Continuity of Care - How Important?

[TANGERINE]

How important is it for the surgeon who did the implant be the person who follows up for post-op care. (Initial inflation, questions that may come up, etc.)

I can have an implant with a relatively low volume..... Or I could go to a somewhat higher volume Urological Surgeon in Seattle w...

I think you should go with the most experienced highest volume surgeon that you think will do a great job. Peno-scrotal approach, I think is important (some high volume surgeons do not like it as much because it takes longer surgery time, but you do get better pump placement and better tubing position)

Regarding continuity of care, this pales in comparison with having someone who will "do it right the first time", though you do need to recognize that if there is a significant problem, then you will end up going back to your original surgeon (unless you decide to cough up the money to pay one of the celebrity surgeons to fix up the mess)

[Lost Sheep]

How important is it for the surgeon who did the implant be the person who follows up for post-op care. (Initial inflation, questions that may come up, etc.)

I can have an implant with a relatively low volume..... Or I could go to a somewhat higher volume Urological Surgeon in Seattle w...

I think you should go with the most experienced highest volume surgeon that you think will do a great job. Peno-scrotal approach, I think is important (some high volume surgeons do not like it as much because it takes longer surgery time, but you do get better pump placement and better tubing position)

Regarding continuity of care, this pales in comparison with having someone who will "do it right the first time", though you do need to recognize that if there is a significant problem, then you will end up going back to your original surgeon (unless you decide to cough up the money to pay one of the celebrity surgeons to fix up the mess)

I tried to go with Dr. Kramer through the Maryland VA.That is doable except for the fact that I would have to fly to Maryland at least twice and I cannot afford the time or the air fare for that. My local VA (Alaska) has a surgeon here who would do the implant, but he is a relatively low-volume (20 in the past 12 months) surgeon with no track record I can access.

My local VA has suggested I could go to Seattle (where the product representatives for my region are located, so there might be better product support in the O.R.), but the authorizations for that are dragging out.

So, with the high-volume high reputation surgeons out, I have two choices.

Seattle, (presumably a bit higher experience level than my local guy and possibly better manufacturer support) with followup by my local urological surgeon.

or

My local urological surgeon (where continuity of care is the sole advantage).

Or skip the procedure entirely as out of my reach.

[Tybeeman]

How important is it for the surgeon who did the implant be the person who follows up for post-op care. (Initial inflation, questions that may come up, etc.)

I can have an implant with a relatively low volume..... Or I could go to a somewhat higher volume Urological Surgeon in Seattle w...

I think you should go with the most experienced highest volume surgeon that you think will do a great job. Peno-scrotal approach, I think is important (some high volume surgeons do not like it as much because it takes longer surgery time, but you do get better pump placement and better tubing position)

Regarding continuity of care, this pales in comparison with having someone who will "do it right the first time", though you do need to recognize that if there is a significant problem, then you will end up going back to your original surgeon (unless you decide to cough up the money to pay one of the celebrity surgeons to fix up the mess)

I tried to go with Dr. Kramer through the Maryland VA.That is doable except for the fact that I would have to fly to Maryland at least twice and I cannot afford the time or the air fare for that. My local VA (Alaska) has a surgeon here who would do the implant, but he is a relatively low-volume (20 in the past 12 months) surgeon with no track record I can access.

My local VA has suggested I could go to Seattle (where the product representatives for my region are located, so there might be better product support in the O.R.), but the authorizations for that are dragging out.

So, with the high-volume high reputation surgeons out, I have two choices.

Seattle, (presumably a bit higher experience level than my local guy and possibly better manufacturer support) with followup by my local urological surgeon.

or

My local urological surgeon (where continuity of care is the sole advantage).

Or skip the procedure entirely as out of my reach.

How old is your local urologist?

[Lost Sheep]

[

How old is your local urologist?

Dr. Robert Allen Jr in Anchorage Alaska. 58 years old 32 years in practice and the past 20 specializing in Urology.

Very intense, but not very talkative.

http://www.akmedicalspecialties.com/Fin ... -FACS.aspx

In Seattle, Dr. Thomas Walsh MIGHT be available to me.

