ED: Injection worked!

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Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/22/2008 8:55 PM (GMT -6)   
I have mentioned in other threads that I had three ....
 
[Post deleted to comply with forum rules; basically said bimix injection worked]

Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0 

Post Edited (Piano) : 5/28/2008 6:02:36 PM (GMT-6)


CT
Regular Member


Date Joined Apr 2008
Total Posts : 25
   Posted 5/22/2008 10:25 PM (GMT -6)   

Congrats on the success tongue   Perhaps after a few times the needle thing gets better (I hate needles!!!)

It can only go UP tongue   from here.


Age: 50 (March 2008)

DX 1/08 @ 49 yo

7/05: PSA 2.6 DRE Normal

9/07: PSA 3.4 DRE Normal

1/08: Biopsy 1 of 12 cores with 10% involvement, T1c, Gleason 3+3=6

4/08/08:  Da Vinci Rad. prostectomy @ Banner Thunderbird, 5 hrs.

                Advised both nerve bundles spared

                Post Op Pathology Report: Tumor confined w/in prostate, pT2c, NX, DX 

    Gleason is 3+3=6, bilateral with 15% total involvement near apex

                Margins and Seminal Vesicles negative!!!

4/18/08:  Staples and Catheter removed. Drip, drip, drip, drip...

Post Edited (CT) : 5/23/2008 9:04:03 AM (GMT-6)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/23/2008 8:27 AM (GMT -6)   
Yabba-dabba-doo! yeah
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/23/2008 8:36 AM (GMT -6)   
Good news indeed.
I have found that injections are the most problematic and unpredictible part of the whole process. My hit.miss ratio is about 60% hit/40% miss. I have lots more misses when I don't wear my glasses (for closeup work), don't preplump with the pump and don't really concnetrate on where and what angle I use to inject. I have had the most failures from just plain not injecting into the cavernous area by not pumping up somewhat, and the short 5/16 needle not getting past the skin which rolls up, and into the cavities itself. Pumping a little plump stretch's the excess skin, thinning it and allowing much better chance of getting the needle inside where it does the most good.
James C.

Age 60
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
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 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
5/7/08 ED- Viagra, pump, no response- Trimix .075ml continues
Post Surgery PSA's: 3mts- 0, 6mts-0


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 5/23/2008 9:52 AM (GMT -6)   
Thank you Piano. You give us all so much hope and encouragement

Brilliant !!! Well done you yeah

Pos
Dx Age 48 Nov 07
PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
No perineural or lymphovascular invasion in the biopsy specimen.
Rushed to RRP without much research- Jan 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence pretty bad until April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement
1st post op Psa <.1 (May 08)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/23/2008 8:53 PM (GMT -6)   

Thanks guys.

James, I tried your  ....

[Deleted to comply with forum rules]


Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0 

Post Edited (Piano) : 5/28/2008 6:05:01 PM (GMT-6)


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/23/2008 9:32 PM (GMT -6)   

Piano,

FYI, the pharmacists at Franck's, which is supposedly the largest compounding pharmacy around, send more 5/16 needles than any other size.

My urologist said that penis thickness impacts the needle length needed, but not as much as one might think.

Proper technique will get one past the tough fibrous envelope and into the corpus cavernosa.  My urologist said that most men who miss the mark do so because they do not take a proper angle when injecting and do not create sufficient, but light tension to make it easier to get through that strong fibrous envelope.  

Men come in to see him fairly frequently saying their trimix or bimix is not working and in almost all cases, the urologist injects them and an erection appears.

He gave me a tip on technique that I am going to try next time.  He used it when he gave me my initial injection, but I was flat on my back so I did not witness it.  Now that I know how he does it, I think/hope/pray I can mimic his approach with similar success.

DanMan


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/24/2008 7:39 AM (GMT -6)   
Piano, notice that I said I clamped off the base of the penis after injecting for a couple minutes, and gently massaged it, to spread the med around and give it time to adsorb. In addition, Danman has addded some more info from the study and the rubber band trick that makes me think this is still a safe approach. He has shared with me the technique that his Urologist showed him which seems to be very workable and offers a good chance of success. I really don't think there is any extra bleeding inside with the plumping, as it is just a little bit, not full grown erection, and the needle makes no more or larger a puncture than when fully flaccid.

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/26/2008 4:54 AM (GMT -6)   

Thanks James -- I should have read what you said more carefully :-)

What is Danman's special trick? -- I'm curious.

Today I did another injection, much the same as before, but this .... 

[Deleted to comply with forum rules]


Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0 

Post Edited (Piano) : 5/28/2008 6:09:59 PM (GMT-6)


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/26/2008 7:39 AM (GMT -6)   

Piano,

Did you use 0.45 ml again this time?  Nice job!!!

Since JamesC is probably home using the results of his latest injection and therefore not available to check in with his cancer comrades right now, I will tell you the "special trick" as you called it...lol.

I have NOT yet tried this, but here is the story.

I saw the urologist Friday, after being frustrated for yet again missing the mark.  I know I missed not only because I got no erection but because I felt significant resistance when I depressed the plunger and discomfort from forcing the meds into the meat (a no no by the way), followed by redness on that part of the penis that lasted an hour or more.

When I had my trial shot at the urologist's office, I was on my back and did not see HOW he did it...so Friday afternoon, after my failure, I called and got an appointment for later that day.  He showed me to he positions a penis when he injects it and said it works virtually all of the time...even when men come in saying they are having problems.

He suggested grasping the penis so that the forefinger is on top of/at the head, the middle finger is supporting underneath and the thumb is on top of the shaft pretty much above the tip of the middle finger.  Do this so that the side of the cylinder faces up at you, giving you a good view/vantage point.  Press upward slightly from below with the middle finger and downward slightly from above with the forefinger and the cylinder will practically jump out of the penis....then inject at the desired 90 degree angle.  If one does it this way, he should take special care to make sure he knows where the cylinder begins and ends......to avoid injecting the urethra.... but the slight pressure supplied if done as described should cause the desired cylinder to be pretty visible in most cases.
 
