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I am proceeding to getting an implant, but am troubled by the administrative process.
 
Neither clinic in my “network” allows easy access (the office staff presents significant insulation) to the Doctors in the practices and the two Doctors with whom I have had contact are not very forthcoming towards mentoring me through the process so far.  One is willing to converse, but does not seem as engineering-oriented as I am.  The other is a bit more experienced, but even less communicative.  However, he does seem willing to take my inputs.
 
It is the operation that is most important, not the level of personality interaction.  Ultimately, the decision is because I am looking for a cure, not a friend.
 
So, here is a draft of my letter to my Doctor.  I present it here because it has a few contributions to the forum. 

1) It cites some of my research which might be valuable to others,

2) It invites the forum members to advise me (where my Doctor does not) and

3) It suggests that patient self-education has value worth the effort

I am skeptical enough to not simply follow experts’ advice, but to seek my own counsel as well.  But I am not so skeptical as to reject counsel from others, either.
 
Here is a draft of the "letter" to my Doctor.
 
I will be content to be my own mentor as long as you hear my inputs, which you have been willing to do so far, thank you very much.  
 
Here is now I wish to proceed unless you deem any particulars medically inadvisable or counter-productive:
 
1) Pre-Op vacuum preparation therapy (At our last meeting, you indicated your willingness to prescribe the Vacuum Device for Pre-Op preparation) as described in
 
Vacuum Preparation Optimization of Cylinder Length and Postoperative Daily Inflation Reduces Complaints of Shortened Penile Length Following Implantation of Inflatable Penile Prosthesis”…  Sellers, Dineen, Salem, Wilson, from “Advances in Sexual Medicine”, 2013, 3, 14-18
 
starting immediately and continuing a minimum of 6 weeks.  While the potential benefits in my case may be moderate, there appears to be no downside to the effort.   I do not seek length as much as the other benefits documented by the paper; ease of insertion during surgery, ease and speed of recovery, less problematic scar tissue formation (encapsulation/”coffin effect”, etc.
 
2) As you suggested before, aggressive sizing of the implant during surgery to minimize the potential of “SST” syndrome/unsupported glans/”floppy head”.  This, to be consistent with patient’s diabetes and the next point, “preservation of cavernous tissue”.  
 
3) On occasion, patient awakes with an erection appearing adequate for coitus (with no indication it would stay that way for any length of time).  Patient desires (recognizing the slim likelihood) to retain this residual erectile function after implantation by “conserving as much cavernous tissue by withholding unnecessary corporeal dilation” as suggested in:
 
“Strategies for Maintaining Penile Size following penile implant”., Translational Andrology and Urology:  Androl Urol 2013 March  by King Chien, Joe Lee and Gerald B. Brock
 
Which cites Moncada I Marinez Salamanca, “Inflatable penile prosthesis implantation without corporeal dilation:  A cavernous tissue sparing technique.  Journal of Urology, 2010.

4) Post-op protocol of early and generous inflation suggests favorable ultimate outcome, especially length retention and early return to work.
Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi and published in “Department of Urology, Civitanova Marche Hospital, Italy” in 2014
 
5) Patient wonders about the having a vasectomy concurrent with the implantation.
  
6) As you suggested before, the AMS LGX does seem most appropriate, as the deficiencies experienced by the AMS Ultrex seem to have been resolved with the LGX and vertical Scrotal incision does seem the most desirable entry method.
 
Thanks for reading and thanks for any advice you may have for me.

Lost Sheep

SOUNDS LIKE YOU NEED TO FIND A BETTER DOCTOR AS THIS SURGERY CAN GO WRONG WITH SOMEONE NOT EXPERIENCED. Have you asked for names of others who used one of them? Type their names in here and search for them. If anyone out there have used them, write to private message and get more info. Did and Kramer ands some other have a lot of experience and good records.

Be very careful who works on you as mistakes can haunt you for a long time. Good luck

Lost Sheep,

I read your letter completely. I doubt that any doctor would. I understand your need to be specific, we all do. But your letter is so "wordy" that it is not easy to read or respond to.

Try taking the important points of the letter and reducing the wordiness down to a short one sentence question. There's no need to explain what you know to the doctor. You know it, and that's what's important.

Craft the letter so it easily readable and you'll get a good response.

These of course are just my thoughts, good luck!!