[Tybeeman]

[

How old is your local urologist?

Dr. Robert Allen Jr in Anchorage Alaska. 58 years old 32 years in practice and the past 20 specializing in Urology.

Very intense, but not very talkative.

http://www.akmedicalspecialties.com/Fin ... -FACS.aspx

In Seattle, Dr. Thomas Walsh MIGHT be available to me.

Damn he graduated Emory and medical at MUSC. Not to shabby on education side. He does about 20 a year?

[Lost Sheep]

When I saw Dr. Allen in August 2016, I asked how many he has done in the past 12 months. 20 was his count.

I asked a few questions... He sizes aggressively, expected to use an AMS LGX for me and tends to leave his patients inflated at about 80%. He wanted to schedule surgery the next month.

We a cardiac test which revelaed an abnormality which needed more checking, but because this is being pid for by the VA there wazs difficulty getting the test done. I also asked about pre-op vacuum preparation. Eventually, he prescribed a vacuum device at my request (and I am glad I went that way, as my research indicates several benefits and my personal experience bears that out.

I don't have a lot of confidence in the administrative staff (they sent the prescription for the V.E.D. pump to the wrong place which would have cost me $500)

I allowed as how I would do some more research, as my education in the matter was slim.

In January, he wanted to use a Coloplast (and I am still not sure why the change in his opinion), but by that time, I had been in communication with Dr. Eid and Dr. Kramer. I decided Dr. Kramer in the VA Hospital in Baltimore would be optimal, even though I would have to pay transportation and lodging and meals and the flight home after surgery would be 13 hours. I coold afford one trip and would put up with the discomfort (Dr K has reputation for minimal post-op swelling and discomfort). Dr. Allen agreed to do followup. I was all set

But Maryland VA insists I fly there before scheduling surgery. I suspect if any pre-op testing is required, multiple trips might be required (cardiac test, diabetes and I have sleep apnea which might complicate anesthesia). They will not accept Alaska VA testing results. That pretty much puts surgery any time soon out of my reach.

Seattle is doable, barely. Local has the benefit of letting me sleep in my own bed post-op and not deal with an airline. But since AMS and Coloplast representatives have to be in the OS at the time of surgery and they don't come up at the same time, we have to pick what device I will get before Dr. Allen has a chance to examine my innards. (Dr Eid says he cannot choose an implant until after he examines the condition of the patient's tunica albuginea and then pick a tunica-dependent or tunica-independent implant.)

My penis is in fairly good condition, I think, except for not being able to maintain any useful degree of stiffness, but I would feel better to have an experienced eye decide which device is best based on MY TISSUES' condition, not availability of the manufacturer's representative or a guess based on external exam.

Problem is, I know Dr Eid and Dr Kramer have good relationships with the manufacturers. I have no idea how close the relationship is betwwen the Seattle-based representatives is with the VA in Seattle. So, any way I go I am taking a chance. I just want to maximize my odds of a successful virgin implant.

Thanks your your concern for my welfare. Thanks for reading through this lengthy history.

[radioradio]

Lost,
You seem to be stuck between a rock and a soft place.
Sorry for the pun...
Would your Alaska doc be able to give you contact information for any of his implantees, so that you could chat with them?
Bob

[Lost Sheep]

Lost,
You seem to be stuck between a rock and a soft place.
Sorry for the pun...
Would your Alaska doc be able to give you contact information for any of his implantees, so that you could chat with them?
Bob

He asked one of them to contact me, but 5 months later, no contact. He gave me the Coloplast Representative's contact phone, but he has not returned my texts or call. Very disappointing.

I did let Dr. Allen's assistant know that contacts failed, but there has been no followup.

[sliphill]

When I saw Dr. Allen in August 2016, I asked how many he has done in the past 12 months. 20 was his count.

I asked a few questions... He sizes aggressively, expected to use an AMS LGX for me and tends to leave his patients inflated at about 80%. He wanted to schedule surgery the next month.

We a cardiac test which revelaed an abnormality which needed more checking, but because this is being pid for by the VA there wazs difficulty getting the test done. I also asked about pre-op vacuum preparation. Eventually, he prescribed a vacuum device at my request (and I am glad I went that way, as my research indicates several benefits and my personal experience bears that out.

