Uro visit - LONG post warning

[bldoink]

I saw my new Uro today for the second time. I'm not sure how thrilled I am with him yet. My original Uro retired a couple of years ago and I'd been using my GP, which also left. I'm having to train a new GP too.

I asked the Uro if there was any medical difference, tissue response wise, if you, for example, took 40 units of 10 mc/ml mix or 10 units of 40 mc/ml. I understood that the med amount was the same. I was wondering if the more concentrated med might cause more tissue shock and possible damage. For what it's worth he said absolutely no difference. I hope I explained that clearly and correctly.

I also questioned the Uro about the possibility of trying Tri-mix and trying it with a reduced Papaverine component. First he informed me that he will only write ED injection mixes to one pharmacy (menMD) and that that pharmacies mixes vary in the alprostadil and phentolamine component but all versions contain the same 30 mc/ml of papaverine. He then informed me that as the straight alprostadil works well for me he would not recommend my changing.

I also asked him why he would only prescribe the ED injection meds through menMD. He replied that he has confidence in them. He added that he gets no compensation from them. It still seems odd.

I also asked the Uro about trying another ED pill. I've been successfully using sildenafil for several years and I was considering trying tadalafil. On this also he advised me to not mess with success and to continue with the generic Viagra.

At my request the Uro gave me a business card from menMD, the pharmacy he uses. As he won't prescribe through any other pharmacy I figured I'd check them out and compare costs to my current pharmacy. After I left the Uro I called menMD and was initially misdirected which resulted in an interesting conversation which I'll get to momentarily. Upon calling a second time I managed to get vague pricing information. I was informed that for the ED injection meds, pricing starts at about $85 for 5 ml and goes up to about $125 for 5 ml depending on potency. I didn't ask about shipping costs. I'm currently paying $120 for 10 ml at my current pharmacy and the price doesn't vary due to potency. Bummer, so now I'm thinking I'll have the choice of finding another Uro or checking with my new GP to see if he'll continue writing my script like his predecessor did that he replaced in the same office (kind of an HMO but not).

OK, back to my misdirected call. My initial call to menMD was apparently misdirected to their consultant who identified himself as Terry Payton. He related that he was a consultant (I think that was the term) for menMD but was a retired Uro....Edit: The previous sentence is in error. I believe he referred to himself as a "Case Manager". He likely referred to himself as retired from active practice as a RN in the field of urology. End Edit.... He further related that he was one of the pioneers (not his term) in the field of alprostadil and tri-mix usage. (Google later confirmed multiple urology papers under that name) I then asked him for advice on some of the same questions I'd put to my Uro. His response was similar: "Don't mess with success." OK, so I'm sticking with my alprostadil and sildenafil.

Next I asked him to clarify my understanding that papaverine was the tri-mix ingredient most likely to cause fibrosis and scaring. He related that he did not believe that to be the case. He attributed the early papaverine fibrosis/scaring connection to PH issues, (which I guess have been resolved). He further related that he believed the scaring and fibrosis was likely mostly caused by the needle prick itself and subsequent, often undetected, internal bleeding. He stressed that compression on the injection site for a couple of minutes was crucial to help prevent the bleeding and possible subsequent fibrosis/scaring. OK, from now on I won't be so much massaging the meds in as just compressing the injection site. (I didn't actually ask about massaging the meds in.) Sometimes I can take advice.

During my conversation with Payton the conversation drifted to alprostadil pain/ache. We didn't get into that topic a whole lot as I don't generally have a major issue with it. I did mention to him that I've found I have less issues with the ache if I inject the meds very slowly. While he didn't confirm or dispute the reality of that theory he did note that I'm not the first user to report that effect and it's been reported by several other people.

I don't claim to be reporting the aforementioned phone conversation with accuracy. This wasn't a transcript and I didn't record it. I may have misunderstood or misinterpreted what I heard. I mentioned his name only to give an illusion of legitimacy to the post. I post this for entertainment purposes only. I hope it was.

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Edit due to errors: There were factual errors in the 7th paragraph regarding titles to which I inserted a correction. I also altered the last paragraph as I confirmed the identity of the person I spoke with and notified him of my use of his name and the sharing of our conversation. I also offered to remove his name or amend my post if requested.
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[tomas1]

I think I would get a different uro and find a GP who can work with you on changing formulas.
I'm lucky to have good, understanding ones.

[bldoink]

Good uros aren't that easy to come by and he otherwise seems OK. I have no complaint about the meds I'm now using. They work! Being greedy I'm always interested if there's something better. I haven't even broached the subject with my new GP but I have a feeling he'll work with me. I don't actually need a new script for at least another 6 months. Being a prostate cancer survivor, where I had cancer in the margins, the uros main job is to watch out for that and I just got a pretty good report from him on that. But I might look for another more ED friendly uro.

[Ahappigui]

I don't see my urologist frequently and I'm not sure I have ever discussed in any detail my ED with my family physician since I first moved here 7 1/2 years ago. Briefly, it's never been a question with any urologist the cause of my Ed - prostatectomy. Both my current and my previous urologist prescribed trimix and each of them directed the one any only pharmacy for service. I cannot wonder if urologists are being coy in saying they don't get kick backs. The business world works on the theory "you scratch my back and I'll scratch yours"! I have been on the same dosage of trimix for 7 1/2 years and frankly I suspect my previous prescription before coming here was the same. My current urologist told me during my initial visit my prescription is the strongest he could prescribe....1mg phentolamine; 60mcg postaglandin; 16.25mg papavarine
The prescription works fairly well, gives me a reasonable erection for at least an hour (but not rock hard) I'm not complaining!