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Posted 7/9/2014 9:30 PM (GMT 0)
My husband went to his surgeon's office to have blood drawn for his PSA test and met with his surgeon's PA. She wants him to do an ED rehab program that includes using a pump. She feels that it will also get rid of his very mild peyronies. My husband has never used a pump and doesn't know much about them. She suggested a battery operated one. It is an extra $100 ($300) while the manual one is $200. It is not covered by our insurance. My husband will get the one which is better, and will not let the extra expense factor into the decision.

Any advice on which type of pump is better?
Posted 7/9/2014 10:20 PM (GMT 0)
I have a manual model. I personally can't see any benefit to the battery model, but some with manual dexterity issues might appreciate them.
Posted 7/9/2014 10:22 PM (GMT 0)
bluebird-

Tewari's office (before moving to Mt. Sinai) sent all his patients to a specific supplier to buy the Obson ErecAid pump. Not sure if Tewari's office still does that. Either way, the medical supplier rep advised me to get the manual pump because it offers better control and is less expensive than the battery pump. The medical supplier worked with Tewari's office to get my insurance to cover the cost as a "durable medical device" needed for post-op therapy.

Regarding Peyronie's and the pump... Dr. Mulhall's assistant (Joe) told me that Dr. M. recommends pumps for guys who are preparing for implant surgery, but otherwise Peyronie's patients are best to use the traction device specifically.

-Gedman
Posted 7/10/2014 1:11 AM (GMT 0)
bluebird: many of the guys here have had great success with those on Amazon.com. A great item is:

http://www.amazon.com/Deluxe-Battery-Manual-Vacuum-Erection/dp/B002P9D7N6/ref=pd_sim_sbs_hpc_1?ie=UTF8&refRid=1NW1WKB8K570METEM4GC

You don't have to spend $500 for a quality product. I used this one for a year (2 times a day) and it worked great. Very well made with both battery and manual modes.

Bill K. from NJ
Posted 7/10/2014 1:23 AM (GMT 0)
When my husband went to have his PSA blood drawn today they put him in a room with a PA who asked him a lot of questions about his recovery from surgery and examined him. Since he still has ED she wants him to try their 6 week program which consists of daily use of a VED, daily low-dose Cialis (7 days a week), full dose Viagra twice a week (and trying for an erection), and injections 2 to 3 times a week. My husband has not taken a PDE5 inhibitor since one year after surgery.

My husband feels that he is at a plateau and is approaching the two-year mark so wants to try this 6 week program. The PA said that she is having very good results with it. The question, according to her, (I was not at his appointment) is whether he has enough nerves left to get function back.

The VED that she (Dr. Tewari's office) recommends is ordered through a company called Firma Medical, and seems to be their own brand. It says in the instructions that he needs to achieve 5 one-minute erections every day with the VED. As he has never used one he has no idea what type to order. The PA recommends a battery operated one because she says that you need to use both hands with a manual one. Do they all work the same way? I like what you said Gedman about a manual one offering more control. Is their any downside to daily use of a VED?

When my husband first developed peyronies we went to see Dr. Mulhall about it. We mentioned using a VED to treat it (Dr. Tewari had recommended it). Dr. Mulhall said that a VED would be helpful but a traction device is better because it stays on longer. The traction device worked well. The peyronies that my husband has at this point is so minimal that he was no longer treating it. The PA wants my husband to use a VED because it is part of her ED rehab program, but said that an additional benefit was that she thought it would help with the scar tissue, which she could feel in the exam.

Thanks for your responses.
Posted 7/10/2014 1:27 AM (GMT 0)
Bill K,

Thanks for your reply. Did you use the VED in battery or manual mode? I did a search on this forum on VED's and most guys seem to have purchased manual ones. It would be great if he could get one that works both ways.
Posted 7/10/2014 3:11 AM (GMT 0)
Bluebird,
I have used a manual one since 6 weeks after my surgery. Insurance paid 100%. I don't know about a battery one, I liked the control I had manually. You need to get a tight seal so a little shaving will be necessary. Manually you can pump it to just before it hurts. If you squeeze it 1 or 2 many times it can hurt you. If it does, you press a button and it will back off the vacuum. I only use one hand so I don't understand why they said a manual one needs 2 hands. A powered one would scare me. I would be afraid it would pump up too fast and too far to hurt me but, of course I never used one. Maybe you could stop it immediately if you went too far.

