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Bimix: well, that was a let down!

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Posted 6/14/2014 3:04 PM (GMT 0)
This is such a minor topic compared to so many here. Not to mention threads such as "It could be worse" which we are dealing with personally with a young family member.

Still, it is something that many here deal with sooner or later. So I will post again about it. I got my Trimix roughly 1 1/2 or 2 months ago, and have experimented with it on and off, at 1st strictly for rehab, then for some fun attempts. Recommended dose(and really do not know what the exact mixture is) of 0.2 ml. ( 20 units? I'm not used to thinking in units). Fear of Priapism(SP?) led me to start with < than 1/2 dose, can't remember right now but something like .05 ml maybe, or maybe even lower. I was pretty pleased with the response from a rehab view and thought this is going to work pretty good, fairly firm, obviously getting some good blood flow though not usable, and with plenty of ache. Kept working the dose up, always lots of ache but not quite usable- but almost. And had some blood return every time with the .5 ml capacity 31 g, shorter than 1/2" ( I think it was 5/16ths? I've used them all and discarded the package so can't go look), always to the hub and usually very slightly beyond with a slight dimple in the skin. My new needles(have not tried yet) are 1 ml, 30g, 1/2".

Got up to .15 or .18 and lost it all when laying down, but actually managed to get er done(just barely firm enough) standing up. So next time I got up to the full dose of .2 ml thinking this would really do it, but nope. Not even as good as the lower doses, could not get er done no way, but of course a lot of ache for an hour or more! Dang!

So while I am getting ready to up the dose past the recommended start of .2 ml, my pharmacy guys mix me up some Bimix at my request to decrease pain. ( don't know the exact mix) This time I take a cooler with me and place it right in there for the hour drive home! Recommended starting dose 0.5 ml! This fills up the last of my 1/2 cc syringes to the max. I not only get blood at the 1st stick to the hub, but I aspirate twice more during the injection and get blood every time, injects pretty easy.

The good news: no ache at all! Yay! The bad news: no erection at all!(no pain no gain? LOL!) There was some minimal response, some puffiness, but not even a feeling of some good blood flow for rehab purposes, not even standing up or sitting. I got a much better response with my 1st super low dose Trimix. WTH?

Assuming the same relative strength mixtures, and assuming both Trimix and Bimix vials some sort of safe starter doses, could there be that much difference in Trimix and Bimix? Am I doing something wrong? I can't imagine what, what with: to the hub+, blood return and easy to inject. Could it be a bad vial? ( I'll call them Monday. or maybe today) Who knows? But very frustrating. I have read of such grand results from many people. It is a bummer to stick yourself there for nothing, not even some decent rehab circulation. ( again, definitely minor stuff in the scheme of things)

Plus I guess I will finally break down and go with JamesC's pump and stick method, looks like I am going to need it! ( JamesC, don't you use Bimix?)

Closing on a positive note: zero Priapism!

Any thoughts?

Old "Needs a lift" Bill
Posted 6/14/2014 4:12 PM (GMT 0)
Thanks for mentioning me...lol First, it is much too early to get discouraged, it was your first try, after all. Try it a few times, before abandoning it. I realize the pump and prick method takes a little more work, but it may be the thing to do to make sure you maximize the chances of success. If you don't have a pump or rings, you can copy the effect almost as much with the milking of blood into the penis for a few minutes and a tight grip of the base during the absorption phase, hard to do with just 2 hands, one for gripping and one for injecting, maybe got a friend to help lend a hand? :)The thing to do is be consistent, don't give up and use every tool that is available to you. Remember, just pump enough to fluff it up, maybe 25-30 % of full erection, inject and wait 3 to 5 minutes before allowing the blood to escape the penis and gently, without squeezing massage the penis to maximum effect. Good luck.....
Posted 6/14/2014 4:19 PM (GMT 0)
Bill,
Yes, bimix won't always work when trimix does. It's missing the key ingredient alprostadil, which causes the ache, and the other two ingredient just aren't as powerful. Some pharmacies make up a "quadmix" that reduces the percent of alprostadil and adds a fourth ingredient, forskolin. It's all an attempt to reduce the ache associated with pure alprostadil (available as Caverject). There's also Muse pellets, but I haven't heard anyone say that it's as good as trimix for them.

