Moving forward after priapism

[Nocturne]

So it’s been 2-3 weeks since my priapism sent me to the ER for a pretty unpleasant experience. I don’t think any serious damage was done - blood oxygenation was at 80% at the seven hour mark when they drained it - which is good.
I was told not to use Trimix again until after meeting with my urologist, which will be happening on the 12th of January.
In the meantime been having mixed success with the usual Cialis. Pretty good experience yesterday morning. I know my issue is “primarily” psychogenic, as in I can get pretty good erections (strong enough to hang a towel on) on my own with Cialis, and have not had any mishaps with masturbation in years - it’s when I’m with my wife that trouble can happen.
I started Trimix because I was in a psychogenic slump after another bad experience in a hotel room on vacation back in April or so. My goal was to have a new trick up my sleeve for vacations so that might never happen again, plus some special occasion nights at home (maybe once a month?) where I could cut loose and try positions other than the two scripted ones we use every time. Would be nice to feel confident enough to switch positions during sex again, take her from behind, maybe even standing up in the shower.
After this incident I am not so sure. Should I stop? Was this it for Trimix for me? I only used it maybe half a dozen times.
I suspect that maybe I wasn’t hitting the right spot on previous attempts, as low dose (10 units) didn’t do much of anything, and up to 30 units produced “erections with stimulation” that went down immediately after orgasm. Then the most recent time at 32 units I was still hard seven hours later! How could 2 units of made such a difference? Plus I noticed that my previous attempts would leave me with an ache and swelling (almost a “lump” on or near the injection site) that lasted for close to a day afterwards, and a bend in my penis that was consistently AWAY from the injection side, whichever one that was. None of that happened with the most recent injection that led to priapism.
The injections still feel inconvenient to me - timing, keeping the Trimix “fresh” by freezing and trying to juggle how to store it frozen or cold, the fact that the fridge I keep it in is as far away from our bedroom as possible and I have to take a “walk of shame” through the entire house to get to it with a needle, fill up the needle in the basement, and take it upstairs for injection… eh.
But I’m thinking I should try to stick with it. Maybe get a mini fridge for the bedroom. This isn’t something I am going to need for most of my sexual encounters, and I know that. I just want it in my back pocket for when there is trouble, and when I know anxiety will be high (vacations), and also maybe to cut loose every now and then and just not have to worry. But of course now the worry will be priapism.
Any thoughts or suggestions or any other kind of insight?

[CanGetItUpButNotOff]

You seem to have a lot of issues, but to the point, I think you should keep trying with TriMix.

My guess is that you are having trouble really getting the needle into the cavernosum. What has greatly helped me is to put on some type of cock ring and plump up my penis, either my myself or with my wife's help (oral is best!). This swells the cavernosum and gives a big target. I also aspirate a little blood to verify correct placement. This has been 100% solid for me. I use a 31ga 8mm needle. What are you using?

Rather than experiment with it occasionally, use it for several times in a real to get a real feel for the injection prices and to gauge its effectiveness over time.

In another thread. @Budwsrd and I encouraged you to get phenylephrine to ease your mind about the priapism. You have stated several times that you like and have confidence in your urologist. But if he won't give you phenylephrine… run as fast as you can to a better urologist. With your history, you MUST MUST have phenylephrine before you take your next shot.

If you're getting lumps, bumps and pain then maybe Bimix or straight Alprostadil is better for you. I've never had any of these symptoms and never tried Bimix or Alprostadil so take this as an uninformed opinion.

You're overthinking keeping the solution frozen or cold. I keep mine pre-loaded (actually several at a time) in a needle frozen until the day of use when I move it to the refrigerator. I find it convenient to leave the bedroom to shoot up in the kitchen. But if that's not the case for you, I'd try this protocol: keep a syringe(s) in the freezer and when it's looking like "go time" move it from the freezer to your bedroom or bathroom and let it sit at ambient temperature for any where from 2 hours to 10 minutes. It will be ready to go and perfectly well preserved. The key is to prefill the syringe(s) days in advance so you have a frozen supply at the ready.