I got the Osborn model like Gedman. In fact, the sales reps for Osborn were at my doctor's ED/Incontinence seminar he held the day my catheter came out and they filled out the insurance paperwork for all of us in the seminar, about 20 people. It was delivered less than a week later, way before I needed it.

I say I used one because recently I had an AUS installed and now I can't get a tight seal any more. The pump presses on the tubes to my AUS and I don't want to damage the tubes.

Sounds like the PA is throwing everything but the kitchen sink at your husband. Viagra and Cialis, hey, I have a 2 year appointment with my surgeon next week. Maybe I will discuss that with them. I don't want to use Trimix at all but maybe both meds would help. Interesting!!!

Bill from Florida cool
Posted 7/10/2014 4:41 AM (GMT 0)
Thanks for the feedback Bill (BigMac). I like the idea of control, as you wrote. A battery one scares me too (although I don't even know how they work). I looked up your VED, the Osbon, and apparently it is the only VED for one-handed use.

This new protocol is definitely the "everything but the kitchen sink" program. The PA explained that the Cialis is for blood flow and the Viagra and injections are to get an erection.
Posted 7/10/2014 12:15 PM (GMT 0)
Bluebird,

The battery powered Firma has a good level of build quality, but is expensive. My insurance did not cover it until after I navigated a couple layers of written appeal. By that point I had purchased a $100 model elsewhere out of pocket just to get started on rehab. Frankly, the design and accessories are more usable in the cheaper model, even if build quality is not as polished. Battery powered is not an issue as neither pump is that fast and there are quick relief valves.

I would ask for clarification about using the VED and injections - using them together is a risk for bruising according to a few sources here.

As an aside, Internet anonymity is a good thing. No way I would discuss this in person even now, but you asked a question I can directly answer. Navigating the insurance appeal on ED treatment was bad enough. The key was to compartmentalize it as a clinical discussion about treating side effects of a covered and necessary treatment plan.

Good luck on the journey.

edit to add - the lower cost package came with manual and battery powered pumps. Both worked fine.

Explorer

Post Edited (Explorer59) : 7/10/2014 6:18:15 AM (GMT-6)

Posted 7/10/2014 12:32 PM (GMT 0)
Thanks for your input, Explorer59.
Posted 7/10/2014 2:08 PM (GMT 0)
I use a Vacurect VED from Bonro Medical. It is a different beast altogether. It is a manual pump that generates vacuum by sliding an outer cylinder up and down outside the tube -- a motion that the manufacturer describes as "more natural" if you take my drift. It also uses a different kind of ring. You pump with the ring already in place and there is no *SNAP* to deploy the ring (the part that lots of guys dread).

They have two versions -- a consumer version and a prescription version. They both have the same device. The prescription version comes with more stuff -- more rings, bigger bottle of lube, longer guarantee, nicer case -- but I found the $195 over the counter version a better value.

My insurance would have "covered" the prescription device as an out-of-network durable medical device but my out-of-network deductible would have applied. Since the prescription model costs $495 and my deductible was $500 the insurance would have "covered" it without paying a penny towards the device and I would have been left five bucks short of meeting the deductible for that year.

The sales guy at Bonro contacted my insurance and thought to ask about whether a deductible would apply. He saved me $300 out-of-pocket. You might ask your insurer about whether a deductible will apply before you pull the trigger.

The only downside to the Vacurect is the lack of a vacuum release feature. You release the vacuum by pressing on the edge of the constriction ring.
Posted 7/10/2014 4:13 PM (GMT 0)
Thanks for your feedback, PDA.

I spoke with the representative from Firma today and he explained the two models they sell to me (manual and battery). The battery one works by pressing a button and it slowly produces a vacuum (or whatever these devices do). He said it works slow - like an elevator and to stop it you just take your finger off the button. Since the battery VED is what his doctor recommends, my husband just went with it.

The cost of the device will be applied to our high out-of-network deductible which we never meet.

This new program will be expensive. Our insurance does not cover any PDE5 inhibitors. Since my husband needs to take both 5 mg Cialis daily and 100 mg Viagra twice a week, the cost of these meds will be much higher than the cost of the VED. My husband does not want to order non-FDA approved meds. Dr. Mulhall told him not to - he said that although the active ingredient may be the same, the fillers could be toxic (I didn't really expect a doctor in his position to recommend ordering off-label). So now I am trying to find the best price for these meds in the US. Perhaps eventually my husband will relent on his position, but for now he will only purchase through a legitimate US pharmacy.