It doesn't sound like priapism is really a big concern for you right now. If you are worried, you can ask your doctor for an Rx for an EpiPen. You inject it anywhere (not in the penis) and it brings it right down. It's a small dose of epinephrine.

- Allen
Posted 6/14/2014 7:43 PM (GMT 0)
Thx guys. James, it looks like the pump and stick is my next option. Wonder if I should try it with the same dose- 0.5 ml- of Bimix that failed so spectacularly the other night- or go back to maybe .2 ml of Trimix?

Allen, believe it or not my pharmacist gave me an ampule of epinephrine and said a dose of .3 ml IC would take care of it. I wish he gave me phenylephrine(sp?)/neosynephrine which is the 1st line drug the ER gives, but actually the Epi is more effective, if more dangerous. ( I have given plenty of both during resuscitation, but never IC!) Still, I had wondered if just giving it as a regular sub-cutaneous shot would also work, and sounds like it will.

But here is a good article on intra-cavernosal injection of epinephrine(they gave larger volumes of diluted epi):
http://www.nature.com/ijir/journal/v12/n6/pdf/3900539a.pdf
Posted 6/15/2014 1:59 AM (GMT 0)
So while I am getting ready to up the dose past the recommended start of .2 ml, my pharmacy guys mix me up some Bimix at my request to decrease pain. ( don't know the exact mix) This time I take a cooler with me and place it right in there for the hour drive home! Recommended starting dose 0.5 ml! This fills up the last of my 1/2 cc syringes to the max. I not only get blood at the 1st stick to the hub, but I aspirate twice more during the injection and get blood every time, injects pretty easy.

Any thoughts?

Old "Needs a lift" Bill

Hi Bill...
Sorry your first try with bimix was not successful. I quoted the paragraph where you discussed aspirating blood during injection, because I DO NOT think that is the right way to do it. For years now, the only time I had less than ideal results was when I drew blood accidently. The injection belongs in the cavernosal passage, so should bleed very little or not at all. I also think you should inject midway at either the two oclock or 10 oclock position. I hope for some feedback from others on this statement.

Good luck and keep on trying.
Posted 6/15/2014 2:38 AM (GMT 0)
Two things here:

1) Are you sure you are injecting into the right place? I share the concern that lifeguyd mentions above.

2) Failing to get erections can be stressful. Stress causes your body to release adrenaline. Adrenaline is a powerful anti-erection chemical. Try to be as relaxed as possible before/during injection and intimacy. (Perhaps a glass of wine beforehand?) Dr. Mulhall's book (linked below) covers this topic quite thoroughly.

-Gedman
Posted 6/15/2014 4:13 AM (GMT 0)
Lifeguy and Gedman, thx for the comments and you may both have good points and be on to something.

I have seen it recommended both ways as far as blood. On the one hand, isn't the Corpus Cavernosa basically a big vein, though a slightly different one in that it is filled with spongy material?

Here is one def from Medterms:
Corpora cavernosa: Two chambers that run the length of the penis and are filled with spongy tissue. Blood flows in and fills the open spaces in this spongy tissue to create an erection. And from Wiki: " These formations are made of a sponge-like tissue containing irregular blood-filled spaces ".

So, assuming I have avoided, and am deep enough, to be past the surface veins, I would expect blood to be a sign that I am in the C.C..

On the other hand: LG's only poor experience being only when he drew blood gives me pause. Plus, I have considered that while I am trying to aspirate blood, I could be pulling out of the right spot. And lastly, I have not seen any directions for injection saying to aspirate blood. So, maybe I should indeed stop doing this?

