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Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 1/8/2008 11:29 PM (GMT -7)   
Later this month I'm scheduled for a consultation follow-up with my urologist and will be discussing questions regarding ED.  So far for me, injections are the only treatment that works.
 
I have a several questions for those of you who use injections made up by a compounding pharmacy:
 
(1) How did your urologist determine whether to use bi-, tri- or quad-mix? 
 
(2) How did your urologist determine what dose to give?
 
(3) What were the instructions re: adjusting the dose?  How much to increase/decrease and why?
 
(4) Is there a substantial cost difference between the bi-, tri- and quad-mix?
 
(5) Were the meds covered by your insurance?
 
   

Age 59 PSA 2.6 (PSA velocity--quadrupled in 1yr) 1 of 12 biopsy cores positive
Bilateral nerve-sparing open RRP 6/21/06  Gleason 5
Cancer confined to prostate, post-op PSA's non-detectable


Ripandburn
Regular Member


Date Joined Aug 2007
Total Posts : 125
   Posted 1/9/2008 7:03 AM (GMT -7)   
Tim,

At my 4 month appointment we started injections. He felt that that was a good time. We went with the Caverject in the office because thats what he had, and used. Before I left that day, I was really hurting, and told him that I did not like the pain and that if he was going to write a prescription for Caverject, I wanted him to write one for bimix or trimix. He thought that the trimix may be a broblem for me and wrote one for 5ml of bimix. He told me I was to use .5ml. After the 1st injection I was quite pleased....and needless to say....so was my wife. That quantity of bimix really was more than I needed. The erection lasted 3 hours before it started to decrease. Much too long. The great thing is that there was no pain!!! I have since reduced the amount to .2 - .25ml. That gives me an hour at least of a good hard erection. If I were 18 again that might not be enough, but now that is great.

As far as the cost, it was $49.00 for 5ml of the bimix. Thats about $2.00 per injection. My insurance did cover it, where as they did not cover the caverject which was about $30.00 per injection, and what you don't use you toss.

I have no idea what the cost of the trimix is.
51 years old
T1c 3+3=6
DaVinci July 16, 2007
largest cancer .2mm
Bladder Sling installed during prostate removal
nerve sparing with both nerve bundles intact
all cancer contained within prostate nothing near margins
PSA after 6 weeks <0.1 - undetectable
PSA after 4 month .07 - undetectable
11 weeks post-op - no more pads


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 1/9/2008 12:50 PM (GMT -7)   
Hey Tim,

I use Trimix and it costs $75 for 5ml. I use .02 - .04 ml per injection so my cost including syringes is less that $1 per dose. At that low dose, I have no pain and the erection lasts for about 1 1/2 hours. I also take 50mg of generic Viagra and 1000mg of L-Arginine.

My doc started me with .1 ml and it was way too much. I cut it in half and .05 ml was still too much so I cut it in half again. That is how I arrived at my current dose. The doc didn't specify how to adjust it or how much Viagra to take. I experimented for several attempts before I got it right.

The vial says that the Trimix is only good for 3 months and to refrigerate it. I am still using the med at 6 months and store it at room temperature. It still works.

I guess that like everything else with this disease, we have to experiment. Most of what I have found out about ED recovery has come from my friends here on HW.

Good luck...

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."
 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 1/10/2008 7:10 AM (GMT -7)   
Tim,

(1) I was given Caverjet as the first injection in the office at what was described as a conservative dose. I got about a 70% erection after 15 minutes but with considerable aching. I had a two hour drive home and the erection became harder after about 30 minutes and the aching worse. The erection lasted about three hours before it started going down. I called my urologist's PA that gave me the injection and told him that I could not handle the Caverjet. He then called in a prescription for Bimix to the compounding pharmacy.

(2) When I received the vial of Bimix it had on it a dosage of .25 cc's. The PA told me to start at .15 cc's.

(3) The .15 cc's was not enough. I was told to increase in .05 cc increments. I did this up to .40 cc's and at this dosage I did not get any harder it just lasted longer. My urologist told me at my six month appointment to combine the injection with Viagra. Take the Viagra about two hours before the injection. When I do this I use a dosage of about .25 cc's. Without Viagra or Levitra I use about .35 cc's

(4)I do not know about the other mixes but Bimix cost me $50 for a 5 ml vial and the expiration is six months. I have used it passed six months and it still work well.

