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Thread: What I Need to Know About ED

  1. #231
    When it comes to injections there are a few critical things that are often not stressed.

    1. Be aware that both bimix and trimix contain drugs are known to cause fibrosis or plaque (scar tissue). Some men get away with injections for years without this side-effect others develop signs of scaring within weeks. Keep in mind, this is NOT scaring from the fine needle, The primary source is the drug.

    2. ALWAYS use direct pressure over the injection site for at least 10 minutes to prevent any bleeding. It is not a drop of blood coming to the surface of the skin that you are concerned with. It is bleeding under the skin in the tunica. Whole blood is known to cause scar tissue such as adhesions after surgery. In addition to the drug, the blood can cause the start of scaring.

    It is important to understand that those with nerve damage or trauma are more susceptible to Peyronies. Peyronies is not just scarring at the site of damage on the penis. That is normal healing. Peyronies is hypertrophic scaring that might be triggered by injury at the site but once set in motion, it continues to overrun undamaged tissue replacing elastin with non-stretching scar tissue. It is similar to keloids that some individuals develop from a cut on the skin.

    I highly recommend that anyone injecting, in fact, anyone with ED, get very accurate objective measurements of their penis so they know if they are losing size. It should include what is known as bone pressed stretched flaccid length and girth measurements at 3 location on the shaft. Nothing is less reliable than a man stressed about his penis just eyeing it to determine if is gitting better or smaller.
    Last edited by Hawk; 07-19-2019 at 06:22 PM.
    History: age 53 It took 3 biopsies (34 cores) to find 2 cores 4+4 Gleason 8
    Lap RP at MSKCC Apr 2004, age 54 All neg margins, nodes & structures. (T2a).
    Post RP PSA: <.1 until Feb, 08 (46 mos) PSA 0.1 - I then got sensitive tests -> 2008: Feb 0.06,
    May-08 0.09 - Jun-08 0.10, - Aug-08 0.10, - Nov-08 0.15
    SRT Dec-2008 ---Post SRT PSA 2009, Feb-09 0.10, May-09 0.09, Aug-09 0.06, Dec-09 .04, - 2010 Mar-09 0.04, 2011 .02, 2012 .02,
    STARTED UP Feb 2014-0.06, Jul-2015 0.10, Oct-2015 0.10, Feb-2016 0.15, Jun-2016 0.17, Dec-2016 0.25, Jan-2019 0.74, Jun -2019 0.72
    Aug 2018 Auximin scan - nothing
    Had an inflatable penile implant 2018 for ED. Best decision ever https://www.peyroniesforum.net/index...oard,56.0.html

  2. #232
    Experienced User
    Join Date
    Jan 2018
    Posts
    78
    Quote Originally Posted by Hawk View Post
    When it comes to injections there are a few critical things that are often not stressed.

    1. Be aware that both bimix and trimix contain drugs are known to cause fibrosis or plaque (scar tissue). Some men get away with injections for years without this side-effect others develop signs of scaring within weeks. Keep in mind, this is NOT scaring from the fine needle, The primary source is the drug.

    2. ALWAYS use direct pressure over the injection site for at least 10 minutes to prevent any bleeding. It is not a drop of blood coming to the surface of the skin that you are concerned with. It is bleeding under the skin in the tunica. Whole blood is known to cause scar tissue such as adhesions after surgery. In addition to the drug, the blood can cause the start of scaring.

    It is important to understand that those with nerve damage or trauma are more susceptible to Peyronies. Peyronies is not just scarring at the site of damage on the penis. That is normal healing. Peyronies is hypertrophic scaring that might be triggered by injury at the site but once set in motion, it continues to overrun undamaged tissue replacing elastin with non-stretching scar tissue. It is similar to keloids that some individuals develop from a cut on the skin.

    I highly recommend that anyone injecting, in fact, anyone with ED, get very accurate objective measurements of their penis so they know if they are losing size. It should include what is known as bone pressed stretched flaccid length and girth measurements at 3 location on the shaft. Nothing is less reliable than a man stressed about his penis just eyeing it to determine if is gitting better or smaller.
    I was doing trimix. Now I’m doing “single mix” Edex. I don’t really like injections. The best results I’ve had is using Sildenafil and a small amount of trimix - like really small.

