Even if you're dead and doing your income taxes, Trimix

 LO Friggin L

Thank you for that information. I haven't researched the matter as much
as you have and will keep your conclusion in mind.

of Viagra six nights a week before bed (a 100 mg. pill cut in

both made it clear that they saw no benefit in using a vacuum erection
device (VED)because

I don't quite understand how the distinction between "circulated old
blood" and (presumably) new blood affects rehabilitation. It is my
understanding that the pump - by creating underpressure - stimulates
blood flow to the penis and that a ring is required to prevent it from
flowing back. Do injections or medicine create "new" blood? What is it
that makes them more effective in rehabilitation than the pump (which as
a practical matter may be less effective for its immediate purpose)?

Hi Leah.

I always enjoy your posts.

Indeed...injections will for sure 'heal the sick, raise the dead' (Oh
wait...that's from the song '7th Son' (Johnny Rivers.) :-)

However...I'll try to be scientific...injections will work...no
doubt...because they don't rely on nerve regeneration.

They SOUND terrible...but as you say...are not so bad once you learn how
to do them properly.

If "I" had a wife or heavy sexual relationship...I sure would try them.

Now...the return of function after surgery...even nerve sparing
surgery...is very individual.

During surgery, even if nerves are spared...they are pulled and
stretched, there are stitches...and they don't know HOW they will
heal...or how long it will take.

My doc, Catalona, used to use 18 months as the time where, if there was
no erectile recovery...there would NOT be.

Now...due to more data...they've extended the time to 3 years.

To ME, the most interesting thing about your post is the use of Viagra
BEFORE surgery.

I understand that blood flow...via pump, shots or pills is very
important.

But your comments made me think that if the chambers got full BEFORE
surgery...it might help recovery AFTER surgery.

I can ask Dr. Catalona about this...but I only see him yearly. (maybe
e-mail)

Thanks so much for posting this Leah.

Best of health to all,

Ron B.

Chicago

Dear Everybody,

[*Correction to my earlier post: Oral meds like Viagra -- not
injections -- are being given to patients before surgery at MSK.  I
have basically rewritten this post and added new info (and a joke), so
please read the whole thing.**]

On Jul 27, I wrote:

I have been researching "penile rehabilitation" for a long time.  My
first post on this subject, "Sex After Surgery" was written back in
November 2006, and I try to keep up with the research.

It's no secret that many men suffer from impotence after RP.  It's
hard to pin down the actual numbers, because they play games with the
statistics.  For example, how do you define "erectile function?"  Let
me count the ways.  Does it include men who can have intercourse
unaided or only with meds.  And just how hard does the tumescence have
to be? You get the picture.

Some people have no problem at all with sexual function after RP --
like the surgeon, for example (:-).  Others are able to get an
erection using Viagra or other oral meds.   This msg is directed
towards men who have not had success with the above.

There are two issues involved in "penile rehabilitation": 1) enabling
a man to have an erection after surgery, and 2) helping to speed up or
restore natural erectile function, thereby preventing long-term ED.  I
am talking about #2 here.
If you are unable to have intercourse after two months, you should see
an ED doctor.  (For help in finding a competent one, see "Sexy Secrets
For Finding An ED Doctor on my blog, prostatecancerblog.net.)

There's a lot we don't know about penile rehab, but the best prospects
at this moment appear to be *injections* along with Viagra.  The
following is from Dr, Raina et al, renowned experts on ED:

"Early cavernosal injections following RP facilitated sexual
intercourse, patient satisfaction and potentially early return of
natural erections. Early combination therapy with sildenafil allowed a
lower dose of intracavernous injections, minimizing the penile
discomfort."

www.nature.com/ijir/journal/v18/n5/abs/3901448a.html.

*Note that there is no mention of the VED (pump).

So why are so many guys told to use the pump after RP?  Makes me want
to jump out the window.

