Insurance is limiting Cialis

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Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 1/24/2009 4:27 PM (GMT -6)   
My urologist prescribed 5mg Cialis daily at this stage of my recovery stating it will reduce chances of calcification of blood pathways owing to the induced ED from the prostatectomy. He wrote me a 90 day prescription, but advised me that owing to the cost, I could go every other day.

I filled my prescription using my employers mail order pharmacy (required) and they are limiting my prescription to 5 a month and dispensed 15 tablets at a cost of $69.43 ($4.63 per dose). I checked with a local pharmacy about the cash price for this same 15 tablet and was told that it would cost $89.50 ($5.97 per dose), so my insurance is covering very little of this medication.

I have a few questions for the experienced folks here:

1) Is the pharmacy limit of 5 per month a reasonable dosage level?

2) Should I ask my doctor for 10 mg dosage prescription and cut tablets? Usually the per tablet cost is the same under insurance regardless the dosage.

3) Are there other medication options to reduce chances of calcification? I'm not trying to achieve an erection at this stage, but want to improve my chances in the future.

4) Would a penis vacuum pump achieve the same blood flow action to keep the plumbing exercised at a much reduced cost?

5) Other ideas?

TIA! turn
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 1/24/2009 5:01 PM (GMT -6)   
Dandapani,
A better option with your current pills may be to ask for the 20mg tabs and split them into 4. Many of the members here have struck the same problem and now source their E.D. meds overseas. Alldaychemist has a reputation for good delivery and feedback from members endorses the effectiveness of their generics with the delivered cost coming in at about $1-00 a pill. I believe though there is a problem with bringing the generic Cialis into the U.S. because of patent restrictions. These restrictions do not seem to apply to either generic Viagra or Levitra. You can check them out here.
www.alldaychemist.com/men_health.html

Cialis ...... active ingredient........Tadalafil 20mg
Viagra......active ingredient........Sildenafil Citrate 100mg
Levita.......active ingredient........Vardenafil 20mg

The vacuum pump is a great solution to keep things in working order if the pills at this stage are not helping a great deal with erection.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 1/24/2009 5:17 PM (GMT -6)   
Cialis or Viagra is usually used more often than 5 a month: you could ask about more regular use which sounds more logical.
Some men often cut the pills  into 2 or 4, depending on the size.
 
Pump could be used in addition to medication.
 
 
Edit: sorry for some repetition: slow typing here

Post Edited (aus) : 1/24/2009 3:21:22 PM (GMT-7)


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 1/24/2009 6:31 PM (GMT -6)   
Dandapani, my health plan sound very similar to yours. They pay for 5 Levitra per month. My cost is about $65. I began to use the generic Levitra through Alldaychemist.com. Very happy with their service and product. I bought 20 pills for $40 ish shipped.
Age 50
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 1/24/2009 9:08 PM (GMT -6)   
All good info. Thanks!
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 1/24/2009 9:53 PM (GMT -6)   
My insurance co (BCBS Federal Plan) covers no ED medication even after I submitted an appeal and a letter from my Doctor. I will use ADC as long as I can and the "big" drug companies can keep their high dollar drugs.
Good Luck,
KW
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
    Oct. 6th, 2008 - AUS Activation by Dr. Morey.  Working Great, only light drips and dribbles.
     


Art662
Regular Member


Date Joined Sep 2008
Total Posts : 54
   Posted 1/26/2009 11:19 AM (GMT -6)   
This is the problem with all insurance for ed - it has or is going away. Until 2005, most insurance companies covered all ed treatments, with the advent of the "blue pill' that has all changed. I have anthem - but it covers nothing. And all other private insuance carriers in Indiana do not cover this as well. This is the big concern among many of us - there is no or very limited coverage. my next trip under the knife will all be 'on me'.
Art
1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/26/2009 4:49 PM (GMT -6)   
My doc prescribed me 5mg Cialis. I received some samples from him that lasted a while, and also went online to Cialis and received a 30 day supply as a free trial. As the doc really wants me to take the 5mg's every other day the freebies from the on-line free trial for me are good for 60 days. I know this is only temporary but with the high costs of these things every little bit helps.