    Trimix by itself I can get by with my Dr’s base mix and only 8 -10 units. Edex, I’m using 10 mcg per shot. It gives me usable and goes away in an hour. Trimix at 10 units can still give my 2 hour erections.

    I can get about 80% but not usable with 100mg of sildenafil. Pumps don’t work for me unless in conjunction with other stuff. Using a restriction band - I find that uncomfortable.

    I’m 14 months from RALP surgery. My two Uros both say i should give it more time. That doing an implant is premature at this point.
    diagnosed at age 55
    PSA 4.5 (8-24-2017)
    Biopsy 12-18-2017
    7 of 12 malignant
    3+4=7 (70%) right apex
    3+4=7 (95%) right mid
    3+4=7 (20%) right base
    3+3=6 (20%) right lateral apex
    3+3=6 (30%) right later mid
    3+4=7 (90%) right later base
    3+3=6 (30%) left lateral mid
    RALP- May 14, 2018 - Johns Hopkins, Dr Pavlovich
    Post op pathology: Gleason 3+4=7, Grade Grp 2. 10% Pattern 4
    pT2
    Max tumor dimension 18mm: pretty much in ALL zones but organ confined
    Lymph Nodes (3 right and 8 left) negative.
    Seminal Vesicle invasion: none Margins: negative
    Prostate= 52g, 4.3cm x 4.5 x 4.3
    Catheter out 9 days later May 23, 2018
    6 week PSA = 0.00 (July 7, 2018
    5 month PSA = 0.00 (Oct 15, 2018
    7.5 month PSA- <0.014 (different lab this time - Jan 3, 2019) 9.5 month PSA <0.014 (Mar 7, 2019)
    10 month ED still present. Trimix works.

  3. #233
    Jake, it is certainly a personal decision but knowing what I know now even if a 100mg Viagra worked great for me I would have preferred and implant. This is my thought process on it. I never liked the side-effects of any PDE5 inhibitor. I would get a stuffy nose and wake up in the morning feeling slightly like I had a hangover. It was not terrible but not pleasant. I would have never considered sex two or three days in a row. on oral meds. The hassle was just too much. The cost was outrageous at the time. I guess it is switching to generic as we speak so that makes things better. I did not like the 30+ minutes lead time that interfered with spontaneity. In reality, it was more time than that because with Viagra I had to watch a meal with fat content because it interferes with absorption so it took planning any late meal if intimacy might follow. I can see if a man has no side-effects, reliably gets a completely great long-lasting erection, and the cost drops, then he might be happy with oral meds.

    Rather than injections, you might consider a cockring and/or adding some L-Arginine. I would also try the 1/2 50mg Trazadone with a small snack before bedtime for night-time erections.

    Apart from those issues, however, If you suspect that salvage radiation, HT, or even aging is likely to take more erection capacity from you, then an implant ends all those concerns. It also ends the concern over losing more length in the meantime and removes the risk of Peyronies Disease from injections. I cannot stress enough however how important it is to get a high-volume surgeon who does more than 100 implants a year. Your chance of proper sizing and a better outcome is greatly increased. There are several things to look for in a surgeon and if you decide to go the implant route make sure you know what those things are.

    I am half asleep so I hope this makes sense when I read it tomorrow.
    History: age 53 It took 3 biopsies (34 cores) to find 2 cores 4+4 Gleason 8
    Lap RP at MSKCC Apr 2004, age 54 All neg margins, nodes & structures. (T2a).
    Post RP PSA: <.1 until Feb, 08 (46 mos) PSA 0.1 - I then got sensitive tests -> 2008: Feb 0.06,
    May-08 0.09 - Jun-08 0.10, - Aug-08 0.10, - Nov-08 0.15
    SRT Dec-2008 ---Post SRT PSA 2009, Feb-09 0.10, May-09 0.09, Aug-09 0.06, Dec-09 .04, - 2010 Mar-09 0.04, 2011 .02, 2012 .02,
    STARTED UP Feb 2014-0.06, Jul-2015 0.10, Oct-2015 0.10, Feb-2016 0.15, Jun-2016 0.17, Dec-2016 0.25, Jan-2019 0.74, Jun -2019 0.72
    Aug 2018 Auximin scan - nothing
    Had an inflatable penile implant 2018 for ED. Best decision ever https://www.peyroniesforum.net/index...oard,56.0.html

  4. #234
    Regular User
    Join Date
    Aug 2016
    Posts
    47
    Hi Hawk.

