Topic
Penile revascularization and fees breakdown
PENILE REVASCULARIZATION SURGERY EXPERIENCE AND BREAKDOWN OF FEES (at bottom)
I am currently 33 years old and just had my surgery 10 days ago. I hope all of this information will help anyone considering having the surgery.
My story
I have always been very active and healthy since I worked in healthcare. I always thought that my penis was indestructible and was very rough with it at times. I fractured my penis about 9 years ago when I was 24 years old. I was having sex with the girl on top, and my erection got bent down forcefully at the base of my penis. This caused immediate pain and loss of erection. Within 30 minutes, my penis turned dark purple with A LOT of swelling. When the pain subsided, my penis was felt completely numb and hung like a limp floppy noodle. Since I worked in healthcare, I was too embarrassed to go to the hospital or to a doctor because I didn’t want anyone I knew to find out about the erectile dysfunction. So, I just put an ice pack on it for and took some Ibuprofen for a few days. After the injury, I went from having a rock hard erection with lots of spontaneous erections to not being able to have an erection at all. This lasted for about 4 months. After that, my penis still had some numbness, and my erections were very very weak. They were at about 70% strength at best. I had to have constant stimulation or I immediately lost my erection. About half of the time, I would lose my erection even with constant stimulation, or I couldn’t get one at all. In the back of my head, I thought that it would heal itself over time and was very passive in actively doing something about fixing the problem. This lasted for the next 9 years. Also before injuring my penis, I abused anabolic steroids from age 21 to 24 to obtain the perfect Men’s Health magazine body which I actually was able to do. After getting into healthcare, I learned about the damage that steroids cause including erectile dysfunction, and I stopped taking them. After stopping the steroids, I began to feel tired and sluggish. Like everybody else does, I spend hundreds of hours on the internet trying to find an answer and learn everything about what could be done to fix the problem. With my experience in working in healthcare, I became an expert on the diagnosing and treatment of erectile dysfunction. At the time, there was very limited knowledge available on sexual medicine. Realizing the severity of my problem, I wanted to see the best and most knowledgeable in the field to restore my penis to normal. As young as I was, I didn’t want to just take a bunch of prescription pills or injections to temporarily fix the problem. When I was 25, I found out about Dr. Irwin Goldstein, an internationally renowned urologist at Boston University on the internet who had a vast knowledge in the area including penile revascularization surgery which could repair the damage. Dr. Goldstein was everything I had been looking for. I sent him an email to ask him a few questions and about seeing him as a patient. He immediately replied back to me and told me to call him which I did the next day. I spoke with him for about 10 minutes on the phone, and I went over everything that had happened. He was very friendly and down to earth, and I could tell he had a lot of passion for his profession. I wasn’t able to see him at the time because he was in the process of finding a place to move his practice and wouldn’t be practicing for a little while. So, he recommended a urologist nearby that had trained under him for a little while- Dr. John Tuttle in Lexington, Ky. Again, I ignored the problem for several years since I wasn’t ready to confront it.
First line of treatment- 2007
I went and had lab work drawn at my local family doctor’s office when I was about 28, and I was diagnosed with anabolic steroid induced hypogonadism. My free testosterone level was 250. A normal young person my age should have a free testosterone level of 500-1000. My LH and FSH levels were very low as well. In other words, I had shut down my natural testosterone production. So, my erectile dysfunction was caused by both hormonal and physical problems. I was put on Androgel to help raise my testosterone levels. This improved the tired feeling a little but not much. After being on the gel for about a year and my testosterone levels staying around 300, I was switched to Testosterone injections at 300mg once a month. This worked great at returning my testosterone levels back to normal, but after about 2 weeks, it would start to wear off, and I would start getting tired again. So, the dosage was changed to 150mg every 2 weeks which worked great since it kept my testosterone levels at a more consistent level. I was hoping that the testosterone would fix some of the erectile dysfunction, but it didn’t improve it any.
Second line of treatment- April 2010
When I was 31 and after about 7 years of ignoring the erectile dysfunction problem with no improvement, I finally went to see Dr. Tuttle in Lexington, Ky. I ended up seeing him about 3 times over a period of a year with very little effort to help. He was a nice guy, but no diagnostic tests were ever performed other than drawing labs. He never seemed to really care about finding the cause of my erectile dysfunction. I ended up trying both the daily and 36 hour Cialis and Viagra, at all available doses. Both drugs were great at first for the first few weeks, but they gradually started to decrease in ineffectiveness. The Cialis and Viagra both also caused migraines. I started taking them right before bed which helped alleviate some of the headaches. I even tried a penis pump on my own. From my own personal experience and working in healthcare, my advice is to stay away from penis pumps especially if you’re using them just in hopes of enlarging your penis. It’s better to have a functioning penis that a big floppy one that doesn’t work. Any penis enlargement you experience is only temporary, and they cause a lot of damage to your penis. At the base of the penis, there is an artery on each side of the penis as well as veins and nerves. This is a very unprotected area and these veins, arteries, and nerves lie right against your pelvic bone. When the penis pump is pumped up with too much pressure, the cylinder of the penis pump presses against the pubic bone mashing the veins, arteries, and nerves of the penis. This damage will cause a numb penis, erectile dysfunction, and loss of spontaneous erections.
