Company rep in Operating rm

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Chiefy

I've read through topics on choosing the right surgeon, and here in Vegas, the pickings are slim.  I've seen 4 docs through this ordeal, and I'm happy with my current doc, Casey McCraw.  He's advertised as the only fellowship-trained uro in town, for whatever that's worth.  I've been pleased with him to a point, especially compared to the previous 3.  

Thanks to this site, I've been asking him more of the right questions.  I'm scheduled for my implant 17 Oct (Halloween is hereby cancelled).  He said he'll be doing a pubic incision, and at the time his reasoning made sense, which included his patients have less pain/complications, a little harder for him, but easier on us, and some other stuff I'm going to revisit).  He said he's done hundreds, but has no #s to speak of here in Vegas as he's recently relocated out here.  He uses titan almost exclusively, having seen better results across the board with them...but said the company rep will be in the room.  He said he doesn't need him for anything and he "just sits in the corner, but the company prefers he's readily available if ever needed."  This alarms me.  Is this typical?  I had an artificial disc put in my lower back in 2006, and the doc said similar things.  Turned out it was his first artificial disc surgery...he botched it and I'm now handicapped for life.  But back to my dick. lol.  

While I like this guy...he did my incision & grafting surgery on 8 Feb, and I haven't seen an erection since.  The stretch test and VED show a CRAZY amount of size loss that he never once warned me about.  But he did suggest traction (I bought a REFLEX) and VED to hopefully get a little back before game day.

Is having a company guy in the room a concern?  

I'm also going to ask to see/play with one of these contraptions so I'm not learning the geography after.  I don't see anyone posting they did this though, is it an unreasonable request?
Peyronies for 2+ years.  Have ED for 8 months
Tried Xiaflex, 3 cycles, zero improvement
Had incision & grafting surgery, Feb 2019.  Fixed curve (I think) but resulted in substantial length & girth loss. 
Facing implant as remaining option

tomas1

I'm in a bad mood and should keep quiet, but you doc sounds like a turd.
85 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Pfract

There is plenty more for concern here than the company rep. Apparently, your doctor botched your fists@surgery awe now you are pgoing to use him again? Or I misunderstood?

Hawk

Chiefy,

If it between this guy and never getting an erection again I MIGHT take the chance IF he could give me the names of 3 patients to call.  IF he could tell me his personal infection rate (not industry-wide numbers).  IF he measured me pre-op, put it in my medical records and gave me a minimum I would be post-op.  If he answered correctly when I asked his view on RTE's.  If any of these did not come out optomistically I would forget it.

Frankly, it was very difficult for me to type that previous paragraph but I am trying to be objective.  Even if all those came out great I would be nervous.  A retro-pubic is not harder on him and easier on you.  That was a lie.  I am not saying it is no good but he does that because that is what he knows and feels comfortable with PERIOD.  That was a lie.  I was awake with a spinal with a scrotal.  I rode home a 4-hour ride after recovery, I was cycling after 3 days.  I had intercourse at 21 days.  NO ONE beats that.

Next, how do you give a guy two chances to mess up your only dick?

If he had told a better lie about the company rep like "he wants to be here to observe a wide range of surgeons". or "He is in the area and his company thinks it is good PR for him to occasionally sit in".  But, he told you that he might run into a situation where he doesn't know how to proceed but the company rep would know more about what to do than he would.  If there is ANYTHING or ANY SITUATION in which the company rep knows more about what to do than the man cutting on your dick knows, THAT IS A PROBLEM.  

You seem to be way too tolerant of sub-par doctors if this man left your dick worse off on a prior surgery, and\ you have been permanently maimed by a doctor dependent on a company rep with spine surgery and are still considering this guy.  Don't you want to assure this is "one and done"?  Having a revision for a bad surgery is not fun.

Keep in mind, I am NOT predicting the certainty of a bad surgery but what I am doing is helping you predict the odds with the concept that you probably want the odds to be the best they can be.

Is traveling to CA out of the question financially?

Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

Chiefy

pfract,

      Thanks for the reply.  I'm not the push over the language/attitude in my post makes me out to be.  But I do try to stay optimistic as opposed to the I'm gonna kill myself now crowd here.  I fast forwarded my story a bit and that made the doc look worse than he probably is. He was surprised with my result (the ED part) and said of the hundreds he'd done or assisted with, this was the first one he'd seen end with ED. I don't have any significant scar tissue, numbness, etc.  It looks great.  And things are actually beginning to improve in the erection department.  I now start to actually get an erection, got the best one yet just last night.  It's hard to quantify, but it gets a little past halfway or so and that's it.  Not hard enough for sex.  What I do get is straight, without the slightest hint of what it looked like before.  It's been getting better slowly (weeks vs days).  I think the traction and VED are helping.  I'm doing 30 min traction followed by 30 min VED every day.  I had posted weeks ago with concerns for how short and pronounced my ligament had gotten, and I've seen substantial improvement there.  And truth be told I was seeing some of this the last few months before my surgery, that I wrote off as the system powering down once it realized there was a substantial curve ahead. lol.  

