This blog details my story leading to a penile implant (IPP). Anyone that has questions or concerns feel free to contact me.
My story I call "One Mans Journey" is in the January archive.






If you would like to tell your story email it to me and I will be glad to post it.







Jack



Thursday, February 6, 2014

Loss of Penile Size

The number one complaint heard by urologist from men with peyronies is loss of penile size. It also happens with men that underwent prostate cancer surgery and other surgeries. It is very emotional for men. This is an article I published on a forum a couple of years ago.

Lost Penile Size

We guys obsess about our penis our ladies are just glad to be with us no matter what. Like I have told many a young man “The size of your penis does not make you a man.”

The beautiful green-eyed lady I have been married to over 45 years, (no she is not blond), has been with me through all my journey with peyronies, venous leakage, corporal fibrosis. Then a failed implant attempt. Now a successful implant. The one statement she made still brings joy to my life. “Jack, I did not marry you for your penis.” She was by my side through my journey.

I lost over 1-½ inches to peyronies. It concerned me but never bothered her. When I came out of surgery at Vanderbilt she had already talked with Dr. Milam. I saw that gleam in those beautiful green eyes and knew all was well.

The first night I was home after my implant was activated I lay on my back with a hard on sticking straight up, no pills, no shots just me. I was still 1 ½ “ shorter than before peyronies but it did not matter anymore.

Over the last 5 years I have been able to gain about 90% of the loss back because of the skills of Dr. Milam and the LGX. I asked her how if felt sexually now than before. She told me she never noticed the difference I feel just the same as always.

Guys, we have to stop obsessing over our problems. The women that love us don’t care about the size or shape of our penis. That is a man thing. They love us for the man we are.

I have had the privilege of talking with many men that have progressed to the stage I have with this mess I have. One single young man kept telling me I can’t a girl will reject me. I can’t I have lost too much size to satisfy her, just on and on. Well 2 months ago (November 2011) he meets a young lady and it was love at first sight for her. One evening after a date he was with her and she started trying to get in his pants. He told her WHOA!! You need to know something. She asked what? He told her “I’m Bionic.” She asked what did that mean; he briefly told her he had an implant. She told him I don’t care I want you anyway.

That night he learned a couple of things. The fact he had an implant did not matter, the size of his penis did not matter, that he could satisfy her and he could go longer than any guy his age. Since then they have been almost constant companions.

What I am trying to say is we cannot let this damn disease get us down. There is help and hope for all of us. Love the lady you are with and she will give you more than you ever expected. The most important thing is NEVER – EVER / NEVER – EVER / NEVER – EVER EVER GIVE UP.

Just my feeling this morning.

Jackp
http://jackp-penileimplant.blogspot.com

Reprint from my post on another forum a couple of years ago.

Friday, December 13, 2013

Floppy Head (Glans)

Floppy Head (Glans) was the most common complaint I found when researching implants.

The discussion came up recently and this is a copy of emails with Todd Doran at Vanderbilt.

From: Jackpjwp104@att.net
Sent: Tuesday, December 03, 2013 2:23 PM
To: Doran, Todd James
Subject: Floppy Head


Todd

A gentleman I have been in contact with went to and implant surgeon Monday. He has not had peyronies, prostate cancer or any other penile shortening problems. Just ED from venous leakage that the pills are of little help. His gitth is just slightly smaller than normal at just under 1 1/2" diamiter. About 4.33 inch girth. When he told the doctor he would like a little more girth he recommended the Titan. He asked about all the stories we hear about "Floppy Head" from men that do not have the length expanding implant. He basicially skirted the issue and told him to just pull the skin back.

Your thoughts.'

Jack


RE: Floppy Head
From
Doran, Todd James

To
Jackp

SST deformity (penis looks like the Concorde SST plane erect), aka floppy glans is a phenomena where the terminal end of the corporal body ends proximal (before) to the glans. This can occur in any penis and can be congenital (born with) or acquired through scarring events such as Peyronie's or the aftermath from a priapism episode. We see this in our LGX population rarely and I think in 10 years we've provided an operative fix maybe three times and really is the only way to correct the situation. I can see the advantage of a device like an LGX providing that needed support as it expands distally and circumferentially. Interesting that the forum talks about that advantage as being real. Clinical experience has demonstrated to me that girth improves as the years go by and rigidity improves with LGX.