Third and hopefully final line of treatment- May 2012
After going to see Dr. Tuttle a few times without any major improvement, I had finally had enough. I found out that Dr. Goldstein had moved 2000 miles away from me to San Diego, CA. This was very upsetting to me due to the distance and financial costs, but after some soul searching, I decided to make the trip to California.
Before first appointment with Dr. Goldstein
I called Dr. Goldstein’s office and spoke with Priscilla to set up the free 10 minute conversation with Dr. Goldstein to discuss making the trip out there and what to expect. Everyone at the office is very nice, and always willing to help with everything that I needed. I spoke with Dr. Goldstein about 3 days later for my 10 minute conversation. He was the same friendly guy I met over the phone 8 years ago. He even remembered my name and the previous phone conversation. I talked with Priscilla again after and set up my appointment. Take note that if you don’t cancel 3 days in advance, your credit card will be charged $75. This applies to any doctor’s office to prevent them losing money from last minute cancelled appointments. Priscilla and Chaline will help you go over everything that you need to bring with you for your first appointment. They’ll have you also fax your insurance cards and driver’s license as well. They don’t take insurance payments but they will help you with setting up any with the other companies that do. Go on to their website at http://www.sandiegosexualmedicine.com and complete the necessary forms and questionnaires for your first appointment. You can fax these or bring them. You don’t need to bring any old medical records with you unless he specifically asks for you to. Dr. Goldstein’s office emailed a lab slip to take to my local clinic to have blood drawn. They took a few days to be ready. I then faxed forms, questionnaires, and lab results to Dr. Goldstein.
I decided to make the trip to California by myself. I still didn’t want anyone to know about my erectile dysfunction. So, I booked my round trip flight, car rental, and hotel through Kayak.com. A round trip 2000 mile each way flight cost me $350 the first trip to San Diego. As of May 2012, I had saved $6500 for a downpayment on a house. So, I used this money to pay for the trip. I will tell you from this part forward, you need to have a sufficient amount of cash or credit available to pay for this trip to be diagnosed and treated since everything has to be paid in advance. Sexual Medicine is new, and it is still not a widely accepted practice with insurance companies. I had to pay almost all fees upfront and then fill out reimbursement forms through my insurance company after the procedures. The second appointment trip to San Diego cost me $500 round trip. So, do some shopping. It usually takes 5-6 hours to travel 2000 miles there with one connecting flight each way.
First appointment with Dr. Goldstein- May 2012
I had to pay for everything for this trip upfront with cash or credit card. This entire first trip cost me $5585. That included flight, hotel, rental car for 3 days, and food. I was a candidate for surgery, So, I had to have every test available ran to prove the cause of the erectile dysfunction & need for surgery for insurance. You may or may not have to have all of these tests done if they find out you are not a candidate for surgery. I will breakdown prices of everything below.
I arrived in San Diego a full day before my appointment. When I arrived at his office the next day, I finally got to meet Priscilla and Chaline who helped me over the phone many times.
First, Dr. Goldstein introduces you to his entire staff one by one. After meeting everyone, you are taken back to a private room. After a little while, Dr. Dicks (who left San Diego Sexual Medicine in July) came in and explained everything the tests that he was about to perform. First, I had a vibration stimuli and temperature stimuli test to test sensation. Those two tests were done with a limp penis. Then, Dr. Dicks injected my penis with a combination of erectile drugs and put some porn on the tv. The injection didn’t by any mean feel great, but it was tolerable. Next, I was told to squeeze my penis firmly for a couple minutes until I started to get an erection. I was told to masturbate until it got hard, but to make sure not to ejaculate because he would have to inject my penis again and start over. So, I made sure I didn’t do this. After that, he came back in to do the ultrasound while you are fully erect. The ultrasound involved rubbing KY Jelly and a sensor all over my penis to see if there was any corporal fibrosis (scarring) or visible blockages to the penile arteries. Dr. Goldstein came in after a little while and viewed during testing. Mine showed possible blockages on both sides of the penis but no corporal fibrosis or venous leak on either side. To confirm this, a DIC (Dynamic Infusion Cavernogram) had to be done. First, your penis is injected again a few more times to keep it hard during testing. Again, this doesn’t feel all that great, but it’s tolerable. This is a sterile invasive procedure that measures the blood pressure in your penis compared to the blood pressure of your arm. Both should normally be the same unless a blockage is present. My blood pressure in my penis was 30 lower in each penile artery than that of my arm. I found out that the injury to my penis 9 years ago caused both of my left and right penile arteries to be partially blocked. After the test is over, my penis was then injected a couple more times to help the erection go down and my penis was squeezed hard for about 30 minutes until the erection went away. Then, my penis was wrapped in a compressive dressing to keep from having any more erections and to prevent bleeding and swelling. This dressing was worn until later that evening. By the second test, my penis was very sore and it was hard to walk for 24 hours. I went back to the hotel. Getting up and going to the bathroom doesn’t feel all that great. This is where a family member or friend really does help.
