New from CA with Insurance/Dr. Questions

[Deadpecker30]

Hey, I live in San Jose and I'm 30. I've been lurking on this form for several months to educate myself. I wish I found it sooner.  I believe my impotence was induced by stupidly taking sidenafil recreationally early during quarantine and I believe I had several priapisms in my sleep, although I never had any pain.  It was never an issue of getting it down when I woke up. Maybe the many 2-3hrs sessions could have done damage? I became dependent on sidenafil after a few months, but the pills always worked. I broke up with my gf around Spring 2021 and stopped taking the pills as regularly as I should have been if I was more educated to keep my penile tissues healthy.  The pills continued to work as I was taking once or twice a week through July 2021 although I noticed them becoming less effective. Once they stopped working, I tried a medical VED 2 weeks later. It didn't work so I got a VED off amazon to prevent size loss which seemed to work better. I've been using VED twice daily since the beginning of September.

I noticed over the next few months that it was extremely difficult get an erection from masturbation and I started to lose sensation. Now, I feel like my penis has severe fibrosis due to lack of blood flow. My glans feel cold and my penis feels woody with very little sensation and extremely difficult to orgasm from masturbation. I've seen Dr. Karpman and the doppler showed arterial insufficiency. I ended getting a priapsim from the injection and had to go to the ER that evening. The erection felt rock hard and dead. I felt like the fibrotic tissues wouldn't drain the blood, but it ended up going down with the max dose of Sudafed and ice after 6hrs. I've also seen two doctors with my Healthcare plan at Kaiser which I had to wait 3 months for an appointment, and both didn't seem to find any palpable fibrosis upon physical examination. Could arterial insufficiency mean there is severe fibrosis since it would damage the arteries within the corporal bodies? I feel like there is no blood flow which would lead to diffuse fibrosis, even if not found by any of the doctors so far.

I'm struggling to decide on a Healthcare plan to cover the implant. My employer sponsored health plan through Cigna excludes the implant, although Dr. Karpman's office is working on them. I'm hesitant to proceed with Karpman as he only does infrapubic and with severe fibrosis the best result seems to be with penoscrotal. I would most likely enroll with Cigna if approved since they allow for out of state. My preference of surgeons would be either Hakky or Clavell as they seem to deal with difficult cases. My other option for employer sponsored Healthcare is through Kaiser and it sounds like they will cover the procedure.  My experience with Kaiser hasn't been great as they made me wait 3 months for an appointment with a specialist as my condition deteriorated, and I'm unsure if the surgeon is truly a high volume implanter.  The final option that I'm leaning toward is a marketplace plan from covered CA with Blue Shield, but they only cover in state surgeons. I'd prefer to enroll on a plan with out of state coverage if available for Hakky or Clavell.  Does anyone know of insurance plans that would cover out of state specialists or high volume implanters in CA that use the penoscrotal approach?

[ViaSwiss]

I would be surprised if you have fibrosis already just from arterial insufficiency. I had pretty bad ED for 16 years and had almost zero fibrosis. Karpman is awesome and can do de-glove approach if needed. I would personally just go with him since he is already in your plan.

[Deadpecker30]

I believe the fibrosis was caused from previous priapisms in my sleep while taking sidenafil and may have lead to arterial insufficiency. I was taking it a couple of times a week during quarantine when I really didn't need it. I've noticed significant changes to my penis over the last 3.5 months after the pills stopped working, seems like it happened suddenly. It feels airy and light like nothing is there and unfortunately barely any sensation even when erect. Good to know that Karpman has other methods in his arsenal.

I would be surprised if you have fibrosis already just from arterial insufficiency. I had pretty bad ED for 16 years and had almost zero fibrosis. Karpman is awesome and can do de-glove approach if needed. I would personally just go with him since he is already in your plan.

[oldbeek]

I also was sure the scrotal approach was the best from reading posts here on Franktalk. I had the pubic approach. List your reasons why pubic approach is less desirable so we can discuss it.

[Deadpecker30]

They both have their pros and cons. The scrotal approach allows for better visibility to place the cylinders and create a channel if there is fibrosis. The pubic approach can damage nerves and I need to preserve the nerves in this area since I have very minimal sensation in my penis. It seems to be more difficult to place the pump perfectly with pubic, but easier placement of the resevoir.

I also was sure the scrotal approach was the best from reading posts here on Franktalk. I had the pubic approach. List your reasons why pubic approach is less desirable so we can discuss it.

