Trimix questions

Today was a busy day for me. I had my 1st electro-stimulation/biofeedback session for incontinence, here is hoping it actually helps if even a little. That was quite a wild new experience! Any one here gone this route?

Next, I drove an hour north to pick up my Trimix. Originally, my Uro's office told me a mail order group would contact me, I would give them $, and when the Trimix arrived I would bring it down to their office for my training. But they called back with in the hour, told me to just drive to this compounding pharmacy out of town(actually, right next to the hospital I used to work at), where I could get a much better price and the pharmacist would give me the training, or actually just directions. Understand, he trusted the pharmacist to give me good directions and apparently also me, as an anesthesia provider who routinely administers the worlds most powerful IV drugs of all types, and have done so in the OR with this Uro. Otherwise, I think he would still require me to come to his office. I paid $35 for 5 ml Trimix, adrenalin and a bag of syringes and tax.

But I know a lot of you guys are ED injection pros, so I thought I would bounce a few questions off of you. I saw some older threads but maybe it's best if I just start a new thread? I know I could ask my Uro and/or pharmacist, but I'd also like to know what you guys in the trenches think.

1: Refrigeration: yes or no? The bottle he handed me was cold. The pharmacist said it did not really need to be refrigerated, though they did anyway. I Googled that, and saw that there is a Trimix for Travel that does not require refrigeration. But I do not know if that is what he gave me, I assume it is just the “regular” Trimix. So after a few hours at home, I put it back in the frige anyway. Anyone think I need to keep it in the refrigerator all the time?

2: He said the starting dose was 0.2 ml, and if needed I could work up slowly to bigger doses, I think as big as 0.4 ml. But I am extra paranoid about Priapism, plus this is not for sex right now. I am still too incontinent for that, right now I just want to get some blood going down there. I don't care if it is not rigid enough for penetration, at least not yet. Any reason why I shouldn't start with a lower dose, like maybe 0.1 or even 0.05 and see what happens?

3: I asked the pharmacist about some Sudafed ( a prescription drug in this state because of Meth dealers). He said that would help, but not near as sure as a little dose of epinephrine, so he just gave me an ampule of that. Said the dose for an ER ready erection was 0.3 ml, injected just like the Trimix. Which I think is the same dose as an Epipen for severe allergic reactions with airway closure. ( of course if it comes to that, I could call one of them and ask ) Anyone know if sniffing Neosynephrine (phenylephrine) nose drops would work as well as Sudafed?

4: Without starting with an erection, I am wondering how I am going to avoid veins. With me being so shrunk up, I can see several veins covering quite a bit of surface, though some are quite hard to see, still I think I see them lurking there. How do you guys deal with that?

5: My doc up at Vanderbilt ( 4 hrs away) wanted me to keep taking the Cialis 5 mg daily along with the injections now and then. Do you think I should lay off the Cialis the day of a planned injection of 0.2 ml, maybe even the day before?

Well, thanks in advance for any info or opinions you have. I will not take any of it as medical advice of course. But I still appreciate the opinions of the experienced.

Also, they tried to deliver my Augusta VED today but it required signature and we were not home, we were out getting the Trimix! Day starts with rectal probe ( electro-stimulation/bio-feedback), then in search of needles for the little fellow, and then suction devices. Who would have ever thunk it? Man oh man, what a wild, crazy new world!

Bill

From my experience -

1) YES!!! the vial must be kept cold. My pharmacy requires that you show up with a cold pack. I get two 5 ml vials, freeze one, use the other, but keep it in the reefer.

2) I started with 0.10, moved to 0.11, 0.12, then 0.13 and an (aborted) ER trip. Aim small, miss small.

3) never heard of nose spray as an antidote.

4) Look. Maybe use your pump to get a little plump first?

5) My uro says DO NOT MIX cialis and shots. He says don't take the Cialis the night before planned trimix use, and no cialis the night of trimix use. I asked about unexpected opportunities. He suggested I consider my risk vs benefit, and consider that he would be meeting me at the ER, so the story had best be a barn-burner, and the 4 hour partner should be one willing to accompany me to the ER.

1) Yes, it needs to be refrigerated. Trimix for Travel comes as two vials, one containing the drugs in powdered form and one containing sterile water. The user is instructed in how to dissolve the drugs before use. I suspect that once it is rehydrated it probably needs refrigeration.

2) I see no reason not to inject as little as you like to start with although having the epinephrine on hand should take some of the worry out of dose titration. You will hear from men who have a very exact upper dose where a smidge more will send them to the ER and from other guys who can inject gallons of the stuff without any problems. I think that depends on how much venous leak a man has. Part of the dose titration process will be figuring out which sort you are. I, sadly, am a leaker and use quite a bit of the stuff.

