Any idea how long is too long a wait to start Viagra?

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mountain top high
Regular Member


Date Joined Mar 2009
Total Posts : 22
   Posted 4/6/2009 6:34 PM (GMT -6)   
I've been fighting with CVS Caremark for 6 weeks now trying to get my Viagra prescription filled. The doctor's office originally filled out the paperwork with an error so it was denied and went into appeals. After several weeks of phone calls and emails between Caremark, my insurance benefits committee and the surgeon's office, the paperwork was resubmitted and the benefits committee told me we were good to go. They contacted me back today to let me know that Caremark's policy is not to accept corrected paperwork for 60 days after the incorrect submission (?!). So now it has to go to the next benefits committee meeting for a decision.
 
Anyhow--do you guys know if there's a window of time where you need to start the Viagra if it's going to do any good? I've been using the VCD twice a day for 6 weeks but there is absolutely nothing going on unaided, and even with 2 bands it's just not sufficient for IC.
Mountain Top High, Age 43
PSA 1.6 (2006), 1.9 (2007), 6.0 (6/2008), 3.9 (7/2008 after 30-day Cipro course)
8/08 biopsy--high grade PIN
11/08 biopsy--Dx (age 43), Gleason 7 (3+4), T1c
Da Vinci RP 2/9/09 (Dr. Abaza, Head of Robotic Uro, James Cancer Center @ Ohio State)
Path--PCa 9%, 39.5 grams, contained in capsule, margins & lymph nodes clear
Catheter 1 week, no nighttime incontinence
@ 6 wks: morning best but still ~4-5 pads/day
Complete ED, pump twice daily, insurance denied Viagra :-(


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 4/6/2009 6:54 PM (GMT -6)   
I think I started viagra at the 3 month mark. If you are close to the doctor's office, I would call and see if they had any samples they could give you.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8
margins clear
9 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/6/2009 6:58 PM (GMT -6)   
As soon as you are able is the trend lately. Many Doc's are even beginning men on one of the big3 just before or the day of/after surgery. Good luck and well wishes.
 
Swim
 


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 4/6/2009 8:41 PM (GMT -6)   
I agree with Rob that you should get samples. Then, I hate to be un-american here, but forget all the insurance BS.
Go to www.alldaychemist.com and order your viagra from them. Their prices can't be beat and it works just as well as the drugs bought here. Insurance will probably only pay for 6 a month or so.
46 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6 (Biopsy 3/07 just suspicious)
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at nine months.
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - Took 100mg viagra every night. for several months
Totally usable erections at 10 weeks, which disappeared over the course of a month or two.
ED bounce is what they call it. Now, at one year, ED is fine with viagra.
One year PSA - undectable!


mirv
Regular Member


Date Joined Nov 2008
Total Posts : 30
   Posted 4/6/2009 10:50 PM (GMT -6)   
Hi Mountain,
The samples route sounds good until you can get a reliable source going on this. Personally, I have to pay for my ED scripts myself, but I think it is a very important therapy to use so I just do what I have to do to keep it going, regardless of the price. I haven't used alldaychemist yet but I do plan to soon, the US prices are so expensive. Also, my experience is that Cialis does not help me much but Viagra and Levitra do, so if you don't get results with one, make sure to try the other ones. Here's one doctor's approach to ED therapy that I ran across:

urologytimes.modernmedicine.com/urologytimes/content/printContentPopup.jsp?id=384316

Mark
Age 52
PSA 3.1 fPSA 26% Dx: 11-07-08
1 of 12 cores with 5% adenocarcinoma
11 of 12 cores clear Gleason grade 3+3=6
Robotic laproscopic surgery 2-4-09
Dr. Garret Matsunaga, Torrance Memorial Hosp.
Free hernia repair! 2 day stay.
Pathology: pT2c NXMX
upgraded to 3+4=7 and <2% tertiary 5
negative margins
negative extraprostatic extension
negative seminal vesicle invasion


