Caverject injection-successful first time

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James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 1/2/2008 9:16 AM (GMT -7)   
I am 3 1/2 mts. post surgery, have gone thru the Viagra and the pump routine, and last night did my first self-administered Caverject Impulse injection.   The Doc didn't do any trial testing in the office, knowing I was capable of doing it myself.  It was comical in some ways.  I had had no response from the Viagra and very unsatisfing results from the pump, so we hadn't had but one semi-successful session of lovemaking since surgery.  It had been successful for her, in a sorta kind of way, as we had to fight a leaking down penis the whole time.  Unsatisfing for me, as I didn't get a whole lot of pleasure and no climax from it.  So we approached the first injection with hope and anticipation.  My Doc recommended I start with a 2.5mcg dose of alprostadil in a Caverject Impulse system, given that I had absoletely no veinous return valve control, allowing any blood drawn in from the pump to run right back out. 
 
Since she didn't want to see me injecting my penis with a needle (not romantic enough, I suppose   lol), I repaired to the bathroom, set up the syringe, and prepared to do the deed.  I will admit I really faltered when I saw that little needle placed against that oh so sensative part of me.  I had to gulp and force myself to make the injection.  As so many have said here, the needle entered easily, and completely with little effort on my part.  It just barely stung, nothing like I was dreading.  My various adventures with the pump and its infernal rings have produced much more pain than this did.  It was just a mental block to get past.  The injection went smoothly, the plunger easily injected 10 mcg of the solution, which contained 2.5 mcg of alprostadil.  I got a couple small drops of blood which easily stopped seeping.  Grabbing a robe, I repaired to the recliner where I massaged my penis, trying to get as good dispersal of the med as possible.  After 10 minutes or so, I began to get a response, slowly increasing in size.  At 15 minutes, we retired to the bedroom and continued with foreplay, watching it continue to grow.  Boy, did it look good to see a fairly firm erection again after such a long time.  At the 30 minute mark, not sure how long it would last, or how much firmer, if any, it would get, we began to make use of it.  At this point, it was maybe 75% firm, compared to the old days, just useable for penetration.  yeah With lovemaking it did lose some firmness, which made it a little more work to keep things going.  I think the physical act of friction, gripping, and pushing overrode the veinous valve closure slightly and allowed some blood to leak back out.  We struggled to keep it going, but managed to get her some pleasure of completion.  We tried a couple different positions , but kept losing just enough firmness to keep penetration, so stopped for that session.  I didn't get any orgasm from it.  I did get lots of pleasure though, so the pleasure receptors in the penis still work.  I did discover that I didn't leak urine during intense lovemaking, like I had done with earlier attempts, so that was definite plus to the experience.  Hard and dry is a good thing...lol
 
Back in the den, watching tv, my erection regained all lost ground and more.  At the hour and half mark, it was firm, nearly upright and ready to party.  Sadly, we weren't.   lol.    At the 3 hour mark, it was still in the same state, so I took 2 Suda-fed and an ice pack, and within 30 minutes or so, down it went. 
 
Total time of start to finish was a little less than 4 hrs, with fullest part attained at around the 2 hr. mark and maintained until taking Suda-fed.  I didn't feel a lot of pain or aching during the first hour and half or so.  It was there, but nothing that couldn't be tolerated, but kept slowly increasing as the evening went on.  At the fullest time and beyond until I deflated it with Suda-fed, the aching continue to increase, until it was really uncomfortable at the end.  Within 15 minutes of deflation, most of the ache was gone again, and in an hour, it was just a slight memory.  I liken the pain and aching to a surgery I had on my hand, where the surgeon used a tourniquet at the armpit to close off the flow of blood to the arm for an hour and a half.  At the end of that, my arm was really throbbing at the choke point from blood trying to get into the arm.  This is what the penis ache felt, like the blood was trapped inside and couldn't get out, rather than it being pain and ache from the drug itself.  That the pain and ache went away so quickly after deflation seems a good sign. I hope so, anyway.  Next time, I will reduce the dose by half, to 1.25mcg and wait longer for that full, firmer erection before attempting any use of it.  Most of our problems this time was not knowing just how long we would have or how hard it would get, so we didn't do as good a job of timing as we could have.  So far, I am pleased with the potential of using Caverject without most of the aching and pain that some 33% of men report from using it.  Once we get it dialed in, things should go much better.  But even with bad timing, and not perfect results, it was gratifing and deeply satisfying to once again enjoy lovemaking with my wife.  I will be doing the Caverject twice weekly as nerve regrowth and veinous valve therepy, along with continuing the 25 mg Viagra nightly routine. I haven't decided about further use of the pump for therepy yet.  The thing is so uncomfortable to use, it had become a necessary evil.  Any comments from anyone?

