Post Surgery ED Care

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Paul1959
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Date Joined Nov 2007
Total Posts : 598
   Posted 11/30/2010 8:20 PM (GMT -6)   
I had an interview today with a reknowned ED here in NYC. He asked me an interesting question. "Do you think the PCa surgeons really like to treat the ED issues that come up after surgery? Or do you think they would rather pass them off?"   My first reaction was that most would rather someone else take over the ED so they could concentrate on PCa issues.  I had to think about my experience for a minute. I told him, that in my case, I had sort of put my faith in the doc who kept telling me to wait. It wasn't until some months had passed when i realized i was probably not getting the ED care i needed.
 
If an ED specialist offered his care after your surgery, would you have responded?  It would not be leaving your surgeon at all. Just penile rehab and ED issues are with an ED specialist.
 
As you know, the vast majority of PCa surgeons are NOT great ED docs (yes, there are exceptions, but we're talking generalities). A complete program of penile rehab would help many men.
 
How do we get men to make the move and get an ED specialist after surgery? What would hold them back from this decision? How could you have heard this message so that you would have responded?
Thanks
Paul

MrGimpy
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Date Joined Jul 2009
Total Posts : 504
   Posted 11/30/2010 9:07 PM (GMT -6)   
Paul,

I suppose it depends on the patient picking a "full service" practice. In my case I worked with an ED specialist as soon as I was diagnosed. Regardless of the treatment option I chose I had a dedicated ED specialist. He is part of the practice that I chose.

Some smaller practices do not have this luxury and it would be up to the patient to even know that this was an option to them

Better Question is : Does that URO that is treating them realize an ED specialist exists to even bring it up in a conversation

Of course there is the $$ part of the equation, would a URO pass on his patient to a specialist if he/she feels that they could do what is needed himself ?

Cajun Jeff
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Date Joined Mar 2009
Total Posts : 4119
   Posted 11/30/2010 9:20 PM (GMT -6)   
Paul, the only thing that was advised to me was to meet with the VED rep. A week after the Uro Dr appt. Rehab info came from the rep! Instill do not know if there is a Dr. In Baton Rouge that specializes in ED. This is just unbelievable to me. What a disgrace!

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

Paul1959
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Date Joined Nov 2007
Total Posts : 598
   Posted 11/30/2010 9:44 PM (GMT -6)   
One interesting thing I have learned, Surgeons do NOT get paid for any patient visits for 90 days after surgery. Most insurance companies assume this after surgery care is part of the surgery fee. So this is far less a financial decision than it is of convenience. I also realize we are getting into an area of ego in all this.

Mr. Gimpy, so most of this would not apply to you, since you had an ED doc built into the system. Most surgeons don't have that. But your second sentence about it being up to a patient to know about it is the crux of the matter. That's why i wanted to know How you could have heard this message? i know it's a multifacted thing and hard to sum up in a sentence. And yes, every uro around here knows this ED doctor. They respect him, but he does not get a lot of post PCa patients. He gets tons of other ED guys, but not a lot of PCa men.

Doctor education is a dead end. Almost all corporations have given up with Dr. education now. The messages all too often do not get to the patients. The current thinking is bypass the dr and go straight to educating the patient.
Was just seeing if anyone had any thoughts about what would have gotten their attention...and how it might have been presented. Brochure? poster? email? commercial? etc.
thanks guys
Paul
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
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
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 11/30/2010 9:47 PM (GMT -6)   
Paul,

After the catheter was removed. I was told to wait 6 weeks so I do not damage the doctor's handiwork. I then started Cialis every other day for a few weeks. Shortly after that they set up an appointment with a VED rep.
After about 7 months when it was obvious pills and pumps were not going to work I was given the prescription for Trimix.
I never saw an ED specialist. Incontinence was much higher on my issue list.
Jeff

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/1/2010 3:49 AM (GMT -6)   
Paul,

The ED issue lingers well past the 90 days of "included" visits. With rising ins cuts to physicians ( ie: Medicare) I suspect its patient seen per hour that drives monthly office manager agendas.

Good point though on the 90 day follow up, I wonder if that 3 month PSA follow up occurred post day 91 or if it were between day 80 and 89, I suspect the former for the reason you mentioned

I can see a patient calling for a 3 mo follow up after robotic and asking for an appt on day 88, receptionist says day 88 is way way to soon to come back in, can you come in 3 days from then

If my ED doc were not presented to me on a silver platter I would have never have known to even look for one. Many people here have never seen one. Perhaps start a poll to see how many member here have seen one

If anything our group here is far more educated that the average patient, so it would be curious to see how well informed patients took this info and took the step to see someone

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 12/1/2010 5:46 AM (GMT -6)   
My surgeon did it all except for the meeting with the VED rep. I felt my surgeon did a good job. I finally got a little chuckel out of him the second time when I mentioned borrowing one of his staff for the real mother nature test.

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/1/2010 11:02 AM (GMT -6)   
Good idea, Gimpy.
Now i just have to learn how to do a poll!
 
Area doctors love this ED guy - it's all he does.  But for some reason, PCa docs don't send him patients...until it is way late in the game and things are in a bad way emotionally, physically, etc. Most of the Uro's say they will treat ED guys, but it is not high on their priority. they want to do surgery...it's what they do. So, just trying fill two needs...help men...and let surgeons off the hook for ED.
 
 We are seeing if there is some way to educate men about seeing and ED soon after surgery. Penile rehab would start the day the cath comes out with oral drugs. heck, you guys know the drill! LOL
Paul

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/1/2010 12:05 PM (GMT -6)   
Paul,

Its not high on a mans priority list to even go for a routine DRE or even a PSA test. ED ? see the Viagra commercials where the guy is embarrassed to even tell his long time GP

Its like going to your GP to get a cholesterol and BP test, gee its 300 and 160/100 what should I do ( a cardiologist would be a thought, as damage may have already been done yet could be reversed) but most Dr's will just start treatment on their own and not even bring up a cardiologist.

How does a patient know when to go get specialized care, it may have already been answered in some other aspect of the medical field

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/1/2010 9:57 PM (GMT -6)   
Gimpy
Good point. And THAT is something no one can combat! Human nature, I suppose, is a hard thing to deal with. But good correlation re the cardio thing. yeah, and I sort of recognize myself when I think about it! i'll just fix it (plumbing, roof, car) myself...till I get in real trouble and have to call in an expert to bail me out. And that's exactly what is going on in this area.

Thanks for your thoughts. I think i will do a poll....and hope to get responses!
Paul
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
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
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!
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