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    Upcoming appt. w PA @ Urologist Office
    otter051069 posted:
    Hey TXMN1212,

    Had a couple of questions thought you might be able to help with. I have an appt. in Sept. with a PA @ an Urologist office and am having some of the same issues that you describe. By the way, your post are very descriptive and helpful. I'm wondering if you were ever prescribed any oral meds for your ED and they didn't work and that is the reason that your Doc put you on an injection?

    What is your health condition that caused the ED? Did your Doc actually give you a diagnosis?

    I had a stess test around 5 yrs.or less ago and was told that I ranked above average for the age group that I was in, so I don't think that is the issue.

    My family Doc gives me the traditional meds to try and they work, but my concern is I'm wondering if there is some other issue going on, that's why I decided to get the opinion of an Urologist. I'm hoping they will be able to come up with a reason, whether it be a physical one or just "mind games".

    Not sure what tests I will be going through, but from what you describe, they leave no stone unturned. Thanks for your help and let me know if you would rather talk "off camera" and I can give you an email address or phone #. Thanks again!!
    txmn1212 responded:
    My family physician prescribed viagra previously. It worked to a certain extent, but I hated the side effects from it. I would get congested, get headaches from it, etc. After using that for about a year or so, I went back to him and asked what other options were out there. He mentioned Cialis and a few other oral meds, then we talked about the injections. He didn't feel he was qualified to do the injections, so he sent me to a urologist.

    My urologist isn't sure what condition is causing my issues. He did the exam and couldn't find anything wrong, but he did talk about the risk of cardiovascular disease that can go with erectile dysfunction. I do have irregular heartbeats and take meds for those, so he thinks that could have something to do with it. I think part of it might be psychological with me, but that's just a guess.

    The lasting power I get with the injections is fantastic, and my wife likes that part. No more worries.

    If you get a good urologist, you'll get the exam of your life---at least as far as your private parts go. They have to do that to rule out all the possible issues. I've been on injections for over a year now, and he still examines me VERY thoroughly every time I go. Urologists are kind of like gynecologists for men, in my opinion. With my family doctor, he does the basics only. Cough, cough---and that's the extent of my gential exam. This guy does everything--and more.
    otter051069 replied to txmn1212's response:
    Thanks so much for replying, I appreciate it!! I have a pretty good idea of what the exam will entail, because of your experience and I appreciate that. I'm still kinda nervous not knowing just exactly what will be asked of me.

    I'm kinda suprised that your Doc would put you on injections with being congested and always having a headache, I had always thought that injections were a last resort, not saying that wasn't the right call for you. I'm glad that it is working for you.

    I did know that cardiovascular disease can go hand in hand with erectile dysfunction and I certainly have that in my background, both Mom & Dad, and I'm hoping that is not the case with me. Maybe just psychological and if that's the case, I can live with it, but just knowing hopefully that that is all that is wrong I think will be a relief.

    I know what you mean with the exam from the primary Doc, mostly the cough thing and you're out the door, so it will be good to have that thoroughly checked out, and I think sometimes the primary Doc has such a tight schedule that time doesn't allow too much detail. He usually checks the testicles and does the prostate exam, but if I want to be checked for a hernia, I have to ask.

    One other thing I thought of, did your wife either go in the room with you during the exam or did the Doc have questions for her or were you in there with either the PA of Doc by yourself?

    Again, thank you for taking the time to get back with me, you have eased my mind a little, and if don't mind, I'll let you know how things went. Thanks again!!
    txmn1212 replied to otter051069's response:
    The injections don't bother me at all. The viagra caused a lot of side effects, but all I get from the injections is a little bruising on my penis---but that's only sometimes. I have to watch carefully when I inject that I don't hit a vein. That's why he examines my penis so closely---if I don't do it correctly, I can get curvature of the penis which is definitely not good. The erection lasts a good 2 1/2 hours, depending, so that can be either annoying or a good thing (LOL). If the kids are home, it can be a problem.

    The primary doc checks me for a hernia, but no testicle check at all, unless I ask for it. I cannot for the life of me understand that. I do self-exams, but I still want a doctor to confirm that I'm good to go. As you said, they're really pressed for time and I've considered seeing a family nurse practitioner who's in the same office as he is to get a more complete exam. If I wasn't seeing a urologist, I would definitely consider it. In fact, I'm due for my annual physical next week and I doubt if he'll do a prostate exam unless I ask him to. I probably will, since I'm 45 and at a higher risk.

    The exam isn't horrible. Probably no two urologists are alike, but you'll probably get most of what I got. The bulbocavernosus reflex test can be a little weird, if he does that on you. He's checking for nerve sensation in the penis, according to what he told me. It's a standard test in diagnosing ED. The position at least wasn't embarassing---I only had to face him with my feet apart in a half to three quarters-squatting position while he inserted a finger into my rectum. He squeezes the head of your penis with the other hand.

    Good luck with your exam. By all means, let me know how it goes!
    txmn1212 replied to otter051069's response:
    I forgot to answer your question about my wife being present. She didn't go with me to the exam---she hates doctors! I was alone in the room with the urologist on the first visit, and alone with the PA on the exams after that. The nurse only stuck around to get the urine sample and to tell me to get undressed.
    otter051069 replied to txmn1212's response:
    Oh my gosh, you have been a world of help, you have eased my nerves considerably!! The only thing left for me is the actual exam, hopefully they'll take it easy on me!

    The reason I asked about your wife going in with you, I was checking WebMD under the ED help section and that was a possibility according to that article, so didn't know what to expect. My wife is old school and I'm sure she would be embarrassed to death, not to mention myself, but anyway, we'll see what goes.

