Question about Prostaglandin injection

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DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/23/2009 2:56 PM (GMT -6)   
Hello,

My urologist just prescribed me a prostaglandin injection -- he says
he does not prescribe Trimix because he finds prostaglandin safer. He
prescribed a 20ug or micrograms per mil (20ug/ml) in a 5ml bottle. The
prescription only said "as directed" and didn't indicate any dosage.
what would be an advisable starting point?

I have used Trimix before and liked it. Now, what should i expect
from prostaglandin alone, pain and effect-wise?

Also, where would be a good place to get an auto-injector?

Thanks very much ...

-- YoLisaMarie

gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/23/2009 4:30 PM (GMT -6)   
YoLisa said...
Also, where would be a good place to get an auto-injector?

Thanks very much ...

-- YoLisaMarie
Hi YoLisa,
 
Can't comment on the prostaglandin part as I am using bi-mix, but on the auto injecter I  have found using insulin syringes that if I stabilize the penis, make sure the needle is at 90 degrees and then just very gradually intoduce pressure that there is almost no pain.  The thought of a stab concerns me more.
 
Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 573
   Posted 1/23/2009 4:32 PM (GMT -6)   

Is your prostaglandin part of a Caverject system?  The Caverject is a self contained dry mix system.  Caverject is much more expensive than just straight prostaglandin (also called alprostadil).

My experience was significant discomfort using the prostaglandin, I used dosages of .10, .15 and .20 ml.  I finally went to the bi-mix that does not contain the prostaglandin. I had no discomfort, but the results were not as good.

I would be very interested to hear why your doctor considers the prostaglandin to be "safer" than the tri-mix.  Ask the question and get a substantive answer please.  He might be right, but I have never heard that before.

I expect you will get a faster, harder erection with straight prostaglandin.  If you do not have pain problems than it will be the right answer for you.



PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.02)
One side nerve spared
success but some plaque with bimix 
born in 1941


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/23/2009 6:57 PM (GMT -6)   

thanks very much for your quick responses. I do not trust my hands, but I will try the diabetic syringes and see how it goes.

my prostaglandin is prescribed separately, and not part of Caverject or Edex. I am also concerned about the pain, and will ask my doctor why he considers prostaglandin safer than a bi or tri-mix.

thanks - LisaMarie


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/23/2009 7:58 PM (GMT -6)   
First, I'm surprised the doctor didn't do the first injection in the office, but maybe he felt you could handle it, as you were experienced with Trimix? Caverject is the commercial name of prostaglandin/alprostadil. I have used Caverject powdered that I had to reconstitute in bacteriostatic sterile water to make the solution. The powder I had was 20mcg strength. That is the amount of drug that was in 1ml of water. So that means that you actually have 5ml's of 20mcg strength prostaglandin/alprostadil. Most of the guys injecting prostaglandin/alprostadil here do so in much smaller amounts than users of Bimix or Trimix. A little goes a long way, as it is the strongest of the 3 types. For info purposes, Trimix is next strongest, as it contains prostagandlin/alprostadil. with the Bimix drugs. Bimix is weakest, containing no prostaglandin/alprostadil.

As to pain, it's almost a general experience with guys that the prostaglandin/alprostadil causes the most trouble with pain and aching. In my case, not necessarily pain as such, but a very painful aching, if you can understand what I mean. It really aches and spreads throughout the penis, testicles and abdomen while working just great to create a usually almost rock hard erection. The aching begins shortly after injection and increases as the time goes on. This is the drug that you are most likely to have the famous over 4 hour erections with.

You say you have used Trimix before. How did you react to it, as far as results of erection and aching? This will give you an idea of what the straight stuff may do for you. I used the 20mcg strength doses by drawing around .15cc/ml (that's the 15 mark on an insulin syringe), using a .5cc or 1cc insulin syringe with a 30 ga, 5/16 inch needle. Injection technique is the same as you would use for Trimix. Since you haven't tried it before, I'd start with a low dose and work myself up. Maybe inject .05cc/ml (5 on the barrel) the first time and see what happens. Slowly move up by 5's until you find your spot. Have some real Suafed pills available- not the generic or non-epe. stuff, to help reduce the erection if it goes over the 4 hour limit.

I'm curious- if you had done Trimix before, it must have been from a different doctor? I can't see why your current one would object to Trimix. There's really no statistical way to prove his point in the literature, that I am aware of. Maybe it's something he read or heard sometime in the past.