Jimbruski

Jimbruski wrote:Lost Sheep,

I read your letter completely. I doubt that any doctor would. I understand your need to be specific, we all do. But your letter is so "wordy" that it is not easy to read or respond to.

Try taking the important points of the letter and reducing the wordiness down to a short one sentence question. There's no need to explain what you know to the doctor. You know it, and that's what's important.

Craft the letter so it easily readable and you'll get a good response.

These of course are just my thoughts, good luck!!

Jimbruski

Brevity is my nemisis. I will make the letter more concise. Presentation will probably be live rather than written.

Thanks.

dirtman1993 wrote:SOUNDS LIKE YOU NEED TO FIND A BETTER DOCTOR AS THIS SURGERY CAN GO WRONG WITH SOMEONE NOT EXPERIENCED. Have you asked for names of others who used one of them? Type their names in here and search for them. If anyone out there have used them, write to private message and get more info. Did and Kramer ands some other have a lot of experience and good records.

Be very careful who works on you as mistakes can haunt you for a long time. Good luck

The choice is between these two or none at all as travelling to the lower 48 is impracticak at this time.

I hear you loud and clear. Thanks

Lost Sheep

Jimbruski,

Here is an edited version.

Thanks for considering my input on my upcoming surgery. 

I have these thoughts (unless you see something inadvisable)

I would like to take advantage of pre-op vacuum therapy as it promises easier implantation, easier recovery and swifter return to my work.

(the original point #2 I am leaving out, as the Dr A’s philosophy on sizing was one of the first things we discussed, so can be considered a closed issue.)
 
2) Patient currently retains some residual erectile function and (while recognizing the likelihood of keeping that is slim), there is some evidence this is possible by “conserving as much cavernous tissue by withholding unnecessary corporeal dilation” as suggested in:
 
“Strategies for Maintaining Penile Size following penile implant”., Translational Andrology and Urology:  Androl Urol 2013 March  by King Chien, Joe Lee and Gerald B. Brock
 
Which cites Moncada I Marinez Salamanca, “Inflatable penile prosthesis implantation without corporeal dilation:  A cavernous tissue sparing technique.  Journal of Urology, 2010.

3) A post-op protocol as described by
Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi and published in “Department of Urology, Civitanova Marche Hospital, Italy” in 2014 
Using up to 80% post-op residual inflation and a two-week starting point for cycling and seems promising for early return to work and satisfactory length retention.
 
4) Patient wonders about the having a vasectomy concurrent with the implantation. 
  
(The original point 6 about implant choice has been discussed with Dr A before, so may be redundant at the point, so can be left out.  Entry incision, too.)9
 
5) Patient is curious to meet the AMS representative for questions of design and development.  
 
(Point 5 is not really surgical in nature, but who else am I going to ask?)
 
Better? Thanks again.

Lost Sheep

That's still a lot!! There is no way to know how any given doctor would respond to that. Some may feel inadequate to do the surgery your way and jump through the hoops. Maybe that would be an indication you wouldn't want that surgeon. Who knows?

As for me, I researched the best on this board, watched a TON of his online videos, found that he was "in network" for me and booked the surgery. I have had a few questions that I sent to him in an Email and he jumps right on it answering them. He's very attentive. Dr. Kramer, Baltimore.

Good luck with your procedure.

To choose to live in Alaska is to accept that it will be more challenging to get the most advanced medical care there. I would wait until I could go to one of the best and then let him do what he does.
Surgeons rarely accept instruction from patients and may fear you are setting him up for a lawsuit. As of a couple of years ago, Dr Karpman offered a surgery/hospital care package deal in the range of 20K.
For less than the cost of a Hyundai Elantra you can have a bionic penis that works perfectly every time.

Lost Sheep,

You began nicely then beginning with point #2 got wordy again.

Eliminate the footnotes at the end of each point. There is no need to include how you know what you know!

You are trying to pull information out of the Doctor so ask very simple questions and make simple statements. He will then feel free to open up with you. If you ask questions or make statements which sound like a challenge to his profession or to him personally he will likely not be very responsive.

You can do this, just simply everything.

Good luck and keep at it!

It may not be possible, but go with Kramer is at all possible. He is so responsive to questions. Quite amazing actually. He'll get an email from me on his iPhone and immediately respond. It's amazing.