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Posted 4/15/2007 12:26 AM (GMT 0)
Hi Tamu!

Well that's certainly good news for you and your wife. One question from us . . .how did you get past the initial fear of sticking that needle into your penis. Bob is still at the "afraid to stick" stage.

We've had company staying for the last 8 days, so now we are ready to try again, but I just know Bob will go back into the "fear mode" which hasn't resulted in a stick yet!

;o)
Posted 4/15/2007 3:23 AM (GMT 0)
lawink,

The injection that was done by the PA with the Caverjet did not really hurt so I knew that it was not going to be painful. I just decided to do it quickly and not think about it much. Actually I ended up poking myself twice as the syringe slipped out of my hand the first time. I do not know how to help Bob get past that initial fear but I can sure tell him that it is well worth it. Just the thought of having good normal sex is a big incentive. I was not really in fear of the injection as much as I was the penile pain that I had with the Caverjet. It was a great relief when I had no pain or aching whatsoever.

Bob, please give it a try. It will more then make your day.

Tamu
Posted 4/15/2007 11:13 PM (GMT 0)
If it helps any, it's only the initial insertion that has some pain for me. I get the needle in a little bit, then press the plunger to get the medicine in SLOWLY, and the needle goes the rest of the way in with the pressing of the plunger.
Posted 4/18/2007 3:47 AM (GMT 0)
Thanks EB; Tamu; Raheeb; Swimom & Mrscow

All of your suggestions have paid off and tonight Bob "bit the bullet" and managed to inject himself. Resulted in about 90% erection at .15 CC, so next time he's trying just under .20 which should do it.

90% was enough for first penetration in 7 months . . . yahooooo!

Now that he's done this once he says it wasn't "that bad", so I'm sure that from now on it'll be much easier.

Thanks again for the supportive and helpful suggestions.

;o) Linda & Bob yeah yeah
Posted 4/18/2007 4:40 AM (GMT 0)
Congratulations! Bob will be my inspiration when I finally get to self-inject next month. Good for him! Good for you.
Posted 4/18/2007 12:07 PM (GMT 0)

Linda & Bob,

Way to go Bob!!  The injections beat the pump by a long ways.  Sounds like your results were about the same as mind.  I know there were smiles all around.  Now that I have the injections I almost feel that I have accomplished all three outcomes; getting rid of the cancer, becoming continent and conquering the ED.  As my wife says the only thing missing now is the spontaniety which hopefully will return one day.

Tamu

Posted 4/23/2007 3:47 AM (GMT 0)
Today I did my second injection with Bimix. I increased the dosage from .20 cc's to .25 cc's. I also switched sides of my penis. I am right handed and found that doing it left handed was awkward but I got it done. Results were good as I achieved a very firm and rigid erection which I would call equal to or better then those I had before surgery. Again no pain at all and the erection topped out at about one hour after the injection and slowly went away over the next hour and a half. The sex was super!! I believe that I now have the right dosage and look forward to enjoying all the aspects of life.

Tamu
Posted 4/25/2007 1:12 PM (GMT 0)
Had a frustrating night with the injections last night. 9 cc did nothing to speak of (a little fullness and soreness), whereas twice previously it worked fine. Wasn't sure if I should try a second injection of a few more cc. Had to get out the vacuum pump, which was kind of painful after the injection. I've been told to only use injections every other day at most, so, gotta wait a couple of days to try again.

Man, this stuff is not getting easier...
Posted 4/25/2007 1:20 PM (GMT 0)
Raheeb,

Do not get discouraged. Keep at it. I did not mention that when I inject myself with the Bimix that I do not immediately get an erection. It takes stimulation to work the medication into the whole penis and foreplay to get it totally erect and firm. Once it gets firm and erect though it stays that way until the medication begins to wear off. Of course, I have only done it twice and maybe next time I may have difficulty.

Tamu
Posted 4/25/2007 5:33 PM (GMT 0)
Hi Raheeb

We are up around the .17cc range at this point. The doctor said to gradually increase, but not to go over .50, so there's lots of area to experiment in between.