And then there is adrenalin. I'm not really aware of any anxiety except maybe a twinge right before thew needle stick. But, I had actually already been thinking about that pre-shot drink, so maybe I should go ahead and do that!
Posted 6/15/2014 4:26 AM (GMT 0)
Good luck on that path, Billy. Time to listen closely to the experienced men with this, they know the ropes, and each guy will react differently to its use and implementation. Hopefully, you will find the right combo and dose that will do the trick for you.

Hope it gets straightened out for you, and soon.

D.
Posted 6/15/2014 8:24 PM (GMT 0)
Hey BillyBob

We talked about aspirating blood from the CC before, and I did a little research on that. While in most cases, you will see some blood, it is a spongy structure, thus may have holes in it that are (temporarily) bloodless, so I think that trying to determine if you are in the correct spot by aspirating blood, is not really viable.

Second, if you remember, we discussed needle length. I started with 1/2 in 29 ga syringes, and had some failures (no erection) that I'm sure were because I missed the CC. I've since switched to a 5/16, 31 ga. syringe, pushed in right to the hub, and (although I've only had a few tries in this limited time), I've had 100% success. My opinion is that, unless yo have an extremely thick member, in a flaccid or even semi-flaccid state, the 1/2 syringe stands a much better chance of hitting the wrong target. Doing some size measurements on typical structure photos, I estimated that the distance between the CC and the outer skin is about 3/16", and this should be about constant regardless of member size or erection status. So, a 5/16 syringe when fully pushed against the outer skin, should protrude about 1/8" into the CC pretty reliably. So far, my results agree. With the 1/2" syringes, I had about a 1/3 failure rate but I haven't had a lot of tries with the 5/16 yet.

Third, keep in mind, we all can have differing responses to the same stimuli at varying times. I've had the exact same injection result in a both a great and a mediocre experience. No matter how damaged your system is, there is probably still some part of it that responds to the brain signals, and the signal level from the brain will still have a significant effect on the quality of your erection.

Lastly, anxiety can have a significant effect. Like Gedman said, it can raise adrenaline as well as cortisol levels which are known erection killers.

JimO
Posted 6/15/2014 8:50 PM (GMT 0)
Dang, Jim, I just used the last of my 1/2 cc, 31g syringes and replaced with 30g, 1/2" syringes! smhair One reason I did this is that the Bimix called for a starting dose of 1/2 ml which maxed out my syringes, and next that expert Dr. Mulhall recommended 1/2" needles(and fatter needles also, maybe 29g?) I have not used them yet, but when I do I guess maybe I should try to avoid going in all the way.

And I guess I'll blow off trying to aspirate blood(an old habit hard to break due to my profession) since seems no one else is doing that. It's great to hear about your 100% success lately, fantastic! Even if on not that many times so far. I forget, are you using Trimix? How much? What kind of usable time are you getting?

Also, I really think next try for me is going to be with the pump, which should give me a little more room for error with the CC being already expanded a bit.

I'm going to talk to my pharmacist about a stronger Bimix solution. My gut feeling still is that I did not miss with that injection, and I was already using .5 ml(50 units?). I guess I can increase it, but that is already a lot of volume. I hate for it to not work, because it was great to not have that pain. But if I have to go back to achey breaky junior, I will.
Posted 6/15/2014 11:57 PM (GMT 0)
I started to become a bit apprehensive slamming the needle in all the way, and trying to go in slow hurts more, so the smaller (and thinner) needle seems to work a lot better, but I still need more data.

The pain is due to the PGE1, which the Bimix eliminates. If you have a real friendly doc and pharmacist, you should be able to work out a dose that works, maybe with less PGE1.

I was real worried about the pain aspect, because I tried the Trimix gel, and, while it worked relatively well, I got an ache that near took all the fun out of it. However, I get little to no ache using the trimix injection, but I'm using a pretty low dose (about 2 mcg of PGE-1). The Trimix gel was 2000 mcg.

