ED questions

My opinion--opinion only--is that injections would be one of the last steps. Give yourself some more time, four months is a typical time for men post RP to begin to see improvements. The improvements will likely continue slowly over time...maybe a year or in some cases 2 years.

Did you try taking 2 ibuprofen at the same time as an ED pill? My initial attempt also produced a headache, but the doc recommended the ibuprofen simultaneously and it pretty much eliminated the problem.

Lastly, keep in mind that if you had other sources of ED before RP, these aren't going to be getting any better by having your surgery. 

hope this helps...

Herman:  I was on Cialis for 5 months after DaVinci RP and zero response. No side effects from the pills but at age 58 wanted to get my sex life back ASAP. The VED did not work and it was boring using it. I think that you are very early into the healing process and what you mention does sound like you are making some recovery in the ED department.  You are certainly not too early if you want to try the injection route.  It is really up to you and your wife. If it is important to the both of you give it a try.  Go with Bimix first.  Injecting is no big deal and you have a 90% chance of having perfect sex back immediately with them. No pain and simply work your way up in dosage. I started Bimix at .22 cc's in the doctors office and went as high as .26 cc's before I got the perfect dose of .23 cc's.  I have done 10 injections to date (started at 5 months post RP) and it seems like my body has been "jump started" and things are getting better naturally. Runs about $3.50 per dose (including needles). I am somewhat leary of injecting myself, so I let my wife do it. And she has gotten better each time.  I think that you should ask for Bimix first, since the Tri-mix is a little more aggressive and may have some aching involved.  The Bi-mix works nicely and I get 100 % erections good for 2 hours!  I still take the pills and get nocturnals every night, but just knowing that you can have excellent sex whenever you want, takes a lot of the stress out of our situations. Hopefully, as with me, this may help you heal in the ED department even faster.  Now is a good time to try it. I simply found a Urologist that knew about injections and it was no big deal at all. (I did see a very "well known" ED specialist and he quickly recommended the injections but he was not on my insurance plan, so as I mentioned, I found a Urologist that "advertised" ED). Again, you really don't need a ED specialist. For what it is worth, go for it...my only regret is not trying it sooner!

Age: 59

PSA: 3.3, free PSA 21%; Normal DRE

Gleason 3+3; 1 of 12 cores

DaVinci RP: 7/19/11, Chilton Hospital, NJ, Dr. Tricia Greene (highly recommended) 

10% involvement, all clear

Immediate Bladder Control

Post RP Psa: 10/11 < 0.01, 1/12 <0.01.

Pursue the injections now. Start with Bimix and work the dose up until it's working for you both.  If Bimix is not enough, ask for Trimix.

Not suggesting you mix shots and pills but you can still take the low doses for bloodflow on days when you are not injecting.

If things improve then you may not need the shots, but why wait?!?

Even with a decision to start now, you could be months in the "development" phase where you are still waiting for the appt, waiting for prescription, shot training, dialing the dosage, etc.

I started at 6 months but should have started sooner.

Good Luck!

Watch some of the videos on youtube from Dr. John Mulhall, or read his book. He gives some great insights into all this. One point he makes is that often the nerve function reduces over the first few months post RP and the low is 4 months. So if you are getting even reasonable response at 4 months, that is a good sign. His protocol includes injections after about 1 month. It seems from the prior replies to this thread many are starting that early and appreciating the results. Sounds like you and your Uro can do as you please to start to please.

Thanks for all the good comments.  I'm going to make an appointment with a urologist specializing in ED.  Life is short.  Got to get down to business.  Why wait when I could find something to aid the healing process and make my sweetheart happy (or at least give her the opportunity).  My guess is when the flag pole raises up, she won't waste the moment. 

Herman, glad you asked your original question, as I have learned some more from the responses.  Got some good suggestions and information last week about Trimix use.  I have tried Viagra, Cialis, and Levitra, and they all gave me a severe headache.  I have tried taking ibuprophen a couple of hours in advance and that helped, plus take a BC green powder just before taking the pill.  The last several months, the pills would not keep my erection, and I have used the pump with it, but that still didn't hold the erection.  The urologist got me on the Trimix injections starting last week (am using a #30 diabetic syringe, and it doesn't hurt much at all).  Found out on this forum that my concentration is extremely low, and very high priced from the doctor.  Someone gave me the name of a compound pharmacy in Florida that is less than half price.  My concentration is 17.65 Papav.; .59 Phentolamine; and 5.89 PGE-1. When I use up my 

$ 125 --5cc bottle, will get a Px for double that concentration from Florida for about $38 plus s & h. 