NV RTRD 2007
Regular Member


Date Joined Jan 2009
Total Posts : 75
   Posted 4/6/2009 11:38 PM (GMT -6)   
My doctor had me started levitra after four months. I took one last saturday night (5mg) because that's what my PCP at the VA gave me though my doctor prescribed 20. Anyway.. no effect. I am not expecting (but wish though) a sudden usable erection. My PCP told me to try for one month (one tablet once a week) and if no progress, she'll increase it to 10 mg. We'll see.
Age 54; Age DX 53
PSA: May 07- 2.9; Dec 07-4.3; Jan 2008- 6.1; May 2008- 6.4; Sep 2008- 7.3 ; Sep 2008- 9.6
Bone Scan: Mar 2007- Normal without evidence of metastatic disease.
Biopsy Mar 2008: 6/6 core right gland- No evidence of malignancy; 5/6 core left gland- positive Gleason score 3+3=6 average tumor volume 5 mm.Clinical Stage II.
Transrectal ultrasound at UCSF Jun 2008: 7x14x10 mm hypoechoic lesion in left gland. DRE positive, PSA Density- 0.23 and Prostate volume - 27 CC.
RRP: 4 Dec 2008; Discharged - 8 Dec 2008; Cath removed- 18 Dec 08.
Pathology Report: Prostate- 33 grams; L/R pelvic lymph node -No evidence of malignancy; Right Lobe- No definite tumor; Adenocarcinoma, Gleason 3+4.
Post PSA: 7 Jan 2009 - <.05.
              10 Mar 2009 -<.05


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 4/7/2009 5:23 AM (GMT -6)   

Greetings everyone.  I agree with some of my brothers here - first go to your doctor and get some samples.  My doc gives me some everytime I go in.  Then go to All Day Chemist and get your regular supply.  I am getting ready to make my second order and have found them to be very reliable and the pills work the same as the name brand.  My insurance pays zero for ED drugs regardless of the reason. 

For what it is worth, my doc says he always starts his patients on Levitra or Cialis and only goes to Viagara as a last alternative.  The first two both work in a similar way but Viagara works a little differently.  Just a thought - you might ask your doc about which drug is best for you. 

Trust you will get it all worked out soon.  David


Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4112
   Posted 4/7/2009 7:24 AM (GMT -6)   
My Doc put me on Cialis 5ml a day at 3 months. My insurance does not pay for ed drugs. I just placed an order with alldaychemis. I also got a ved at 4 months. Use it 2x a day. I am at my 6 months post op and starting to get a pit of reaction with the little man. Things are starting to look better.

AndrewJ
Regular Member


Date Joined Jul 2007
Total Posts : 25
   Posted 4/7/2009 4:20 PM (GMT -6)   
My surgeon, one of the leading guys in this field in Europe, was convinced that an aggressive approach to PDE5s (viagra, etc.) is a key part of a proactive approach to ED after PCa. He had me take 5mg of Levitra the evening before surgery and then every evening from the day of the surgery till 2 or 3 months afterwards. He showed me many medical journal articles showing how this helps the system to recover (encouraging blood supply, etc.) Apparently the erectile tissues can atrophy if they do not get regular increased blood and oxygen supply. As he said, it's keeping the tracks ready, even if there are no trains running. These studies are out there, so I can't understand why all treating doctors don't follow this. I'll never know for sure if it helped my recovery, but I am very happy with my outcomes.
46 years old (45 at diagnosis), Australian living in Germany
PSA: started around 3.5 in 2005, 6.1 at time of surgery
Biopsy: nothing found in 2006, 3 May 2007 3 of 24 cores positive, Gleason 3+3 or 3+4 depending on pathologist
RPE in Munich, Germany on 22 June 2007
Post surgery pathology: organ confined but less than 1mm from margins, Gleason 3+3, pT2c, Lymph nodes removed and clear
First post-surgery PSA 31 July 2007: 0.01 Confirmed every 3 months since. Fully continent immediately after removal of catheter on Day 8.
No potency issues but still taking small doses of generic Levitra "as required" as my security blanket.
This man knows he has been VERY lucky.


meister
New Member


Date Joined Sep 2008
Total Posts : 13
   Posted 4/7/2009 10:00 PM (GMT -6)   
My doc prescribed one fourth of  a 100 mg viagra one week after surgery.  My health insurance only allows me to have sex 6 times a month so cutting a pill into quarters left me 6 to 7 days short on pills.  It costs about $50 for 2 pills so taking the wisened advice from my Healing Well brothers, I became a fan of alldaychemist.  For the cost of 2 pills at my pharmacist, I was able to get 60 pills for just a few bucks more.  I have been using them to augment my script dosage and see no difference.  I can now get back in the game with some help, but see gradual improvements 7 months post op.  Hang in there, take the advice of your brothers here, and dont be afraid to buck the system for meds that can help.
Age:  55
Pre-op PSA:  6.7
Gleason:  3+3 = 6
Surgery Sept. 9, 2008, Mercy Hospital Pittsburgh Pa
Post Surgery PSA results "Not Detectable"
My Journey can be found at:
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/7/2009 10:16 PM (GMT -6)   
Mountain,