Here is an example of the "gold standard" in penile rehab today.  A
*top* expert in sexual medicine at Sloan Kettering, Dr.John Mulhall,
prescribed this for a new RP patient recently:

====>Re:  *Before Surgery*

Six weeks before surgery, the patient was advised to take 25 mgs. of
Viagra six nights a week, to be taken before bed (a 100 mg. pill cut
in fourths to save money) to increase blood flow to the penis prior to
the operation.

======> *After Surgery

*Dr. Mulhall and his associate Dr. Nelson Eddie Bennett, Jr., both
made it clear that they saw no benefit in using a vacuum erection
device (VED) after RP for penile rehab because it only "circulated old
blood" to the penis*

Scardino says the same thing on page 366 of "The Prostate Book":

"VED's do not produce an actual physiological erection and therefore
don't promote the circulation of fresh, oxygenated blood.   Therefore,
they may not help avoid fibrosis [scarring] after radical
prostatectomy."

So even if the VED doesn't work for penile rehab, most men are told to
use it anyway, with or without pills.  No mention of injections (I
call it "the Pinprick.")

I have seen info in the medical lit which says that the pump _does_
work for penile rehab, but they do not point to specifics. And, in the
last few days, I have *again* reviewed all the articles I have about
this subject, and I have not seen any proof of the above.  My husband
is from the "Show Me" state, so I gotta see the "beef."

I do know of one knowledgeable person online who is the moderator of a
newsgroup but certainly not a doctor, who described state-of-the-art
treatment for penile rehab as injections plus oral meds *and the use
of the pump 15 minutes a day.  I doubt there is any harm in using the
pump and it can give you an erection.  The thing to do is as a
competent ED doctor.

Ideally, injection therapy should start about six weeks after RP.
Naturally, men don't like the prospect of shooting up *there,* but you
*can* get over it.  Give yourself a chance.  Also, you can have a sex
life right away.  (For more info, see the post on my blog, "How I
Became the Trimix Lady.".)  Even if you're dead and doing your income
taxes, Trimix will give you an erection.:-)

I have to say that there is a risk of scarring or "fibrosis" from
using penile injections. Some men get "Peyronie's Disease," which
results in curvature of the penis. The docs say this is rare, but I
don't believe it.  In my husband's case, after about 8 mos. his penis
kind of started to bend in the middle at a 45 degree angle.  I guess
the advantage is that you can fold it easily :-).  (Husb has refused
to consult his ED doc about this). So you have to be careful of how
you inject (on both sides) and I believe you need to leave the needle
in place for 5 minutes.

Remember, ask your doctor if any of this is right for you.  But be
sure he or she is an ED expert.

Good luck.

[Using a laptop makes me suicidal.  Have been working on this about 6
hrs.]

----------------------------------------------

And just for fun: This is my favorite story in the world: how I came
up with the word "pinprick" as a substitute for "injection".  I was
looking for a way  to convey to guys that shots for ED aren't so bad
after all.  So I told them the injection is just a "pinprick, no big
deal. I think it worked for some people.

What made me think of this word?

When I got engaged to my husband, the first thing we did was call both
of our parents to tell them the news.  We conferenced everybody in on
the same line.

The first question my very devout mother asked after they were
introduced was: "Did your son have a "Bris?" In other words, was he
circumcised?  Great way to get acquainted.  Never heard the end of
that.

His stepmother replied after a pause, "I think so, but I don't think
it was done in a ritual way.  A doctor did it. Isn't that right,
Chuck?"

Well, my mother wasn't satisfied with this at all.  She insisted that
Ted had to be circumcised *properly.*  So I asked her, "How can a man
be circumcised twice?"

She replied, "It's no big deal -- just a ceremonial thing.  All
they'll do is give him a 'pinprick'.   And maybe recite a blessing.
Then we'll all have a little celebration."

Anyway, T. wasn't interested in having a "circumcision party," and he
refused to get it done, even for me.  Just to get my mother off my
back.

And that's probably why he got the PC, I think.  Measure for measure.
He refused the "pinprick"  then, and now he's getting pricked all the
time.

My mother always gets her way.

Best to you all and have fun.

Leah

prostatecancerblog.net

All you need to know about PC: Get It From a Wife!