Medicare, Transsexual Surgery, and the office of Dr. Reed

Dear prospective patients who are on Medicare or are considering Medicare to fund their transsexual surgery,

Yesterday, we got a verbal update from Medicare (phone call) and their policy is always evolving.   As of November or December, 2014, our office is no longer going to be listed as an accept assignment office.

Allowing a month for transition, after either December, 2014 or January, 2015, we will still see Medicare patients, but they will get the check, which may be 10 to 15% less than if they went to a doctor who accepts Medicare assignment.  The catch is, doubtful you will find a doctor who will doing MTF vaginoplasty for the 1,800 or so Medicare has allowed.

What this means is with each Medicare patient we will have a written agreement that we are not accepting assignment.  The patient will get the check directly from Medicare.   To schedule surgery which will be done at the hospital for Medicare patients, simply call Anne, our amiable office manager.  Our fees will be reduced, because the hospital is the facility (not our office)  – Medicare takes care of that, and anesthesia is also provided by the hospital.  A savings of several 1000 s of dollars.  We will fill out your Medicare form, send it in, provide you with a copy.  So you will be paid directly by the US government.

We have always been looking for a comfortable way to make Medicare work and I think for now this is it.

Should you have any questions, please call our office and speak with Anne.  We will try to make your dreams come true at a real savings.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

Why do (should) men seek circumcision revision

July 21, 2014

Hello Dr Reed,

My name is Jim and I was hoping you could answer a quick question.

I am currently researching circumcision and have found information online in regards to circumcision revisions.  Is there a common reason or reasons that men would need to have a circumcision revised?

Jim

July 23, 2014

 Good morning Jim,

Thank you for your interest in what we do here at the Reed Centre.  10% of our patients request revisions of previous circumcisions for reasons including: white cross hatch suture marks (scars), frenulum breve (tight frenulum), peno-scrotal web, uneven cut, loose skin covering penis when flaccid or a waddle of skin on the underside of the penis.

 We allow the patient to bring in a work sheet  to which we add recommendations to produce an optimal cosmetic result.  Healing time is similar if not faster than a original circumcision. Patient feedback is uniformly satisfactory.

 If you have any further questions please feel free to contact via email or telephone.

Have a great afternoon,

 

Harold M. Reed M.D.
305-865-2000
Urologist,
Phalloplasty Surgeon

 

 

My circ was loose, then OK, now loose again. Please explain

July 23, 2014

Hello,

This is interesting as I have loose skin covering penis when it is flacid. I am 42 now but when I was younger, after my penis had reached maturity in my early teens the skin ended at the head of my penis. Now it is looser and partly covers the head.  My son is circumcised and now a teenager and his penis is exactly like mine was.  Will this happen to him as well?

What is the procedure for circumcision revision in my case?

Many thanks,

Mike

 

July 23, 2014

Hi Mike,

Thank you for being a loyal member of our PROCIRCORG Yahoo group.

The most common reason for laxity of skin when it had not been noticed during young adulthood is the onset of weight gain with middle age (may not relate to you).  The weight of the abdominal panus drags not only the abdominal skin down, but in doing so seems to create more penile skin (which is attached).

The best remedy is not re-doing your circumcision but a small lower abdominal tummy tuck.  To verify if I am on the right track, stand in front of a mirror and lift your pubic area, and so if you like that look.

Some more technical information.  (Again this probably does not apply to you)  Overweight men with more fat stores make estrogens.  Yes, estrogens (don’t need ovaries) and estrogens can cause some penile atrophy, breast growth, and of course impact on erectile performance and libido.

Once your skin has laxity (redundancy), weight loss will usually not restore your situation as excess skin which is related to a multiplication of new cells, will not go away.

Hope this is of help,

Harold M. Reed, M.D.
305-865-2000
Urologist

How soon after circumcision can I have sex?

July 21, 2014

Dear Dr. Reed,

You have me scheduled in for a cosmetic adult male circumcision
on August 5th, 2014.

How soon after circumcision can I resume sex?

Alan

July 21, 2014

Good morning Alan,

Please keep this precept in mind.  An incision does not recover
full tensile strength until 8 weeks after surgery.  So the answer is 7 to 8 weeks,
or until complete epithelialization has occurred.  No areas of delayed wound healing.

You could probably have gentle touching sex a few weeks earlier than that if that’s any
consolation.

We look forward to your visit and believe me we will show you every courtesy,,

Harold M. Reed, M.D.
305-865-2000

PS.  The humorous answer is it depends on whether you have a private room
or a semi-private room.