I think the "weirdest" thing is having an erection long after sex is done. . . . been years since Bob has had to try and function with that as a distraction. Certainly does away with the occasional "quickie" before you go out somewhere. . . . hey maybe THIS part should be in our humor post.

;o) Bob & Linda
Posted 4/26/2007 2:37 AM (GMT 0)
The long term erection is an issue. My wife and I have to be sure that the kids are not going to drop in and we do not plan on going anywhere. The quality is so good though that it is well worth the planning. I am still looking forward to getting normal erections back and the spontaneity that come with that. Someone mentioned that injections could jump start normal erections. I certainly hope that is the case.

Tamu
Posted 4/27/2007 4:54 PM (GMT 0)

Had surgery 4/3, ok so first I just wanted to wake up, this being my first surgery at 54, no pain, good, home with JP drain, OK, but kept on going up, had cath out after 10days, great, JP drain still going up, found out it was not urine in JP drain, great....ok...still have JP drain...pain taking 1/2 tablet of viagra everyday, not thinking anything about it, and then last night, is the first time I got depressed...hey i got a bag (JP) on the side of my leg, two little kids tryin to get to do homework and go to sleep, started work this week, a little anxious...watched ****o, yeech, who are these guys, isnt there any normal guys in these things? and nothing's happening...hey i have not thought about it much, I dont know.....but here are my questions...1) does it ever come back with Viagra after a month, 2) does it just happen 3) When is the best time to take, I usually liked my sex first thing in the morning, should I wake up at 5pm and take it then, or take it in the evening 4) How long should I give it before I go into panic mode 5) should I just say, enough get the injections....if you have any answers to one or the above, please email...oh yeh, cancer was less than 5% of total prostate...I would imagine that any of the thousands who die from this cancer, would love to have these problems...thats what I keep telling myself...great to be a babyboomer.                  

Posted 4/27/2007 5:45 PM (GMT 0)
Sirius07,

Hey, I have been there and know what you are dealing with except for the JP drain which I do not understand. As to Viagra impact for men that have had a prostatectomy the statistics show that it produces erections with the first use post op in only about 30% of the cases. My urologist placed me on a penile rehabilitation plan after surgery. The plan included taking 25 mg of Viagra on the third week anniversary day of surgery for six days and do not try and have any sexual stimulation. On the 7th day take 100 mgs and sexually stimulate. I did this for four weeks and never really got much of anything. I then went to a combination of Viagra and the vacuum pump. This produce an erection good enough for penetration but it lack a lot in quality esepcially for my wife. After trying this for about a month I finally had enough and my motivation to try the injections became very high. I made an appointment with my urologist's PA and he injected me with Caverjet. This did produce about an 80% erection but I had a lot of aching and pain with it. This killed my motivation for about a month. The PA then prescribed Bimix which does not have any Caverjet in it. I tried this about three weeks ago and it worked liked a charm. No aching, no pain and very firm and solid erection and great sex. You have to get past the fear of the injection into the penis. The syringe used is an insulin syringe with a very small needle. It is just a pin prick.

As to the Viagra it works best on an empty stomach(At least two hours after you have eaten), alcohol depresses the effect and it takes about an hour after you take it for the full effect. I can tell when it has hit because it causes me to have flushing in my face. Even though it may not provide you with an erection it is good to take it to increase the blood flow to the penis. Most men after surgery are taking one of the ED pills for this reason. I took it daily for two months and then was told by my urologist's PA that I could stop taking it daily. I still take 100 mgs about two or three times a week just to make sure that the blood flow is good. I am almost six months post op and the Viagra has more of an impact now as I get about a 50% erection with it and sexual stimulation.

Does it ever come back? Yes, it does. A few lucky men have it come back immediately. A few get it with one of the ED pills. The others have to intervene with vacuum pumps or injections until ti comes back later. It has been mentioned here that when the nerves are traumasized by the surgery it takes them at least 8 months to heal.

