approved for implant by the VA, some questions

[EricDraven]

I've been fighting with the VA for around 8 years to get approved for the implant procedure. I'm scheduled for surgery on May 5th.

I've read topics on this board for years, and it makes me very concerned after meeting my surgeon.

First, she is very young. I'm guessing early 30's. She doesn't have a lot of experience. She was actually advising me to not have the surgery, saying it was hit and miss. It may work, it may not, there may be infection, there may be loss of feeling. I understand those things, but I don't feel very comfortable with the doctor and there are no other choices as I don't have personal insurance. She also said size would be smaller and it would get smaller over time, not larger. What? Am I missing something?

Need some good advice. I should add that the VA has botched 1 prior surgery (kidney) and has been severely lacking overall.

I"m early 50's, and have had ED for 10 years. been through pills, pumps and injections

[tomas1]

Run, don't walk away from her.
Maybe you could see who did Lost Sheep's procedure.
I believe he used VA but it was in the NW.

[HappyAgain]

My doctor told me the number 1 thing after surgery is preventing infection. I had terrible permanent shrinkage due to my 4 lower back surgeries and venous leakage. The implant has made my limp sick back to its original size and larger and thicker when erect. Your doctor sounds a bit wishy washy if you ask me. Maybe you can get a consult with a good urologist to answer some questions. Good luck. I hope that it will improve your life the way it did mine. My male ego was terribly bruised for at least 3 years. After the implant I feel like a stud.

[Lost Sheep]

I've been fighting with the VA for around 8 years to get approved for the implant procedure. I'm scheduled for surgery on May 5th.

I've read topics on this board for years, and it makes me very concerned after meeting my surgeon.

First, she is very young. I'm guessing early 30's. She doesn't have a lot of experience. She was actually advising me to not have the surgery, saying it was hit and miss. It may work, it may not, there may be infection, there may be loss of feeling. I understand those things, but I don't feel very comfortable with the doctor and there are no other choices as I don't have personal insurance. She also said size would be smaller and it would get smaller over time, not larger. What? Am I missing something?

Need some good advice. I should add that the VA has botched 1 prior surgery (kidney) and has been severely lacking overall.

I"m early 50's, and have had ED for 10 years. been through pills, pumps and injections

I agree with Tomas1. She sounds like she has little experience and is lacking in confidence. Without confidence, she may not size you as aggressively as a more experienced surgeon. Also, infection prevention requires a steady hand and an experienced surgical team, not just the surgeon but the whole team.

Ask how many she has done. Ask to speak to prior patients. Ask how she determines the size of implant to use. Find out which manufacturer's implant she plans to use and call the Patient Liaison for that company and quiz him on her reputation, letting him know of your concerns. Is she a VA doctor or out in the community. Are you near a metropolitan center that might have a wider selection of surgeons? Getting authorization for someone out of network is possible.

You only get one chance to get your first implant. Don't waste it.

Do be kind to your surgeon. She will do her best, but it seems to me that she just does not have enough experience. Experience is best gained by studying under a highly experienced surgeon. When you ask her about her experience and her approach to this surgery, be thorough in your questions, but do not alienate her. Having researched medical journals (more about that later) will encourage her to listen to you and not dismiss you. For example, you could ask just how aggressively she measures distally and proximally. If she subscribes to Montague & Angermeier's advice to subtract 2 cm from the sum of the measurements (and have a copy of the article with you when you do).

Here is a link to the article
"Cylinder sizing: less is more"
DK Montague and KW Angermeier
http://www.nature.com/ijir/journal/v15/ ... ion_detail


No man I know of on FrankTalk with an implant has gotten smaller over time. The implant pretty much guarantees that. It is a non-organic device and pretty much cannot get smaller unless one does not use it (then scar tissue can encapsulate it). But I have never heard of anyone actually having that happen.

Choose a surgeon carefully - one how has done a lot of implants with a high proportion of satisfied patients, or who is under the supervision of such a highly experienced surgeon or who has trained extensively under a highly experienced surgeon AND!!! who is dedicated to his patients' welfare and favorable outcome above all other considerations. That last part is part of your responsibility to interview your surgeon thoroughly and establish a good working relationship where your desires are recognized and honored.

Remember, even in a bureaucracy, you are the patient and have rights, including the right to have confidence in your treatment. If you have the medical knowledge to be accepted by that bureaucracy as part of your medical care team, you are miles ahead of where you would be without that knowledge. Asking for a different surgeon is not unreasonable, especially if you can explain your misgivings. A surgeon who essentially promises size loss might be trying to reduce unreasonable expectations (unreasonable patient expectations is a major reason for patient dissatisfaction) or she might be expressing a lack of confidence in her own skills. NO COMPETENT SURGEON (absent complications in the patient such as advanced Peyronie's Disease, etc) has any excuse for a patient's size being less than what he had the day before surgery.

I do recommend you measure your erect length and girth (as much erect as you can get by any means necessary).

[Lost Sheep]

Through embarrassment, I did not discuss my ED with anyone except sexual partners. I would reveal to potential partners that, "My penis does not work as well as it should, but I will do all I can to please you." This worked for a number of years, but sexual encounters became fewer and fewer as my confidence waned.