Considering phalloplasty, have phimosis, advice sought

July 19, 2014

Dear Dr. Reed,

Considering phalloplasty but have phimosis, advice sought

Mitchell

July 19, 2014

Good morning Mitchell,

Good question.  By all means have a cosmetically performed circumcsion (as we perform it) to remove the phimotic scar).

Wait 3 motnhs and then have length and or girth as we provide.

Patients who have lengthening usually leave for home the next day.  You could probably return to an office environment in 3 days..  Or consultation on Thursday, surgery on Friday.  Monday, back to work.

From surgery anticipate a 3/8″  increase in length and with dedicated use of traction, 8 hours a day in divided sessions, anticipate a 1/8″ gain each month such that after 6 months you’ll have 3/8″ plus 6 x 1/8″ or 9/8″.  We say about an inch longer erection in 6 months.  Flaccid lengths will be correspondingly longer.

Please recognize that American Urological Association policy statement of 2008 remains unaltered?   ?The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious.   The AUA also considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious.?

Whenever you stop using traction whatever you have gained is permanently yours. If you continue, more length gains will be accrued.  We do not do simultaneous surgery, such as any combination of length, girth of shaft, girth of glans, circumcision, or pubic liposuction.

Hardly a week goes by when some disillusioned patient done elsewhere calls us for a revision.  And we told you so.

Generally speaking the penis does not appreciate simultaneous surgery with a few exceptions.

With AlloDerm, we can say quite conservatively you can anticipate a 3/4″ gain in circumference if you have not already had penile girth enhancement which is permanent as far as we know having followed patients for 8 years or so who have had AlloDerm.  Most patients will do a lot better than that.

While you do not have to be circumcised for lengthening, you need to be circumcised for girth enhancement.

AlloDerm patients must be on strict bed rest with the exception of getting up to use the commode or eating in their room for 4 days.  Surgery is the zero day, and we certainly recommend you stay at the Daddy O Hotel, one block from the office (305-868-4141) so I can see you daily as your penis will continue to swell for several days, and your dressing will be replaced often to accommodate a larger sized penis.  Mention my name for a discount.  Less expensive is tourist class Whitehouse Inn on the Bay (305-893-8280).

AlloDerm is like particle board, when immersed in body fluids, it swells and swells for several days.  This spreading of the collagen fibers is helpful to permit ingrowth of a capillary bed and new cells of your own making.

Early mobilization  is the great enemy of good graft take.   Again plan on staying in your room, stocking up on food or sending out for food.  Good Italian, Greek and Chinese restaurants abound with delivery service only a telephone call away.  I’ve have been known to go shopping for some patients at Publix.  You won’t starve.

If you have AlloDerm surgery on Tuesday, you could be back in an office environment on the following Monday.  If you do manual labor you may wish to wait a good week after surgery and avoid trauma to your genitals. Most likely you will have many questions and we are available for consultation only, if that suits your purposes.

Candidates who wish to schedule surgery with our facility are required to have phone consultation with a favorable response to questions of concern.  Assuming this, you will be given the nod to send in a 50% deposit which is non-refundable.

All patents will require these blood tests: a recent CBC,  platelet count, PT and PTT.  This can be done at our office the day before surgery or in your home town. These tests run about $100.  If you are over 40 or are on medications, please call the office before scheduling surgery, as a letter of medical clearance may be required.

If you are a smoker, you must stop completely for 2 months before surgery (girth enhancement especially) and please never again.

Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and enhances anesthetic risk.  However, most of our penile surgery is done under local anesthesia with IV sedation.

This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke. Again not for 8 weeks before and not for 8 weeks afterwards. Hopefully never again.

Please no aspirin or aspirin products, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for a week before surgery. No Vitamin E or excessive alcohol or spices for a week before surgery as this may promote bruising. Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice a day, Arnica montana (Boiron brand) dose 30C (take 4 small tablets sublingually, 4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss it beforehand.

Boiron brand is available at Whole Foods and on the web at http://www.vitaminshoppe.com for “pennies” and we do notice a difference.  You will need 2 vials.   We hope to have the pleasure of serving  you whenever your travel plans include the South Florida area.

