Doctor inattention

[Lost Sheep]

My Doctor is actually very attentive, but...

I went to see him twice. The first time I described my condition (losing erections, difficulty getting erection stiff enough for penetration, oral medications help, but not enough, I still get morning erections once a week or so, but nothing robust).

I explained that I was not interested in vacuum pump, suppositoties or injections.

He told me he has done 20 in the past year. I don't know if that is a lot or a little for the doctors available to me.

He looked over my (fairly complete) lab work from the V.A. and ordered a Testosterone level test.

Second visit: Testosterone was 431. He said I was a good candidate for implant. Probably AMS 700 LGX.

Scheduled surgery for less than a month out (Sept 19)

No discussion of post-op projections. No Doppler test or even the postage stamp test. No objective test whatsoever and only my clinical (layman) observation.

And no response to some questions I left for his P.A. (Physician Assistant)

I had a pre-op appointment (consent form, EKG, etc) and pretty much insisted on another meeting with my Surgeon to clear up my misgivings. Chief among those misgivings is lack of explanation of what I can expect in the days, weeks and months after implantation. I have no assurance his staff will be any more attentive to my eventual post-op questions than my pre-op questions. I have never seen one of these devices (only still pictures of the device and pictures and videos of implanted ones being pumped up).

I know that at our initial meetings I gave him the impression I am well-informed, but I am still a layman and may well be missing a crucial piece of information or incorrectly nterpreting my subjective observations.

Should I be concerned?

My Doctor is very attentive in the appointments, but... his support staff and his availability outside of appointments has me concerned.

Lost Sheep

[jonbaldbg]

Support staff can suck sometimes. I'm scheduled with Dr. Kramer and his support staff has been helpful and pretty responsive.

You have to have confidence in the whole team is my opinion.

Where are you located? Can you get to Baltimore for your implant?

Kramer has the reputation of being top notch in his field and he does a high volume per year.

[Lost Sheep]

Support staff can suck sometimes. I'm scheduled with Dr. Kramer and his support staff has been helpful and pretty responsive.

You have to have confidence in the whole team is my opinion.

Where are you located? Can you get to Baltimore for your implant?

Kramer has the reputation of being top notch in his field and he does a high volume per year.

Thanks for your perspective. I feel the same way about confidence in the entire team and the process. But my options through the Veterans Administration are limited to Alaska Urology clinic and Anchorage Urological Institute, which means only one of two doctors.

Where I am in Anchorage Alaska is a long way from Baltimore. Going to Seattle might be adoption but I have no one there to put me up. I have relatives in Stockton California, worth waiting for the surgery 'til later.

Lost Sheep

[ED2013]

I highly recommend you consult with Dr Karpman in Mountain View California. Just a couple hours from Stockton.

[mouseco]

Dr Kramer also consults with VA hospital in Baltimore. It is adjacent to University of Maryland hospital.

[woodturner]

You are absolutely right about your concerns with the support staff. The best doctor is not very effective if his staff is substandard. My wife and I have left more than one doctor (this includes the doctor I originally did a consult with for an implant) because of issues with the staff.

[Lost Sheep]

Yes it's true, Kramer goes to the VA in Baltimore I'm pretty sure, though it may be a tricky procedure to get yourself plugged into his vA system. I may be wrong,it could be extremely easy. I just don't know for absolute sure. But once there, my guess is you could get yourself admitted there until totally stable to go home, since VA is good with total coverage. It's your best option is my guess

If I could get the V.A. to go for a week or until able to travel comfortably that would be GREAT. Surgery from the best (or one of) specialist in the world (or country). Medical followup for the most troubling period post-op. Meals I don't have to cook myself (or do dishes). It would be like a resort vacation (except for the pain and no tourism activities). And I do have a friend in Baltimore I have not heard from for a year or so. Not a close friend, but still....

I did not think the VA would go for that, though, so did not even ask. I would have to go through the First Choice program and if there are providers closer, they usually narrow the options to those.