Make sure the druggist gives you the bacteriostatic water to go with the pwoder (If you indeed do get a powder in a vial) and some info on how much to add to reconstitute the vial, if powder. If it is already liquid, keep refrirgerated, not frozen. Shelf life says 3 months, but mine went 6 months or more. As long as you practice sterile drawing technique and the liquid doesn't turn milky it should he fine.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 12 mts.-.04, 16mts.-.04

Post Edited (James C.) : 1/23/2009 7:01:28 PM (GMT-7)


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/24/2009 12:39 AM (GMT -6)   
James,
 
thanks for your quick reply.  You are probably right - the Dr. may have thought that I will be able to handle the titraton and injection myself. Well, he prescribed the liquid form of prostaglandin (just a 5ml bottle).  So will start very slowly ...its been a while (2002-2003) since I used Trimix (i was not in US at the time, and was seeing a different doctor). I had no problem with it -- it took some experimentation; first i started high in the Doctors office, and then adjusted the dose to suit various occassions -- a quickie, a long march, etc.  So, I believe I might start around .03 or .04 and then work my way up.  Is there anything to take to neutralize the pain....
 
thanks again - YoLisa

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/24/2009 9:17 AM (GMT -6)   
Some people say they take an over the counter pain reliever, such as ibuprufen or such. I don't know if it has much effect on it.

In another thread you said:
Thanks for a very nice and informative group. I am a 44 year old man who have had a persistent ED problem for a while -- i think it is psychological -- since I do get nocturnal erections (early morning wood) quiet often. I have used Trimix in the past and it worked. But since it finished, I have tried Viagra and Cialis, and they do work, but then the erection doesn't last for long...sometimes, I have to take about 50-100 mgs to have any effect. Thus, I am willing to try Trimix again.

Thus, I am wondering if anyone know of a good urologist around Philly area -- I need to see one, and would appreciate some leads, especially one that is sympathetic to and knowledgeable about Trimix, and willing to prescribe one.

It appears that you haven't had Prostate Cancer or any of its treatments hence you are not suffering any of the known side effects of the treatments on erectile dysfunction. Your case may be quite different, due to the nature of your problem.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 12 mts.-.04, 16mts.-.04

Post Edited (James C.) : 1/24/2009 8:38:57 AM (GMT-7)


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/24/2009 10:16 AM (GMT -6)   
Jim,

yes, i don't have prostrate cancer and any of its associated treatments, hence my case may be different, despite the commonality of ED. Well, I will get my stuff from Wedgewood Pharmacy next week. I have booked another appointment with a doctor who seems more sympathetic to Trimix - and I am wondering if I should go and see him for a separate Trimix prescription. Well, I might try the Prostaglandin first and see how it works....

thanks for all your support - rgds, YL

Post Edited (DannyP) : 2/1/2009 3:28:46 PM (GMT-7)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/24/2009 2:21 PM (GMT -6)   
In your post you say you have had PCa. When was your prostate treatment and what course did you take? Are you a zero now?
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 12 mts.-.04, 16mts.-.04


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/24/2009 2:30 PM (GMT -6)   
Jim, sorry, i am not on any prostrate treatment now. I do have yearly prostrate exams though, and so far, all is normal.

thanks - YoLisa

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/24/2009 2:33 PM (GMT -6)   
OK. understood now..Make sure you come back and let us know your experience with the prostgladin and the Trimix, if you do go to that later.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 12 mts.-.04, 16mts.-.04


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/24/2009 5:06 PM (GMT -6)   
ok, thanks. Jim.

rgds, YLM

DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/30/2009 12:47 PM (GMT -6)   
Well, just an update:

I picked up the prostaglandin medication this morning from Wedgwood pharmacy in Swedesboro, NJ.

It is a 20mcg strength in a 5ml bottle. I have ordered the B-D Autoinjector (http://www.bddiabetes.com/us/main.aspx?cat=2&id=421), hence opted for the 1cc, 31ga, 5/16 BD Insulin needle and syringes. I will pick up the autoinjector later this afternoon from Medicineshoppe pharmacy, and then experiment later this evening. I left a message for my doctor to suggest a dose. If I don't hear back from him, I will start low: probably between .20 and .30 on the insulin syringe and see what happens.