I do agree that Titan gives a rigid shaft and I can see where someone would see a more rapid girth difference immediately postop. Problem is that it is less likely to change over time due to the mechanical properties of the device and if there is an SST deformity then it will probably stay that way but the risk should be low if performed by a high volume surgeon which is really the key. Hope that was helpful.

Todd

Todd J. Doran, MS, PA-C, DFAAPA
Senior Associate in Urologic Surgery
Vanderbilt University
Dept of Urologic Surgery
A-1302 MCN
Nashville, TN 37232
615-322-2880

Thursday, August 1, 2013

PEYRONIES

PEYRONIES WITH HOURGLASSING THE DAY BEFORE SURGERY

TWO MONTHS AFTER SURGERY WITH MODELING


The most common complaint Male Sexual Function Specialist hears is shortening of the penis.

From Mayo Clinic Staff
Peyronie's (pa-ro-NEEZ) disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections.
Men's penises vary in shape and size, and having a curved erection is common and isn't necessarily a cause for concern. However, in some men, Peyronie's disease causes a significant bend or pain. This can prevent a man from having sex or may make it difficult to get or maintain an erection (erectile dysfunction). For many men, Peyronie's disease also causes stress and anxiety.
In some cases, medications may help. Surgery to treat Peyronie's disease is generally only recommended if the curvature and pain are severe enough to prevent sexual intercourse.

Peyronie's disease symptoms may appear suddenly or may develop gradually. The most common signs and symptoms include:
· Scar tissue. The scar tissue (plaques) associated with Peyronie's disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.
· A significant bend to the penis. Your penis may be curved upward, downward or bent to one side. In some cases, the erect penis has an "hourglass" appearance, with a tight, narrow band around the shaft.
· Erection problems. Peyronie's disease may cause problems getting or maintaining an erection (erectile dysfunction).
· Shortening of the penis. Your penis may become shorter as a result of Peyronie's disease.
· Pain. You may have pain during an erection, only during an orgasm or anytime your penis is touched.
The curvature associated with Peyronie's disease may gradually worsen. At some point, it generally stops getting worse. In most men, pain during erections improves within one to two years but the scar tissue and curvature remain. Rarely, both the curvature and pain associated with Peyronie's disease improve without treatment.
When to see a doctor
See your doctor if pain or curvature of your penis prevents you from having sex or causes you anxiety. An accurate diagnosis is needed to determine whether treatment may help and to rule out other causes of your symptoms.
The day before implant surgery with modeling by Dr. Douglas Milam at Vanderbilt in Nashville TN. A 24 year old single young man had peyronies with hour glassing and ED. Erections would only last a few seconds.
His surgery was an implant with the AMS 700 LGX and modeling.
Two months after implant surgery and modeling by Dr. Douglas Milam at Vanderbilt in Nashville TN.
With the AMS 700 LGX implant and modeling he has now regained to within 1cm of his normal penile size. The LGX is the only implant that expands in both length and girth. CAUTUON: a very skilled Male Sexual Function Specialist that does about 100 a year should only do this surgery. Only less than 4 or 5 qualified doctors worldwide.
He now has a normal sex life and many girl friends. The girls tell him he is the best they ever had.
Pictures used with permission.
Jackp

Friday, July 19, 2013

Healing Broken Hearts

http://www.medscape.com/viewarticle/807829

Cardiologists and Peyronie's Disease: Helping Mend These 'Broken Hearts'
By: Dr Melissa Walton-Shirley
Jul 15, 2013

Not until fictional Grey's Anatomy character Dr Mark Sloane suffered a "broken penis" in a 2009 episode did most of the world know this malady even existed. Peyronie's disease is a condition in which the erect penis is angulated or misshapen to the point that it makes intercourse uncomfortable or impossible. Rarely, it's heralded by an obvious injury, a "miscue" during sex, but more commonly nothing unusual has been noted in the days or weeks preceding presentation. Nine percent of males, mostly over the age of 55, develop the problem and tens of thousands are diagnosed annually.