(5) My insurance does not cover any compounded medications.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/10/2008 11:43 AM (GMT -7)   

Biker90...Woa!  I need a response or from you or anyone else regarding this.

I just threw away a vial with lots of Tri-Mix left in it.  I threw it away because the lable warned not to use beyond 3 months.  It cost $160!  I was afraid to use it past expiration date for fear of infection, etc. 

So you say you're still using for 6 months past expiration date and store it at room temp?  Is that safe?  If you think it is, why do you think that?  I suppose it must be that you did not get infected as a result.  Is that right?  So the next order I get, I will think really hard before I throw any of it away!  I am not ciritizing you.  I really want to know, and I'll bet others do too.

Gene



Age: 63
07/05 - Biopsy: Suspicious looking cells. 
12/27/06 - Biopsy
1/24/07 - Dignosed cancer: Gleasn Grade: 3+3=6
02-14-07 Radical Open Nerve-sparing surgery
Pathology Stage of cancer: T2c
4-18-07: First Post-Op psa = 0.011
05/31/07: Cystoscope reveals "Stricture"
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.
8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news! Still leaking.
8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05
8/31/07:  First Bio Feedback session.
9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. 
9/26/07 - Started injections 
10/27-07 - Began using clamp at uro's encouragement.
1/6/08 - Still incontinent & impotent... and still "down."   
 
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 1/10/2008 1:34 PM (GMT -7)   
Hey Gene,

My uro said that the 3 month expiration means that it could lose potency beyond that time. He said there is no danger in using it as long as it works. The literature on this compound says not to let it get higher than 86 degrees. Refrigeration is a precaution as some room temp storage could exceed that amount.

I only draw the meds with new, sterile needles so there is no way anything bad could get into the vial. Without further instruction from a professional, I would not try to re-use the syringes. Maybe someone else here could expound on that. I buy diabetic syringes and they only cost 25 cents apiece so I don't see the need to re-use.

Everything about this disease and treatment requires us to do our own investigation. Docs tell us things that are standard practice and deviation requires research on our own. Especially, when it comes to ED treatment, unless the doc has done it himself, we need to find our own way.

I certainly don't recommend that anyone do what I do. My life is in my hands and yours is in yours...

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."
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 1/10/2008 7:18 PM (GMT -7)   
Gene6163 said...

Biker90...Woa!  I need a response or from you or anyone else regarding this.

I just threw away a vial with lots of Tri-Mix left in it.  I threw it away because the lable warned not to use beyond 3 months.  It cost $160!  I was afraid to use it past expiration date for fear of infection, etc. 

So you say you're still using for 6 months past expiration date and store it at room temp?  Is that safe?  If you think it is, why do you think that?  I suppose it must be that you did not get infected as a result.  Is that right?  So the next order I get, I will think really hard before I throw any of it away!  I am not ciritizing you.  I really want to know, and I'll bet others do too.

Gene


I've been using my Quad-Mix past the expiration date, too.  As Biker90 said, and his urologist confirmed, as long as it's still working, it's ok to use.  It's not a good idea to reuse syringes or needles, even if you're the only user, because of possible contamination.  Always use a new, sterile syringe and needle.  At $150 a bottle, I wouldn't get rid of it unless it loses potency.


Age 59 PSA 2.6 (PSA velocity--quadrupled in 1yr) 1 of 12 biopsy cores positive
Bilateral nerve-sparing open RRP 6/21/06  Gleason 5
Cancer confined to prostate, post-op PSA's non-detectable


Kirk_B
Regular Member


Date Joined Dec 2005
Total Posts : 31
   Posted 1/11/2008 7:35 AM (GMT -7)   
Tim,
I see that no one has answered your question on whether to use bi, tri or quad mix.

I have this same question.

What are the advantages / disadvantages for each of these.

I just had my visit with my ED doctor and will not see him for another 6 months.

I will see a nurse practitioner march 1st and I will ask her.