James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- 25mg Viagra nightly-no joy 
10/19/07  Dry 24 hrs, pad at night just in case
11/15/07  ED-continue 25mg Viagra, no response, begin Vacorect pump-
11/15/07  1st PSA-0.01, fully continent- no pads
12/17/07  ED- 3 mts.-continue Viagra and pump-no change-no response
01/01/08  First use of Caverject 2.5mcg, successful, erections at last


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 1/2/2008 12:05 PM (GMT -7)   
Hey James,

Good for you! The anxiety of injecting that sensitive part and the small amount of pain are worth it to get our sex life back on track.

I use Trimix and found that it took several trials to get the dose and timing dialed in. At first I was afraid it wouldn't stay up very long and we hurried the love making. Sort of like a lab experiment and not very romantic. As time passed and I got used to the routine and more confident, we found that it is like pre-surgery - only it lasts longer. Also, the ache doesn't happen anymore after my penis got used to being filled up again and I got the dose figured out.

When first diagnosed with PCa, I read about injections and swore I'd never do that. It looked too gruesome to try. As things turned out, our sex life now is better than it was for years before cancer. Funny how things turn out in this journey...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 10/17/07 0.00. 
Next PSA test on 1/15/08
 
"Patience is essential, attitude is everything."
 


Educator
Regular Member


Date Joined Oct 2007
Total Posts : 37
   Posted 1/2/2008 12:20 PM (GMT -7)   
James C.
 
You are about four weeks ahead of me so I cannot be of any help to you but your post is a help to me.
 
I am almost eight weeks post surgery and I am taking 1/2 of a Levitra tablet three nights a week with no response. Once a week I take a whole tablet with no response except a headache of sorts, the wrong head of course. Just with my wife using lotion and massage I can get chubby I guess you would call it, but I can't get hard enough yet for penetration. I don't seem to leak urine while lying prone on my back so I believe if I could get hard enough we could have leakage free sex.
 
I have been thinking of purchasing a pump but it sounds like you did not have much luck with one. It may be too soon to be trying anything else at this time. I am suppose to see my doctor on January 26th for by first PSA test and follow up to surgery. I am not sure what his recommendation will be at that time for my erectile rehabilitation. I have been reading about the injections and I did have nerve sparing surgery so maybe I just need to wait a little longer on something to happen. I don't have any experience with injections as of yet but it is something I am probably going to have to go through soon.
 
I was glad to hear you say that it was not as big of a deal as you thought it was going to be. I don't think giving myself a shot will be a big deal as I seem to have a pretty good pain threshold. I am a little confused on which chemicals to use as I have
heard of a few different ones mentioned.
 
If anyone has suggestions as to things I need to be doing further I would appreciate your help.
 
Educator
 
 
Diagnosed 10/15/2007
Age 55
PSA 4.2 9/15/2007
PSA 3.9 10/1/2007
Pre Operation TC-1
 
Prostate, Transrectal Needle Biopsy 10/05/2007
 
Results 10/15/2007
 
A-D Right Base, Right Mid, Right Apex, Left Base;
Benign Prostatic Tissue
 
E. Left Mid; Adenocarcinoma, Gleason's Grade 3+3=6, 10% involved
 
F. Left Apex; Adenocarcinoma, Gleason's 3+3=6, Less than 10% involved
 
2 of 12 involved as two samples were taken from each area.
 
Pre-operational PSA 6.5
 
 11/9/2007 Robotic Surgery
11/16/2007 recieved pathology report
 Everything negative for malignancy
 
 Both Nerve Bundles Saved
 
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 1/2/2008 2:11 PM (GMT -7)   

Educator, I may have given the wrong impression about the pumps effectiveness.  It works and works well for getting blood into the penis and stretching the vessels and tissue.  Using the pump, I can get about 3/4 sized of normal, and can get barely enough firmness to penetrate.  The thing with the pump I use (Vacurect) and maybe with the others is the vacuum from the pump necessitates that the base of the pump will seal on the abdomen around the penis base, and the scrotum.  Using lube or soapy water in a shower, you pump the penis up by it sealing onto the abdomen around the penis.  Sometimes, a part of the scrotom will get into the pump, and on the penis side of the ring that is used to hold the blood in, and will create a painful situation, resulting is what appears to be a blister on the skin.  At its best in my case, the vacuum action pulls the skin on the penis back towards the body, stretching the skin around the head too tightly, resulting in pain at it's utmost vacuumed action.  I am sure that men who have better veinous valve action and who can keep the blood in their penis easier and requiring large rings can use the pump and be satisfied with it better than me.  The thing to remember is that no matter what we are dealing with in this cancer care and recovery, each man is different and will react differently to each situation.  The pump gives me much needed blood infusion and a sense of ability to have an almost erect penis again.  That little edge is worth most of the discomfort, plus the therepy benefits for tissue health and nerve regrowth has helped me along the way to recovery.  I wouldn't recommend the most expensive pump, there's a couple in the $75 to $100 range that will work just as well, if insurnace won't pay the bill and you have to buy it out of pocket.  Your next visit to the Doc is about in the timeline (2 1/2 to 3 months) to begin talking about pumps , injections and such. 