Why cardiologists?

Although cardiovascular healthcare providers interface with this "at-risk" population daily, cardiologists rarely discuss it. What's worse, many of us are uninformed about the near-miraculous surgical fixes available.

Healthcare professionals should not only screen for this malady but also be ready with information that can save relationships and quality of life.

What's the pathology?

The development of a "plaque" occurs at the site of an injury or weak point in the shaft of the penis. When it heals, it's woven of a different fabric of plaque that is less pliable or distensible. When an erection occurs this new unforgiving fabric pulls the penis to one side or flexes it upward or downward.

I once made weekend rounds on a patient in his early 60s who for reasons unclear had never told his regular cardiologist of 20 years about his malady.

"It's difficult to maintain a relationship with my wife," he said, "because sex is impossible."

"What do you mean?" I inquired.

"Ever heard of Peyronie's disease?" he asked.

I answered truthfully that I'd heard of it but didn't know exactly what it was. He shrugged and said, "Life is miserable." I suggested he see a urologist and discharged him home, never knowing if he ever got the courage to bring it up again. The one time he was brave enough to mention his problem, the cardiologist who stood before him was an inadequate information resource. I sooth my conscience by thinking perhaps there really wasn't much help for him way back then.

Morning glory

Fast forward to just three years ago when a patient described in horror his awakening one morning to urinate. He called his wife to see the curiosity staring back at him as he stood over the toilet bowl. "It's shaped like a morning-glory vine," he lamented, a rather unusual description for a 90° upward angulation of his penis, but he got the point across. I recognized his description from my quick review many years before and referred him to the late great local urologist Dr Bo Marcol, who started him on verapamil injections. After weeks of no improvement, he was referred to Dr Douglas Milam, associate professor of urologic surgery at Vanderbilt University in Nashville, TN.

Dr Milam and his team completely restored the erectile function of the patient whose sex life had become nonexistent overnight. The couple no longer sits with furrowed brows from the frustration and denial of their favorite expression of mutual affection. The cause of their temporary stress is still a bit of a mystery. The patient recalled no episode of "rough sex" or injury prior to developing Peyronie's. He also denied any pain with erections. He was on cholesterol medication as his only cardiovascular drug but had noted decreased rigidity after he was placed on finasteride for hair loss. The patient fully blames this medication for his difficulties because the issue was temporally related.

Surgical options

When I inquired regarding surgical procedures available for repair of Peyronie's disease, Dr Milam replied, "We have found that the least invasive procedures involve a longitudinal incision and transverse closure, which works well in patients with up to 50° to 60° degrees of curvature. Patients who have more severe curvature, many of which are up to 90°, are usually better managed with a plaque incision and placement of a graft. Graft material can include small intestinal submucosa from a sheep, which is what I use. Others will use Tutoplast. Some previously used dermis donated from the patient himself," he explained.

Who's right for surgery?

"Other types of [erectile dysfunction] ED could be present," Dr Milam pointed out. "One must ascertain if the patient has adequate rigidity for intercourse. None of the Peyronie's procedures, other than an implant, improve rigidity at all. So up front if they don't have adequate rigidity, a surgical procedure is not helpful unless it's a penile implant. We have several questionnaires that tease out the history, and data support the use of these questionnaires" to guide surgical options.

Medications

Dr Milam listed a number of treatments that are largely viewed as failures by the urology community, including steroid injections, vitamins, verapamil injections, stretching devices, etc. There is, however, some hope for an up-and-coming medication called Xiaflex (collagenase clostridium histolyticum, Auxilium Pharmaceuticals/Pfizer), a collagenase enzyme that attacks the plaque. It was approved in 2010 for the treatment of Dupuytren's contracture, a disorder in which collagen buildup in the fingers causes them to flex permanently. "Treatment involves as many as eight injections of the drug into the penile plaque over a period of a few months," according to company press releases. "Physicians may also manipulate the penis manually to help break up the plaque." The company reported that the treatment yielded a 37.6% reduction in penile curvature in one trial and a 30.5% reduction in the second. "That's a pretty good result for patients with moderate curvature, but for patients with severe angulation, that is not an acceptable result," according to Dr Milam.

