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Making the case for Cialis

User
Posted 05 March 2016 23:34:24(UTC)

Having trawled through the archives of this forum for related posts, I saw that a few posters, in the (unspecified) areas where Cialis was not routinely available, talked about making a business case for obtaining a prescription of low dose Cialis via their GP. This was for the purpose of optimising circulation to potentiate any recovery in the future, not to get an  drug induced erection. 

I live in Wales and was denied daily 5mg Cialis when I saw my GP yesterday. I had pre-empted this visit by emailing my Urology Consultant in England to confirm that I could and should start low dose Cialis, which he duly did. 

Despite this, my GP informed me that he could not give me it, but that  I could appeal this decision. He told me that he knew that a previous appeal had been unsuccessful. He also told me that even if I was successful, I would probably be offered Viagra only ( I understand that generic 'Viagra' has been available cheaply for a few years now, but the Cialis drug patent doesn't expire 'til 2017). 

Now, I understand that the next All Wales Medicines Strategy Group meeting is on 23 March and I hope to present a case to overturn the existing decision to refuse Cialis. The most recent quality study I could find, suggested there was benefit in prescribing Cialis to specific patient groups:

http://download.springer.com/static/pdf/406/art%253A10.1007%252Fs00345-014-1377-3.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs00345-014-1377-3&token2=exp=1457220314~acl=%2Fstatic%2Fpdf%2F406%2Fart%25253A10.1007%25252Fs00345-014-1377-3.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs00345-014-1377-3*~hmac=478f2f097c403c4212d71fe3479577fc0ed35b9db8924626ff93f08f40a47065

I wonder if anyone has done the spadework on presenting a successful appeal already and if so, would they be prepared to share it here. Maybe there are pitfalls to avoid, reasons that were given if you were unsuccessful?

Looking at Dr Google, across the border in England, I note that some Trusts deny Cialis in primary Care ( the GP), but allow for up to 3 months prescribing of it via the Consultant , at which time the patient is then nudged onto the cheaper generic 'Viagra'. Has anyone been through this?

Anyhow, I left the GP, mightily p1ssed off, got home, found out about private prescriptions, 'phoned him back, and got a 28 day 5mg Cialis private prescription free of charge. I then trawled the internet for a reputable UK based on-line pharmacist. It pays to do your homework here, as the prices for that prescription medication varied between about £55 and £200.

If I am successful in the appeal, my GP tells me I will be able to claim the cost of the private medication back from the NHS. OK. I have to shell out some money, but I reasoned it's doing more for my recovery than anxiously waiting/stressing for a committee to make their decision to give me some viagra...

User
Posted 06 March 2016 11:59:16(UTC)
My other half had brachytherapy so slightly different to prostate removal. He told the GP that things aren't quite the same since brachy, he can still get an erection but it's just more work to keep it there, he was hoping for viagra to use occasionally but gp prescribed cialis 2.5mg daily. With excellent results.
After doing research I found a study in Germany saying prolonged use of cialis in men with prostate cancer had showed that the cancer was more likely to return. This is due to the fact cialis encourages the body to make more testosterone which prostate cancer thrives on, also it encourages blood into the prostate which prostate cancer also loves
But the study said only in patients taking the drug longer than 4 years. So for you guys that have had prostates removed I'm guessing you would not need the drug for that long. Whereas with brachy things in that department get words over time, so the drug will be needed permanently.
After reading this my other half isn't taking the drug. But no problem getting cialis to start. It certainly encourages blood down to the right place. So without knowing much about prostate removal I'm guessing it must make a difference with healing.
Thanked 2 times
User
Posted 06 March 2016 08:38:47(UTC)

All the very best with your quest !
I am in the Southampton area. From initial diagnosis right through to now being 9 months post-op , I have had nothing short of excellence. Rapid consults , smooth system, loads of scans , 3 biopsies , the op , immediate ED referral , pump demo , pump and rings prescribed , straight onto very effective injection therapy etc etc.
Free incontinence pads -- NO
Daily Cialis -- NO
This area does not recognise the benefits of Cialis over daily use of a vacuum device. I've questioned this 3 times. They simply insist not enough clinical evidence. I don't think it's cost ? My doctor on the other hand said I could try it no problem if I want , and there is no cap on the Viridal I'm being prescribed. Quite a few people on this site had their ops at the same time as me , some faring better ED wise and some worse. I think the benefit of Cialis is not a maybe more rapid recovery , but it can be taken at night and slept on and merrily does its work , whereas with the pump you need to be committed to a daily workout.
Best wishes
Chris




If life gives you lemons , then make lemonade
Thanked 1 time
User
Posted 06 March 2016 08:39:31(UTC)

Helllo Walnut.