I found out last week on this forum that most folks are using a concentration about double what I am using.  After the doctor tried .1 ML in his office with no results, I tried .2 on the other side a couple of nights later.  A small erection for 3 minutes.  Then .3 on alternate side with a few minutes of erection.  Tried .4 ml Saturday night, and got essentially NO erection.  Tried  .55 tonight on right side at 2 o'clock position, and after 5 minutes got an erection (about 80%) that lasted for maybe 8 to 10 minutes.  With some stimulation, he stayed large, but the erection left.  Will try about .7 ml next time, and maybe one half Viagra pill beforehand (someone on the forum said they tried the Viagra before the injecton).

I think several of the responses I got last week on forum said they were using .2 ml of Trimix each time, but their concentration was much more than mine.  Any more suggestons or ideas for me would be appreciated.  I take testosterone injectons (1 cc every two weeks), and my pointer curves some whenever it does get erect, but they never found any plaque in arteries.  It has all been frustrating for me. 

Hayfarmer

age 67

No cancer 

 

James C,  thank you for the information which is very helpful.  I tried .55 cc of my LOW concentration last night, and will try .65 tonight.  Had thought about trying one half of a Viagra pill beforehand, but don't think I will try that tonight.  Will instead try the pump before I inject, and the stimulation or rubbing after I inject to see if that helps with the increased dose.

Hope it works.

Thanks,

Hayfarmer

Age 67

no cancer

Well, I tell you. Approximately four years ago I had surgery (RLP). Began taking .25 mg V  or .5 mg of C as prescribed. Nothing. Bought a VED.  Worked but not usable for me. A little progress made. 18 months later began EBRT which of course knocked hard on the ED door. Still tried the oral meds as before and the VED. Little to no response. By the end of that year, some progress was being made but of very little use. Along with the end of the same year came the beginning of HT. Almost a year later, I began Trimix.  Wow! Like I used to be but of course a smaller model with   "almost" all of the original options.  My Uro had suggested injections years ago but I would not consider them.

Now, almost four years later,and after 10 injections over the last month, things are stirring a little on their own.  As my libido (T level) returns from HT SE's, I am hoping for an even better response. I might start trying small doses of oral meds in between injections.

My purpose in writing this post is to share a four year post RLP experience that proves you should never give up at anything.  What a difference in the way I feel about myself.

At some point in the thread someone mentioned taking half a Viagra and do the shot in the same day - my uro's advice on that is "absolutely DO NOT mix pills and shots the same day" since it significantly increases the risk of a trip to the ER.

After one near-ER experience, I'm not going to risk it.

142,

At some point in the thread someone mentioned taking half a Viagra and do the shot in the same day - my uro's advice on that is 'absolutely DO NOT mix pills and shots the same day' since it significantly increases the risk of a trip to the ER. said...

On the other hand I ALWAYS am mixing pills and shots on the same day. Can't say it has ever had any effect. I think the main issue with mixing is: If your pills do help get you to some XXX% by themselves, then yes if you mix close to a shot then the effect might be additive. But if you are like me where pills have virtually no effect, then, well, I am just trying to use em up before they expire, and before I expire!

Also, my only brush with the a potential ER run due to shots was cause BY my clueless Uro using 3X my current shot amount, not by me going off on my own. Some don't have the sense of a chicken when it come to this stuff.

J

Post Edited (JStars) : 3/2/2012 9:04:24 PM (GMT-7)

Guess I should actually answer the original questions, based on my experience with my Uro and the mainline books on the subject:

Is 4 months too soon to expect more from ED pills (Levitra, Cialis, Viagra, ect.) ?

 - Nerve healing can take up to 2 years according to my uro, Mulhall, and most of the published doctors. So, yes, it is too early to presume they are not actually helping.

How long before your urologist suggested injections?  

 I asked, at just under two years out from surgery. We had discussed them, but I was not receptive to the idea, and insurance would not allow the trimix early on. It took an aggressive pharmacist to get it covered, and he used the "two year" argument to get an appeal through.

Do the ED drugs have to be totally ineffective before a Urologist will prescribe trimix?

 Not from the reports I've gotten. Insurance may be another issue though. 

Is it a treatment that can be discontinued after your body heals?  or once you start injecting is it a forever thing?

 If/as your nerves heal, you may be able to reduce the quantity or strength of the mix, and perhaps be able to stop using it. The general ED treatment that is irreversible is an implant, as they remove the internal tissue.