I don't have a lot of confidence in the administrative staff (they sent the prescription for the V.E.D. pump to the wrong place which would have cost me $500)

I allowed as how I would do some more research, as my education in the matter was slim.

In January, he wanted to use a Coloplast (and I am still not sure why the change in his opinion), but by that time, I had been in communication with Dr. Eid and Dr. Kramer. I decided Dr. Kramer in the VA Hospital in Baltimore would be optimal, even though I would have to pay transportation and lodging and meals and the flight home after surgery would be 13 hours. I coold afford one trip and would put up with the discomfort (Dr K has reputation for minimal post-op swelling and discomfort). Dr. Allen agreed to do followup. I was all set

But Maryland VA insists I fly there before scheduling surgery. I suspect if any pre-op testing is required, multiple trips might be required (cardiac test, diabetes and I have sleep apnea which might complicate anesthesia). They will not accept Alaska VA testing results. That pretty much puts surgery any time soon out of my reach.

Seattle is doable, barely. Local has the benefit of letting me sleep in my own bed post-op and not deal with an airline. But since AMS and Coloplast representatives have to be in the OS at the time of surgery and they don't come up at the same time, we have to pick what device I will get before Dr. Allen has a chance to examine my innards. (Dr Eid says he cannot choose an implant until after he examines the condition of the patient's tunica albuginea and then pick a tunica-dependent or tunica-independent implant.)

My penis is in fairly good condition, I think, except for not being able to maintain any useful degree of stiffness, but I would feel better to have an experienced eye decide which device is best based on MY TISSUES' condition, not availability of the manufacturer's representative or a guess based on external exam.

Problem is, I know Dr Eid and Dr Kramer have good relationships with the manufacturers. I have no idea how close the relationship is betwwen the Seattle-based representatives is with the VA in Seattle. So, any way I go I am taking a chance. I just want to maximize my odds of a successful virgin implant.

Thanks your your concern for my welfare. Thanks for reading through this lengthy history.

Leave his patients inflated to 80%! Wow I can't imagine having an almost full woody for 6 weeks. I would say I'm between 20-40% inflated, and it's a bit uncomfortable.

[ccrider]

How important is it for the surgeon who did the implant be the person who follows up for post-op care. (Initial inflation, questions that may come up, etc.)

I can have an implant with a relatively low volume..... Or I could go to a somewhat higher volume Urological Surgeon in Seattle w...

I think you should go with the most experienced highest volume surgeon that you think will do a great job. Peno-scrotal approach, I think is important (some high volume surgeons do not like it as much because it takes longer surgery time, but you do get better pump placement and better tubing position)

Regarding continuity of care, this pales in comparison with having someone who will "do it right the first time", though you do need to recognize that if there is a significant problem, then you will end up going back to your original surgeon (unless you decide to cough up the money to pay one of the celebrity surgeons to fix up the mess)

I tried to go with Dr. Kramer through the Maryland VA.That is doable except for the fact that I would have to fly to Maryland at least twice and I cannot afford the time or the air fare for that. My local VA (Alaska) has a surgeon here who would do the implant, but he is a relatively low-volume (20 in the past 12 months) surgeon with no track record I can access.

My local VA has suggested I could go to Seattle (where the product representatives for my region are located, so there might be better product support in the O.R.), but the authorizations for that are dragging out.

So, with the high-volume high reputation surgeons out, I have two choices.

Seattle, (presumably a bit higher experience level than my local guy and possibly better manufacturer support) with followup by my local urological surgeon.

or

My local urological surgeon (where continuity of care is the sole advantage).

Or skip the procedure entirely as out of my reach.

Lost Sheep:

Why would it take two trips to Baltimore from AK if you can do it with Dr. Kramer? I'm almost sure you could go a few days early and get the testing done there. A couple of months before I had my procedure done, Connie called me to advise of a cancellation in October. I said that I didn't have my testing scheduled until the 30-day window before Dec. 7. She told me that they could do expedited testing at U of Maryland...of course, I was using private insurance versus VA coverage...