Now, as to injections, the way I view them, they are the third stage in recovery of penile function.  first pills, then pump, then injections.  Most Docs start off the patient with pills, then move to the pump, then with the single chemical Caverject solution, then move onto BiMix and TriMix if that isn't successful.  Most of the Docs are experienced with what is needed, and have a protocol of treatment they follow.  Having your Doc at Vanderbilt is a plus as they should be well versed in ED management.  If not, then there's others that are available to switch to in Nashville.  I'm sure Nashville has several specialists in ED restoration. 


James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- 25mg Viagra nightly-no joy 
10/19/07  Dry 24 hrs, pad at night just in case
11/15/07  ED-continue 25mg Viagra, no response, begin Vacorect pump-
11/15/07  1st PSA-0.01, fully continent- no pads
12/17/07  ED- 3 mts.-continue Viagra and pump-no change-no response
01/01/08  First use of Caverject 2.5mcg, successful, erections at last


41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 1/2/2008 10:38 PM (GMT -7)   
James, sounds like a Happy New Year :)

My doc suggested going right to Trimix. His words of wisdom were that it was generally too soon to see effectiveness from the viagra, levitra or cialis. Those lucky ones who respond soon after surgery are not the norm. He said the pump can be frustrating and not very effective. So I succumbed and did it and was surprised to find it not too bad.

Now I have to say, this is one of those things that for most guys with PCa who are a bit older with older kids out of the house, you are lucky. With two 10 year olds in the house, I have to plan carefully if I'm gonna have an erection for 2 hours! But that issue aside, it's worth it.

I may try the bimix as has been suggested as I have experienced the ache which the pharmacist indicated is from the third ingredient in trimix, prostaglandin (or something like that).
 
42 yo.
PSA 4.65
Gleason scores from 4 pathologies of the same biopsy with 2 of 12 cores positive for cancer (if this isn't confusing to the patient...):
 
1) both cores 3+4 (Weiss Memorial)
2) one 3+4 and one 3+3 (Univ. of Chicago Hosp.)
3) both cores 3+3 (Mass General Hosp.)
4) both cores 3+4 (Northwestern Memorial Hosp.)
 
 
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.
 
and the winner is...post op Gleason score of 3+4.
 
Good pathology report with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  Amazing how something so small can cause such problems!
 
9/27/07 - Catheter removal...let the games begin...
 
 
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 1/3/2008 7:53 AM (GMT -7)   

41:

I am still holding out the possibility of trying maybe the Bimix next, if the Caverject ache doesn't lessen when I get the dose adjusted to get the 1 hr. firm erection.  If it still is there, then I will be knocking on Doc's door for a Bimix prescription.  I wonder why Trimix is prescribed so much as a replacement for the single one, if it still contains the chemical that causes the ache to begin with? 


James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- 25mg Viagra nightly-no joy 
10/19/07  Dry 24 hrs, pad at night just in case
11/15/07  ED-continue 25mg Viagra, no response, begin Vacorect pump-
11/15/07  1st PSA-0.01, fully continent- no pads
12/17/07  ED- 3 mts.-continue Viagra and pump-no change-no response
01/01/08  First use of Caverject 2.5mcg, successful, erections at last


41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 1/3/2008 6:39 PM (GMT -7)   
James,

The pharmacist indicated to me that the 3rd ingredient is the most potent (protaglandin). It reduces the dosage of the injections by making the medication more concentrated and powerful. It works for many people for whom Bimix or Caverject don't work. The "normal" dosage of Trimix is .2 CC or 20 units in the insulin syringe. I'm using .03 CC or 3 units with the desired affect. But because of the ache, I'm thinking about switching to Bimix. I figure if such a small dose works, that I can use a less potent medication.

At least I know something works until the nerves wake up.
 
42 yo.
PSA 4.65
Gleason scores from 4 pathologies of the same biopsy with 2 of 12 cores positive for cancer (if this isn't confusing to the patient...):
 
1) both cores 3+4 (Weiss Memorial)
2) one 3+4 and one 3+3 (Univ. of Chicago Hosp.)
3) both cores 3+3 (Mass General Hosp.)
4) both cores 3+4 (Northwestern Memorial Hosp.)
 
 
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.
 
and the winner is...post op Gleason score of 3+4.
 
Good pathology report with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  Amazing how something so small can cause such problems!
 
9/27/07 - Catheter removal...let the games begin...
 
 
 
 

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