[ViaSwiss]

You should look into "hard flaccid". It sounds like you have that instead of fibrosis. Certain types of pelvic floor exercises can help with the symptoms, although its tough to actually cure. Getting an implant "fixed" most of my HF symptoms.


PS
-easier to get the most size
-easier if there is scar tissue

IP
-lower infection rate
-quicker healing
-need to pull on pump more so it doesn't sit high

[Deadpecker30]

Thanks for the suggestion. I previously looked into HF when the pills stopped working. I have no pain that is usually associated with HF. It seems that with HF you still have some functionality, but I have zero without excessive manual stimulation. I haven't had morning or spontaneous erections for at least 1.5yrs without pills and now can't even get them with pills, which leads me to believe fibrosis has progressed from the abuse I put my dick through with recreational usage of sidenafil. I really wish it was HF but I have my doubts. My dick has gotten paler at the glans and where the corona and shaft meet. I just hope the implant can bring back some sensation and that I can get close to my current erect length of 7.25" which is about 1.25" longer than my SFPL by the Dr. Karpman said I wouldn't lose any size from injected length but I feel like that was part of his sales pitch. It is my understanding that the nerves adhere to scar tissue, which could be a cause for loss of sensation. With cycling, hopefully the implant would break up scar tissue and maybe restore some sensation? Maybe I'm just dreaming.

This is causing a great deal of distress to the point where I'm seeing a therapist this week before I go off the deep end. What helped you cope with your ED mentally for 16 years? I' started smoking weed and it helps some to get my mind off it and not care as much, but I try to only use it at night. I could use something for daytime.

You should look into "hard flaccid". It sounds like you have that instead of fibrosis. Certain types of pelvic floor exercises can help with the symptoms, although its tough to actually cure. Getting an implant "fixed" most of my HF symptoms.


PS
-easier to get the most size
-easier if there is scar tissue

IP
-lower infection rate
-quicker healing
-need to pull on pump more so it doesn't sit high

[oldbeek]

They both have their pros and cons. The scrotal approach allows for better visibility to place the cylinders and create a channel if there is fibrosis. The pubic approach can damage nerves and I need to preserve the nerves in this area since I have very minimal sensation in my penis. It seems to be more difficult to place the pump perfectly with pubic, but easier placement of the resevoir.

I also was sure the scrotal approach was the best from reading posts here on Franktalk. I had the pubic approach. List your reasons why pubic approach is less desirable so we can discuss it.

The nerve damage thing goes back 30 years. Unless you have a hack surgeon, there will be no nerve damage. My incision is only 3/4 inch vertical and everything is in the right place. The tubing from the cylinders does come out over the top, which was a little irritating for a few months.

[ViaSwiss]

Thanks for the suggestion. I previously looked into HF when the pills stopped working. I have no pain that is usually associated with HF. It seems that with HF you still have some functionality, but I have zero without excessive manual stimulation. I haven't had morning or spontaneous erections for at least 1.5yrs without pills and now can't even get them with pills, which leads me to believe fibrosis has progressed from the abuse I put my dick through with recreational usage of sidenafil. I really wish it was HF but I have my doubts. My dick has gotten paler at the glans and where the corona and shaft meet. I just hope the implant can bring back some sensation and that I can get close to my current erect length of 7.25" which is about 1.25" longer than my SFPL by the Dr. Karpman said I wouldn't lose any size from injected length but I feel like that was part of his sales pitch. It is my understanding that the nerves adhere to scar tissue, which could be a cause for loss of sensation. With cycling, hopefully the implant would break up scar tissue and maybe restore some sensation? Maybe I'm just dreaming.

This is causing a great deal of distress to the point where I'm seeing a therapist this week before I go off the deep end. What helped you cope with your ED mentally for 16 years? I' started smoking weed and it helps some to get my mind off it and not care as much, but I try to only use it at night. I could use something for daytime.

You should look into "hard flaccid". It sounds like you have that instead of fibrosis. Certain types of pelvic floor exercises can help with the symptoms, although its tough to actually cure. Getting an implant "fixed" most of my HF symptoms.


PS
-easier to get the most size
-easier if there is scar tissue

IP
-lower infection rate
-quicker healing
-need to pull on pump more so it doesn't sit high

You can have both HF and venous leak / arterial insufficiency. But you are going to have a better idea than me. For me, learning stoicism was a big help as well as making to to indulge in things that I enjoy (watching and playing sports), being around other humans, focusing on my career and studies, etc.