I am so sorry for not having read your post clearly. To anser your question about how long is too long;

Not sure there is any real evidence on too long out there. Start when you can. Right now you're still well within the window of time where most are beginning to really work on recovery. Venous leakage is a common issue early post-op so don't be too worried about the rings not working well yet. That too will come in time. Keep doing what you're doing and let things happen. It wouldn't be unusual for things to take up to a year to see good progress and as much as 2+ for many. Hang in there.

swim
 


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 4/8/2009 5:56 PM (GMT -6)   

 

 I agree with Paul, he gave me some pretty good advice when I started this little trip....as far as starting with the ED thing, my guy started me the day after I had my catheter removed, then I decided to switch to Levitra after a week. Worked much better....been working pretty good since, had no complaints! Good luck-Blue


 
  age: 53  Pre-op PSA Feb 08' 5.0, April 08' 4.1
  Biopsy 5.1.08, 5 of 15 cores postive, T2a, Gleason 3+4=7
  DaVinci performed 7.29.08
  Bladder sling installed, umbilical hernia repaired during surgery.
  Path report, "cancer fully contained, margins clear".
  Cath removed 8.8.08, ED therapy begins 8.9.08
  100mg Viagra three times a week, pump for ten minutes daily
  and hold for ten minutes.
  8.16.08 switched to Levitra 20mg, immediate results
  9.15.08 Pad free at night, one thin (light) pad during the day
  9.18.08 1st Post-op PSA Undetectable Zero's....Yes!
  12.22.08 2nd Post-op PSA  Zero's still...
  Pads gone 1.3.09, finally found the courage...Thanks ya'll
          ".....tryin' to reason with hurricane season...."
       


mountain top high
Regular Member


Date Joined Mar 2009
Total Posts : 22
   Posted 4/9/2009 7:26 PM (GMT -6)   

I did get some Viagra samples from the doctor a couple of weeks after surgery. They gave me 2 sample packs (8 pills @ 50 mg) and said that's twice what they usually give people. They told me to take one for 4 nights then split them and take 1/2 pill for the next 8. The doctor's post-op instructions say you should start taking 100 mg/day when they take out the catheter tho. It's been about 8 weeks now and other than those 12 nights I haven't had anything. I didn't have any reaction whatsoever to the Viagra but I'm not sure 12 nights at low dosage is enough to make a determination.

Sounds like there's some variation in when others' doctors are starting them--I'm hearing anywhere from before surgery to 4 months afterward. I am getting antsy about the wait--I may check out that foreign source that several of you mentioned. It's irritating that after the thousands of dollars I've already paid in deductibles & coinsurance that I'm gonna have to fork over more to go around the insurance (especially since they're not contesting now that they will cover it, it's just getting through all their red tape BS that's taking forever).

Mark, thanks for the link. There's quite a bit in there that I haven't come across anywhere else. Sounds like he's all for acting quickly.
 
Thanks for all the feedback, guys!
Mountain Top High, Age 43
PSA 1.6 (2006), 1.9 (2007), 6.0 (6/2008), 3.9 (7/2008 after 30-day Cipro course)
8/08 biopsy--high grade PIN
11/08 biopsy--Dx (age 43), Gleason 7 (3+4), T1c
Da Vinci RP 2/9/09 (Dr. Abaza, Head of Robotic Uro, James Cancer Center @ Ohio State)
Path--PCa 9%, 39.5 grams, contained in capsule, margins & lymph nodes clear
Catheter 1 week, no nighttime incontinence
@ 6 wks: ~4-5 pads/day; @ 7 weeks 1-2 pads/day with ab/core exercises
Complete ED, pump twice daily, fighting with insurance for Viagra :-(


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 4/10/2009 9:37 AM (GMT -6)   

You need to watch what you eat with Viagra or it won't work. No fatty meats such as a hamburger or a ribeye steak. No french fries, thick salad dressings, etc. This is applicable for up to 4 hours before you take a pill.

I started on Viagra in 2002 and learned this by trial and error. The ED then was caused by my hypertension medication. My PCP also gave me a prescription for Cialis which at first worked great but you do build up an immunity to it's effects after some years.

Viagra always worked great for me on an empty stomach in the morning as did Cialis.