I am also using a Trimix mixture - the doc was not high on pumps because he says the pump does not effect the area most needful for reconstruction which is not exercised by the pump.

Only passing this on as information. I am still fighting the same battle most of us are fighting with the hope of future improvements.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/26/2009 5:21 PM (GMT -6)   
Dandapani, Blue Cross(State Plan) limits me to 6 100mg Viagra a month. I'm just 17 days post-op at this point so I have not started them yet, even with the total ED. Still a bit sore down there and the doctor has not given the OK yet.
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09
Pathology Report says it's gone!
First Post-op PSA due 2-17-09


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 1/26/2009 9:01 PM (GMT -6)   
Thanks all. I ordered the 20mg Cialis from ADC. I haven't heard anything from them yet on the order so fingers are crossed. Thanks for the pump info. I guess that's not the answer either.
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED

Post Edited (Dandapani) : 1/27/2009 4:15:15 AM (GMT-7)


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 375
   Posted 1/27/2009 1:02 AM (GMT -6)   
My BCBS plan covers 8 Cialis per month.  For the remainder - from a total prescribed of about 16 per month - I think my co-pay is about $80/month.  I pay an additional approx, $80 for the MUSE, per month.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 1/27/2009 6:07 AM (GMT -6)   
I wonder how you guys getting Cialis (tadalafil) from ADC here in the US are managing it. I just got this mail from them:

===

Dear Dan

Thank you for placing an order with us.

Please note we cannot ship tadalafil (to USA) if it is meant for consumption in USA.

(OPTION ONE) If you can send us a mail stating that the product is not for consumption in the US and then we can ship the product to you.

(OPTION TWO) Alternatively, we can ship it to any other country (besides USA) OR

(OPTION THREE) we can ship you 10 pills + 10 pills free and 10 pills extra Vardenafil Hcl 20 mg instead of Tadalafil.

Other internet sites offering Tadalafil for sale in USA are putting you at risk.

PLEASE INFORM US WHICH OF THE OPTIONS (ONE, TWO OR THREE) YOU WISH TO UTILIZE.

This is for your kind information please and we look forward to your confirmation about the above.


With warm regards

ANUJ
Tel (US): (213) 814 1441
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 1/27/2009 6:31 AM (GMT -6)   
Dandapani
If you go back to my earlier reply to your original opening post you will see that I mentioned there was a problem with bringing Cialis (Tadalafil) into the U.S. The manufacturer Eli Liley, still has a stranglehold on the patent. Many U.S. members have spoken of their problems trying to import it and ADC has a warning on their site that they are not permitted to sent Cialis generics to the U.S. Strange because we have no problem here in bringing it into Australia. Levitra and Viagra generics do not have the same restriction and their effect is the same although some members report differing side effects to Cialis (or the generic). Now if your were to declare to them that you were not going to consume them in the U.S (perhaps a little white fib) they will obviously send them to you, but I do not know how you will get on with U.S. customs. Other members may be able to chime in and help with that.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 1/27/2009 6:31 PM (GMT -6)   
Sorry, BillyMac, I missed your first post. Yup. Looks like I'm SOL with the Cialis formula.

Anyway take the Levitra at the lower dose on a daily/every other day basis... ?
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 1/27/2009 8:03 PM (GMT -6)   
All those drugs work by the same methods.........i.e. they all relaxes muscles and increase blood flow to particular areas of the body. They are known as phosphodiesterase inhibitors. So I should think the Levitra generic would be taken at the same dose rate as Cialis (5g/day or 10g every second day) or if using Viagra generic then 25g each day or 50g every second day would be the equivalent. Some members have reported better response from the different drugs with some preferring Cialis while others prefer either Viagra or Levitra. This is a quote from an article I remember reading:

"What Are the Differences Between Cialis, Levitra, and Viagra?
Cialis, Levitra, and Viagra work by a similar mechanism to cause erections. There are subtle differences in how long the drug works and how quickly it works. Levitra works a little longer than Viagra. They both take effect in about 30 minutes. With Levitra, the effects last for about 5 hours. With Viagra, the effects last approximately 4 hours.
Cialis works a bit faster (within about 15 minutes), and the effects last much longer -- up to 36 hours in some cases."