These six weeks will be an experiment to see if a guy who has some erectile function, but not enough, can be helped by a very aggressive ED rehab program.

If it doesn't help much, trimix has been working well for us lately.
Posted 7/10/2014 4:33 PM (GMT 0)
Bluebird,

If you hunt around you may be able to get the equivalent of the Viagra for a lot less if you know about "Revatio". Revatio os exactly the same drug as Viagra (sildenafil) and its on-label use is to treat pulmonary arterial hypertension. Unlike Viagra, for which the patent doesn't expire until, as I recall, 2019, the patent has expired for Revatio and there are generics available. Each Revatio generic pill contains 20mg of sildenafil so to get the same dose as a 100mg Viagra he will need to take the little pills five at a time. At my local pharmacy (North Carolina) I pay one dollar a pill. If you can find the same price (and I expect you can) you can knock the sildenafil cost down to ten bucks a week.

Can't help much with the Cialis, but it wouldn't hurt to shop around. Prices vary a lot from pharmacy to pharmacy and there are legit online pharmacies.
Posted 7/10/2014 6:32 PM (GMT 0)
My insurance refused the Cialis at first, but between the uro and pharmacist, they came up with an alternate path.

The insurance company works from the concept that ED is an age related issue, and not covered. After several conversations, the pharmacist picked up the concept that my ED was directly caused by the surgery, thus the fault of something done under the guidance of the insurance company.

At that point they agreed that they would cover 8 pills per month. This was a count of pills, not considering strength. At this point I buy 8 20mg Cialis pills, and cut them into (more or less) quarters, which gives me a general 5mg per night dose.

I also pull a small trick on the company. Cialis will give you "one month" free per year with a new prescription. That would be 30 pills if the Rx is 5mg, but only 3 pills if 10 or 20mg. So I get an Rx for 5mg, 1 per day. I take it to the pharmacy, and use the coupon to fill the free month. Then I forget about that one. I get another Rx for 8 x 20mg pills, and actually buy those.

And learn to beg without shame for samples at both the GP and Uro's office.
Posted 7/10/2014 11:49 PM (GMT 0)
BB,

That's great that you guys are moving ahead on the Pump at least. You did say 2 years on huh? That is a little disappointing to hear since your PA (and doc) seems to be pretty progressive right now -- but where was she two years ago? That is when the pump should have been started. But maybe PA/doc figured if your Hub recovered fast he would have saved money by not needing the pump? Who knows.

That said, you and your hub should pay a visit over to FrankTalk.org and visit the Pumps section. There's some good pics there showing some of the accessories (rings and sleeves) you can get for pumping -- and the results they can give. Might get you and hub excited about his future possibilities.

Also many threads on injections too .. when you get to that stage.

Have fun...

J
Posted 7/11/2014 10:38 PM (GMT 0)
Bill K. here: To answer your question...I used the battery mode for about 4 months and it was Ok. ( I believe that the one that I gave you the web address for on Amazon was a DUAL mode model.) Then one day I forget the batteries and I used the manual mode. I found the manual mode much more effective in getting an erection because the suction comes in pulses rather than a uniform manner. These pulses were far more stimualting and I got quicker and much better erections. I guess the "pulses" are closer to natural sex and that is why this mode works better. It only takes a few pumps so it is not like any type of difficult work. To be honest, I never went back to battery mode again. A few other tips in getting these things to work to the max: 1. trim the pubic hair on your groin for better suction. 2.Warm up the cylinder with warm water and let it stay wet. 3.Run a little lube on the inside of the cylinder. If your husband's penis "sticks" to the side of the cylinder due to not enough lube; that will greatly hamper getting a good erection.

It is tough on a man when he is able to have nice erections before surgery and then in a matter of a few hours; they are gone. At least, by using a VED, your husband can once again see that they can indeed happen again and that is a good "shot in the arm" for his masculinity. And with a little practice he can get them even larger than pre-surgery. Good luck.

Bill K. from NJ
Posted 7/12/2014 2:08 PM (GMT 0)
Bluebird,
Haven't you been using the Trimix most of this time with good results? If so, that should have been getting plenty of rehab blood going. If you have been doing that, I'm curious why the sudden push for pumps and PDE5 inhibitors from your Doc? Unless you maybe just want to get off the injections?

