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Posted 11/5/2008 6:09 PM (GMT 0)
Coming up soon on my next visit to urologist, and no action is going on with the Viagra. Would imagine he is going to suggest injections which I am not to thrilled about. Do the injections help with possible achieving one after using the injections? Curious also my both sides of nerves were saved but nothing going on?

Thanks!

 

Posted 11/5/2008 7:30 PM (GMT 0)
My surgeon gave me the impression that we'd wait till the first 12 months had passed and go from there if needed.
Posted 11/5/2008 9:38 PM (GMT 0)
SHU93
First, you are not very far after surgery , and just now approaching the point where you should start expecting recovery, as most men fall within the 6 to 9 months range as to starting to see some erections starting.

Mine suggested bimix, then trimix injections 3 months after surgery as part of the rehab process, along with daily use of a pump and 50mg Viagra at least every other day. His and my motto about it is use it or lose it. Injections are the closest you will get to a natural erection. Pumps will infuse blood into penile tissue, but will not firm up or 'exercise' that part of the penis inside the body. Injections will make it erect from the beginning inside the body to behind the head, which will not get firm, by the way. I read here that some studies indicated that injections used regularly is the fastest method for rehab and the most likely to be successful. That said, I am now at 13 months and have nothing to show for all that, after nerve sparing surgery, so it goes to demonstrate that each man is individual as far as recovery of ED function is concerned. If working at it and working hard at regaining it paid off, then I would have fully recovered with the work I have put into it, so don't expect any of this to be the magic cure... I hope you are of the ones who bust the curve.
Posted 11/5/2008 11:42 PM (GMT 0)

SHU93 said...
Coming up soon on my next visit to urologist, and no action is going on with the Viagra. Would imagine he is going to suggest injections which I am not to thrilled about. Do the injections help with possible achieving one after using the injections? Curious also my both sides of nerves were saved but nothing going on?

Thanks!

 

       If I read your profile correctly, you had your surgery in July.  That was over three months ago.  It is not uncommon for your doctor to suggest injections at that point. However often it is later.  I read your age as 37, so you are young and hopefully will begin improving soon.  I suggest that if your doctor agrees that you begin injections soon.  It is not going to slow down your recovery and quite likely will speed it up.  Unless there are other problems, I think you will immediatly start getting very good erections with shots.  It really is no big deal once you get passed the idea that it might hurt.  It works well for most users.  I am having some plaque buildup problems right now, but hope to put that in the past.
Posted 11/6/2008 5:24 AM (GMT 0)
Hey SHU,

Injections work. I am nearly 2 years past nerve sparing surgery and was able to achieve useable erections with Viagra but they were inconsistent. I have been using Trimix since August last year with excellent results. The routine I use is in my signature below.

I am currently on chemo therapy and it made me completely impotent. Nothing, nada, flat tire. Using Viagra, L-Argenine and Trimix, I get very useable erections. So my experience is that injections will overcome almost anything short of a penectomy.

Jim
Posted 11/8/2008 4:28 AM (GMT 0)
Injections definitely work, and popular theory is that they can help recover function by improving blood flow. That said, your surgery was recent, don't give up the ship yet, although my surgeon was willing to start injections 3 mos following surgery. I was hesitant, but at six months, tried them and feel that it has helped restore natural ability, although this could also have occurred by the passage of time and further healing, I don't know. Whatever the case, do what you feel comfortable with. Don't be skeptical or afraid of the injections, to me, the hesitance was quickly outweighed by results.

Randy
Posted 11/12/2008 8:38 PM (GMT 0)
I agree with most of what others said.  I would start with Bimix first. You have to find a compounding pharmacy in order to get that (ask your doc) If you live in a small town you may have to buy online (see other threads here).  Caverject is most often perscribed by the Doc's, it works, but many have substantial pain with it (I did), and it can last for 2 hours.  Bimix consists of two drugs, papaverine and phentolamine which are mixed by a compounding pharmasist. It works for many just as well,- no pain and much cheaper depending on the dosage required. If it doesn't work, you can always go to tri-mix which includes the two drugs in bi-mix plus Alprostadil which is the drug in caverject. Part of the cost of caverject will likely be covered by your insurance, while the bimix may not be covered. However, even with insurance paying part, for me, the bixmix was much less expensive $5 per injection versus $20 for caverject.
Posted 11/13/2008 2:09 PM (GMT 0)
not me (or anyone with knowledge)
You have obviously been down the road further than me. I had read on here that most people have best results from bimix, or trimix but as you state the local doc insisted on Caverject (who am I to argue). He first prescribed Caverject Impulse which after visiting 3 pharmacies was found to be discontinued. So then we went for the regular Caverject, which also was a hassle to find. Finally, one pharmacy ordered it - outrageous price. Then after receiving it, there was no sterile solution for mixing so I am having to go hunt that down, and they furnished 1 inch needles with it (must think I am a horse). One other tidbit to this generally embarassing bunch of pharmacy interaction is that it always seems the pharmacies have these little teenage girls waiting on you at the counter - how can you converse with them about such matters?