Penile Artery Angiogram at Alvarado Hospital
The next day, I had to get up and be at Alvarado Hospital around 5am which is within walking distance of Dr. Goldstein’s office. There, they performed the penile artery angiogram to confirm the blockage and see if I had a sufficient length of donor epigastric artery. I was put to sleep with anesthesia and awoke later in the recovery room. After a few hours, Dr. Goldstein’s office was called to come pick me up and take me back to the office. The blockage artery and donor artery were confirmed. I was lucky that I was a candidate for penile revascularization surgery. After some lingering affects of the anesthesia wore off, I drove myself back to the hotel. Again, a family member or friend is a much safer idea with the congestion of San Diego traffic at times and all the lane changing to get to your destination.
There is a strict criteria to be a candidate for surgery & Dr. Goldstein will be happy to go over all of this with you. I know some of the criteria are confirmation of artery blockage, no corporal fibrosis, no venous leak on diagnostic tests. There also has to be a donor epigastric artery of sufficient length to use to bypass the penile blockage. Even though I was able to do this first trip by myself, I would bring someone with you. Some of the tests they might have to perform are invasive, and they will leave you in pain and barely able to walk for a few days. I took off for an entire week to ensure that I had enough time to get everything needed done and still have time to recover from any invasive tests that had to be performed. Again, I’m a tough guy who never complains, but I would HIGHLY recommend doing this. After leaving his office, I returned to the hotel and left on my flight home the next day. Make sure you get up early so you can make it to your plane. I’d make sure to have at least an hour and a half between any connecting flights so you don’t miss your plane. It will be difficult for you to walk very fast since your penis and hip will be so sore from the penile angiogram. The flight was a little uncomfortable, but I managed okay. The trip was a little overwhelming with everything that went on, but Dr. Goldstein and his staff are great & will take the time to answer any concerns you might have.
Second trip/appointment with Dr. Goldstein- Late June 2012
I finally had penile revascularization surgery 5 weeks later. I financed the entire amount of my surgery with cash, a medical loan with MedLoan, & a few 0% interest for 12-18 month credit cards. The MedLoan is also interest free if paid off in a year, but it had a $2300 fee financed into the loan. I filed for FMLA (Family Medical Leave Act) for my work about an entire month before my scheduled surgery date. This is recommended to prevent any problems that might arise before your trip. This took a couple of weeks to get lined out since you have to call the FMLA people and have Dr. Goldstein sign some forms.
After 9 years of erectile dysfunction, I was ready to get it over with and really wasn’t nervous about having it.
Day Before Surgery- Tuesday
I went to the hospital to have pre-op lab testing. I did a lot of talking with Dr. Goldstein and his staff as well as researching on the internet and the http://www.sexualmed.org forums. I didn’t eat or drink anything after midnight. I made the mistake of going to bed at 8pm, and I was starving by the time I was able to eat after surgery which was about 2 pm the next day.
Day of Surgery- Wednesday
I went to the hospital at 5am for pre-op stuff and was taken to surgery at 7am. After the surgery, I woke up in the recovery room with a catheter and an On-Q pain pump with novacaine in it to numb up your abdomen to make it easier to move. Shortly after, I was taken up to my private room on the floor. All of the employees at the hospital were great. I was a little nauseated after surgery from the anesthesia and not eating all day, but I never threw up. I took some IV Zofran once or twice the whole time I was there. The pain was tolerable as long as you don’t move around to where you’re using your core abdominal muscles. If you do move, it feels like your guts are about to be ripped out. So, I would avoid sitting up much in bed even when eating to avoid this. You’ll have be on a clear liquid diet until you are discharged or have a bowel movement. You’ll be on bedrest until morning. The catheter is very uncomfortable if you’ve ever had one. On day 10 after surgery, it still hurts a little when I pee. In order to be discharged the next day after surgery, you have to walk a few times, eat without throwing up, tolerate pain well, and urinate. I did all of this and was discharged around noon the day after surgery. Walking was very hard the first day, and I was a little dizzy at times.