The 2 mcg (starting) dose seems to be more than needed. I'm getting usable time in excess of 1.5 hrs, and it is taking close to 3 hrs to subside completely, so I'm starting to cut the dose. Seems it's hard to get complete accurate data, since each time is a little different depending on circumstances. Used 2 mcg the other night and was withering within about 40 min, but I was also nursing some back pain from an old injury.

Hang in there tho, I'm sure you'll be able to get something that works, but it may take a bit of experimentation on your end. Hopefully your pharmacist will help with that....... A mix with less PGE-1 might be the way to go.

JimO
Posted 6/16/2014 3:53 AM (GMT 0)
BillyBob,

Why don't you come on over to FrankTalk and continue this thread.
There are more stickers there that might be able to help.

Plus I can send you a PM while on over there and I have some info for you.

J
Posted 6/16/2014 4:27 AM (GMT 0)
Most of my husband's injections are successful - occasionally they are not. It took a long time to find the perfect amount of trimix to use - 11 units. If he goes below this he is not consistently successful. My husband injects at the 10:00 and 2:00 positions. He recently remarked that the key to success is injecting at a 45 degree angle. When he injects at the wrong angle the injection fails. He uses 29g needles, per Mulhall's instructions. He never experimented with needle gauges - just used what was prescribed.

Although even low amounts of trimix initially were uncomfortable, at this point trimix is not painful.
Posted 6/16/2014 1:20 PM (GMT 0)

JStars said...
BillyBob,

Why don't you come on over to FrankTalk and continue this thread.
There are more stickers there that might be able to help.

Plus I can send you a PM while on over there and I have some info for you.

J

I will try to do that latter today, I have been meaning to post over there. Tried last night with a slightly increased dose of bimix from .5 ml to .6 ml and pumped up 1st with ring on. It made the injection easier to miss surface veins and just over all easier, but made no dif in effect. Which is to say no pain but also no usable effect, not even as much a I had with my very small 1st test doses of Trimix.

How does the scale work? Is it a 6 which is barely usable for penetration, and 9 or 10 is rock hard? And I suppose flacid is zero? If so, then one time I got briefly to a 6 with maybe .16 or .18 ml(I'm starting to lose track of the specifics, guess I should have wrote it down) of Trimix. Maybe 4 or 5s with the lower doses, but not even quite a 6 when going up to .2 ml.

With Bimix .5 ml, and last night .6 ml injected slightly pumped up with a ring left on for several minutes, maybe a 2 or possibly 3. IOW, puffed up a little ( it was pinker 2nd time) but totally useless. ( the ring did cause me to bleed a bit after injection, not surprising)
Posted 6/16/2014 1:22 PM (GMT 0)

bluebird123 said...
Most of my husband's injections are successful - occasionally they are not. It took a long time to find the perfect amount of trimix to use - 11 units. If he goes below this he is not consistently successful. My husband injects at the 10:00 and 2:00 positions. He recently remarked that the key to success is injecting at a 45 degree angle. When he injects at the wrong angle the injection fails. He uses 29g needles, per Mulhall's instructions. He never experimented with needle gauges - just used what was prescribed.

Although even low amounts of trimix initially were uncomfortable, at this point trimix is not painful.

Thx Bluebird, good to hear that about the decreasing ppain because looks like I am going back to Trimix. 45* angle, eh?
Posted 6/16/2014 3:18 PM (GMT 0)
Hi BlueBird

I'm trying to get a good handle on the dosages. You say your hubby is using 11 units. If you don't mind sharing, I'd like to know what the concentration of the PGE-1 and other chemicals is. Best way would be to copy the prescription right from the bottle.

FYI (and also BillyBob) -- units are an arbitrary measurement. Usually a 1.0 ml syringe is calibrated in units 0 to 100. So, 11 units is 11/100 of a ml. Typical PGE-1 concentration is given in mcg/ml. So, if your husbands script is 2.0 mcg/ml, he is using .22mcg per injection (.11 times 2.0).

However, the above only applies for 0-100 units in a 1.0 ml syringe. Unfortunately, to make it complicated for all of us, the number of units in a syringe can be 100 or any other number, so 11 units is only meaningful if you know the size and calibration of the syringe and concentration of the chemical. Whew! Hope that was clear!