Hope this helps some. You have accomplished the main goal that is getting rid of the cancer. I hope your incontinence does not last long and perhaps you are doing well in that area. The ED will probably be the last thing to go away.

Good Luck!

Tamu
Posted 4/27/2007 8:26 PM (GMT 0)

Tamu,

Thanks, Questions. You are saying that you did not take Viagra till the 3rd week, and were told not to stimulate yourself? Why. What is Caverjet and Bimix and does this needle thing always work?

Posted 4/27/2007 10:12 PM (GMT 0)
Well, tried again last night, .9 cc.  No erection.  I am wondering if my medicine went bad.  Twice I was able to get erections that lasted a couple of hours without stimulation, one of those times with only .7 cc.  The last two times I used .9 cc and used stimulation for quite awhile (the second time with 150 mg Viagra), and nothing.

Most frustrating thing is to try again, I have to wait 48 hours.  And if I need a new batch, assuming this batch is bad, I will have to wait another 48 hours.

Posted 4/27/2007 11:00 PM (GMT 0)
sirius07,

To tell you the truth I do not know why the instruction was not to stimulate yourself. The day we left the hospital they came in and gave us all kinds of information and papers and I was just ready to go so I did not get into the details. I think the three weeks was to just be sure that any swelling was complelely gone. There are three medications for penile injections. Caverjet is the trade name for one of the medications. Bimix is a combination of the other two. Trimix is a combination of all three. Here is a web site that gives you more information.

http://www.ustoo.com/PDFs/Injection.pdf

Well, the needle thing is suppose to always work but Raheeb's recent experience indicates that it does not. It has always worked for me but that has been only three times. Another post I read somewhere a guy had used it 39 times and it worked everytime. My urologist told me that he never has had anyone that has tried it where it did not work. Caverjet is usually the first one tried because it has less of a side effect of priapism(an erection lasting more then 4 hours and causing pain) and/or Peyronies(which is curvature of the penis from the erection). It does have a higher degree of associated penile aching and pain then the other two or the combinations. Trimix is used first in many cases because it seems to have a higher effectiveness. Bimix is used if the Caverjet medication is causing aching and pain as I had.

You have to be motivated to go the injection route and it sounds like you may be getting there. Talk to your urologist about it but you may be jumping the gun some being only a few weeks past surgery. There is still a lot of healing to take place and there have been guys that have gotten their erections back during that healing phase. I would give it another couple of months before proceeding beyond the Viagra and see where you are at but it is your call and I do not think that the injections will hurt anything.

Tamu
Posted 4/28/2007 1:05 AM (GMT 0)

Hey, im not ready for the injections, like i said i still have this jp drain (Lymph fluids, who knows) I am completely dry from day 1, new technique by dr. tewari, other patients the same, i was just getting ahead of myself and expecting miracles...but i more question, from what you know should the injections then help with natural erections? nono

Posted 4/28/2007 1:50 AM (GMT 0)
My medicine may have gone bad. I traveled by plane for 4 hours with it on ice packs, and I'm staying in New Orleans. . I am wondering if the electricity in my room went out and the hotel fridge stopped working, or the flight killed it. I will give it one more yet tomorrow before requesting a refill.
Posted 4/28/2007 2:19 AM (GMT 0)
sirius07,

I cannot say that I have heard anyone declare that erections from injections will help the return of natural erections but I have heard and read several times that until the natural erections return you need to keep the penis in shape for when that occurs. The nocturnal erections that all men before surgery had was nature's way of keeping the penis exercised. Without this natural exercising then we have to intervene with assisted exercising either by ED pills, vacuum pumps or injections. Not doing this can result in the soft tissue of the penis atrophying.

Being dry from day one of removal of the catheter is a great outcome that many men on this forum, including me, wish were our experiences. If you know details about Tewari's technique please share it. There has been mentioned similar results from Menon's patients and we know the two of them worked together for a while.

I understand where you are coming from. It is better to get ahead then wondering if you have missed something along the way. I am not trying to sell injections to anyone just sharing my experience.