Third appointment with Dr. Goldstein- Thursday
As soon as I was discharged, I went straight to Dr. Goldstein’s office to have the bandages removed from your penis and to have a repeat ultrasound done. This visit doesn’t cost anything since you paid for it in the $11,160 fees listed below. Dr. Goldstein removed the dressing from around my penis that was similar to when I had the DIC test and the penile artery angiogram. Everything was fine and Dr. Golstein let me hear the sound of my new penile artery. Dr. Goldstein was very excited and gave me a high five. haha Walking was really rough the first 3 or 4 days, but it started being a lot better after a week.
Fourth appointment with Dr. Goldstein- Friday -Home Saturday
I had the On-Q pain pump removed that Friday. After that, I was taken back to the hotel by my dad. He went and picked up my prescriptions for Percocet for pain and Ambien for sleep. I was given 50 Percocets and 30 Ambiens to help me out over the next few weeks. The next day was Saturday, and I flew home. I had my dad carry my bag since I wasn’t allowed to lift more than a gallon of milk. I am also not allowed to lie on my stomach or drive for 6 weeks.
After Surgery/Results- Day 4 through Day 10
The first days home were pretty rough. I took about 4 Percocets a day until Day 8. It has now been 10 days since my surgery at the time of writing this. I will try to remember to post updates every now and then to better inform you on the process. Everything is going well. Today I’m not walking with a limp anymore and only take 1 or 2 Percocets a day now. It still takes me a few seconds to get out of bed in the morning. Incision looks a lot better. From the appearance of the way the incisions are healing, the scars should hardly be noticeable even naked. I have really good morning erections the last 3 days. The erections hurt bad enough to wake me from sleep. I haven’t had morning erections of this quality since before the injury. I’d say that they are close to 90-100% of what they once were. If they continue like this, I would be very happy. I have no regrets other than wishing that I would have been able to do this 9 years ago, and you can’t find more caring great staff than at Dr. Goldstein’s office.
BREAKDOWN OF FEES:
First Trip:
Dr. Goldstein Appointment Fee $525
Vibration stimuli $105
Temp stimuli $185
PEP Injections (erection drugs) $180
Penile Ultrasound $420
DIC Test (Dynamic Infusion Cavernography) (if needed) $945
Dr. Goldstein Total $2360 (Filed all of this with insurance myself)
(Got additional $180 back.)
Penile Artery Angiogram Doctor’s Fee (if needed) $1350
Alvarado Hospital Fee for Angiogram (if needed) (they filed) $675 (Was told insurance paid rest of $2500)
Hotel for 3 days (cheap hotel) $250
Round trip flight $350
Rental Car for 3 days $300
Food $100
Gas $30
Total $1200
Entire 1st Trip Total $5585
Second Trip:
Penile Revascularization Surgery Dr. Goldstein Fee $11,160 (Got note saying not covered by insurance)
(Will appeal)
Alvarado Hospital Fee (they filed with insurance for me) $814 out of pocket (told insurance paid rest of
$7800 bill)
Anesthesia Fee (did not have to pay upfront- filed insurance) $0 (Been 10 days, & haven’t been billed $1750)
(So, not sure if have to pay)
Surgery Total $12,000
Hotel for 4 days (nice hotel) $500
Round trip flight $510
Rental Car for 4 days $400
Food $200
Gas $30
Total Travel Expenses $1650
Entire 2nd Trip Total $13,650
Both Trip Total (diagnosing/surgery) $19,235
I had an additional $2500 financing fee on top of this since I took out a medical loan. I’d recommend 0% interest cards and pay off balances.
THINGS I RECOMMEND TO SAVE TIME AND MONEY:
Keep all medical receipts for insurance reimbursement.
Cash & credit cards
GPS
Print maps of all airport terminals.
Bring friend or family member to go with you.
Wait until you meet your insurance deductible later in the year to not have to pay as much upfront.
Carry-on bag only (preferably with wheels) Make sure you check airport carry-on bag size limits
Rental car
Price shop flight & hotel through kayak.com in advance (cheapest hotels $60, decent hotels about $100-150 a night)
Get a hotel near Dr. Goldstein’s office.
Arrive at least 24 hours before your doctor’s appointment date. (flight delays, jet lag)
Shop around on internet for cheaper places to eat. Some places are very expensive to eat at in San Diego.
Download free iPhone apps for travel: Kayak, GasBuddy, AroundMe, & all airlines’ apps which check flight status & pull up boarding passes on them.
File for FMLA a month in advance.
File for any medical loans or credit cards you might need a month in advance.
Additional notes:
Also, starting the first day after surgery, you will be taking 25mg of Viagra every day. I prefer to take it at nights to avoid any headaches associated with the Viagra.
There were also some additional fees that I forgot to add:
Percocet $12
Ambien $5
I’d also recommend taking an over the counter stool softener like Docusate Sodium (Colace) or Sennakot to prevent constipation. If you get constipated and do a lot of straining, your abdominal muscles are really going to hurt from where they had to cut through them to get to your arteries.