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Need for Cialis or injections?

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Posted 6/13/2015 3:45 AM (GMT 0)
As documented in another thread, i had a "positive" echo stress test and my PCP, who is a Board Certified Cardiologist as well, took me off Cialis (and put me on Toprol XL, a beta blocker. Up to that point i have had no ED problems since RALP.
The other day, after having gone 5 days with no Cialis, i engaged in "doing the deed" and still had no problem at all. So does this mean i no longer need to be on Cialis (putting the heart issue aside), or is it still too soon to tell?

My Uro's NP, whom i called when this development occurred last week, said that being off Cialis for a few weeks wont hurt, but that they do like to keep patients on it longer term for a while, to promote blood flow. And she further said, that if i cannot go back on it in a few weeks or a month, they would suggest injections/Trimix, which i REALLY REALLY REALLY want nothing to do with, if i can avoid it.

So just curious if anyone has any thoughts on 1. being able to "do it" after 5 days with no ED Meds means I'm home free, and 2. is it really important to do the injections to keep blood flowing, 5 months after RP, if i am getting full erections at will, with no meds, 5 months post RP

Post Edited (Pratoman) : 6/12/2015 9:50:06 PM (GMT-6)

Posted 6/13/2015 4:12 AM (GMT 0)
If you want a knowledgeable and definitive answer I suggest that you consult with John Mulhall at MSKCC. He is the authority on what you need to do. I do not think that any uro has the knowledge and insight that he does.
Posted 6/13/2015 4:17 AM (GMT 0)
Bluebird, thanks. I thought Mulhall deals primarily with ED issues? Its not an issue for me, which is why i question whether i really need trimix if i cannot go back on Cialis.
I am seeing Dr Tewari for a 6 month follow up, next month, i think this topic will be on my agenda, as a first step. Maybe it leads to him getting me in to see Mullhall if its appropriate.
Posted 6/13/2015 9:34 AM (GMT 0)
Prato,

I thought the PDE5i protocol was merely to help with nerve recovery until such time when you can do it au naturel. However, as a protective measure since you are only 6 months post op, perhaps you are required to persist taking Cialis for longer to help with nocturnal erections!

Doing it, au naturel, helps with the spontaneity and it has a major psychological effect because you've got your mojo back! Enjoy, mate, enjoy!
.
Posted 6/13/2015 10:46 AM (GMT 0)
Prato, not being a medical expert, if it works without drugs, then enjoy! I've been drug free from the start, and it's great. I'm not sure what the problem is. I suppose I'd look at this way also: ED won't kill you. High BP will.
Posted 6/13/2015 12:17 PM (GMT 0)
Blood flow to Mr Pee Wee is blood flow... Getting it done without medication sounds like a better deal to me.
Posted 6/13/2015 2:36 PM (GMT 0)
Prato gotta agree with Steve! Your NP pretty well answered it for you!

Cheers, Doug
Posted 6/13/2015 2:47 PM (GMT 0)
The comments here all seem intuitively correct to me, and mirror what i am thinking... if it works, why do i need meds, because if it works, the blood flow is there already without the meds. @Doug...no,,, the NP didnt answer it for me, she confused me. She is saying that if i dont go back on the Cialis in a few weeks i should consider Trimix. Again, why do i need it. Maybe she is confused, which is why i will ask the Doc directly. Assuming its still working by then
Posted 6/13/2015 3:28 PM (GMT 0)
Prato, what I was referring to was the need for blood flow, which you were getting naturally. She wasn't listening to you, in my opinion.

Cheers, Doug
Posted 6/13/2015 3:42 PM (GMT 0)
Got it, yeah, thats what i was thinking, maybe she didnt hear me when i politely told her i was having no issues with function
Posted 6/13/2015 4:16 PM (GMT 0)

PSA3DOT7 said...
Prato,

I thought the PDE5i protocol was merely to help with nerve recovery until such time when you can do it au naturel. However, as a protective measure since you are only 6 months post op, perhaps you are required to persist taking Cialis for longer to help with nocturnal erections!

Doing it, au naturel, helps with the spontaneity and it has a major psychological effect because you've got your mojo back! Enjoy, mate, enjoy!
.

My thoughts exactly. The whole idea of a Cialis/Viagra rehab is the theory that it might cause some blood flow to Mr. Happy, even if you are not getting daily erections. To help keep things from deteriorating during the healing period.

If you are so spectacularly lucky as to be able to achieve an erection naturally(I can not even imagine) during the 1st few months of recovery, then by definition you have blood flow during that erection. So what is the need for Cialis or viagra from a rehab standpoint, if you are willing and able to get erections frequently by a more natural means?

The only caution is I have heard some guys recover pretty good during the 1st month or two and then lose it for some period of months. If that should happen, you might need to get back on one of the pills if safe to do so.
Posted 6/13/2015 4:34 PM (GMT 0)
Yeah, my one concern is that maybe I am still doing ok because of residual effects of the Cialis. It's been a week and I seem ok. No morning wood, usually, but I get wood when I need or want to. But I wonder if after a few more weeks of no Cialis, I might find I'm not doing so well after all.

I guess the only thing to do is wait. Maybe talk to the Cardiologist on Monday after my follow up to see if I can go back on, maybe even every other day
Posted 6/13/2015 7:33 PM (GMT 0)
Cialis half-life is 17.5 hours. According to my pharmacist daughter it takes 5 or 6 cycles to eliminate a drug from your body. So say (6 * 17.5) / 24 hours a day = 4.3 days. Double that and add a little just to be on the safe side and say at 10 days there isn't any Cialis left in your system.

So give a few more days or a week and you will know for sure if it's you or the drugs. On the flip side we gave it a try without a PDE5 about a week ago and it's very clear I still need it and feel very fortunate they are working OK for me.
Posted 6/14/2015 3:56 AM (GMT 0)
Pratoman – Here’s my understanding of penile rehabilitation: You need to have erections to keep the erectile tissue healthy while you wait for the nerves to heal. After surgery you almost always have to use medicine (pills or injections) to facilitate the erections. But in your enviable case you’re having erections without meds, so I see no need to continue the pills (or switch to Trimix) to help you get what you’re already getting!

IMHO I would be sure to get some form of “exercise” 2 to 3 times a week, under the “use it or lose it” policy, until you’re at least 1 year out; just to make sure everything stays healthy and to promote blood flow.
Posted 6/14/2015 4:21 AM (GMT 0)
Tigerfan , you echo my thoughts pretty much spot on.
With that said, Graytechs comments are very useful and Nicaea I don't really know for sure if I still need the MEDS, and won't know for another few days. I am on day 9 without Cialis. So we'll see
Posted 6/14/2015 5:45 AM (GMT 0)
Take that exercise supplement with all the amino acids. forget the name. Does the same thing…widens the vessels, which gives the athlete the pump. Its expensive, so i take 50mg of viagra to accomplish the same thing when I work out at the gym…not for the pump, but it dos give me staying power in my work out and its cheap because I get mine from Tonto…Kimo Sabe… Oh its Force Factor, the supplement. You should never " get to that" re. the injections…never
Posted 6/14/2015 6:30 PM (GMT 0)
Logos,what are you saying? Are you advising to stay away from injections at all costs?
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