loose and breathable. Exercise on an empty stomach (e.g., do not eat for an hour before exercise). Note that empty stomach does not mean starving. Warmup for at least 5 minutes every single time. Breath fully and avoid the Valsalva maneuver (holding breath and exerting) when possible. Perform a light axial extension during exercise. Drain your varicocele post-exercise.

EXERCISE 8: ANAEROBIC EXERCISE (HIGH INTENSITY EXERCISES) Some examples of anaerobic exercise are weight lifting, martial arts, and sprinting. Anaerobic exercises require short-bursts of high effort. I have the exact same recommendations for anaerobic exercise as just provided for aerobic exercises. However, for anaerobic exercises, you should give proper form and breathing precedence over exercise intensity. Anaerobic exercise is important for overall health. Those with varicocele should performed anaerobic exercises with caution. Copy Right Daniel Johnson 2014

EXERCISE 9: MUSCULAR/POSTURAL IMBALANCES Muscular imbalances have a large contribution to varicocele development. Certain postural imbalances misalign your digestive organs, put excess pressure on the pelvis, and inhibit proper blood circulation. Caution: Muscular imbalances are not easy to spot to the untrained eye and can be difficult and tricky to correct. I recommend seeing a qualified healthcare practitioner for further instructions if you think that a muscular or postural imbalance may be negatively affecting your varicocele. A skilled personal trainer or athletic therapist may also be of significant help. ANTERIOR PELVIC TILT AND ROUNDED BACK Anterior pelvic tilt is a postural imbalance. It means that the pelvis tilt is excessively forward. This condition primarily causes tightness in and hyperextension of the lower back (lordosis) and forces the belly to hang out. It also exaggerates the curve of the upper back (thoracic kyphosis), giving a slouched forward look. Mickey Mouse has this postural imbalance. The anterior pelvic tilt disables abdominal muscular support for the digestive system, forcing the digestive organs to hang out. The overall effect is an irritation and inflammation of the digestive organs, decreased rate of digestion, and impaired blood circulation. The cause of this condition is tight hip flexors and quadriceps, and weak hamstring, abdominal and gluteal muscles. As noted earlier, correcting postural imbalances is difficult. If you have an anterior pelvic tilt, you are going to have to perform exercises that strengthen your gluteal, abdominal and hamstring muscles, and stretch your hip flexors and quadriceps. Exercises that will help correct these imbalances are axial extension, bridge pose, plank, lunge stretch, cat and camel, and standing quadriceps stretch. You should also follow the exercises recommended in the rounded back and shoulders section. View the resource section of the website if you want more information about these exercises. POSTERIOR PELVIC TILT AND ROUNDED BACK A posterior pelvic tilt is a postural imbalance. It means that your hip is tilted too far backward. Rounded shoulders are also symptomatic of the posterior pelvic tilt. These conditions greatly increase abdominal and lower torso pressure and cause the ribs fall onto the diaphragm. The result is impairment deep breath and both digestive and circulatory problems. The cause of this condition is tightness in the hamstring, abdominal, chest and maybe gluteal muscles, and weakness of the spinal extensor, hip flexor, and upper back muscles. Some exercises to for correcting this postural imbalance are back extension exercises, back extensions, standing leg raise, sitting hamstring stretches, axial extension, sphinx pose, and Copy Right Daniel Johnson 2014

upward dog. You should also follow the exercises suggested in the rounded back and shoulders section. View the resource section of the website if you want more information about these exercises. ROUNDED UPPER BACK AND SHOULDERS As mentioned earlier, rounded back and shoulders are postural imbalances that impair proper breathing, digestion, blood circulation, disrupt the structural integrity of the internal organs and increase the pressure on the lower torso. The back rounds and the shoulders rotate forwards when the spinal extensors and back muscles are weak and the chest is tight. To correct this, I recommend the following exercises: Chest and shoulder stretch, rows, lower back extensions, lat pulldown, wall arm slide, axial extension, sphinx pose, upward dog, and back extensions. View the resource section of the website if you want more information about these exercises.

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