When you say he injects at 45 degrees, do you mean 45 degree along the long axis. The needle gauge is not that important except for pain. Thinner needles (I'm currently using 31 ga.) cause less pain, but the downside is they also to bend or break easier.

JimO
Posted 6/16/2014 3:24 PM (GMT 0)
BillyBob

A thought - if BlueBird's husband is injecting at 45 degrees from the long axis for consistent success, that kinda agrees with my thought that the 1/2 syringes are too long.

JimO
Posted 6/16/2014 4:10 PM (GMT 0)
JimO,

papaverine 30mg
phentolamine 1mg
prostoglandin 10 mcg/ml

The packages that the syringes came in has a label which reads:

needle/syringe 29G x 0.5 ML (BD) Units

The actual syringe says on it BD U-100 Insulin. 0.5 mL/cc. The numerical markings on the body of the syringe go up to 50. I just called the compounding laboratory where my husband gets the trimix and syringes and the woman I spoke with said that the needles are 1/2 inch. When my husband was instructed in injection technique Mulhall's nurse called the prescription for the trimix and syringes to the pharmacy that they use. We never analyzed or thought about the needle size or trimix ingredients. My husband just followed instructions.

Bill,

Level 6 erection is described in Mulhall's literature as "Erection just firm enough for penetration". When my husband was instructed in injection technique Mulhall' nurse showed him how to tell if an erection was a level 6 (I was there). If you place your open hand with the palm facing your member and lightly press, if your member does not buckle you are at a level 6 (or above). Below a level 6 your member would buckle. Level 10 is described as "100% response".
Posted 6/16/2014 6:02 PM (GMT 0)
Thanks Bluebird

Those are the typical numbers. with 11 units, your husband is getting 1.1 mcg per injection (.11 x 10mcg/ml). He might be more comfortable and have more success with a shorter needle.

JimO
Posted 6/16/2014 6:43 PM (GMT 0)
BillyBob,
Was going to suggest that you had missed with the bimix but after your second attempt failed with a pretty hefty dose that seems less likely. Was also going to recommend putting or leaving a ring on after the injection in case venous leak is taking blood away as fast as it is coming in but it seems you have done that, briefly at least. Other than tinkering with prescription strengths and verifying your injection technique is sound I don't know what else to suggest.

I am fortunate to get long lasting erections from 5 to 10 units of either bimix or relatively weak trimix and little to no ache, so I go with trimix. I started with 29 gauge, 1/2 inch needles but switched to 31 gauge, 5/16ths, pushed in to hilt with a dimple. My thinking was you couldn't go too deep with 5/16ths and the thinner gauge equals less pain from the stick. I inject perpendicular to the long axis and the circumference. I don't check for blood aspiration and have never been instructed to do so. I occasionally have a miss caused I believe, by not being perpendicular and missing the cavernosa or perhaps bending a needle. Depending how badly I want an erection I have gone to the other side and tried again (successfully), definitely a no-no according to the medico's. BUT I emphasize it was clear that the 5-10 units that provides me with a proven response had gone astray, I'm certainly not recommending you double up doses. I often put a ring on for awhile for the main event - it gives me more girth and a fuller glans, which is often lacking even though the shaft is rigid, particularly while on hormone therapy (ADT).

Not sure that any of this is helpful to you, everyone responds differently, but that is my experience with several years with injections.

Not
Posted 6/16/2014 9:53 PM (GMT 0)
Biker

Thanks for the input. I think you are correct that BillyBob may need to tinker with the prescription makeup to get something that works. I did quite a bit of research on this before settling on a combination that seems to work for me. Unfortunately, in my haste to get something working (after 1.5 years of suffering) I didn't really do my usual categorizing and saving of my results, but I'm trying to resurrect some of the research to help Billy.

I'm glad to hear you agree with the 5/16 needle length and 31 ga. As you say, pushed to the hilt with a dimple, and you're still pretty certain to be in the CC. as long as you're not on an angle.