41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 1/11/2008 9:13 AM (GMT -7)   

There have been lots of posts on this lately...refridgerating the drugs and the expirations.  And I'll tell what I learned on Tri/Bi mix...assume similar for Quad, though I had not heard of this.  I spoke directly to the pharmacist on these since I travel and had concerns.

Refridgeration:  drug (at least the tri/bi mix) should not be exposed to heat over 86 degrees which is only about 16 degrees above normal room temp.  So no hot cars, or next to heaters, etc.  But room temp is actually fine. Refridgeration ensures that it is not exposed to higher temps.  Won't lose potency from room temp.

Expiration:  due to regulations...can't ensure sterility over long periods of time due to the way people use it.  The longer the time from filling, the more incidences of contamination.  So they put a 3 mo expiration on it for safety.  The pharmacist told me if I do it right, the drug itself does not lose potency and should not become contaminated.

Needle Reuse:  NEVER DO THIS.  I saw it was mentioned as I scanned the thread of responses.  HORRIBLE MEDICAL PRACTICE AND DOESN'T MAKE ANY SENSE.  They syringes are dirt cheap compared to the drug...I just paid $10 for a box of 100 insulin syringes ($30 without insurance).  THROW THEM OUT AFTER YOU USE THEM...OR IF YOU DROP ONE...OR ACCIDENTALLY TOUCH THE NEEDLE TO ANYTHING BUT THE INSIDE OF THE SYRINGE CAP. 

Bi/Tri Mix:  bimix has two meds, tri mix has three...logical.  The difference is prostagladin (spelling?) which is the most potent ingredient, but is not always needed for some guys.  It's also the ingredient that can cause aching.  I have had some aching, but not too bad.  Haven't tried the bi mix yet.  My doctor goes right to the trimix since he's had the most success with his patients soon after surgery.  I'm glad because the Levitra was not doing much or anything and I wasn't about to wait out months with no erections...I figured I had been through enough!  I started it at 6 weeks.

Dosage:  Trimix "recommended" dose is .2 CC which is 20 units on a .5 CC insulin syringe.  I started with .04, because of what I read on here, which is 4 units and that lasted plenty long.  Then I went to .02-.03 which works for me.  Sometimes I don't get a full erection, but mostly it's more than enough, so really haven't increased dosage.  

Hope that info helps. 


 
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...
 
 
 
 


StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 353
   Posted 1/11/2008 10:41 PM (GMT -7)   
(1) How did your urologist determine whether to use bi-, tri- or quad-mix? He started me on PGE-1, which gave me pain. Then he had me try tri-mix, which also gave me pain. He was about to suggest quad-mix, but a different urologist in his office said to try bi-mix because it didn't include prostaglandin. No more pain.

(2) How did your urologist determine what dose to give? For bi-mix, the urologist said 2 cc. I should probably try to back off and use smaller doses to see if that works, but, frankly, I'm still trying to learn how to give the injection right.

(3) What were the instructions re: adjusting the dose? How much to increase/decrease and why? Very little information was given to me, other than increase slowly, and not to use too much, and what to do if the erection lasted more than 4 hours.

(4) Is there a substantial cost difference between the bi-, tri- and quad-mix? For me, they were all around $135-150 per refill.

(5) Were the meds covered by your insurance? Yes, I have to buy first, then get reimbursed except for my co-pay, which is $20.
____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .545 (6 for 11)
- Trimix batting average: .500 (1 for 2)

"Lost in the valley without my horses, no one can tell me what my remorse is..."


StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 353
   Posted 1/11/2008 10:44 PM (GMT -7)   
As for using past expiration, my urologist told me if the medicine is still clear, there's a good chance it will work, but if it is cloudy, don't use it.
____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .545 (6 for 11)
- Trimix batting average: .500 (1 for 2)

"Lost in the valley without my horses, no one can tell me what my remorse is..."


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 1/11/2008 11:24 PM (GMT -7)   
My uro started me on .1ml of Trimix which was way too much. It hurt and lasted way too long. I cut it in two then in two again before getting satisfactory results. Now with ,02 - .04 ml I get not pain.

Like everything else with this disease, I think we are all different and have to find our own way. Docs tell us what the standard practice is (one size fits all medicine) and we have to make adjustments to suit ourselves. Reducing the dose from the recommendation can't hurt so I report to him on what I am doing but don't ask if I can do it. I think that is what he expects me to do.