When we first approached our GP I went armed with all the information I had gained on this site, Cialis, Viagra, pumps, ED clinic etc.

Our GP was prepared to offer Sildenafil (generic Viagra) only and said that if that didn't work there was still Levitra before anything like Cialis was offered. I said I had contacted John's designated nurse with a view to obtaining an ED appointment but he wasn't happy with that either.

As it happens, Sildenafil works for us (because our problem was event related, unlike yours) and the GP is kind enough to give 6 a month instead of the normal 4.

There will be a number of people on here, men and women, who will give you information on a Business type plan and I am sure they will help.

As I understand it, Viagra is only for an event. Cialis is for penile rehabilitation so the GP is actually inaccurate offering you Viagra if the appeal is successful.

I'm pretty sure that one of the ladies on here has done the research and put together a cohesive argument in favour of Cialis as a rehabilitator.

I hope so anyway

We can't control the winds - but we can adjust our sails
Thanked 1 time
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User
Posted 06 March 2016 08:38:47(UTC)

All the very best with your quest !
I am in the Southampton area. From initial diagnosis right through to now being 9 months post-op , I have had nothing short of excellence. Rapid consults , smooth system, loads of scans , 3 biopsies , the op , immediate ED referral , pump demo , pump and rings prescribed , straight onto very effective injection therapy etc etc.
Free incontinence pads -- NO
Daily Cialis -- NO
This area does not recognise the benefits of Cialis over daily use of a vacuum device. I've questioned this 3 times. They simply insist not enough clinical evidence. I don't think it's cost ? My doctor on the other hand said I could try it no problem if I want , and there is no cap on the Viridal I'm being prescribed. Quite a few people on this site had their ops at the same time as me , some faring better ED wise and some worse. I think the benefit of Cialis is not a maybe more rapid recovery , but it can be taken at night and slept on and merrily does its work , whereas with the pump you need to be committed to a daily workout.
Best wishes
Chris




If life gives you lemons , then make lemonade
Thanked 1 time
User
Posted 06 March 2016 08:39:31(UTC)

Helllo Walnut.

When we first approached our GP I went armed with all the information I had gained on this site, Cialis, Viagra, pumps, ED clinic etc.

Our GP was prepared to offer Sildenafil (generic Viagra) only and said that if that didn't work there was still Levitra before anything like Cialis was offered. I said I had contacted John's designated nurse with a view to obtaining an ED appointment but he wasn't happy with that either.

As it happens, Sildenafil works for us (because our problem was event related, unlike yours) and the GP is kind enough to give 6 a month instead of the normal 4.

There will be a number of people on here, men and women, who will give you information on a Business type plan and I am sure they will help.

As I understand it, Viagra is only for an event. Cialis is for penile rehabilitation so the GP is actually inaccurate offering you Viagra if the appeal is successful.

I'm pretty sure that one of the ladies on here has done the research and put together a cohesive argument in favour of Cialis as a rehabilitator.

I hope so anyway

We can't control the winds - but we can adjust our sails
Thanked 1 time
User
Posted 06 March 2016 10:41:14(UTC)

Hi Walnut

I was initially prescribed Cialis 5mg daily by my consultant for 1 month on removal of my catheter 

When I asked my GP for a repeat prescription he refused.........but after a brief conversation with my consultant he agreed to prescribe Cialis 20mg =  8 per month for an 'event' 

My GP tells me there is no current evidence that Cialis 5mg daily is beneficial and that's why he was not prepared to prescribe it for me..

Whether this is correct or not I have no idea.......but I assumed he was acting in accordance with NICE guidelines

Hope you have better luck than me....