With regards,

Harold M. Reed, M.D. FICS
Phalloplasty Services
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons

Adult male circumcision, 2 advantages

 

 

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Male Circumcision: 2 Things You May Or May Not Know About Circumcision

 

By Justin Caba | Jun 11, 2014 08:00 AM EDT

 

1. Lowers STD Risk

 

Although research in the past has shown that circumcision can reduce the risk of contracting the human immunodeficiency virus (HIV) in men by 50 to 60 percent, the exact cause has not been well understood. A recent study conducted at the Translational Genomics Research Institute revealed that removing the foreskin from a penis can change the bacterial community known as the “microbiome,” leading to improved protection against the HIV infection. TGRI researchers based the study on 156 men in Uganda who were circumcised as adults and reported back a year after the procedure when bacteria amounts had dropped by 33.3 percent. A specific type of bacteria reduced by circumcision was found to activate Langerhans cell in the foreskin. Although Langerhans cells are known as the body’s first line of defense, when activated, they can actually enable HIV transmission by binding the virus to CD4 and T cells — cells that are specifically targeted by HIV.

 

2. Lowers Prostate Cancer Risk

Researchers from the University of Quebec’s INRS-Institut Armand-Frappier in Montreal have found that on top of STI protection, circumcision may also protect a man against the risk of developing prostate cancer. The study, following up on research surrounding lower rates of prostate cancer among Muslim and Jewish men in the West, was based on interviews from 3,208 men (1,590 of which had been diagnosed with prostate cancer). Compared to uncircumcised men, those who were circumcised as infants were 14 percent less likely to develop prostate cancer. Surprisingly, men who were circumcised later in life were 45 percent

 

My 14 year old has only one testicle, please provide implant info

July 12, 2014

Dear Dr. Reed,

My son now is 14 YO, he only have one testis, can he has a testicular implant/prostheses and when the right/best time for him to have the surgery. Thank you

Regards,

Ruth

 

July 12, 2014

Good morning Ruth,

Thank you for visiting our web-site http://www.penisdoctor.com/testicular.htm

Your son needs to have a diligent attempt at learning what happened to his other testis.  Is it still undescended?   Imaging studies and skillful exam by a urologist could help.

It needs to be removed because of possible malignant degeneration.  Your son is entering the time for pubic growth.  He could have an implant put in now, but I would choose an adult size implant.  If the scrotum is not  capacious, then wait until he is about 18 years old, but strive to subject him to only one surgical procedure.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

When will my implant with fluid loss self correct (seal) and work again

June 8, 2014

Dear Dr. Reed,

I had an AMS LGX implanted in 2009. For the last two years I have had problems getting the pump to inflate, when I depress the pump bulb it feels like it is full of air or fluid and will not release properly after the first pump.

When I squeeze the pump above the inflation bulb very hard it will start working. It is a major distraction as you can imagine fiddling with this for 5 minutes beforehand to get it going.

ve given it some time t. Has anyone else heard of this problem ? Thx

June 8, 2014

Hi Joe,

The human body when injured tries to heal and does this amazing well. The AMS is a mechanical device devoid of any human tissue, so it does not have that capacity.  Also the original fluid placed in your reservoir is long since gone. (reabsorbed by local body tissues).

Even having human tissue around it will not help a leak site to re-constitute.  Also think of us when you are looking for more length.

Harold M., Reed, M.D.
Senior Member of the AUA
2500 Implant case experience.

305-865-2000

 

Have some phimosis and considering phalloplasty lengthening

June 8, 2014

Dear Dr. Reed,

Order of Operations?.

I have been thinking about having a phalloplasty lengthening, with secondary girth enhancement at a later date.  Over the last several months I have been having mild issues with phimosis that I have been able to manage.

I believe I will get a circumcision as well to help correct this, but I was not sure what surgery I should have first, the lengthening or the circumcision.

Your thoughts?

Andrian

June 8, 2014

Good morning Adrian,

First things first.  Yes, Ideally get your circumcision done first ideally by a urologist who has done 8000 circumcisions and understands phalloplasty as well.  The reason being applying traction to phimosis does not work well.

Sincerely,

Harold M. Reed, M.D.

305-865-2000

Considering phalloplasty but have phimosis, advice sought

Hi Adrian,

First things first.  Yes, Ideally get your circumcision done first ideally by a urologist who has done 8000 circumcisions and understands phalloplasty as well.  The reason being applying traction to phimosis does not work well.

Sincerely,

Harold M. Reed, M.D.

305-865-2000

Andrew a_sams12@yahoo.com 64.148.250.118

Order of Operations….

I have been thinking about having a phalloplasty lengthening, with secondary girth enhancement at a later date.  Over the last several months I have been having mild issues with phimosis that I have been able to manage.

I believe I will get a circumcision as well to help correct this, but I was not sure what surgery I should have first, the lengthening or the circumcision.

Your thoughts? Andrew