Age 60
PSA 2007 4.1
PSA 2008 10.0
Diagnosed April 2008
Biopsy: 6 of 12 cores positive
Gleason 4 + 5 = 9
CT and Bone Scan negative
Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared
Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th
pT2c
lymph nodes negative
PSA Sept 28, 2008 0.00
PSA Jan 22, 2009 0.00


mountain top high
Regular Member


Date Joined Mar 2009
Total Posts : 22
   Posted 4/10/2009 6:29 PM (GMT -6)   
Thanks for the heads up on the food. The doctor told me not to eat a lot of grapefruit or grapefruit juice with it either. Something about grapefruit increasing absorption. (Being a former Floridian who loves grapefruit I asked how much and he said you can have it, just don't go overboard and it's best not to take it at the same time as the medication.)
 
I went ahead and ordered from alldaychemist. Something happened while it was processing my credit card (had to go through some kind of Visa password system) and I got an error, though. I got an email back thanking me for the order but sounded like I should have gotten a second one if the transaction went through, which I didn't. Not sure if the transaction completed so I sent them an email asking for clarification. Haven't heard back yet.
Mountain Top High, Age 43
PSA 1.6 (2006), 1.9 (2007), 6.0 (6/2008), 3.9 (7/2008 after 30-day Cipro course)
8/08 biopsy--high grade PIN
11/08 biopsy--Dx (age 43), Gleason 7 (3+4), T1c
Da Vinci RP 2/9/09 (Dr. Abaza, Head of Robotic Uro, James Cancer Center @ Ohio State)
Path--PCa 9%, 39.5 grams, contained in capsule, margins & lymph nodes clear
Catheter 1 week, no nighttime incontinence
@ 6 wks: ~4-5 pads/day; @ 7 weeks 1-2 pads/day with ab/core exercises
Complete ED, pump twice daily, fighting with insurance for Viagra :-(


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/10/2009 11:43 PM (GMT -6)   
Funny you mention grapefruit. A friend of ours who also had surgery 3 years ago says he takes his Levitra with juice because it seems to work faster for him. I wondered about it...thanks!

swim
 


mountain top high
Regular Member


Date Joined Mar 2009
Total Posts : 22
   Posted 4/24/2009 10:18 PM (GMT -6)   

Wanted to pass on an update, with a followup question. So CVS Caremark apparently doesn't have a philosophical problem with approving my Viagra prescription now, they are just going the route of trying to kill it with bureacracy (support desk keeps saying "we don't have any record of it being approved in our system" even though the benefits committee chair says it was approved and we're good to go).

I did get an email back from alldaychemist telling me to just ignore my first order that popped up an error, and it would cancel off the system, and to fill out an order again. The second time I tried I didn't get the error message but also didn't get the second email confirming that my VISA charge was processed. So sent them an email asking if it went through that time. No response to that email so after several days I called the phone numbers in the email that they sent to me earlier. Both gave me messages that the mailbox was full and couldn't take any more messages. Finally got an automated email a week ago that it had been shipped with a tracking number (and the VISA charge showed up on my card). Each day I could see the progress--left India, in NY customs, on to Columbus, then misrouted (which I found humorous--I worked for the USPS in the mid-80s ;-). It arrived yesterday! So I started last night with the 100 mg nightly dose, which is what my doctor prescribed.

Which leads me to the question. Did the side effects eventually subside for you guys? I quickly got several of the side effects that I've read about. My face flushed (felt hot like a mild sunburn) after about an hour. Sinuses swelled up so I couldn't breathe through my nose, so was waking up through the night with a tissue-paper-dry mouth. And had a pounding headache from the sinuses all night and today. Took naproxen, which helped, but I don't want to have to take those all the time too. When I took the 50 mg and 25 mg samples a couple months ago from the doctor's office I didn't have any side effects at all.

Thanks for all the suggestions about alldaychemist, and other stuff!


Mountain Top High, Age 43
PSA 1.6 (2006), 1.9 (2007), 6.0 (6/2008), 3.9 (7/2008 after 30-day Cipro course)
8/08 biopsy--high grade PIN
11/08 biopsy--Dx (age 43), Gleason 7 (3+4), T1c
Da Vinci RP 2/9/09 (Dr. Abaza, Head of Robotic Uro, James Cancer Center @ Ohio State)
Path--PCa 9%, 39.5 grams, contained in capsule, margins & lymph nodes clear
Catheter 1 week, no nighttime incontinence
@ 6 wks: ~4-5 pads/day, since 7 weeks out 1-2 pads/day with regular ab/core exercises
Complete ED, pump twice daily, fighting with insurance for Viagra


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 4/25/2009 2:43 PM (GMT -6)   
I took 50mg nightly for the first year, now I take 50mg 3 times a week, and still have the same effects from it, flushed face, a little swimmy headed, and general feeling of out of sorts. I don't think the symptoms ever drop off or stop, from my experience of 17 months use.
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

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