    We'll see what I wind up with, maybe nothing more than what I am doing. If I do wind up with the injections I may call on you for some support, I'm sure they will instruct me on what to do, but it's always nice to talk to someone who is doing the same thing as you.

    Many thanks again, and I'll let you know the outcome, don't see him until the 15th of this month, long enough to worry I guess, but you have certainly helped calmed the worries down.

    Take care!!
    txmn1212 responded:
    Hey OTTER051069, how did your app't go? Did you make out ok?
    otter051069 replied to txmn1212's response:
    Well...., certainly nothing like you had, in fact didn't even get an exam of anything, kinda bummed!! I was hoping that for once and for all, I would get an answer, but that kinda wasn't the case. I liked the guy O.K., he talked to me about what I had been using, (Viagra & Levitra) and asked if the erections were good with either or both and I said yes, just didn't like the side effects, as you had indiciated. He then asked me if I had ever tried Cialis and I answered no, so he gave me two trial samples of that. He did write a request to have blood drawn to check for testosterone levels and those came back good. The free level was a little low, but nothing too bad.

    He did talk to me that probably was age related, (I'm almost 65) and I don't expect to perform like a twenty year old, but I was hoping to do a little better than what I am doing. Anything I have read about ED states that age has nothing to do with it, so I don't know.

    Because of your heart meds, I'm wondering if that is why your Urologist put you on injections, and maybe I'm just not to that point if the oral meds are working for me, but I'm sure not fond of the headaches and congestion that go with it. Maybe a small price to pay for the benefit.

    So for now, I'm with the oral meds, so we'll see. I wasn't too impressed with Cialis, barely got hard, certainly nothing like Viagra and Levitra, so don't know if I will stick with that or not.

    A couple of other questions I thought to ask you, if you don't mind, after you have done the injection and you have an erection, does it go down after you have ejaculated or does it still stay hard for awhile? How long does it take to get an erection hard enough to have sex?

    I have thought of asking this PA what other choices there are besides the oral meds. I have wondered about a vacuum device, I know Bonro Industry makes one that looks like it may not be too bad, but I don't know of anyone who has used one and if it did the job or not. Then I wonder if you are able to ejaculate with the tension device in place and the orgasm feels the same.

    I did find a device at Wal-Mart that did help some, a vibrating ring made by LifeStyles. That added stimulation seemed to help both myself and my wife, so maybe stick with that and the oral meds, and take Tylenol for the headache afterwards.

    Thanks for the continued support, just wished I had gotten a better exam, well an exam....period, but maybe his thought was, he wasn't going to waste his time on "this old duffer", who knows??

    Thanks again for concern. Take care of yourself

    "Life isn't about the breaths you take in and out...,it's the moments that take your breath away."
    txmn1212 replied to otter051069's response:
    I'm surprised that you didn't get an exam! Very odd, but then again, I am on the trimix injections, so I guess my urologist feels that warrants the detailed exams that I get. To answer your questions, it takes anywhere from 2-4 hours for my erection to go down after my wife and I have sex. It varies. As far as how long it takes to get an erection, I can usually have a "useable" erection within 45 min to an hour. Full erection occurs in about an hour and a half.

    Viagra had a totally different effect on me. It didn't actually "produce" an erection---it simply relaxed the blood vessels in my penis, which made an erection easier to attain. I---or my wife---had to massage my penis to make it erect. The trimix injection actually makes an erection without any stimulation on my part at all. It's very different....that's the only way I can describe it. But, it works!!

    I almost think I would have said something during your app't regarding the lack of an exam. But, then again your PCP may do a good job regarding your physical exam. Mine doesn't----in fact, I was just there a few weeks ago and the guy didn't even do a hernia check. No testicle exam, no hernia check, no prostate or rectal exam, no nothing. That's why I'm glad that the urologist is so thorough with me when I go. Peace of mind, I guess.

    Best of luck to you! And you're welcome for the support.
    otter051069 replied to txmn1212's response:
    You're right....I probably should have said something to him, when he went out to get the samples of Cialis about if he was going to do an exam of some sort, but one thing I didn't mention was, I had taken copies of previous lab reports my primary Doc had run. Those reports came back with no limits out of the ordinary. They were run for various things, chlorestol, liver enzymes, thyroid, maybe a PSA (don't remember) and whatever else and I had sent them with the thinking that would help him with his diagnosis. Maybe this is what led him to not do any exam because he figured it was fruitless.

    My primary does a good job at physical time, but when I mention something about ED, he askes me what pill I want to try and out the door, so that was my motivation for making an appt. with the PA @ the Urologist, thinking he wouldn't shove a pill at me and I would be done. Unfortunely that wasn't the case, so maybe I shot myself in the foot on that one, who knows??

    Oh, I'll give it try for awhile and if I don't feel that this is the answer, I'll make another appt. and see what else there is to try.

    I have to commend you for what you go through to have sexual relations with your wife, that stinks for you, but I guess we do what we have to and fortunely it works for you and I'm glad that the injections work so well.

    Again, thank you so much for responding to my questions and the very best to you and your wife. Take care of yourself!!
    An_206220 replied to txmn1212's response:
    Wow! The bulbocavernosus test sounds like it would be a little awkward. I've never heard of it before. What did the Dr have you do? What happened when he did the test?
    otter051069 replied to An_206220's response:
    Hey Anon,

    The bulbocavernosus test is explained by txmn1212 very well in your original question of "going to the doctor." Scroll back and read and I think you'll have your question answered. Let me know if you can't find it.

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