Regarding the "double dose", one of the "Male Clinics" was giving an OK on that, provided there was no response to the first shot. I would think that since the volume is so small, if you miss the target and the shot gets into the system, it would have little effect. I had a couple misses like that with 1/2" syringes. One I think went into the CS and cause a little bleeding at the glans. Freaked me out at first, but it was really only a small amount and stopped within about a minute.

If you care to share, how long are you lasting on what dose?

Jim
Posted 6/17/2014 12:00 AM (GMT 0)
I planned to call the pharmacist today and see if there is a much stronger dose of the Bimix, so that I won't have to be using over 1 ml of it, plus to see how much I can move up from .2 ml on the Trimix. But I didn't get it done, I had my appointment for electro-stim + bio-feedback for incontinence, plus went to visit our daughter-in-law who is seriously ill. That last is all any of us can think of at the moment. So I didn't get it done but maybe tomorrow.

Because I really don't think I missed on either of, or certainly not the 2nd, Bimix dose. My feeling is it is just way too weak for me. But hard to really know for sure. There are too many folks at the house (sleep overs) during this illness to give me the privacy to test as often as I would like. So I doubt I will try going back to the Trimix tonight with a bit over .2 ml just to see if things work better with that. But it is on the agenda.

And both of those times with the Bimix, I did think about going back for a 2nd shot after I gave it a good 15-30 minutes and it obviously wasn't going to work. But that is going to get expensive. That ampule of 10 X .5 ml doses cost as much as my Trimix 25 X .2 ml doses. If I have to end up using, say, 1 ml of the Bimix then I would be down to 5 doses at the same cost as 25 Trimix. Whew! That's a big difference! Unless I can get 5 ml a much stronger Bimix mixture at about the same price as 5 ml of Trimix.
Posted 6/17/2014 12:32 AM (GMT 0)
Hi Billy

Sorry bout the Daughter-in-law.

Note on the cost. Very surprising. I did some research on purchasing the chemicals and found that the PGE-1 is really the expensive one. I was getting prices in the area of several hundred $ per mg. The Papa and Pav were much cheaper.

JimO
Posted 6/17/2014 12:44 AM (GMT 0)

*JimO* said...
Hi Billy

Sorry bout the Daughter-in-law.

Note on the cost. Very surprising. I did some research on purchasing the chemicals and found that the PGE-1 is really the expensive one. I was getting prices in the area of several hundred $ per mg. The Papa and Pav were much cheaper.

JimO

Well that is surprising, and I will discuss that with them also. It seems that they are charging me about the same amount for a 5 ml bottle of either Trimix or Bimix. Except, the Bimix only had 10 doses(if it worked at the .5 ml dose) compared to the 25 doses of Trimix(if it worked at .2 ml) Maybe they are just taking a chance to make a much bigger profit after cost on the Bimix?
Posted 6/17/2014 3:29 AM (GMT 0)
Jim,

My trimix is 5.9 micro gram/ml Alpros, 17.6mg/ml Papaverine, 0.6 mg/ml Phentalomine. The bimix sample I tried is long gone and I can't recall the formulation. My first injection in the doc'c office was 5 units. It produced an erection that appeared to be fading within half an hour but then came back stronger on the drive home. At the 2 1/2 hour mark I took two Sudafed and wondered if I had priapism but it subsided soon after.

I continued with 5 unit doses and regularly had erections lasting 4 hours or more but a bit of research on priapism revealed that it is very rare, usually accompanied by sickle cell anemia and the penis is rock hard, cold and painful. None of those applied to me so I became less concerned about the long duration. Early on I didn't have a partner and on ADT I often couldn't be bothered to go solo, just slept it off and considered it therapy. Later my new partner and I made good use of those 4 hour woodies. I now use 10 or sometimes 12 units and the duration has dropped to 3 hours or less and will fade and recover a bit during that time with stimulation.

Hope this helps.
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