After an overnight stay in the hospital with six-week break from any attempts at intercourse, the surgical patient is placed on a daily dose of tadalafil (Cialis, Lilly) 5 mg postoperatively. This encourages nocturnal erections that in theory should provide adequate stretching of the graft to avoid shortening and improve function. "Even at that, nonrigorous sex is recommended for several months," said Dr Milam. "Woman on top and no bending backward is recommended. Adequate lubrication is a must. I've had a few gentlemen require two separate surgeries, and we never want to see that happen. I once had to give the partner of one of my patients a talking to," he said.

Fixing broken hearts

Thanks to the expertise of Dr Milam and his surgical team at Vanderbilt, the two-year long ordeal for my patient and his wife was finally over. This procedure is of course also available at other sites around the world, but it is perhaps "a best-kept secret" of the urologic world. Thanks to a quick referral, erectile dysfunction is no longer a topic for conversation for this couple. I am grateful I had the forethought to refer this patient to an excellent local urologist who knew where he could send his patient for definitive therapy.

As cardiologists, we must admit that a broken penis is really tantamount to not just one, but usually two, broken hearts. Thankfully, there is real help to mend them. As healthcare providers, we owe it our patients to take the time to find out where that help is. Just in case.

Monday, January 21, 2013

Questions and Concerns

This is a email I received from Mike a few days ago. He had just had his implant activated and tried it for the first time.

Jack, Hope this finds you doing well. Thank you for you blog it was very beneficial to me as I prepared and finally made the decision to get a AMS LGX implant. I made it through the surgery and recovery ok with little or no complications. There was one thing that I felt was a complication and that was one cylinder seems to be about 3/8" shorter than the other. This is the case whether the implant is inflated or deflated. The Doc agreed that one was shorter that the other and mumbled a word or two about possible causes but said it should not cause any problems. Now onto my sand concerns. The first "go around" at 6 weeks was very disappointing to both my wife and I. I had quiet a bit of uncomfort which bordered on pain and felt very little sensation. My wife didn't enjoy the act at all and she did not get much sensation either. To be honest it was a very big let down. Prior to this I have been inflating and deflating twice a day and initially felt pain and discomfort but had gotten over that. When I inflate I notice that things seem smaller that before surgery. Before I could get a erection 25 percent of time for a very brief period and. I was not surprise by the shorter length as I had read that this could be suspected. I do still have good blood flow to the glands which helps things look closer to normal. When inflated the erection looks fair but it is not as rigid as I thought it would be. Things are hard so to speak but just not rigid. I pump the bulb until it gets hard and can still make small pumps but am afraid to pump to much and damage something. I know I have given you a lot of info but I wanted give you enough details so you might could give me some advice. I guess my main question is the performance of the implant supposed to be like this at 6 weeks? Will things get better for the wife and I or is this it? I know there is a learning curve and I have read several places that sensation returns and things stretch out over the course of the next year. I hope this is the case. Thanks again for you blog and any advice you can give. Mike-




Hi Mike

First RELAX things you are experiencing are perfectly normal. Let me give you some pointers.

My left cylinder is 1cm shorter than the right, it is not a problem. Dr. Milam told me about it right after surgery he said it may have been from the urethra puncture by the first doctor or it could just be the way I am. I know a few men with severe peyronies that one cylinder is 3cm shorter than the other. It is not a problem for sex and over the next several months you will be the only one that knows it.

The first "go round" is not easy on either of you. Our first time I had to quit less than half way through because it hurt!!! It will get better each time you use it. Try 800mg (4 200mg pills)of ibuprofen about 30 minutes before you try again. Do Not take prescription pain meds because they will dull the sensations in your glans.