My Trimix costs $75 for 5 ml and I pay for it. I guess ED is optional...

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."
 


StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 353
   Posted 1/12/2008 8:25 PM (GMT -7)   
A good FAQ on injections can be found at http://www.ustoo.org/PDFs/Injection.pdf .
____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .583 (7 for 12)
- Trimix batting average: .500 (1 for 2) Grand total 12 for 25 = .480

"Lost in the valley without my horses, no one can tell me what my remorse is..."


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 1/13/2008 1:24 PM (GMT -7)   

Thanks for all your helpful responses to my questions.  As always, you folks are the best! 

 Even though the quad-mix I was prescribed has the same ingredient (Prostaglandin)  as the Caverject, I don't get the pain like I did with that.  And it works ok, though I still have a hard time warming to the idea of injecting myself in a sensitive area.  (I use an auto injector, which helps with the needle injection). 

Has anyone used any desensitizing creams like licocaine or EMLA when doing self-injection?

My $150 bottle of quad-mix was not covered by my health insurance, but I'm under new insurance and hopeful that injection meds will be covered.  'Time and patience. Patience and time.' 



Age 59 PSA 2.6 (PSA velocity--quadrupled in 1yr) 1 of 12 biopsy cores positive
Bilateral nerve-sparing open RRP 6/21/06  Gleason 5
Cancer confined to prostate, post-op PSA's non-detectable

Post Edited (TimG) : 1/13/2008 1:33:07 PM (GMT-7)


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 1/14/2008 8:29 PM (GMT -7)   
I was a little nervous about the whole idea of the injections.  But watching the nurse practitioner do it, it looked fairly easy.  So when I tried it on my own at home it turned out fine.  I find a quick steady stab is the least uncomfortable...

Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/14/2008 10:02 PM (GMT -7)   

Today I visited with an ED specialist.  I hope to detail some success in my ED department, but to be brief, two important things came out of the visit. (1)  He switched me to a quad-mix that worked good in the office and (2) the method of deivery was an automatic injector.  I didn't even feel the needle... it went in and out so quickly!  I know TimG gets his with that method.  Tim, do you agree that's the best method? If it works that good for me at home, I'll never poke my poker again with a needle... I'll let the injector do it.

Gene 


Age: 63
07/05 - Biopsy: Suspicious looking cells. 
12/27/06 - Biopsy
1/24/07 - Dignosed cancer: Gleasn Grade: 3+3=6
02-14-07 Radical Open Nerve-sparing surgery
Pathology Stage of cancer: T2c
4-18-07: First Post-Op psa = 0.011
05/31/07: Cystoscope reveals "Stricture"
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.
8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news! Still leaking.
8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05
8/31/07:  First Bio Feedback session.
9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. 
9/26/07 - Started injections 
10/27-07 - Began using clamp at uro's encouragement.
1/6/08 - Still incontinent & impotent... and still "down."   
 
 
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 1/14/2008 10:59 PM (GMT -7)   
Gene--The auto injector works well for me and takes away my squeamishness at injecting myself in the penis with a needle.  I just press the auto device against the right spot and bingo! the needle's in.  All I have to do--much easier for me--is inject the solution.
 
By the way, if anyone is interested in this technique, Auto Injectors can be purchased for about $20 via Amazon--the cheapest I found. It is the same thing used by diabetics.
 
 
Age 59 PSA 2.6 (PSA velocity--quadrupled in 1yr) 1 of 12 biopsy cores positive
Bilateral nerve-sparing open RRP 6/21/06  Gleason 5
Cancer confined to prostate, post-op PSA's non-detectable


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/11/2009 9:43 AM (GMT -7)   
bump for current reading

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4044
   Posted 5/11/2009 6:24 PM (GMT -7)   
Thanks guys you are the greatest. I have been looking for this info. I think this is going to be my future and I am not real excited about it but we have to do what we have to do.
Jeff T Age 57
9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable
 ED- 5 mg Cialis daily, pump daily,


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4044
   Posted 5/17/2009 5:06 PM (GMT -7)   
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