    I was really intrigued by the mention of the L-Arginine and started reading up and it. I was ready to pull the trigger on buying some supplements since the reviews seem to support better and longer lasting "wood". But I googled it along with the term prostate cancer and it led me to this from Livestrong.


    https://www.livestrong.com/article/5...ostate-cancer/

    "Since L-arginine improves blood flow, it is sometimes used to treat the side effects of chemotherapy by reducing inflammation. However, never take amino acid supplements without your doctor's permission because of the varying effects they can have on your cells. For example, arginine may actually increase the size of your tumor if you have prostate cancer. By contrast, arginine supplementation effectively decreases the size of tumors in some kinds of cancer because it boosts your immune system."

    Soooo...I didn't pull the trigger yet. But I am also still googling and reading.
    Biopsy 7/16 (50 Yrs. 6-1, 235lbs at the time of biopsy)
    20 Cores: 5 positive
    Left Side:
    Lat Base: small focus of atypical glands
    Lat Mid: 3+4 2 of 2 cores (discontinuous 25%, 20% 3.5mm, 3mm)
    Apex : 4+3 1 of 3 cores (30%; 3mm)
    Base : 3+4 1 of 1 cores (70%; 9 mm)
    Mid : 3+3 1 of 2 cores (50%; 3mm)

    Right side : All cores benign

    DRE: 30 gm prostate without nodules; Hypoechoic areas: none
    Measurements: 2.4 x 4.5 x 3.4cm Tz measurements: 1.7 x 2.4 x 2.7cm
    Vol: 19 cc Tz volume: 6 cc
    Density: 0.17 ng/ml/cc
    Boundaries of the prostate and seminal vesicles were: normal

    PSA 06/10 0.74; 4/15 1.26; 5/16 3.72; 6/16 3.15 Free 13% 4K score 8% 9/16 PSA 3.51

    1/31/17 PSA 3.07 Low Dose Brachy at Cleveland Clinic. 90 seeds.
    8/17: PSA 0.45
    2/18: 0.37
    5/18: 0.28
    8/22/18 0.30 (19 mo.)
    11/22/18 0.60 (22 mo.)
    5/23/19 0.39 (28 mo. FlowMax, Vesicare)

  5. #235
    Management of erectile dysfunction post-radical prostatectomy [2016, Full Text]

    Future treatments

    Dietary
    A number of trials (including two randomized, placebo-controlled trials) have looked into the combination of l-arginine and Pycnogenol (extract of the French pine tree Pinus pinaster) with promising results. l-arginine has been shown to increase levels of eNOS and Pycnogenol, an antioxidant that stimulates the conversion of l-arginine into NO via eNOS. The trials demonstrated increased patient-reported EF during 1 month of supplementation without the use of on-demand therapies (eg, PDE5i). The major limitation is that the trials were designed for non-radical prostatectomies and therefore more appropriately designed randomized controlled trials involving patient post-RP are required.4

    Care should be taken when discussing dietary supplements, as there have been a number of commercially available supplements promoted as a means of natural enhancement. The lack of efficacy studies should be highlighted to the patient.4
    [Emphasis mine]
    Last edited by DjinTonic; 07-23-2019 at 12:43 PM.

  6. #236
    Quote Originally Posted by MikeCav View Post
    Hi Hawk.
    https://www.livestrong.com/article/5...ostate-cancer/

    "Since L-arginine improves blood flow, it is sometimes used to treat the side effects of chemotherapy by reducing inflammation. However, never take amino acid supplements without your doctor's permission because of the varying effects they can have on your cells. For example, arginine may actually increase the size of your tumor if you have prostate cancer. By contrast, arginine supplementation effectively decreases the size of tumors in some kinds of cancer because it boosts your immune system."

