Here's a post I made sometime back, sorta an overview of the whole injection process. Maybe some of it will pertain to your problems.
Injection drugs are obtained by a doctors prescript
ion and must be filled by a specialized pharmacy- an compounding pharmacy- which mixes the drugs to be used. There are 3 types of drugs- Caverject (alprostadil), Bimix and Trimix. Alprostadil is a a single drug, bimix is a mixture of papaverine and phentolamine, usually in the strengths of 30mg papaverine/1mg phentolamine when written on the prescript
ion. Trimix is the same as bimix, with the addition of alprostadil to it, and usually written as 30mg/1mg/20mcg, the 20mcg being the alprostadil. In listing strengths, the alprostadil is the strongest and seems to obtain the most effective result. It is also the most expensive and lots of guys have problems with both aching, pains and piraprisms (SP)- erections of longer than 4 hours. Trimix is the next strongest and results in very good erections, with much less chance of the aching/pain and the 4 hour hour erections. Bimix is the llowest strength of the 3 , but seldom gives the aching/pain or the 4 hour erections. Dosing sizes of Trimix is usually much less than Bimix, so it takes much less to get the same result, however it does seem to have a chance of giving more troubles with aching/pain and the problem erections.
Most doctors will begin the injection treatment with Caverject (alprostadil) injected in the office to get a baseline of what is needed and to teach the man how to inject. Some men have a bad experience with this, as the alprostadil is usually injected at a much higher dose than needed, which creates the aching/pain and the over 4 hours erections which we hear about
once in a while. It seems doctors have a set formula of what they are taught to inject and that isn't always the best. If it works in the office, he will usually send the patient home with a prescript
ion for alprostadil and further instruction on how to use it. It seems that most doctors don't begin with Trimix or Bimix, unless they are dealing with an educated patient who can ask for, explain why, and can advocate for themselves trying something different. I am fortunate to have a doc who will deal with me on an equal basis and is willing to try what I suggest with different ratios of strengths to dial it in for me. I feel that a man who is starting injection therapy should begin with either Trimix or Bimix, rather than alprostadil, as the chances of a ache/pain free experience will have him much more willing to continue. The physical act of injecting is simply pain free for me now, but it took quite a bit of repetition and experimenting to reach this state. Once a guy begins injecting, he needs to keep at it, experimenting and dialing in what he needs to get the best results with the least amount of drug or trouble.
As far as technique, its simple, actually. Use the least diameter needle, usually a 5/16" 31 ga. insulin syringe, and inject into the penis midway between the head of the penis and the body, at the 9 or 3 o'clock position. A little milking motion of the penis will help
open the cavernous cavities a little, so the drug cane be deposited into the space. A little massage and the erection should begin, usually within 5 to 10 minutes, and if enough drug is injected and adsorbed, results in a penis erect for an hour or so. That's the idea goal. It can vary. Done right, with practice, the injection can and will be painless for most guys. There's no reason to think you would be any different. I don't combine by injections with other items such as pills or pump, but some here do. I, and several other guys, use what I call a pre-plump method to ensure successful injections. It begins with a penis pump, if you have one, and a penis ring. You can accomplish nearly the same thing using a milking motion to fill the penis with blood, and a regular rubber band. Using the pump, obtain a partial- maybe 30%- erection and apply the ring. This engorges the penis with blood,
opening the cavernous cavities and filling them with blood. Then inject into this expanded cavity. Imagine injecting into an uninflated balloon, and putting the drug into the inside, versus injecting into a partially inflated one. That's what is being accomplished with this method. When injecting, you can easily tell when the needle point enters the cavity, as the resistance will drop and the needle will feel like it has 'fallen' into it. Inject and very lightly massage the penis, the purpose is to spread the drug around and ensure optimium adsorption of the drug. Keeping the ring on for 3 or 4 minutes holds the blood (and drug) inside and lets it have the best chance of being adsorbed. Continue to gently massage the penis and the drug around for 3 to 4 minutes, then remove the ring- the blood will most likely run back out of the penis, until the erection begins. You should get the drug induced erection in 5 minutes or so. Most of us who use this method find we can use much less drug, we can control results more consistently from one time to the next and reduce the chance of priaprisms.
Yes, once in a while we will have guys here have a bad experience, resulting in a 4 hour erection and a trip to the hospital or doctors office. It's traumatic, of course, but frankly still part of the risk of using injections. The draining of the penis blood was sorta overkill, IMO, usually the penis is injected with epenephrine(SP) or such, which counteracts the penile injection drug. I have only had one over 4 hour erection, I relieved it with Sufafed, rathert than a hospital visit. That was the first time I self-injected, it was alprostadil and it was the doctors recommended dose, which was 3 times more than I found I needed.
There's several excellent websites with great instructions on the process, and we can look at them later, when you are ready to start the injections.
This is a general overview of the process, stressing they general or average, or normal process and results by the majority of the guys here, to give you a general look at the normal experience and answers to your questions.
Here's a few links to a posts that will contain some research info for you to continue your study:www.healingwell.com/community/default.aspx?f=35&m=1347869&p=1www.healingwell.com/community/default.aspx?f=35&m=897291www.healingwell.com/community/default.aspx?f=35&m=1062508www.healingwell.com/community/default.aspx?f=35&m=1115024www.healingwell.com/community/default.aspx?f=35&m=1022627&p=1&ord=dwww.healingwell.com/community/default.aspx?f=35&m=1069182www.healingwell.com/community/default.aspx?f=35&m=1110785www.healingwell.com/community/default.aspx?f=35&m=992063www.healingwell.com/community/default.aspx?f=35&m=1285932www.healingwell.com/community/default.aspx?f=35&m=1072323www.healingwell.com/community/default.aspx?f=35&m=1274734&p=1&ord=awww.healingwell.com/community/default.aspx?f=35&m=106647
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing
open RRP, 110gms, Path Report- Stg. pT2c, 10 gms., margins clear
32 Months: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN
Post Edited (James C.) : 5/16/2010 11:46:05 AM (GMT-6)