Trimix unsuccessful, bad reaction, extremely Low BP

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Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/22/2010 11:13 AM (GMT -6)   
Just got home from my 8:15AM Uro appointment for my first Trimix injection.
The fact that I am writing now, 11:15, means it did not have the happy ending I had hoped.

First the good news: my 6 month PSA is 0.05,and the DRE was clear.
Now the bad: The nurse came in and demonstrated how to do the Trimix #1 injection. Start small and work up to a dose that has the desired effect. Start with 0.15 ml. (15 units) . I did it while sitting on the examining table and was supposed to sit there for 15 minutes to let it work. At about 5 minutes I started to get light headed. I figured it was psychological so my wife put the table down so I could lie flat. I felt better for about 5 minutes, sat up and then felt really light headed. My wife called for help. My blood pressure was dropping. They put a monitor on and by then I was almost out. My BP had gone down to 49/26 and I was out. It felt just like going into surgery. I could hear things but not react. They started an IV and kept taking BP 55/30 ... 75/40 After a while it started to come up to 110/50 and I began to feel something happening between my legs although that was the farthest thing from my mind. Once the BP came up, I got a 20% erection but everything from the injection site to the tip was red.
The PA said I might have had an allergic reaction to the Trimix. Oh well.
I will most likely get a call from the Uro tonight with some suggestions.

Has anyone here ever had a similar reaction? This was a first for their office.
What is left after Trimix, VED, Viagra, Cialis?

On the bright side, there will be no earthquake induced tsunamis on the Lake Ontario shoreline.

Jeff 2
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next? See Uro 1/20/10
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.

Post Edited (Worried Guy) : 1/22/2010 12:01:28 PM (GMT-7)


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 1/22/2010 11:25 AM (GMT -6)   
Jeff 2. I am so sorry that you did not get the same recation that I got. Do keep me posted as to what the Uro has to say about this.

Will give you a call this afternoon.l

Jeff T
Cajun Country
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

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/22/2010 12:36 PM (GMT -6)   
Jeff,

Man is that a downer. Well, maybe have to try Caverjet or Muse.

Glad to hear the PSA is holding steady.

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/22/2010 12:52 PM (GMT -6)   
My wife said I got two 500 ml IV bags of saline - the first one was flowing wide open. Plus I drank a ~250 ml bottle of orange juice. I woke up from my nap just now and peed with the force of a fire hose. We get our pleasure where we can, I guess.

I was thinking of possible causes.
1) I had been taking 5mg daily cialis -maybe that lowered my BP. But my BP was normal 126/70 before the shot.
2) Did I hit a vein? No, I withdrew the plunger before injecting and there was no blood so I was in the right spot.

The mix I got is labelled:
Papaverine Hydrochloride USP 83.5 mg; *Phentolamine 0.6 ml; *Alprostadil 0.075 ml
The prescription reads:
Trimix #1 (16.7/0.56/0.0056) mg/ml injectable

My injection was 0.15 ml
I'm so disappointed - I didn't get the chance to wear my P-Cozy II with Bluetooth.
Jeff 2

Post Edited (Worried Guy) : 1/22/2010 12:09:59 PM (GMT-7)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/22/2010 12:56 PM (GMT -6)   
You weren't doing your limited liquid deal were you? I would say if you were 2 quarts low, you may have been dehydrated as well.

May have just been a perfect storm, with the cialis, dehydration, and trimix.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/22/2010 1:06 PM (GMT -6)   
jeff2

my sesimograph didnt wiggle here in sc. your good news is good news, on the psa front. on the injection, never even read of anyone having that kind of reaction before. it was good that all this happened in the safety of your doctor's office. glad you werent home experimenting on your own.

hope you and your doc can find another solution, and then try try again.

david in sc
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 1/22/2010 3:05 PM (GMT -6)   

Hey Jeff,

Really sorry to hear that. Maybe your docs can figure it out and you can move forward. Hope you're not allergic or sensitive to trimix and it is something else (or combination as Goodlife suggested). My 5th experience with trimix was one of a 5 1/2 hour event ending in an ER with priapism. This was at a dose lower than my starting dose of 0.1mL and you started higher. Saw my ED Uro and he diluted my Rx and I will try at 0.05mL next...or equiv to 0.025mL based on original strength.