If I continue to improve or get to anything usable, I'll cancel the surgery a happy man.  The Doc is tracking here too.  His schedule is several months out, so I'll leave it on the books and reassess when it gets closer.  

I'll ask the questions you suggest today and will post the answers received.  Having the company guy in the room still sends up red flags for me; will look for a better explanation.  And I have no problem whatsoever traveling elsewhere if it comes to that.  
Peyronies for 2+ years.  Have ED for 8 months
Tried Xiaflex, 3 cycles, zero improvement
Had incision & grafting surgery, Feb 2019.  Fixed curve (I think) but resulted in substantial length & girth loss. 
Facing implant as remaining option

Alibaba

I found almost no reviews of Dr. McCraw other than he is "young, sweet, and cute".  That says nothing to his professional ability as a surgeon. Otherwise, he graduated from medical school in 2012.  https://npino.com/npi/1336403260-dr.-casey-owen-mccraw/.

My personal opinion is infrapubic penile implant installations should be outlawed. Dr. Perito does 15 of them a day. Dr. Karpman does them and has an excellent reputation for bedside manner( he might also fit in the cute category but I have never met him in per).  I had significant size loss and pain issues from my infrapubic as have a number of people I know. 4 doctors when seeking a revision, told me I should never have had infrapubic, it is best suited for older overweight men and those who are diabetic. The main advantage, I was told, was it is easy for the doctor to install the reservoir and with a SKILLED  doctor, there are no advantages to the patient other than no feeling loss at the incision site of the scrotum since there is none. Tubing issues and high placed pumps are the most common issue with infrapubic. From a mechanical standpoint, it is difficult to understand how they can properly measure the penis that way. Nerve damage is a risk infrapubic and is multiplied several times over on a revision because the scar tissue from the tubing above your penis also then involves the nerves to your penis. My penis no-longer has any feeling. Yes, it has been tested to the point of pushing a fine syringe needle through my glans. No be whoop. A normal person would jump to the moon if the point touched their glans.  Every doctor has their favorite method. Every doctor has to have beginning patients.  Yours might be the next super star, but on an issue like this, maybe you don't want to be gambling. Loss of erections after grafting is not uncommon. I have talked to 2 young guys this week that are seeking an implant after grafts also.  Size loss is also common.  Back to your doctor. He is not big on the kick back $ list but he does get some. https://projects.propublica.org/docdollars/doctors/pid/151128  . My advice is research your doctor well and ask for references.  My first implant surgeon was recommended on a forum and went for him. BAD mistake. On further research after my implant, I found MANY horror stories from patients of the same doctor. Cheers guy.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Chiefy

Thanks Alibaba,
      It's funny you mentioned he might be the next superstar.  My doc previous to him was planning to refer me to someone in CA, but asked if I could wait until McCraw got to town as the practice had gone to great lengths to recruit him.  He was supposed to be fellowship trained and "done more of these than everyone else in town combined" blah, blah.  If the numbers aren't there, along with reasonable answers to the other Qs, then I'm going doc shopping again.  Thanks for the links as I've been trying to find as much info on docs as possible.  Here's what the local site says, not that it's unbiased. https://lasvegasurology.com/people/casey-o-mccraw-md/  
       
Peyronies for 2+ years.  Have ED for 8 months
Tried Xiaflex, 3 cycles, zero improvement
Had incision & grafting surgery, Feb 2019.  Fixed curve (I think) but resulted in substantial length & girth loss. 
Facing implant as remaining option

Junior

Hi Alibaba,

It seems that all doctors get some kickbacks look at Dr Eid

https://projects.propublica.org/docdollars/doctors/pid/280617

Dr Kramer

https://projects.propublica.org/docdollars/doctors/pid/1165571


I'm lost for words, right now these are the two doctors that I have in mind, If I go ahead with a doctor other than someone near Boston or NH
Junior
ED - born 1952   /Peyronies Disease Onset 7/2018 at 65 / Prostatectomy 4/1/2019 / Low - T testosterone therapy June 2019 / June 2019 Peyronies Disease at 70 degrees - July 2019 started Xiaflex 1st cycle

Pfract

Alibaba, couldn't have said it better.  

