RE: [PCAI] Trimix

[Guest guest]

Absolutely excellent explanation regarding priapism (or not), ! You

can bet I will save this to my file on priapism to provide patients who may

come to me for advice on this subject (usually I just refer them to you in

view of the research and study you have involved yourself over the years

regarding erectile dysfunction).

I've added a few other PC support lists since this is necessary information

for others to be aware.

Chuck

Always as close as the other end of your computer to help address any

prostate cancer concerns.

" What you leave behind is not what is engraved in stone monuments, but what

is woven into the lives of others. "

(Chuck) Maack - Prostate Cancer Advocate/Activist

Email: maack1@...

PCa Help: " Observations " http://www.theprostateadvocate.com

Re: [PCAI] Trimix

**********

Hi,

I've been meaning to respond to this for a while, but have been busy - sorry

for the delay.

I don't know anyone who has experienced true priapism. I have probably

worked with a couple of hundred guys as patient advocate, if you will.

Both my doc at MGH and the BU clinic said that priapism is a rare response

to injections, unless the patient has certain blood disorders, like sickel

cell anemia, that cause the blood to thicken dramatically in the corpus

cavernosa in response to the vasoactive drugs.

Otherwise, many patients DO HAVE PERSISTENT ERECTIONS, sometimes for several

hours, but these erections do not present as ischemic priapism. They are

just normal erections that persist, and are safe. The erection might be

quite firm or hard but will be more warm and pink than purple/blue and

cold, indicating circulation, will bend at least slightly, and are not

painful in the sense of ischemic priapism, though they may have discomfort

from Alprostadil.

There ARE a few guys that are VERY sensitive to the meds. BUt if you start

guys at a conservative dose, like 5 mcg Alprostadil or 20 units of trimix

30/1/10, you will identify these guys early.

They might get in trouble with an initial 20 mcg dose of Alprostadil, but

that is way to high to start with.

My personal experience is that guys starting injection therapy frequently

have erections that persist, for 3 hours or more, but after a few months

they usually lose full rigidity in the 60 to 90 minute range.

My doc at MGH said that he figures almost all of the guys who show up at the

ER for Priapism after injecting, have safe persistent erections, but get

treated anyway, since most ER's never see this, sometimes with damage to the

penis.

Since most docs and patient instructions tell the patient " go to the ER if

the erection persists for more than 3 hours " , but DON'T tell how to

recognize priapism, most of them go with just a persistent, partial

erection.

And the ER is the ER, they like to DO SOMETHING, so they do.

I find this AUA treatise on Priapism to be very helpful. Ishemic priapism is

what we want to avoid.

http://www.auanet.org/content/guidelines-and-quality-care/clinical-guideline

s/main-reports/priapism/online.pdf

It would be really helpful if our doctors could provide more usefull advice.

My doc told me that if you have true priapism that is dangerous:

You will most likely also have a blood disorder such as sickel cell

anemia, and would know that in advance.

You would know right away you were in trouble. The extreme erection

usually is apparent from the get-go.

The erection will be really hard, like a wooden stick, unbendable.

Harder than ANY erection you EVER had, even as a teenager.

It will be blue/purple, very cool or cold - it will be apparent that

there is no blood circulation.

It will be very painful, but a " normal extended erection " for guys who

have had RP may be painful due to the normal response to Alprostadil in the

injection, so pain itself is not a clear indicator.

Your erection might be quite hard or firm, but if it is more warm and

pink than blue and cold and you can give it a slight bend, wait it out.

When you are new to injecting and still have an erection after 5 hours, it

can be scary, but as long as there is some evidence of circulation, wait it

out. Read a book, take a walk, take Sudafed if you want. Take a hot soak if

it feels good. DOn't apply ice. This will thicken the blood more and make it

worse. Heat will thin the blood.

Don't expect the ER to make the right call. They almost never see this. They

probably don't have the AUA article mentioned above. They will probably try

to treat you, no matter what, and that might include draining blood from the

penis with a large bore needle.

I have probably " talked down " about 20 guys from going to the ER.

One guy was still too nervous and went anyway. Later he told me: " ...by the

time they got to me I was only half erect, but they still used a large bore

needle to withdraw blood from my penis. "

He couln't continue injection therapy for 8 weeks due to the damage.

Be well,