The ER experience was humiliating, but I am undeterred. I am mad at my myself for not having some sudafed on hand (psuedoephedrine type). That seemed to lull the event and no further intervention was necessary. I knew about it and it could've saved an ER visit. Bought some and showed it to ED Uro...for next time, if needed.

ED Uro was OK with ER visit. Says, it shows I'm healthy and should make positive progress in the future...maybe med free. Will do some more asking and reading about that. 

Good luck and don't give up.

 

Mike


-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.
-Bladder control within 48 hours of catheter removal
-ED ongoing but improving significantly with Trimix at 7 months post-op. Oral ED meds didn't do much.


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 1/22/2010 3:21 PM (GMT -6)   

Jeff...just got back into my home office when I made my last reply...A busy day and a bit scattered...

Very good news on the PSA. Hope that is where it will stay! That is the best news.

Mike

 


-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.
-Bladder control within 48 hours of catheter removal
-ED ongoing but improving significantly with Trimix at 7 months post-op. Oral ED meds didn't do much.


cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 1/22/2010 4:39 PM (GMT -6)   
Jeff,


darn...talk about a bad day. Sometimes we just can't catch a break. Congratulations on the zero, that is really good news and the most important news too.



Steve

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/22/2010 5:08 PM (GMT -6)   
Hey Mike,

I gotta know, did you at least use it once before the ER ?

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/22/2010 5:16 PM (GMT -6)   
Another good thing about all this is that you didn't have the problem of hiding the erection while you got home. :-)

The fact that your penis went red as well indicates some kind of reaction to the Trimix. I certainly wouldn't want to risk the low BP again, unless you tend towards this condition.

Another option might be Bimix -- like Trimix but without the Alprostadil component. But if you tried any other injection, you'd want to start with a real low dose.

I quit injections because of a slight bend developing. And while we hadn't tried the VED much for intercourse, we now find that after a bit of practice, and a little natural function returning, we can use it successfully. So that may be an option for you too.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/22/2010 5:40 PM (GMT -6)   
Piano,
I'm hoping to try something else. Bimix or Cav. I will not give up. The next time will be in the hospital clinic. I'm either very brave or very stupid.
No BP problem here- typical is 110/70 and I am blessed with a fairly athletic pulse. This was very unusual for me.

I'll tell you right now, that little bottle of Kickapoo Joy Juice will not go to waste. If I can't use it, then it's going to end up in someone else's mailbox. There are 30 shots that must be used by April 18th and I refuse to let it molder in a landfill.
We'll see what the Uro says and then act accordingly.

Jeff (the one with the red naughty bits)

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 1/22/2010 8:53 PM (GMT -6)   
Jeff, I'm sorry you had the experience you did with Trimix. I haven't tried that myself, but have used Caverject and Bimix. Both worked for me, and I have continued with Bimix, just because it is cheaper and works. However, I believe that for me, there is less risk of priapism with the Caverject. Glad you are going to carefully try one of them - I would recommend the Caverject since it seems to be more endorsed by the medical profession at this point, and may be more dissimilar to the trimix than the bimix. Let us know how it goes.

I don't want to hijack this thread, but Mikey, is it a well-known fact that pseudephedrine is the first line of defense against priapism? I have had some close calls with the bimix - I'd like to know the details on that for future's sake.
Thanks
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/23/2010 7:37 AM (GMT -6)   
Last night, after my head cleared, my wife and I figured out what had happened.