Couple of questions - do Urologist know the solutions bimix, and trimix? What I mean is do we have to educate the docs? Regarding Caverject - I have read that some have pain - is that associated with the injection spot, the length of time of willie be erect, or the substance in the solution? If you know about the mix - the solution is gauged at 20 ml potency. I take from this that since it is drawn in 1 cc solutions that to inject at rates of 2.5 mg I would be injecting 1/8 cc per 2.5 mg injection - is my thinking correct?

Thanks in advance for your wisdom!

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008
Posted 11/13/2008 2:31 PM (GMT 0)
I went the Caverject Impulse, then powder reconstitued route and understand your problems. I wanted a vial of it, they ordered 6 vials, $360, which insurance covered, thankfully. The sterile solution was included, but I did have to ask for it. Don't deal with those little girls, ask for the pharmacist and use their consultation area to discuss it. If I remember correctly the 40mcg dose powder was reconstitued and the dose was .18cc in syringe to get a 40.mcg injected dose. I used 5/16 inch, 30 guage insulin syringes. Either 5/15 or 1/2 inch will work, depending on the thickness of your penis. The sterile water is available at any pharmacy for little cost. Is the doctor gonna have you do the first does solo, or are you gonna go back to him for the first? Unless you are familiar with injections and such, I recommend yo go back tohim and have him show you and him do the first one.

The pain is from the solution in the penis itself. Some have speculated the pain was caused by tissue being enlarged and used that had been dormant for a whuile, but ai tend to disagree. My pain was specific to Caverject and stopped when I stopped it. It came back on a small scale, as discomfort when I began trimix, which contained the same chemical, in a smaller percentage.
Posted 11/13/2008 3:00 PM (GMT 0)
Thanks James,
I explained to the doc that I had given shots for years as my oldest daughter was a type I diabetic. He told me to begin in 2.5 mcg increments - showed me where etc. to inject. At the time he thought I would be using the Caverject Impulse which does the mixing and dosage in a more automated manner - well that didn't work out.

The only question I have with that is that the fomula papers do not really explain how the dosage is derived. My vials are 1cc solution with the powder and 20 mcg dosage potency - so I have assumed that to get a 2.5 mcg dosage I would be injecting 1/8 of the 1cc solution. One other question - once mixed do you have to throw the unused in the vial away, or will it last if refrigerated?
RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008
Posted 11/24/2008 4:34 PM (GMT 0)
I have no knowledge of the mixing procedure.  What I discovered is that no one had all of the answers that I was looking for. I researched everything from the drugs to needles. If I were you, I would locate a compounding pharmacy and have them do this for you - (if none locally there is one in Florida online)-. The chemical that is used in caverject, once mixed, has a very short shelf life even when refigerated, so I assume it would have to be mixed each time.  This would seem to be very inconvenient and when combined with the pain issue (caused by the caverject drug) I would not use it. The bi mix works great for me - about $90 a vial, enough for about 20 injections. My pharmacy furnishes 28 gage .6 inch needles, but I wanted the smallest needle possible, so I buy the needles separately online. I found 31 gage needles - 3/8 inch long, I think. The result is great, no pain from the drug or injection.  One other thing.  Prior to starting the injections, I was using the pump, taking viagra daily. I was very happy with the size restoration that resulted from this, but was never able to keep an erection for the desired length of time. I discontinued using the pump when I began the injections. about six months later I noticed a decrease in length and diameter. I began using the pump again (just for therapy twice a week) and that issue has been solved.
Posted 11/24/2008 5:19 PM (GMT 0)
RB, sorry for the delay answering, I just plain missed your return question.

I am not current on what ratio I was using, so won't make any guesstimates about how much to mix at what cc in the syringe, other than to say I was using 40mcg strength at .18cc dose level per shot.