It would probably be a wise move to ask your doc if he feels there is any difference between the drugs for surgery recovery purposes.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 2/1/2009 11:42 AM (GMT -6)   
I just went to pick up my prescribed 15 pills of cialis (20 mg) to be able to take 20mg every other day. Pharmacy said BCBS would only approve 4 per month? So even if I cut in half and take 10mg twice a week it is still less than the every other day I am supposed to be taking. I have a call in to my doctor to get his advice on whether to go ahead and take the 10 twice a week.

After reading some posts here I think I will order from ADC and give them a try. It would cost me $250 per month to get what doctor prescribed!

Also, the pump cost me $475 out of pocket - not real crazy about and not real good results from it but I will continue to use every day.

Just wanted to share my experience.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - Duke Medical Center - left side nerves spared
Catheter removed 1/15/09 - no pain!

Post operative results:
Pathologic stage - T3aN0Mx
Post surgery biopsy - Bladder neck margin negative, lymph nodes negative, specimen confined, extracapsular extension positive, perineural invasion positive, seminal vesicle invasion negative, all margins negative, Gleason 3 + 3 = 6.

1st post op PSA scheduled for 4/16/09

"Pick a good doctor and say your prayers"


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4453
   Posted 2/1/2009 12:44 PM (GMT -6)   
Tom, alldaychemist is not allowed to import Cialis generic into the USA. You can get Viagra generic and Levitra generic though. The Levitra generic should be a good substitute for the Cialis. The reason BCBS won't pay for more than 4 a month-according to my BCBS Rep.- is they still consider it a sexual aid, not a rehabilitive drug. Still living in the past as far as understanding the need for rehab use of the drug, but that's their stand. I guess they figure a man can live with sex once a week, but there's no need to regain what he has lost, it will just cost them money.... turn
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


RSteve
Regular Member


Date Joined Mar 2009
Total Posts : 20
   Posted 3/24/2009 4:50 PM (GMT -6)   
Dandapani said...
I wonder how you guys getting Cialis (tadalafil) from ADC here in the US are managing it. I just got this mail from them:
Send a reply email that elects: (OPTION ONE) If you can send us a mail stating that the product is not for consumption in the US and then we can ship the product to you.
"Please send the tadalafil, as ordered. I will not be consuming this medication in the United States."
ADC is just covering its rear with regard to patents. I doubt if it will strap a polygraph to your email to see if you're using tadalafil inside or outside the U.S.

 

Roger G
Regular Member


Date Joined Apr 2008
Total Posts : 150
   Posted 3/25/2009 9:18 AM (GMT -6)   
I had to jump through hoops to get my ED meds approved by my insurance company.  Once approved I was REALLY supprised that they limited the amount covered.  The coverage did not even come close to my one a day prescription.  They claimed the limit was in place to stop the recreational use of the drug.  Next time I go to an old age home I going  to look for their supply of blue pills tongue
 
ADC was the answer I got from this forum, and it works well.
Age: 43 (2008)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
01/2008: Still working on ED.
 
 


justus1292
Regular Member


Date Joined Feb 2009
Total Posts : 63
   Posted 3/25/2009 9:18 AM (GMT -6)   

Congratulations! You are now in the harriest part of this ball game.  (Pardone the pun about "ball" because that's what you are doing very little of.)

I'm retired military and my insurance only pays for 6 x 100 mg Viagra monthly.  My uro says it stupid because 10 cost the same price.  Go fig.

As for the vacume device, it probably saved my marriage...not to mention my Johnson.  Yes to the VED. Minimum of 2 to 4 times a week.  Trust me, over the past six months I failed to do it regular and have noticed about a quarter inch loss in length.  I can't emphasize this enough.  Check with your uro first.

Even with the Viagra script, I use the dickins out of that pump and stock piled my pills.  Now I'm on the needle, sometimes in conjunction with Viagra.  Don't worry about the needle.  If you want an erection, that little prick in your prick isn't all that bad.  But, it looks like that's down the road for you still....if you insurance will pay for it.  Its like a couple hundred bucks for 10 ml bottle.
 
Here again though, ALWAYS CHECK WITH YOU DOCTOR FIRST!
 
Good luck.
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