Thanks and will welcome other thoughts ..

rgds, LisaMarie

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/30/2009 1:00 PM (GMT -6)   
Good deal, be sure to let us know how things go.... wink Make sure you do sterile injections- alcohol wipe on the needle, then vial top and the penis, in that order....lol With 20mcg strength, I personally would start with .10cc. Your choice...of course. Gotta say it's a little disconcerting to talk to someone named LisaMarie about penile injections. You got a male name we can use when addressing you...??? tongue
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Post Edited (James C.) : 1/30/2009 12:03:25 PM (GMT-7)


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/30/2009 5:45 PM (GMT -6)   
James,

thanks for all your useful and encouraging advice. I agree - gendered name is a bit disconcerting. I have made a change.

all the best -- from DannyP.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 1/30/2009 5:50 PM (GMT -6)   
Good deal, Danny, that feels better smilewinkgrin

DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 1/30/2009 6:26 PM (GMT -6)   
James, I called my doctor and he said that I should start with about .15ml and then adjust to my capability. So I think your advice given over here (http://www.healingwell.com/community/default.aspx?f=35&p=1&m=1022627) about beginning with lower doses and adjusting to individual tastes should be well taken.

I am yet to try it....maybe over the weekend. I will report back...

rgds, DannyP

DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 2/1/2009 5:11 AM (GMT -6)   
Some update:

On saturday morning, I tried about .20ml, and it didn't really worked. the erection was just about 40% firm, and I lost it rather quickly. later in the evening, I couldn't resist the temptation to try again -- this time increasing the draw to .40ml; again the erection was not firm, i had to add a 40mg Tadalfil (cialis) to get a usable wood. So I am not sure what is wrong...maybe I would try again on tuesday with a .60ml. I would appreciate any helpful hints.

thanks - Danny

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 2/1/2009 6:05 AM (GMT -6)   
Sorry you had such poor results. First, as tempting as it can be, I wouldn't recommend injecting twice in one evening. Every couple days is the usual interval. Now then, do you have a VED? (penis pump and rings?). My technique, which is used with success by a couple guys here is this: Using a pump, pump an erection that is about 30 to 40%. Just a good plump stage. While in this state, place the smallest ring you have on the penis, to hold the blood in. Do your regular injection- maybe .2cc ?, and very gently massage the sides of the penis with the ring on, to spread the drug throughout the cavernous cavity and into the tissue of the penis. Keep the ring on for 3 to 4 minutes, then remove and continue. a gentle stimulation until full erection may be required. The reason this is sometimes needed is the veinous valves in the penis, which holds the blood in and creates the erection, is weak or even non-working in your case, for a variety of possible reasons. This condition lets the drug out of the penis before it can be adsorbed. The partial erection opens up tissue to better adsorb the drug, and the ring holds it in long enough to adsorb it. Injecting in the 9 or 3 o'clock position in the area from 1 inch or so from the body, up to and inch or so behind the head of the penis will get the best results. Alternate sides with each injection.

Also, injecting and expecting an instant erection doesn't work that often. Gentle stimulation and mentally getting into the mood for lovemaking will keep it going and sustain it, especially until the drugs kick in good.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 2/1/2009 7:02 AM (GMT -6)   
Jim, thanks for your thoughts. Actually, the first injection was in the morning, and the second later in the evening. I like your suggestion of getting a partial erection, before doing the injection. I thought of that, and decided to take some cialis first, but decided to see the effect of an increased dosage first (on its own). Now that didn't work out well, probably due to poor circulation of the medication in the shaft, I need to get some partial first, and then gently stimulate it and see what happens next. I will get the cock and constriction rings too and apply it. I have never done it, so that might be a neat experience. I would next try an adventure maybe on Tuesday, with a full arsenal of preparation.

thanks again,you are so helpful.

rgds, Danny

DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 2/5/2009 2:11 PM (GMT -6)   
Hi,

Well, Jim, I took all the advice given, and was able to finally obtain a fairly usable wood by injecting about .65ml (and could even go up to .70) of prostaglandin. Even then, the erection lasted for just about an hour, and the pain was manageable. I'm wondering why this is the case since most people tend to do well with between .20 and .50 -- I want to notify my doctor since I am injecting right and massaging the sites and penis properly, unless 20mg is not strong enough for me...

thanks - Danny

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4438
   Posted 2/5/2009 2:53 PM (GMT -6)   
Danny, give it a couple more tries at the .65 level. Your tissues maybe could use some exercise before they start working right. Did you use the pump and ring deal? That seems to work best for success. I had the same trouble with it when I first started, it took large amounts, in the same .5 to 1.0 range for me, until a few tries and I got the targeting right and experience started working. Don't give up yet, you still got plenty of drug and time to find what works best.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


DannyP
New Member


Date Joined Jan 2009
Total Posts : 18
   Posted 2/5/2009 3:06 PM (GMT -6)   
James, I did follow with the pump and the ring. Ok...so my experience is not unique, and my tissues would need more relaxing before getting the right dosage. Whewww... did you also start with Prostaglandin alone or Trimix right away? Thanks - Danny
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