Yes we all are shorter after surgery until the LGX expands. A tip that works well is to put your wife's butt on a pillow and use a little astroglide. (With astroglide a little goes a long way.) This changes the angle of penetration just enough and makes for better penetration. Try shorter strokes for a while, just enough for a good feel in the glans.

It will get harder in the shaft. The glans takes a while. Just before penetration try to squeeze the pump a few times you may get a little more expansion. Do this for at least a year. Continue to inflate the implant twice a day for the first 18 months. I recommend holding for about 5 minutes then deflate. Do this about 3 or 4 times twice a day. This gets the implant expanding as soon as possible. YOU CAN NOT PUMP TOO MUCH AND DAMAGE SOMETHING!!! I still inflate mine at least once a day and it has been over 4 years. Dr. Milam said to "knock my self out" trying to damage it doing this.

You are doing just fine at 6 weeks. Complete healing and expansion takes up to 18 months so don't rush things. The last time I saw Dr. Milam he said he is now seeing men with expansion up to 3 years.

What else can I tell you. Just relax and don't push it. Keep on trying to have sex with the wife every few days. The more you try the sooner the soreness will work out. It is just like physical therapy for the penis. Don't forget to put a pillow under her butt, all the couples that try it stay with it even after the implant heals.

Anything else I can help with let me know.

Jack



Jack,

Thanks for your response. You don't know what burden you have lifted off of me. Getting the implant was the light at the end of the tunnel so to speak and the first time out it looked like my light had went out. I have spent the last few days thinking that I may have made one of the worst mistakes of my life. My wife's apparent disappointment did not do anything but add to my anxiety. Prior to the surgery I was able to get a decent erection with Viagra about 25 percent of the time but when I took enough to achieve this, I had some of the worst headaches I have ever experienced and it took me a day or two to get over it. I had did a a lot of research during the year before the surgery at which time I went through the unsuccessful tries with the pump and injections. So I knew a little of what to expect but I guess I had to high of expectations so early in the ball game. I am also relieved about learning the one cylinder being shorter than the other is normal. This has been a big concern of mine since I first discovered it as I thought it might mean I would have surgery to fix the problem. Thanks again I will rest much better tonight and I am sure I will have more questions for you as things progress. Keep up the blog, I don't know if you are fully aware how much a help it is to those who are considering or already have the implant. -Mike



PS ED and other problems that lead to an implant make it hard on a couples sex life. I would like to recommend a book. Intended for Pleasure by Dr.Ed Wheat. It held us and other couples through this trying time in our life. The last time I checked it was available at amazon.com.

Jackp

Sunday, July 15, 2012

Lee's Story

This is a message I received from Lee. He has quesions and concerns.

One thing he says about the differances in the Coloplast and the AMS LGX us regular size guys need to read it how the two feel different. For us men less than 7" this is from a man that has had both.

Jack

Good Morning Lee



After reading your message I had some concerns and sent a copy to Todd Doran at Vanderbilt for his opinion.



Let me go through your message and address my concerns and when I hear from Todd I will let you know what he says.

--- On Sat, 7/14/12, Leland Spring <> wrote:



From: Leland Spring <>
Subject: Penile Excercises
To: jwp104@att.net
Date: Saturday, July 14, 2012, 4:45 PM


Jack

I have very much enjoyed your posts in the blog. I e-mailed you a couple of weeks ago, I have had 4 implants done and am now recovering from # 4, surgery was on July 11, My uro has told me to start pumping. He said to pump it once a day for 15 minutes each day.
4 days seems real early to start inflating the implant to me.
He is not big on the AMS 700 implant, I don't know why he's not much of a talker.
He is probably old school and stuck on the old ways.
I had him install an AMS 700 LG .
Good for you!
Do you mind sharing who the doctor was and where he is at?
That is what I had the first time I had one and it was good for me, then I had a coloplast titan put in, two of them. Since my penis is less than 7 inches long it felt very stiff , not comfortable for my wife.
Thanks for letting me quote you. Todd and Dr. Milam have told me this but you are the first patient that has told me.
I would like to know if you could give me some more info, be more specific about the pumping you did when you first started pumping after surgery. My main concern is that I gather as much info as possible for the first three months post op so I do not miss any steps and insure my best chances for great success with this implant.
Was there any certain routine you followed as far as pumping was concerned?? Time, length of keeping implant fully pumped and how many times a day?? Did you do any special therapeutic exercises?
I am going to give you the entire routine at the end of this post, I am also attaching the AMS Double Handed Method of Inflation. The pump is very stiff until it is broken in. The key to starting the pump is to grasp the pump firmly and squeeze hard and quickly release this will activate the pump. I am also attaching a user's guide. Any questions let me know.
Any response that would help me be successful would be appreciated. If you would like to share this post feel free to do so.