3) No idea about the nose drops. The instructions I got for the Sudafed call for four pills for a trimix OD. Since I am a leaker (see above) I have never had occasion to find out. It might take a lot of the nose drops. Oh, and you were thinking about spraying it into your nose right?

4) Stretching your penis and swabbing it with alcohol tends to thin out the skin and make it more transparent. The veins aren't that hard to see. Just try to miss the big ones.

5) Over our pay grade here. Talk to your doctors about the drug interactions.

PSA3DOT7 said...
Ive got a Trimix script which I need to take to a compounding pharmacy; I'm scheduled to start early May.

But I dont give up easily, so today at

1. 8:30am I took 10mg Levitra (i actually split a 20mg)
2. waited - watched a movie - the comedy channel
3. 9:40am I took a 100mg Viagra
4. waited - watched the History Channel
5. 10:40 - started stimulation in a standing position (lying down does not work -- gravity works against me)
6. 11:00 - Had a massive hard-on (90% firmness) which stayed firm for about 20 min.

I think I was a bit impatient with the PDE5is (Viagra, Levitra and Cialis). But waiting 2.5 hours to get a usable hard-on is not my ideal, but I was encouraged by the results suggesting that some nerves still work!

I hope that the Trimix would have a shorter cycle; Like you I'm concerned about Priapism and Penis Scaring (Pyronies).

I had one massive headache this afternoon.

.

Wow, looks like with enough time you are not going to need injections! Lucky dog! But, that is a big dose and the headaches and other possible side effects would stink. Still, no needle!

Yes to refrigeration, my URO told me to start at 25 cc and work up as needed. After reading here I decided that was to high a starting point so I tried starting at 10cc which worked great, next time 10 % more at 11 cc which was actually 1cc too much, thus 10cc does the trick for me.

Something that never occurred to me till I read this thread, my URO prescribed 5 mg ciallis daily and never advised any changes when I started Trimix a few months later. I never could find a script at price I liked so procured 20 mg from off shore pharmacy which I split into 10's.

I take 10 mg daily in the morning......maybe this is why 10cc Trimix is all I need to achieve results I want, it normally lasts 2 hours which is bit longer than I'd like, a couple times lasted around four hrs.

142 said...
Rich, check your numbers. I think 10cc is a LOT, and would take several syringes to inject

Agree, that would be a painful shot, even more so the 25 ml you were told to start with. A 10 ml syringe is quite huge compared to the insulin syringes so many use for Trimix, in fact 20 times larger than the 0.5 ml insulin syringes I have. Did you mean 0.1 cc(ml)? They told me to start at 0.2 ml(cc) for example.

Post Edited (BillyBob@388) : 4/17/2014 12:10:28 PM (GMT-6)

In reference to refrigeration, what I have found after more than two years of Trimix usage is that after a month or so in the fridge the effectiveness of the Trimix started to deteriorate.
My solution to this problem is to pre-fill all my syringes with the correct amount ( 25 units for me ) on the day I collect the Trimix from the pharmacy and then freeze them.
When ready to use an injection I get one from the freezer, hold it in my warm hand for a minute or two and then inject. Works perfectly, right up to the last syringe.

Bill, I think you have it backwards. Some of us aspirate but when we do we only inject when we draw blood. It's related to the problem I mentioned with the needle being barely long enough. The corpus cavernosus is basically a big, involuted blood vessel. If you can't aspirate blood you are in the wrong place. As for the blood being dark and venous-looking, that is one of the things the trimix helps with. In the absence of regular nocturnal erections the erectile tissues don't always get enough oxygenated blood. Trimix helps with that.

And even if you were to inject into a big vein, you are injecting a tiny little bit of a mild blood-pressure drug. The systemic effect will be zip.

PeterDisAbelard. said...
Bill, I think you have it backwards. Some of us aspirate but when we do we only inject when we draw blood. It's related to the problem I mentioned with the needle being barely long enough. The corpus cavernosus is basically a big, involuted blood vessel. If you can't aspirate blood you are in the wrong place. As for the blood being dark and venous-looking, that is one of the things the trimix helps with. In the absence of regular nocturnal erections the erectile tissues don't always get enough oxygenated blood. Trimix helps with that.

And even if you were to inject into a big vein, you are injecting a tiny little bit of a mild blood-pressure drug. The systemic effect will be zip.

142 said...
No blood being drawn back means you missed, maybe having the needle stuck into tissue instead of the open space (already containing some blood). Blood seen is a sign you got it right.

My uro won't consent for patients to do the first shot on their own.

All righty then, and thank you! So I was right in the exact place I needed to be, and should have injected, apparently. I thought that the NP at my uros office up in Vandy said that I needed to draw back blood, but my wife and I thought we had heard her wrong or she meant if you draw back blood pull out. However, with the mechanical injectors, NO aspiration is even done, you just put it against the skin and push the button. Still, you can see where confusion could arise since you are trying to miss veins and what do you get if you hit a vein? Blood!