    Soooo...I didn't pull the trigger yet. But I am also still googling and reading.
    Mike, I appreciate you sharing that. In the years I have researched information on L-Arginine and L-Citrulline and the research into diet and its potential effect on PCa I have never run across any such suggestion. I have taken a ton of L-Arginine in the last 15 years since my surgery. Unfortunately even talking to your doctor is not likely to get great information since many doctors readily admit to being next to clueless about nutrition. It would be a great topic for discussion with Naturopathic Doctor that works in conjunction with a team of physicians specifically dealing with PCa.

    Thanks again. Now, off on a digging spree.

    PS: I am kind of disappointed that Memorial Sloan-Kettering CC (MSKCC) that has a great nutritional section shows nothing on this. It says there is inconclusive evidence it could cause breast cancer tumors to grow but no warning on prostate cancer. Harvard Health Publishing is totally silent on whether arginine is an issue and only warn that it can drop blood pressure (well established) and that if can activate herpes virus (also well established). Dr. Mulhall a sexual health Physician who I used to go to (not my favorite) practices at MSKCC and Presbyterian Hosp. in Manhattan gives no warning. There is, however, a PubMed study about Arginine depletion in conjunction with some cancer treatments.
    Last edited by Hawk; 07-23-2019 at 01:04 PM.
    History: age 53 It took 3 biopsies (34 cores) to find 2 cores 4+4 Gleason 8
    Lap RP at MSKCC Apr 2004, age 54 All neg margins, nodes & structures. (T2a).
    Post RP PSA: <.1 until Feb, 08 (46 mos) PSA 0.1 - I then got sensitive tests -> 2008: Feb 0.06,
    May-08 0.09 - Jun-08 0.10, - Aug-08 0.10, - Nov-08 0.15
    SRT Dec-2008 ---Post SRT PSA 2009, Feb-09 0.10, May-09 0.09, Aug-09 0.06, Dec-09 .04, - 2010 Mar-09 0.04, 2011 .02, 2012 .02,
    STARTED UP Feb 2014-0.06, Jul-2015 0.10, Oct-2015 0.10, Feb-2016 0.15, Jun-2016 0.17, Dec-2016 0.25, Jan-2019 0.74, Jun -2019 0.72
    Aug 2018 Auximin scan - nothing
    Had an inflatable penile implant 2018 for ED. Best decision ever https://www.peyroniesforum.net/index...oard,56.0.html

  7. #237
    Regular User
    Join Date
    Aug 2016
    Posts
    47
    I just noticed there are 4 references cited if you click the reference link at the end of the article. I'm at work and haven't had a chance to check them out yet.


    REFERENCES & RESOURCES

    MayoClinic.com: Arginine
    Medline Plus: L-Arginine
    Cancer Research: Arginine Deiminase as a Novel Therapy for Prostate Cancer
    Life Extension: Arginine and Fish Oil May Help Cancer Patients
    Biopsy 7/16 (50 Yrs. 6-1, 235lbs at the time of biopsy)
    20 Cores: 5 positive
    Left Side:
    Lat Base: small focus of atypical glands
    Lat Mid: 3+4 2 of 2 cores (discontinuous 25%, 20% 3.5mm, 3mm)
    Apex : 4+3 1 of 3 cores (30%; 3mm)
    Base : 3+4 1 of 1 cores (70%; 9 mm)
    Mid : 3+3 1 of 2 cores (50%; 3mm)

    Right side : All cores benign

    DRE: 30 gm prostate without nodules; Hypoechoic areas: none
    Measurements: 2.4 x 4.5 x 3.4cm Tz measurements: 1.7 x 2.4 x 2.7cm
    Vol: 19 cc Tz volume: 6 cc
    Density: 0.17 ng/ml/cc
    Boundaries of the prostate and seminal vesicles were: normal

    PSA 06/10 0.74; 4/15 1.26; 5/16 3.72; 6/16 3.15 Free 13% 4K score 8% 9/16 PSA 3.51

    1/31/17 PSA 3.07 Low Dose Brachy at Cleveland Clinic. 90 seeds.
    8/17: PSA 0.45
    2/18: 0.37
    5/18: 0.28
    8/22/18 0.30 (19 mo.)
    11/22/18 0.60 (22 mo.)
    5/23/19 0.39 (28 mo. FlowMax, Vesicare)

  8. #238
    Regular User
    Join Date
    Jul 2016
    Posts
    48
    Looking for thoughts on injections.