Alibaba

Junior, you are correct but in comparison, Kramer and Eid have been established for years and have thousands of successful implants under their belts plus train their techniques and do seminars. They get paid to do that.  Compare those 2 to doctor Perito who takes in $1 million.   By comparison, McCraw who has done 140 implants in his life is just a newly hatched chick.   When you scroll down the page, you see WHO has been paying. Top payer is Titan to McCraw.  I have no complaint about a Titan product. I think they are advantageous in some ways, but does that put a patient at a biased disadvantage that might should have a Boston Scientific for some reason. If McCraw has completed 7 implants since moving to Vegas, ask for as many references as possible from those implantees. Patient satisfaction is paramount PLUS finding out how well the center where the implant takes place and infection rate are. I know a few years ago, Dr. Eid stated he would not do an implant at Presbyterian because their infection rate was too high. Many variables to consider.   Fellow only means the doctor's credentials have been peer reviewed to verify he is qualified to do whatever it is he purports to be capable of. It is not a level of quality standard. Every good doctor has their first patient. They may be good from 1 or may get better by 200 or 1,000. They may change their methods as they go to operate cheaper, do better work, or improve the patient outcome or satisfaction. Only years of practice lets a person know where things lie. Some doctors have very bad result records because their patients are the sickest of the sick and likely would have no good results no-matter who their doctor was. Some doctors may only deal with young healthy patients and refuse those who have any risk that might look bad on their record (I've been to several of this kind) so track records can be skewed too.  A doctor who will take anyone and has a good record and low infection rate is one to look for. I am interested an hope cute McCraw is a good one. Past implant surgery reports on some of the forums make it clear that Vegas could use a rock star instead of doctors who give maybe acceptable but less than stellar results. Been there, did that, don't want to do it again. Life is short. Research, ask questions. Move on if you are not satisfied. If satisfied, and your gut feels comfortable, go for it. I say all this from experience. I've had 2 dozen surgeries in my life. Learned a lot from them. Most did not turn out the way the "sales hype" stated.  It pays to be choosy.  Cheers.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Chiefy

Alibaba, exceptionally well said.  Looking at the pay out list for these docs, looks like they haven't paid for a meal in years.  You said McCraw has done 140 implants.  Was that a figure of speech or did you find that data somewhere?  Oh and my wife says McCraw isn't that cute.  

The hospital that McCraw uses most has about the best infection rates in town.  I've asked about his personal data as pfract and you suggest.  Vegas essentially has nobody else, but that is certainly no reason to chose a surgeon.  There are a few that claim "years of experience" doing implants, but even a cursory look shows cracks in their claims.  

I've been reading about company sales reps being in the OR.  Makes some sense for joint replacements with lots of tiny pieces and/or procedures that have options as you go and having an expert on hand can be valuable.  With an implant, seems it's either to provide tech/expert advise to surgeons with little experience with it or it's just about the money.  Doc doesn't need them but they're there anyone...cause everyone is getting paid.  Any reps in the room for you?
Peyronies for 2+ years.  Have ED for 8 months
Tried Xiaflex, 3 cycles, zero improvement
Had incision & grafting surgery, Feb 2019.  Fixed curve (I think) but resulted in substantial length & girth loss. 
Facing implant as remaining option

Alibaba

I calculated the number from an average of 20 implants per year over the 7 years he has practiced going by what some of the most active local yokel urologist do. Several I contacted in St. Louis when trying for my first implant said they do about 1 every 2 weeks.  We have 14 urologists in our town which is  a medical hub for Southeast Missouri, Southern Illinois, West Kentucky and Northeast Arkansas  and they only do 3-5 per year. I asked how many they did when I made appointments. McCraw may do more, may do less. I was trying to be generous in calculating w/o knowing. My wife agrees with your wife. Always listen to the wife.  ;) Cheers.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Chiefy

Update.  Doc's office called back and he'd like to sit down and go through all of my questions/concerns.  Appointment is 10 Sept.  Will update after.    
Peyronies for 2+ years.  Have ED for 8 months
Tried Xiaflex, 3 cycles, zero improvement
Had incision & grafting surgery, Feb 2019.  Fixed curve (I think) but resulted in substantial length & girth loss. 
Facing implant as remaining option

Alibaba

Hope it is productive. My oncologist's secretary called twice Friday to tell me he will take time out next Friday to go over my concerns.  Not going to do it as I see nothing productive coming from it. Every past visit has been a 1 way coversation. He was too adamant last visit that he "does not have time".   Every question I had last week was met with "You have the right to fire me as your doctor and go to St. Louis" instead of giving me an answer what his reasoning is for the decisions he makes. As a patient, I feel I have that right. You do also. Make a list. Take a buddy along if you feel you might allow him to bulldoze or drown you in spin.  Make any decision based on what is best for YOU keeping in mind he is not the only surgeon on earth and that adding a factory rep salesman to the surgery will not improve your chances as the rep is not the surgeon.  I say this because several times I have been told that a doctor says he will have the rep come for the revision to advise how to fix things.   As doctor Kramer told me, "when everything is done, I am the one who is responsible for every single thing that goes on and happens in that operating room."   Cheers man. Keep us posted.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders