Impotence Support - who usually treats E.D

Author

who usually treats E.D - PCP or specialist?

marinabob60@yahoo.com

2005-07-29, 8:47 am

I had posted earlier that at the age of 60 I am at the onset of E.D.
Sometimes I can perform. I am not a totally hopeless, but probably
heading in that direction.

After educating myself about E.D. on the internet, I see where the
diagnosis can be very complex, and in many instances can incorporate a
battery of different tests including ultrasound ($$$$).

My question is - for someone with E.D. at age 60 (or above), what is
the customary practice for diagnosing and prescribing treatment? Is
this usually handled by the internist PCP, or are patients usually
referred to the specialist? Is the practice the same for a 60 year old
as it would be for a 40 year old? I figure at my age, the PCP would do
the standard physical, discuss the symptons, and then give me the free
trial of V, L, or C. Is this not the case? I didn't want to make a
big production out of it. Maybe my problem could even be a little in
the head, but I just don't know. BTW - I do get a lot of nocturnal
erections. Is this a good sign that I can be helped?

Thanks.

Marina Bob

Wanderer

2005-07-29, 11:47 am

On Fri, 29 Jul 2005 0:55:31 -0400, marinabob60@yahoo.com wrote
(in message <1122612931.247025.219280@g44g2000cwa.googlegroups.com> ):

> My question is - for someone with E.D. at age 60 (or above), what is
> the customary practice for diagnosing and prescribing treatment? Is
> this usually handled by the internist PCP, or are patients usually
> referred to the specialist? Is the practice the same for a 60 year old
> as it would be for a 40 year old? I figure at my age, the PCP would do
> the standard physical, discuss the symptons, and then give me the free
> trial of V, L, or C. Is this not the case? I didn't want to make a
> big production out of it. Maybe my problem could even be a little in
> the head, but I just don't know. BTW - I do get a lot of nocturnal
> erections. Is this a good sign that I can be helped?

It's a very good sign that you get frequent nocturnal erections. In fact, it
suggests you may not really have ED, but some form of performance anxiety.
Either way, the first step is usually to see your regular doc and ask him/her
for a prescription for Viagra or Cialis. Mine originally didn't do any tests
at all, just asked me a couple of questions. You may find that using Viagra a
few times gets you over whatever hurdle you are facing. Very often, episodes
of occasional ED can be triggered by meds we are taking, or even from
overindulging in things like coffee or alcohol.

If it should happen sometime in the future that your problem becomes chronic,
you may find that further tests, and some form of specialist, are necessary.
The experience of many here is that there isn't one type of doctor that is
best for treating ED. So many issues can come into play in cases of sexual
dysfunction -- everything from diabetes and vein issues to hormonal
imbalance. The key is finding a doctor who is experienced in treating male
sexual problems and familiar with the latest therapies. But if I were you, I
wouldn't worry about that now. If you are getting strong, frequent nocturnal
erections, it means your equipment is working just fine. Have you been under
any stress? New relationship? Switch in medications?

Wanderer

Paul H.

2005-07-29, 11:47 am

marinabob60@yahoo.com wrote:
> I had posted earlier that at the age of 60 I am at the onset of E.D.
> Sometimes I can perform. I am not a totally hopeless, but probably
> heading in that direction.
>
> After educating myself about E.D. on the internet, I see where the
> diagnosis can be very complex, and in many instances can incorporate a
> battery of different tests including ultrasound ($$$$).
>
> My question is - for someone with E.D. at age 60 (or above), what is
> the customary practice for diagnosing and prescribing treatment? Is
> this usually handled by the internist PCP, or are patients usually
> referred to the specialist? Is the practice the same for a 60 year old
> as it would be for a 40 year old? I figure at my age, the PCP would do
> the standard physical, discuss the symptons, and then give me the free
> trial of V, L, or C. Is this not the case? I didn't want to make a
> big production out of it. Maybe my problem could even be a little in
> the head, but I just don't know. BTW - I do get a lot of nocturnal
> erections. Is this a good sign that I can be helped?
>
> Thanks.
>
> Marina Bob
>

First, the statistics say that >95% of the guys in this situation can be
easily helped back to reliable, penetrable erections with a PDE5
inhibitor (oral or injectible). Less than 5% have something going on
that requires more extensive treatment, endo workup, neurological
studies, surgery etc.

My PCP's first question was whether I was having NEs. She might have
done better by asking about the quality of those NEs--and explaining to
me how to assess NE quality. I'll be sexist here--I don't believe that
my female PCP and I could have worked through to a complete discussion
of NE and ejaculatory quality in a time-efficient manner. Female PCPs
are OK but you'll find it easier to communicate on a common plane with a
Uro (preferably male).

Fortunately, at the time, my HMO required a board Urologist to sign off
on all Viagra prescriptions. (This is no longer the case--the PCP can
initiate a trial of Viagra or Levitra and if that is successful, there
is no Uro consult).

Uro care for a guy over 60 or 65 should be no different from regular
trips to the dentist after the age of 4 or 5 -- assuming you want to
keep all of your natural teeth beyond the age of 18. God didn't make
dental floss. I think that I'm not making a big production out of it
when I submit to having a periodontist do some root-planing on my teeth
to rehab my gum structure.

As we age, most of us do not fully erect as frequently as we did in our
20s and 30s. Without our awareness, our NE quality may wane. If this
isn't turned around--and I failed to do so in my 50s and early 60s--we
become a candidate for E.D. I hit that wall at age 68, stayed in denial
for 3-4 months and then, in desperation, whined to my PCP. I was placed
in the hands of a caring Uro who put me on Viagra and a constructive
rehab program.

Just finished my third annual URO check. It went like this: Filled out
questionaires to determine my LUTS score (bladder/prostate) and an IIEF
score (erectile quality). I was asked what my last PSA was and how my
NEs score. The Uro performed a DRE, checked testicles & ordered the
nurse to give me a shot of Trimix. Ten minutes later he's back back in
the room, assessed penis condition & had me taken back down to flacid.
We had a quick chalk talk on how my oral meds are working (Hytrin for
bladder neck & Viagra for E.D.) He queried me on how I'm doing on
ejaculatory frequency (my target is twice a week), daily vacuum drill
and how I'm doing with P.E. He changed my E.D. med and came up with new
dosing instructions, keeping it 6 hours away from the Alfa-blocker.
Handed me samples of Levitra, and a new vacuum cylinder a prescription
for the pharmacy and I was out the door. He'll probably call me twice
over the next 90 days to see how I'm doing with the med change. All of
this took just over an hour -- half the time that I spend in the dental
hygenist's chair each year. Not much different in principle that having
a stress test at the cardiologist's office.

While my daily vacuum cylinder drill might shock my old Sunday school
teacher, it's really no different than using a treadmill to maintain
cardio health or a powered flosser to clean under the dental bridge in
my mouth. It's no "big production." The end result keeps me and my
spouse pleased. Use it & care for it or loose it!

HTH....... Paul.

ernestnolan

2005-07-29, 11:47 am

Hi,

Age related ED is a classic. Many times there are subtle causes of our ED
getting gradually worse such as emotions, medications and the typical age
related damaged nerves.

V and the rest help those damaged nerves which happen just like the other
nerves that are changing in your ability to taste and smell. They will
perform better with help from these chemicals and it may take more as time
goes by to get the same effect.

Then when the nerves get really bad the nerve paths necessary for erections
finally stop working reliably there is injectibles like caverject and trimix
which I prefer. These are injected with a syring in the side of the penis
and will provide a very firm, several hour, erection you can hang a towel
on. The needle doesn't feel very bad in spite of what your imagination tells
you. The fantastic results make it all possible.

Urologists are the providers of injection therapy.

ernestnolan

<marinabob60@yahoo.com> wrote in message
news:1122612931.247025.219280@g44g2000cwa.googlegroups.com...
> I had posted earlier that at the age of 60 I am at the onset of E.D.
> Sometimes I can perform. I am not a totally hopeless, but probably
> heading in that direction.
>
> After educating myself about E.D. on the internet, I see where the
> diagnosis can be very complex, and in many instances can incorporate a
> battery of different tests including ultrasound ($$$$).
>
> My question is - for someone with E.D. at age 60 (or above), what is
> the customary practice for diagnosing and prescribing treatment? Is
> this usually handled by the internist PCP, or are patients usually
> referred to the specialist? Is the practice the same for a 60 year old
> as it would be for a 40 year old? I figure at my age, the PCP would do
> the standard physical, discuss the symptons, and then give me the free
> trial of V, L, or C. Is this not the case? I didn't want to make a
> big production out of it. Maybe my problem could even be a little in
> the head, but I just don't know. BTW - I do get a lot of nocturnal
> erections. Is this a good sign that I can be helped?
>
> Thanks.
>
> Marina Bob
>

marinabob60@yahoo.com

2005-07-30, 8:47 am

Thanks for the informative replies. I am beginning to think that I may
have some performance anxiety because most of my NE are as hard as
rock. Too bad I can't wake up my wife in the middle of the night, but
she is pretty worthless at that time. Maybe a little dose of V will
help me get over this like Wanderer said.

To respond to some other questions about myself - I am in a long term
relationship (almost 30 yrs). I take no meds, either presription or
over-the-counter, and no street drugs either. As for choice of
doctors, I prefer female doctors. At my age, I just don't feel
comfortable with a guy touching me in my privates, even a doctor. It
is more natural when a female does this. I have no inhibitions about
this with a female doctor. I am due for my annual physical in 45 days.
I will talk to my female doc and get the trial of V, L, or C and see
what happens. It seems that may be all that will be needed, at least
for now. Thanks again for the informative responses.

Marina Bob