    So far Viagra and Cialis have had little effect. I have been using the pump but the bands are uncomfortable and so far the only band that has helped me keep and erection felt like it was going to squeeze my junk off. Im thinking of trying injections to see how they work but wanted to get some thoughts ahead of time.

    How well do they work?
    Are they less painful or awkward than the pump?

    I know that I'm still early in the game, I'm a little over two months out, and I know I need to be patient but at this point I just want to weigh my options and see what works best. My wife is having surgery and will be "out of the game" until the beginning of the new year so I'm probably going to keep going with the pump until then and then try injections if I'm not having any more success than I am now.
    DOB 4/11/1969
    PSA: 5/12: 3.46, 3/13: 2.38, 3/14: 3.49 6/15: 3.10 7/16: 3.19 12/17: 3.5 04/18: 3.8 12/18 4.1 4/19 4.5 6/19 4.8
    Nodule found during DRE 7/2016
    Biopsy: 7/22/2016
    RMB: adenocarcinoma, Gleason score 3+3=6
    Total surface area 5% involved
    perineural invasion present
    Biopsy: 7/19/2017
    Gleason score 3+3=6
    Total surface area 30% involved

    RALP 8/15/2019 United Hospital, Dr Sershon
    Path report: gleason 3+3, grade group 1 of 2, pT2 (organ confined), margins: positive (limited, left apical), prostate weight: 53 grams.

  9. #239
    Efficacy and tolerability of sildenafil/l-arginine combination relative to sildenafil alone in patients with organic erectile dysfunction [2019]

    CONCLUSION:
    Adding l-arginine to sildenafil demonstrated more efficacy than sildenafil alone for treatment of erectile dysfunction patients.
    The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis [2019]

    CONCLUSION:
    The results of our systematic review and meta-analysis provide evidence on the effectiveness of arginine supplements for mild to moderate ED.

  10. #240
    Quote Originally Posted by wbigs View Post
    Looking for thoughts on injections.

    So far Viagra and Cialis have had little effect. I have been using the pump but the bands are uncomfortable and so far the only band that has helped me keep and erection felt like it was going to squeeze my junk off. Im thinking of trying injections to see how they work but wanted to get some thoughts ahead of time.

    How well do they work?
    Are they less painful or awkward than the pump?

    I know that I'm still early in the game, I'm a little over two months out, and I know I need to be patient but at this point I just want to weigh my options and see what works best. My wife is having surgery and will be "out of the game" until the beginning of the new year so I'm probably going to keep going with the pump until then and then try injections if I'm not having any more success than I am now.
    I have a nice pump, but having issues with it. I can not seem to get into the pump. The opening needs a little bit of firmness to push through, and I am far too flaccid for that.

    I use Trimix.

    The needle is the smallest they make, so the prick is minor. In 20-minutes I have a solid erection.

    The process is quick. You can do it in the bathroom by yourself, or if your girl is up for it then maybe she can give you the injection. The injection site needs to be swabbed with an alcohol pad, then the injection, and your done. The longest thing is measuring the right dose. It can all be done in less than a minute.

    I get two vials at a time, they both are stored in a freezer. Then one day before you need a shot, move one vial from freezer to the refrigerator. In the refrigerator it will thaw and be ready for use. Frozen they last forever, but in the refrigerator they only last 30-days.

    I will eventually go to the hydraulic prosthetic.
    At age 55, PSA 22, Gleason: 9 (4+5), 8(4+4), 7(3+4), 6(3+3)
    8 out of 12 cores positive
    DaVinci 14 October 2014
    Pathology of surrounding tissue samples was negative, though they annotated it as stage 3.
    Post surgery PSA:
    Jan 2015 <0.04
    2016 <0.04
    2017 0.05
    2018 0.1


    In 2018; 45 radiation treatments and hormone treatment [with Lupron for the next 2 years].
    In 2019; on Lexapro to deal with the Lupron.

 

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