Again, I have not yet tried this approach, but he said this is what he does every time he injects someone, with virtually 100% success.
 
DanMan



Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


DoctorAlsoPatient
New Member


Date Joined May 2008
Total Posts : 2
   Posted 5/26/2008 11:42 AM (GMT -6)   
My urologist prescribed Trimix. he said that over time I will notice that the starting dose (0.1 cc) will become less effective because the medication loses its potency fairly rapidly over time. He said that the maximum shelf life in the refrigerator is 2 months. So that I should gradually increase the dose during that time period, but never more than 0.5 cc. So I am now at 0.15 cc, gradually increasing in 0.01 cc increments. I have gotten satisfactory results every time (3 times), with an erection good enough for penetration each time, but I have found that I should not hurry into the bedroom after the injection. Maximum erection always seems to occur right after orgasm; between 30 and 45 minutes after injection. Then I am fairly incapacitated due to penile pain for about 1.5 hours, until the erection goes down. Any suggestions regarding what to do for the pain? Narcotics are starting to look attractive at this point.


Preop PSA 2.8 Sept 07, then 2.9 Oct 07
Biopsy Oct 07: 6 of 12 Positive cores gleason 3+4
DaVinci Lap Prostatectomy 1/10/08 Gleason 4+3, margins negative, Nodes neg.
PSA April 08 0.01

DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/26/2008 12:47 PM (GMT -6)   

DoctorAlsoPatient,

Welcome to the group.

I am no expert here, but will offer some thoughts for consideration.

First, search on this site for trimix, bimix, caverject, quadmix, and penile injections.  There are many good threads on the topic, including several that mention dosage amounts, side effects and treatments.

Which trimix formula are you using?  There are several.

Several here who started with "standard" trimix (30 mg papaverine, 1 mg phentolamine, 10mcg alprostadil (aka PGE-1) were advised to begin with 0.1cc and found that was too much for them.  Have seen one guy here who ended up with 0.03cc being his best dosage, another with 0.05cc....so there is nothing magical about the 0.1cc except that it seems to be the most commonly mentioned starting point that is suggested by urologists for standard trimix.

I read a report that indicated that 40+% of men report pain from Caverject, which is alprostadil (PGE-1).  The same report mentioned that around 3% of men report pain from trimix, so you might be among that 3%.

Some here....biker90 for one....reported that at the 0.1cc level of trimix, he had priapism and significant aching.  He ended up using 0.03cc, but again, that is just his situation.

My compounding pharmacy says the trimix has a maximum shelf life of 90 days, but whether 90 or 60, it is supposedly short.

Did you experience the same pain with 0.1 cc as with 0.15 cc?  Have you tried a dose less than 0.1cc to see if the erections are good but with less aching?

Sudafed and Extra Strength Neo-Synephrine spray are used to get rid of prolonged erections, but I am not sure if the erection is causing your aching or the presence of the alprostadil...but am mentioning in any case.

If you continue to experience pain at any level of trimix, you might consider trying quadmix or bimix.  Bimix does not contain alprostadil.  Quadmix does contain it, but that 4 drug cocktail requires even less drug to be injected than trimix and supposedly has fewer incidences of significant aching.

Sorry to ramble on.  Hope this helps a little bit.

DanMan


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 5/26/2008 12:57 PM (GMT -6)   
Bob was having almost the same scenario . . . pain for an hour and half or even longer with Trimix. His urologist has switched him to Bimix and he cannot believe the difference . . . no discomfort and erection goes down within the hour to hour and a half . .. before the total was closer to the 3 - 4 hr. mark, just enough shy of 4 hrs. to avoid a trip to the ER. So for him, Bimix is the answer. The most common side effect of the Trimix seems to be pain.
;o) Linda & Bob


Bob (62) - Laproscopic Prostate Removal Sept 27, 2006 at age 60.
2 of 12 malignant biopsy samples - gleason 3 + 3 = 6.
Pathology - Gleeson 3 + 4; stage T2; cancer completely contained, even a second more aggressive, previously undetected cancer) PSA UNDETECTABLE Nov 2006; Feb, May, Oct 2007; May 2008.  WHOOO HOOOO! 
Bob also has two secondary conditions -- Polycythemia (elevated red & white cells & platelets) and . . Myelofibrosis) -- If anyone has experience with or information on these, please email us.

Post Edited (lawink) : 5/26/2008 4:37:41 PM (GMT-6)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/26/2008 4:02 PM (GMT -6)   
Danman, thanks for the tip -- and yes that was 0.45ml (cc). Next time 0.4ml. My Bimix formula is Papaverine 10 parts to  Regitine (Phentolamine) 1 part, so it's a little different to the 30/1 mix others here use.
 
I also have found Bimix to be ... 

[Deleted to comply with forum rules]


Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0 

Post Edited (Piano) : 5/28/2008 6:12:23 PM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/26/2008 6:17 PM (GMT -6)   
Danman, maybe I have trouble following direction, but I can't for the life of me figure out the forefinger on the head/top part. The other 2 makes sense and are easy to accomplish, but I haven't figured out the other, yet. BUT, using a modified version with the middle finger and thumb/forefinger together, I was able to roll, squeeze and inject just fine. With a little practice and figuring out how that forefinger goes, this seems like a much easier method of getting to correct placement into the cavities.
James C.

Age 60
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
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 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
5/7/08 ED- Viagra, pump, no response- Trimix .075ml continues
Post Surgery PSA's: 3mts- 0, 6mts-0

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