If I decide this Doctor is not prepared to allow me to be sufficiently participatory and to include me in his thought processes, it might be better to cancel and seek treatment elsewhere or even to shelve the idea entirely (though the option of spending the rest of my life incapable of coitus is nearly as extreme an idea as going into the surgery blind)

So, thank you, MarloStanfield1940 for puttin gthe option in my mind. Thank you everyone for your thoughts. I will continue reading here, as I have another pre-op appointment on Friday Sep 9 where I hope to have my thoughts sufficiently succinct to deliver my message loud and clear to him. Phrases like, "I am a participatory patient", "abandoning sex for the rest of my life is preferable to going into surgery blind", "I know what many men report on forums, but have no idea what your patients usually experience" and "I want a map of what to expect in the way of contact and support from you and your staff in the days, weeks and months post-op and what I have experienced pre-op is not reassuring"

Pardon me for venting. I do not usually require a lot of hand-holding, but this us usually because I am fully prepared and informed before a major life decision. In this case, I am not.

Thanks for reading, everyone and thanks for your support.

Lost Sheep\

p.s. Since my Doctor has not told me, does anyone here know just how surgeons measure the corpus cavernosa for sizing the implant. I know generally, but understanding how the sizing decision is made would be reassuring to me (even though I will be unconscious at the time-maybe especially because I will be unconscious at the time).

[oddjob]

Lost Sheep

I too was very concerned about the sizing of the corpus cavernosa (cc) so I asked my doc to walk me through it...essentially, they insert a tool into the cc to measure it...the tool looks like a metal cylinder/rod that has graduated markings on it...and this is only done while you are under anesthesia.

Once the cavity is measured, the doc chooses the correct sized implant from the implant rep. However the one thing the doc can't do is give you more than you already have in the length department.

My doc was very up front about cautioning me that the implant surgery would result in a loss of length, but as my penis was useless after 2 decades of debilitating ED, having a functional penis was more important to me than a loss of original length.

Remember that the female vagina is not some never ending tunnel, but is actually on average, only 4-5 inches deep...so having a 10 inch penis is actually overkill.

Trust me, after the surgery, having a penis that is fully functional and is no longer just a limp appendage will be a great feeling!

Joe

[dirtman1993]

If you can , go to see Dr. Kramer as he and his staff are outstanding. I have a major fear of needles from childhood and they worked with me to use a gas to put me under before inserting needles for the operation. I met with the doctor who was to administer the gas/drugs to put me under and keep me there. Then I met Patrick who has been with Dr. Kramer over 10 yrs. who will oversee me during the operation. His has a very nice and caring team.

I emailed Dr. Kramer numerous times before deciding and he was always there for me. I still have questions and he is there for me. Very very happy with recovery, lack of pain during healing and outcome.

Photo is about two months out after surgery and you can see some bruising yet. Most was gone by this time.The top photos you can see the stitches and some of the discoloration still present.

If you have any questions let me know and will try to answer.

[REM1947]

Hi Lost Sheep:
I am use the VA Medical System. About six weeks ago I met with a resident urology surgeon for the first time at the VA Hospital in Pittsburgh, PA. She asked a lot of questions, no test, and I got a call from her two days after we met and I was approved for the implant. I am going to have the AMS 700 LGX Penile Prosthesis. While I meeting with the resident surgeon she showed me an implant and I got to hold it and pump it up. Nice unit. Went over a months and did not hear from her or the Impact Clinic, (they are in charge of the pre-op testing and info gathering), until last Thursday. I was all set to have the operation this Wednesday and then yesterday morning to resident surgeon call me and said she made a mistake in booking the operation room and had to reschedule me. Now I will have my operation on Oct. 3rd. Nothing like being moved to the end of the line. HeHe That's life.
My surgeon is going to be Dr. Rusilko from UPMC Mercy Hospital in Pittsburgh and the University of Pittsburgh. From what I have been able to find online, a great surgeon.
With the VA, we have "My Healthy Vet" web site that we can sent secured messages to any of our doctors. I have always received answers from the doctors or their nurses with in a day or so. Tuesday I will sent a message to my resident surgeon asking her to move me up in the schedule if a opening should happen.
Above I had said that the resident did no tests, well my local urologist at the Erie VA Hospital had done many tests over the years and it was in my record that I had used the pills, shots, pumps, and gels which did not work for me. I have not had an erection for over a year and it is not that I have not tried, just does not happen any more. I am using a pump to try to increase my length since I have lost so much. Which now I have time to work with the pump a little longer. It has only been a couple weeks since I started using the pump. A tip I got here on 'Frank Talk.'
I would say that if you have questions about what is going on, call and talk with your doctor's nurse and get some answers.
I wish you all the best!
Bob