Best wishes
Luther

Thanked 1 time
User
Posted 06 March 2016 11:59:16(UTC)
My other half had brachytherapy so slightly different to prostate removal. He told the GP that things aren't quite the same since brachy, he can still get an erection but it's just more work to keep it there, he was hoping for viagra to use occasionally but gp prescribed cialis 2.5mg daily. With excellent results.
After doing research I found a study in Germany saying prolonged use of cialis in men with prostate cancer had showed that the cancer was more likely to return. This is due to the fact cialis encourages the body to make more testosterone which prostate cancer thrives on, also it encourages blood into the prostate which prostate cancer also loves
But the study said only in patients taking the drug longer than 4 years. So for you guys that have had prostates removed I'm guessing you would not need the drug for that long. Whereas with brachy things in that department get words over time, so the drug will be needed permanently.
After reading this my other half isn't taking the drug. But no problem getting cialis to start. It certainly encourages blood down to the right place. So without knowing much about prostate removal I'm guessing it must make a difference with healing.
Thanked 2 times
User
Posted 13 March 2016 22:32:33(UTC)

I live in Oxfordshire.
My doctor also denied me the cialis 5 mg saying he could not subscribe it.
I contacted NHS Uk, and they advised the Oxfordshire health authority would sucribe it, back to the Doctors who then changed there mind?
For me it works well.
Hope this information is of some use.

User
Posted 27 May 2016 22:34:00(UTC)
We are very fortunate. Our GP prescribes cialis 5mg on repeat prescription AND viridal injections. He did question both being prescribed together, but we just told him the ed nurse suggested it (she did) and he signed the form.

I think he still feels guilty about missing the initial high psa!
User
Posted 28 May 2016 06:26:15(UTC)
I have been very lucky. I saw my GP re ED and she has been very supportive. She referred me to the urology investigation dept at my hospital in January this year. At the consultation there in March , the urologist went through all the options with me. He recommended muse with viagra but told me to go back to my doctor to discuss the all the options further. He dictated a letter to her in front of me so I could hear what he would send.

When I saw my GP his letter made reference to muse with viagra , Caverject and Cialis as well as a pump. It was up up to us to decide what would be best. Her preference was for Cialis (5mg) daily with the pump. If this didn't work then I was to go back to her and we would try another combination. In essence I could have what I wanted and funding would be no problem. She said that my health and well being were the most important and she would support me throughout.

To date I am using the pump and taking the Cialis daily. I realise that I have been fortunate and I told my GP this. She was annoyed that so many of you are having to battle with this. Her view is that it your right to have medication to assist and that as a patient you must be determined and insist and that doctors must help whatever the cost.

However my RT friend saw the same person as me in the investigation suite only a month before me and he was only prescribed sidenafil and recommendation for a pump. He had been referred by his Onco at a review meeting. It may be that having gone via my GP helped me as she was able to set out my case as she knew me better . I'll never know.

Good luck to all of you.

John
User
Posted 28 May 2016 07:00:34(UTC)

Hi like John (Surr33) I am an RT guy and knew nothing about ed problems or penile rehabilitation but at a standard urology appointment with my specialist nurse I mentioned about loss of libido(from HT) and I also have Peyronnes disease, she told me she was the ED nurse also and straight away wrote a request to my GP for 20mg Cialis, one two times per week, and a pump and rings. I took this to my GP and three days later had tablets and pump to start doing their work.

How is it that we are all part of the NHS in England yet availability depends on where you live and what trust you are under?

Chris/Woody

Life seems different upside down, take another viewpoint

User
Posted 28 May 2016 07:37:42(UTC)

Cialis/Taldalafil and, or Viagra/Sildenafil on prescription seems to be a bit of a postcode lottery. And maybe some GPs have there own slant to put into the consideration pot when thinking about wether to issue our not?

I presented the "business case" for my being prescribed the meds in a letter to my GP. He was not anti, just wanted to know from my perspective why I thought it MIGHT help, not necessarily that I could prove that it WOULD help. My surgeon recommend both meds, that helped.

Some thoughts you may wish to consider and explore to support your claim, is that not all meds are appropriate for all men at any given time?

Some men are not affected by Cialis, others can not cope with the side effects. There are so many variables. As a result, results from any general trials are only accurate and relevant for those men involved in those trials. For everyone else it is only a guideline. What a shame if you are one of the minority of men that would benefit, and due to random statistics, yo are denied the chance?

Similarly, some drugs may have little or no effect for some time, but then, and excuse the unscientific terminology, "kick in" later with beneficial affect?

Perhaps related, perhaps not, in surgery cases penile rehab is supposed to be as good as it gets at the 2 year post op point? Some even suggest 1 year is as good as it is going to get. I know that both these timescales are incorrect.