The shelf life of the Caverject powder is one year before reconstituting and 3 months after reconstitution with sterile water. I kept mine in the frig, and only pulled the syringe load just before use. I would draw it about 15 minutes beforehand to allow it to warm up, or keep it in my hand to warm it up to body temp.
Posted 11/24/2008 8:17 PM (GMT 0)
SHU93:

First, I agree with a number of your early replies that you shouldn't get in too big a rush. Relax and be thankful that the PC is gone. I'm 8 months out, somewhat older, and making some progress, but not nearly where I'd like to be. If the idea of injections bother you, try a product called MUSE-it uses the same basic drugs as the injections, but is administered as a small pellet using a special applicator through the tip of the penis-no real problem- and it does work fairly well when viagara won't.

Hang in there.
Posted 11/25/2008 3:33 AM (GMT 0)
I would probably give the body a little time to heal up before starting shots. But you are the one that is living it.
Good Luck,
KW
Posted 11/26/2008 12:50 AM (GMT 0)
Thanks for all the good info and suggestions. The inections are no problem - I used insulin syringes and can hardly feel it. I have found the Caverject solution to work, but like others the aching pain associated makes it not worth the risk. I suppose if I could find just the right amount it might be OK, but the risk of pain is too great - I don't think I will try again.

Now, some dumb questions about BiMix - how did you get your doctor to prescribe it, and are the doses all the same mix? There are compound pharmacies where I live. The odd thing to me is that if the BiMix, or Trimix are so much superior to Caverject - why do the Urologists always prescribe the Caverject.

Happy Thanksgiving!
RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008
Trying Caverject
Posted 11/26/2008 3:20 AM (GMT 0)

RBinCountry said...
The odd thing to me is that if the BiMix, or Trimix are so much superior to Caverject - why do the Urologists always prescribe the Caverject.

The cynic in me says they make more money from Caverject. wink Another possibility that you noted earlier is that they just don't know about Bimix and Trimix.

Try asking your doc for the prescription. The Bimix mixture can vary between 30/1 and 30/5 (papaverine and phentolamine) -- depending on who does the prescribing.

I'm on a 30/3 mixture, and for me each injection is a fairly low 0.2ml.

Priapism (rock solid erections lasting more that four hours) is supposedly more of a problem with Bimix, but has never happened to me. For this reason, I suggest start with a low dose and work your way upwards. 

Posted 11/26/2008 1:57 PM (GMT 0)
Several possibilities why the Caverject is pushed. It is aggressively marketed by drug reps, whereas the bimix and trimix is a generic form, compounded by individual pharmacies. It is fairly easy to fill a Caverject prescription locally, even if you have to wait a couple days for them to order it. Also, it if the only one that my (most?) insurance companies will pay for. It's shelf life is much greater than the mixes, reducing costly waste from out of date ingredients. It's usually the main thing that most docs know about and hear about from the above drug reps, along with their having access to samples to start the patient off with right in the office. There is some evidence that Caverject does cause less side effects to the penis, such as curvature, Peyrones, etc. It is also more reliable (dependable) for getting a successful injection resulting in a usable erection . My experience has been the docs are familiar with the mainstream drug, Caverject, and have heard of but don't have much experience with the mixes. A patient usually has to be assertive to know what to ask for and to push to get it. I know my doc had heard of the mixes, but had never prescribed for a patient before me. His protocol was pump, then Viagra, then CAverject, until I became a patient. I had to educate him, as well as myself, to tell him what I wanted and how it should be compounded. I suspect that is the case with most docs, outside of a specialized clinical practice.
Posted 11/26/2008 3:10 PM (GMT 0)
James,
Thank you for the great information. Also, thank you for being moderator and all the good work you do here. I know that I have learned a lot from reading your responses. Happy Thanksgiving.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008
Posted 11/26/2008 4:16 PM (GMT 0)
I have used Bimix for 18 months now and have been very happy with the results.  I use a very small amount (.15ml) along with 50mg of Viagra.  I buy Bimix from Franck's  Compounding Lab located in Ocala, Fl.  Last week I paid $40.00 for a 5 ml vile of 30:1 mixture plus $7.95 shipping for 2 day delivery.  Bimix does not have to be refrigerated now, so shipping is not a problem.
Posted 11/26/2008 6:21 PM (GMT 0)

Age 56, RRP May 2007. Have used Cialis with no benefit, Trimix since April 2008.  Have not been able to obtain serviceable erection.

Posted 11/26/2008 11:52 PM (GMT 0)
Try some tight constriction at the base of your penis while you do the injection, and leave it on for a few minutes afterwards. I use rubber bands doubled over but constriction rings (as used with VEDs) should also work. This has made a huge difference to me, and I now have 100% reliability.
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