Of course, it is now obvious that the difference is: I am trying to miss the surface veins- probably to avoid excess bruising or hematomas, but in order to get to the bigger more or less vein underneath, where "These formations are made of a sponge-like tissue containing irregular blood-filled spaces".

Duh! I should have realized that, but still I was shocked to pll back blood. I did indeed have it backwards. Naturally enough since my whole mindset is to avoid nerves, arteries(both along the top), urethra and VEINS.

OK, maybe try again tomorrow or this weekend! I want to get some fresh oxygen down there ASAP!

My wife can't understand why, if I do this say twice a week, I would want to bother with the expensive Cialis. But my surgeon and Mulhall seem to think it might protect vessels more than a once or twice weekly erection would.

I thought 10 cc referred to 1/10 of one ML

bluebird123 said...
Not sure what you guys mean by aspirating blood. My husband's instructions from Dr. Mulhall were to inject at either the 10:00 or 2:00 position, at a 45 degree angle (switching sides every time). He first pulls out his member as far as it will go, wipes the spot where he plans to inject with an alcohol swab, injects the needle into the correct place, and then pushes the plunger to inject the trimix..............................
My husband took low dose Viagra on the nights that he did not inject for one year after his surgery, per Mulhall's instructions. After a year Mulhall told him to discontinue the low dose Viagra, as he found that it has no value after that point. Now his instructions are to take a full dose of a PDE5 inhibitor at least once a month and try for an erection.

Thx for the helpful details, Bluebird! Aspirating blood is a pretty standard technique used for giving injections that you want to be sub-cutaneous(SC) or Intra-muscular(IM)- IOW the standard shots of antibiotics or flu shots etc etc that we have all had- when you DO NOT want to inject IV(Intra-venously) or arterially. Because the drugs would burn or do damage or have way too much effect. So any drug that you wanted to make sure, for example, that you were injecting into say a muscle and NOT into a vein or artery, you would 1st pull BACK on the plunger instead of pushing it for injection. If you get blood, then you would not inject, because you are in a vein where you don't want to be. That routine IM/SC injection approach would be called aspiration. ( the opposite if you need to inject a vein, you want to aspirate and hope you do see blood, but still you are aspirating unless thr blood runs back in the syringe by itself)

Since the directions were to avoid any veins( or surface veins at least) then I thought that the getting blood was something to avoid, and aspirated to make sure I was not in a vein. But now I realize that though I am indeed trying to avoid surface veins, the corpus cavernosa that I am hoping to hit is itself a vein also, although filled with spongy material. So blood return should be no surprise, or even a positive sign to show the needle is in far enough. And I guess this is explains why there are no instructions anywhere to aspirate, and my old habits as a shot giver were interfering.

Richp14 said...
I thought 10 cc referred to 1/10 of one ML

CC=ML. They are the same amount. 1 cubic centimeter(cc)= 1 milliliter or 1/1000 of a liter. So 10 cc= 10 ml, or 0.1(1/10) ml=0.1(1/10) cc. Maybe you are thinking of units or U's, which are are also marked on the insulin syringes we use? 1 ml = 100 units, or 0.5 ml=50 units, or 0.1 ml/cc= 10 units.

Post Edited (BillyBob@388) : 4/18/2014 8:39:54 AM (GMT-6)

Dr. Mulhall has my husband applying pressure to the injection site for 5 minutes after injecting (same as 142 does). Dr. Mulhall has his patients who take daily aspirin apply pressure for 5 minutes, guys who don't take daily aspirin apply pressure for 3 minutes.

My husband recently went through a period where trimix was only working some of the time. He found that by increasing the amount of trimix he was using (from 8 units to 11 units) it started to work all of the time.

PeterDisAbelard. said...
Bill,

Do bear in mind that when we compare notes about the number of units we inject to get this or that result, not only do different men react differently but our doctors have prescribed different concentrations of the various drugs. If your trimix is the usual watery starter mix that most urologists prescribe for new guys (to make it unlikely that over-eager dose titration will land them in the ER) then my mix is a bit more than three times as strong as yours. Unless you compare the concentrations per ml from the labels on the vials first, comparing number of units is meaningless.

Very good point, Peter. And I have no way of knowing what the Doc prescribed ( I can ask but he called the scrip to the pharmacist I never saw it) as the pharmacist just mixed it in a vial that has no info about what's in it. I know with the epinephrine, it is in a bottle straight from the manufacturer, but this pharmacist pre-mixed vial has no details on it.

So I really have no idea what kind of mixture I have, other than I was told it was trimix. I will still start low, lower than what he told me at 0.2 ml, and see what works. But, I may call the pharmacist and get the details just for my general info.