Ultimately, I revealed to my primary care physician (PCP) that I had E.D. and was prescribed each of the oral medications, in turn. Each lost effectiveness over time and I began to research E.D. and its other treatments. (I am a disabled veteran, enrolled in the Alaska Veteran's Administration-VA system.)

During my research (almost exclusively on the internet) I found a lot of dross, come-ons, advertisements for questionable sexual aids and very little useful information outside of medical journal articles (which were VERY useful) until someone suggested the website FrankTalk.org. I had been about to give up on finding useful information, so this was a virtual Godsend.

I spent a couple weekends reading through a few years of past posts and armed with that education when eventually, my Primary Care Physician (PCP) said I was a candidate for an implant. I jumped on the opportunity.

He did remark to me that I knew more about ED and its treatments than he did. I suspect that may have affected his recommendation that permitted me to be authorized an implant. So, I recommend spending the time on FrankTalk to learn as much as possible, including reading medical journal articles from the internet (legitimate peer-reviewed journals, not popular magazines so much). Peer-reviewed medical journals may be hard to read through but knowing the language and having the printouts increases your credibility with your PCP. That will pay dividends.

Talking about dividends, be sure to invest in every person you talk to. Thank them by name at the end of every phone call (people love to be acknowledged as humans). Thank them even if they were not helpful; they gave you their time and you want them to remember you kindly. (The travel nurse I tell you about later is an example; she was not helpful at first, but ultimately, she called ME. Had I not told her my story and been polite, that probably would not have happened.

Take notes of every contact, time, date and name. I found in the Air Force that keeping an audit trail is handy to make sure your ducks are in a row and no stone left unturned. It is especially important to pave the way for your campaign. Operate this as if it were a military mission.

Thus began my search for a surgeon. I knew from Franktalk that the judgement that comes from vast experience is essential to a good outcome. I contacted two surgeons who were well-known on FrankTalk via email (Dr Eid and Dr Kramer) and they were very helpful with advice. I selected Dr Kramer as he was in Maryland where an old (short-term) lover (who became a friend) lived. (Aside: All of my breakups were friendly.) I enrolled in the Maryland VA system, anticipating travel there. (Enrolling in a VA system outside your area is possible, but you have to deal with bureaucracy, travel arrangements and such.)

Making travel arrangements were fraught with complications, but a travel nurse/clerk who knew of my situation called me up and told me that a surgeon recently assigned to the local base hospital who was an expert at the procedure might be available if I would be willing to consider him. "HELL! YEAH!" was my thought. "Well, yes, I would consider that, thank you." was my response on the phone.

I met with Dr. Shaw and found him friendly, willing to listen to me and include me as part of my medical care team in decision-making. On a side note, my PCP remarked to me that I knew more about ED and its treatments than he did. I think that may be part of the ease in getting the Alaska VA to approve the implant. Also, Dr. Shaw's assistant told me that he had told her that I was the most well-informed patients he had ever had. I am a particularly participatory patient. Some physicians like that and some don't. Dr Shaw is the former kind. What clinched the deal for me was his remark that if he were in private practice instead of active duty Air Force, "This would be my specialty."

[vajim1]

You have not mentioned where you are located and what VA facility you use. I am in Virginia and I know of some one who used a different Va center because he did not like the local one.

[josemaria]

I have heard that there is a very competent urologist in the Miami area. I do not know the VA hospital there but a guy I know wanted me to get the surgery done in Miami instead that in Puerto Rico.
Like everybody else says - your body, your choice...
Good luck!

[Lost Sheep]

You have not mentioned where you are located and what VA facility you use. I am in Virginia and I know of some one who used a different Va center because he did not like the local one.

I was on track, getting authorization for travelling from Alaska to Maryland's VA (where Dr Kramer was available to me) when Dr Shaw was assigned to the base hospital near me. Prior to that, I had authorization to use a local civilian surgeon but when that did not work out, the Alaska VA sent me to the Washington State VA. I interviewed the surgeon there and did not like the protocol they used (not a tissue-sparing technique).

With the VA, if you have your primary care physician advocating for you, you have choices. Get him/her on your side. Make yourself accepted as an integral part of your medical care team.

[Old Guy]

Got to agree with Lost Sheep, good advice.
I didn't know squat about implants before going under the knife. All I knew is it would enable me to get erections again and I let the surgeon decide everything. Overall, I am happy with the results despite losing length. After reading numerous articles here on FT if my surgery was tomorrow things would go a lot different.
My thought of that surgeon makes me think she's not very up to date on implants. There is no way an implant can shrink over time since it's manufactured to a specific length. Infection is a very minimal risk as long as proper procedures are followed. Sounds more like she has something against implants since she gave you all the negatives.

[scoop317]

Well, I'm a vet and VA did my implant almost 5 weeks post-op now. The Dr was not negative at all, he was very supportive. But you should ask to see head Dr in urology dept or just ask to see a different Dr.,they usually have multiple Dr's in that department. But I wouldn't let the Dr you mention touch my"Jr". She sounds scary.
Also check into "community care"