Anyway, as far as rehab goes I have become fairly pleased with the Encore manual pump. At 1st I was very disappointed with it, but practice makes perfect, so I'm still practicing. At 1st I was concerned about the "cold" member, which def had and I think is supposed to be pretty standard. I think the authorities say it is doubtful how much rehab you get since you are drawing in poorly oxygenated venous blood. So I was just hoping the stretching action would be useful. But now I notice it seems pretty warm/pink in rehab only mode, things don't start cooling down until I try to use it or otherwise apply the rings. So that makes me think that it might indeed be useful for rehab? That maybe I am actually pulling some helpful amounts of oxygen in there?

Of course either for rehab or love making, it is about as inconvenient as it could be. Plus so far for other than rehab, the rings seem to reduce sensation quite a bit and pretty quick. So I don't use it near as often as I should.

I think they once wrote a song about VED use, title was "Pump up the Volume"?

Bill

Post Edited (BillyBob@388) : 7/12/2014 8:12:07 AM (GMT-6)

Posted 7/22/2014 2:00 PM (GMT 0)
Bluebird,

If I know anything in this world, it is this topic. I have had a decade long intimate association with the Peyronies Disease Society which has been the undisputed presence on the internet for 10 years. The Vacuum Erection Device (VED) is a common tool for both ED and treatment of Peyronies Disease (PD).

For certain you should get a manual model. (I personally use a Vacurect). VED'S run from cheap to medical grade. They all make a vacuum and therefore all work. A cheap one just won't last. The Vacurect is different in that it uses different size flat silicone washers or discs with a hole in them as opposed to rubber bands that snap off of the VED and onto the penis. Remember, a VED used irresponsibly can injure penile tissue. A manual model gives the user more precise control. Avoid tight constriction rings (or any bands) when using for oxygenation and penile health. Use the rings or bands only if needed for sex.

Since your husband has "mild PD" this means he at least has a tendency toward this condition and avoiding any trigger is key. That means careful sex especially if he is semi-erect where constant bending or telescoping of the penis occurs with every move. It means lots of lubricant. Don't get me wrong, frequent sex is good, enjoy it but just eliminate any trapeze dives etc. ;) Female on top is especially risky and MANY PD cases are triggered by injuries sustained in this position.

It also means total avoidance of trimix injections. The danger with Trimix is not just the needle but the Papaverine used in the mix. It is a bigger contributor to fibrosis than the other 2 drugs. Here is one link but the internet is full respected medical studies and literature on the topic. http://www.ncbi.nlm.nih.gov/pubmed/2908935

Combating ED cannot be discussed without discussing Over the counter (OTC) L-arginine. It is a Nitric Oxide precursor and helps with blood vessel dilation. Body builders take huge amounts of it prior to workouts but 3000 mg is sufficient (eat a small snack after dose). There is a TON more but I will leave you with the best secret out there. Taking 1/2 of a 50 mg prescription trazodone tablet with a very small snack prior to bed-time will promote night time erections (NTE's) that oxygenate the tissue. It is also used in those tiny doses to assist with insomnia. More is NOT better and it has minimal effect on waking erections. The best thing is that it costs a few cents per dose.

Best of luck to you both
Tiercel
PS: PD is to be taken VERY seriously since it is usually progressive. I seriously suggest you visit www.peyroniesforum.net

Post Edited (Tiercel) : 7/22/2014 11:37:23 AM (GMT-6)

Posted 7/22/2014 11:41 PM (GMT 0)
An ED specialist at UCSF I saw said that you can spend a lot of money, but it's ok just go online for "Vacuum erection device" at ebay you'll find one that's inexpensive. He said the device is very simple and there's no need to limit yourself to an FDA-approved model.

I use a battery operated one myself. It has a dial on it, so you can set the maximum vacuum. It inflates slowly enough that I have never been afraid of "overdoing it" and creating too much vacuum. The doc said you body will tell you if you pumping too hard; it will be uncomfortable. If that happens just back off.

I don't think battery vs. manual makes a difference from the standpoint of rehabilitation. It's just a question of personal preference.
Posted 7/23/2014 3:51 PM (GMT 0)
My husband has been using his battery powered VED for about a week. He likes it. In the brand of VED that he purchased, the sales rep explained to me that the manual model is more powerful than the battery one. Although I started this thread to get information on VEDs, I knew that my husband would order the model that his doctor recommended. He is a guy that always follows his physician's instructions. I am the person who researches and questions.

Thanks for your input, Tiercel.
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