I am not familiar with the post op treatment regimes and their successes, or the average time it should take to recover from other similar surgical procedures. I do not know if for example the variations on recovery and rehab I hear and read about for prostate operations is as varied and diverse for breast cancer operations or lung cancer operations.

Clinical trials are a guideline. Unless you try the meds, no-one, not the GPs, not you, will not know with certainty, if it will work for you. That is what I would emphasise.

If you buy the meds privately, and they have a beneficial effect, that evidence should enhance your business case? But see my note on timing. Are you prepare to buy privately for some time?

ate

dave

Edit to add: Anyone seeking the meds and buying it privately in the meantime might conduct their own clinical trial on themselves?  If taking Cialis and your circulation improves, as shown by extended or increased finger and toenail growth for example, that may indicate that your he blood is circulating more efficiently, that might be a fact worth mentioning?  Just a thought?

dave

 

Be content with your choice of treatment at the time you make it. Then make the best of every minute, every hour, every day.
Thanked 1 time
User
Posted 29 September 2016 17:44:20(UTC)

I was turned down today for my prescription of Cialis, apparently its blacklisted in Worcester health authority.

When i pointed out it has been prescribed on a previous visit i got a very curt reply of, it shouldn't have!!!

I think my GP practice and my consultant are about to have a bun fight. 

 

User
Posted 29 September 2016 18:33:25(UTC)

Hello mate
As you know from the word go I was denied Cialis. My consultant to this day insists there is no evidence that it cures ED any better than a pump. It probably doesn't , but damn it's nice to be able to get an erection virtually on demand now. I tried everything and although injections worked there was massive after-pain. So I self funded daily Cialis 5mg. Cost me about £40 for 3 months. Almost instant results when taken on a daily basis. I eventually had a wob and told my consultant I wanted to see him privately about ED. He saw me NHS and agreed it was working for me. He wrote to Dr and I'm now being prescribed it free of charge but I admit my doc seemed a bit hesitant. Fight for it or self fund. Good luck
Chris




If life gives you lemons , then make lemonade
User
Posted 29 September 2016 18:58:35(UTC)

Originally Posted by: Online Community Member

Hello mate
As you know from the word go I was denied Cialis. My consultant to this day insists there is no evidence that it cures ED any better than a pump. It probably doesn't , but damn it's nice to be able to get an erection virtually on demand now. I tried everything and although injections worked there was massive after-pain. So I self funded daily Cialis 5mg. Cost me about £40 for 3 months. Almost instant results when taken on a daily basis. I eventually had a wob and told my consultant I wanted to see him privately about ED. He saw me NHS and agreed it was working for me. He wrote to Dr and I'm now being prescribed it free of charge but I admit my doc seemed a bit hesitant. Fight for it or self fund. Good luck
Chris

 

Hi Chris, 

Excellent that you persevered, and that it works for you, and that you could go back to you Consultant and say OI, IT WORKS FOR ME, prescribe it!

I don't think Cialis cures ED as such.  So your Consultant may be right, but as I understand, from my personal experience, it promotes blood circulation to everywhere, throughout the body?  And if an area somewhere is damaged or has a weak or broken and leaking supply line it will still promote circulation sufficiently that all this may be overcome?

A pump does a similar thing, but focuses mechanically on the penis.  If the penis has to expand to fill that vacuum it has to get some volume or filling from somewhere in order to do so.  

 

Johny - GPs are guided by guidelines, guidelines are based on trials that produced certain results for those on test.  The thing to consider is that unlike some operations, broken arm for example the outcome of an RRP is not predictable.

The more I see and hear the more I come to believe that it is not all down to the number of ops your prospective surgeon has carried out, or his or her skill.  It is more likely down to pot luck.  Men have the same basic bits to begin with. But when they are interfered with "BIG TIME" they all seem to react differently.

You have options.

1.  self fund, keep a record of how successful it is for you, and it will be successful, I am sure, then ask for it on a script.

2. get a cheap pump, Anne Summers is fine, doesn't have to be a Rolls Royce, when it works ask for a Rolls Royce Pump on a script.

3. hoover nozzle will work quote well, so I am told.  Err, turn it on though, eh?  

4. submit a business case for what kit you want to your GP.  Make it impossible for them to turn you down.

If I can help with a letter or words, let me know.

I was once where you are now.  3 years and 6 months down the line I'm happy.

atb

dave

 

 

Be content with your choice of treatment at the time you make it. Then make the best of every minute, every hour, every day.
 
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