Clearly all the blood was drawn from my brain and was rushing to fill a massive member. Something the size of a forearm would take at least 2 pints of blood to fill. smilewinkgrin No wonder I got light-headed.

This is also a medical explanation for the expression: "Thinking with the wrong head." tongue
Jeff

Post Edited (Worried Guy) : 1/23/2010 8:02:43 AM (GMT-7)


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 1/23/2010 7:47 AM (GMT -6)   
Jeff,

It would also explain why you were so aware of what was going on. Your eyes were wide open as you had no skin left to blink or close your eyes. rolleyes

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 1/23/2010 7:58 AM (GMT -6)   
"Something the size of a forearm would take at least 2 pints of blood to fill"
 
Ya right.....Me thinks Jeff is afraid of needles..freaked out/passed out.
 
But, we be glad you're alright.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/23/2010 9:10 AM (GMT -6)   
Well... I am afraid of needles... But that does not explain why Rudolf's Red nose was suddenly attached to my crotch or the 49/26 BP.

Thanks for the explanation Sonny. Now I know the reason for those facial stretch marks.

Jeff

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/23/2010 9:59 AM (GMT -6)   
Jeff
 
Remember how they said we would would probably die from something else besides PC ?  Bet you never thought it would be a hard-on that did it.
 
Maybe if you stand on your head next time, just your feet will get cold.
 
Goodlife

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/23/2010 10:04 AM (GMT -6)   
Jeff, one thing that keeps coming back to my mind, even though you said you checked, is you may have injected straight into a small artery, hence the sudden and dramatic change. Either that or you really are afraid of needles.... devil

I really think another go at it with Trimix- cut the amount some-, in a controlled setting is in order. I'd then try the Bimix, it being the next lowest in strength and effect, not containing the alprostadil. Save the Caverject for last.
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 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/23/2010 2:14 PM (GMT -6)   
Just got the call from the Uro. 3 PM Saturday. He would like to try the Trimix again, but this time I should wait a couple of weeks to let the Cialis clear out of my system. I had been taking 5mg /day for the previous 2 weeks.
I will schedule another appointment and try a slightly lower dose. I'll be sure to let you guys know what happens.

James C. Did you discuss this with the Uro? It sounds like his advice. ;-)
Hey Goodlife. Maybe I can do the injection while hanging off the table. Or maybe I should invent an injection table that looks like a massage table but has a hole in the center that is accessible from below. Hmm... I'll have to think about that a bit.

I won't give up. There are 29 shots left in that bottle.
Jeff

Post Edited (Worried Guy) : 1/23/2010 5:35:15 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/23/2010 6:31 PM (GMT -6)   
That's good news to read Jeff, hopefully things will work better on the next attempt, hoping you didn't feel too discouraged about what happens, as they say, IT happens, despite your best mindset and preparations. We are with you, no matter how many times it takes.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 1/23/2010 6:41 PM (GMT -6)   
Jeff 2, I am pleased the you Dr is willing to try again under better conditions. I hope this time the Dr will be with you for the injection. Hang in there just think about it a couple of more wks to work on that invention. Before you know the Bluetooth with be buzzing away!:)

You buddy

Jeff T
cajun Country


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

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)

Post Edited (corvetteman3) : 1/24/2010 10:08:56 AM (GMT-7)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/23/2010 10:48 PM (GMT -6)   
Could we send a film crew ?
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 1/24/2010 6:27 AM (GMT -6)   
Don't forget about designing the P-Cozy III - made out of rubber with a choke collar to force the blood out of the monster and back into the body.  

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/24/2010 7:33 AM (GMT -6)   
Those are great ideas for the P-Cozy III. I'll check out Goodwill and see if I can get a used pressurized flight suit. I can power it off outlet side of my VED.
I would have pulled out of my episode much quicker had the nurses attached the blood pressure cuff to my freshly injected member. And I wouldn't have these stretch marks on my face. smilewinkgrin

Now, where do I put the camera.....
Jeff
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