Tamu
Posted 4/28/2007 6:03 PM (GMT 0)
I took my first injection yesterday.  The result was minimal erection (low dose), but significant penile pain for almost 2 1/2 hours.  I will not use the trimix solution again due to the pain involved.  I will request bimix and try again.  I am using the BD syringes and the Auto-injector.  I use the auto-injector because it is large enough to easily maintain contol of the syringe while slowly injecting the solution.  It also would eliminate any hesitation for those who are the least hesitant about injecting themselves, all you do is position it over the injection site, then push the release button.  It works equally well right or left handed so the minimum fine motor control in my left hand is no issue(I am right-handed). 
Posted 4/29/2007 5:35 AM (GMT 0)
Bravo for the details. Very helpful and much more discriptive than the doc has provided so far. Cialis, etc have no effect so I was given an Rx for the TriMix. I'd like to know what depth is the needle typically inserted and is the needle placed at 90 degrees to the penis or at a different angle? 
Posted 4/29/2007 2:06 PM (GMT 0)
Bjay,

The needle is about a half inch long and I insert it most of the way. I am using Bimix. The injection is given at approximately the 3:00 or 9:00 o'clock positions depending on which side of the penis you are injecting. It is given at a 90 degree angle and you avoid any visible veins. You switch sides each time. You can give it anywhere along the shaft from the base of the penis up to the head. I have been injecting from the base up to about midway. I am not using the auto-injector but I have gotten over the initial difficulty and now inject myself without even thinking about it. You do not have to be that particular about the injection you just do not want to inject on top or the bottom or angle it toward those two areas. I have found in my four injections so far that the effect is the same no matter where I have injected myself. I am fine tuning the dosage amount now but it is very close. My last erection was very firm without any pain. In my case the erection is peaking out at about 35 to 45 minutes after injection and then it takes up to two hours for it to go completely flacid.

Tamu
Posted 4/29/2007 5:55 PM (GMT 0)
Tamu,

THanks. Apologies for the profile...was posting for my wife on Crohn's. My profile should show this time. I'm about to embark on the injection route with Rx in hand...vacuum seems too "mechanical', so have not tried it... I'll post my experiences when I get there.
Posted 5/2/2007 4:50 AM (GMT 0)
Raheeb,

I picked up my first Rx of Alprostadil, a generic of the TriMix, today. The pharmacist cautioned me very strongly about not letting the solution get warm since it degrades in a relatively short time out of refrigeration… to fill the syringe at the refrigerator( not at bedside ) ... but to let the medication warm in the syringe before injecting.

Get this – at the pharmacy the medication was frozen and put inside a container surrounded by ice. Here in Florida the present daytime temperature is running in the low nineties, so that may have something to do with the extra precaution.

Raheeb, this brought to mind your difficulty with not having the same dose work after having ‘done it’s job’ the first couple times. Seems possible the trimix went bad due to the temperature.

Oh, oh… Now I’m confused… found this on http://www.peacehealth.org/kbase/multum/d01387a1.htm and on another website for Edex brand…exact same instructions.

- Store alprostadil injectable at room temperature. The 40 microgram strength of unmixed alprostadil can be stored at room temperature for up to 3 months, or until the expiration date on the label, whichever happens first.
- Do not expose alprostadil products to freezing or very hot temperatures. Do not store your medication in a closed automobile, or pack it into luggage that will be placed into a cargo area during travel.

I do not understand what the above means concerning the 40 mg 'unmixed'. Mine is pre-mixed - just draw out the amount in the syringe.

What's the concensus - refrigerate or room temperature?
Posted 5/2/2007 6:32 AM (GMT 0)
A couple of comments:

- I am using prostaglandin, not trimix (and not bimix or Caverject).

- I did use it successfully last night. Another 3 hour erection from using .7 cc. Will probably reduce to .5 cc next time.

- I think the problem before was either that I had had a few drinks and/or anxiety.

- My understanding is that Caverject (unmixed prostaglandin in powder form) can be kept at room temperature, while mixed prostaglandin must be refrigerated.
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