Regards
Thank You
Lee

This is the inflation routine I used and was recommended by Dr. Milam and the staff at Vanderbilt.
You may only want to do this once a day for the first 6 weeks. After that do it twice a day. A hot shower or bath can also be helpful while doing the inflation.



Twice a day, every day for the first 18 months, inflate the implant for 15 minutes and hold it. Then every 3-4 minutes squeeze the pump a few times to help the ipp inflate to it's max. When you deflate the implant hold down the deflation button for about 6 seconds and then squeeze your penis from the head to the base a few times to get the fluid back to the reservoir. This will do a couple of things, give you a more natural flaccid look and make the implant easier to inflate the next time.



You should have been told to keep your penis up on your stomach for the first 6 weeks. This will help you heal straight and be less painful. I found that the Jockey Pouch Briefs did a great job helping. They have a special H cut that will help hold you up. I got mine at Macy's and Kohl's. I like them so well I still ware them and get them online at jockey.com They offer about the same support as a jock strap without the discomfort.



My concern for you,at this early stage, is pain and discomfort. If it is painful or very uncomfortable take 800mg of ibuprofen about 30 minutes before you inflate.



It takes the LGX up to 18 months to fully expand in length. (The last time I say Dr. Milam,last August, he said he is now seeing men with expansion up to 3 years.) You may not be happy with your size at first but do not despair. At 3 months post op you will see expansion, for me it was 1/2". Since my implant 10/08 I have gained back almost an inch and a half.



Anything else I can help with let me know.



Jack

Sunday, June 10, 2012

Double Handed Inflation Method

I have been getting several email lately from men having difficulty inflating there implant. The AMS Double Handed Method is a great solution and I am posting a copy here. From AMS Enclosed is the standard User’s Guide for your general reference. However, you may prefer to use both hands (left-hand thumb over right-hand thumb on front side of the inflate bulb, with left-hand index finger over right-hand index finger on back side of the bulb) to squeeze the inflate bulb HARD/FAST to “pop” the valve into the inflate position, rather than just using one hand on the inflate bulb. This method will stabilize the inflate bulb between your fingers and provide you with double the squeeze strength. Be sure that after each complete squeeze of the inflate bulb, you relax your fingers and allow the bulb to refill. To give slight, partial squeezes will only increase greatly the number of squeezes you have to give the pump bulb because you’ll be pushing very little fluid into the cylinders with each little squeeze. After the initial very HARD/FAST squeeze of the pump to activate it, each subsequent squeeze of the inflate bulb is done with firmness. Follow the deflate instructions as shown in the AMS 700MS User’s Guide. Best regards, Elizabeth Rae AMS/Worldwide Senior Patient Liaison PH: 800-328-3881, ext. 6261 011609 USER TIP Fully depress the inflation bulb and hold it for 3-4 seconds after it is depressed. Release your grip on it and wait 5-8 seconds while the bulb refills with saline solution from the reservoir. Repeat that process over and over until the desired firmness is achieved. A stinging sensation is noticeable as the corpora cavernosa is stretched tighter and tighter -- a sensation that will disappear over time. Jack Other Tips: When you deflate the implant hold down the release button 4-6 seconds. Then squeeze your penis from the head to the base a few times. This gets most of the saline out and give you a more natural flaccid look, it also help with inflation the next time.