[Golfboy307]

Nocturne

Glad to see you are still posting! You might remember me from the peak testosterone forum. You may have already gone down this route, but I thought I would throw it out there. I’m not sure how much daily Cialis you are taking. But I like to throw in an extra 20mg of Vardenafil when we have some time set aside for sex (on top of the 5-7mg daily). I don’t need it all of the time but it is nice when erections aren’t running as strong as normal. Out of three primary oral meds Vardenafil works much better for me. This is all on top of various NO supplements and others to help keep the arteries clear. Of course you are dealing with LPa which is a different beast. And yes performance anxiety sucks.

If you have already gone this stacking route please ignore. Keep fighting the good fight!

[Martin6469]

Nocturne: "Cangetit.." is right, you need to perfect your injection technique. An ache, swelling, a lump, and a bend away from the site are just what I get when I inject outside the corpus cavernosum. I also use the 31g 8mm needle mostly and a 31g 12.7mm (1/2 in) needle for sites where the corpus is deeper. You're in the corpus when there's no resistance to plunger movement. The plunger should feel like the needle is in air. And there should be no or a very little pain when the Trimix comes out of the needle. Burning pain means Trimix is uselessly going into the surrounding tissue. If there is resistance or pain I push the needle in a little more, or pull it out a little because it's possible for me to go through the corpus, mine being quite thin. Practice solo every 3-4 days until you can confidently hit the corpus. It took me a month of practice to get reasonably adept.

Yes, your psychological ED will be overcome by Trimix, but no one has 100 percent success every time. After eight years I still get a misfire about every tenth time. We keep bigger-than-me dildos in the bedroom for those occurrences; she doesn't complain.

Some FT guys have said that injectable phenylephrine is available from Olympia Pharmacy.

I don't have the injectable but I keep oral phenylephrine capsules and plan to take 120mg if I need it. After 400 injections I've only needed it once, so far, because I try to be slow and careful.

I've never frozen Trimix - in fact I've used Trimix which had warmed to room temperature for 4-5 days on vacations, with no change in effectiveness. In my opinion, freezing it is a waste of time. I simply keep mine refrigerated at 40F (4C). I've used six-month-old vials stored this way with no change in effectiveness.

Our sex is usually once a week in the morning. The previous evening I load a syringe and put it in the bathroom next to our bedroom, no refrigeration there. In the morning I go into the bathroom and inject. It takes maybe 10-15 minutes to inject because I'm slow and deliberate. I go back to bed and she loves to feel me getting hard just like the old days, but slower.

[Nocturne]

You seem to have a lot of issues, but to the point, I think you should keep trying with TriMix.

Thanks and thanks for the other advice as well. My urologist is really a men’s health guy and he has been fantastic for getting my hormones sorted out, and really got me through the worst of it ten years ago. And to be fair I never actually got to see HIM through all the Trimix stuff, it was some other men’s health place (“Game Day”) first, because I could not see him for months due to scheduling issues - and THEY were VERY irresponsible, basically just game me the vial and said “here ya go” with no instruction or practice. I knew better than to start without more serious help so I sat on that vial until I could see my doc’s nurse practitioner, who has been working with me. In a couple weeks I talk to the actual doc, so we’ll see what he advises. I’ll definitely ask about being given some P.
But this guy has done right by me so many times over the last decade it would be hard to see him as anything but competent.

[Nocturne]

Nocturne

Glad to see you are still posting! You might remember me from the peak testosterone forum. You may have already gone down this route, but I thought I would throw it out there. I’m not sure how much daily Cialis you are taking. But I like to throw in an extra 20mg of Vardenafil when we have some time set aside for sex (on top of the 5-7mg daily). I don’t need it all of the time but it is nice when erections aren’t running as strong as normal. Out of three primary oral meds Vardenafil works much better for me. This is all on top of various NO supplements and others to help keep the arteries clear. Of course you are dealing with LPa which is a different beast. And yes performance anxiety sucks.

If you have already gone this stacking route please ignore. Keep fighting the good fight!

Good to see you Golf, and yes I remember you! I’ll consider the V. but I already take 5 mg Cialis daily (10 on Friday nights).

Since you mentioned my Lp(a) and you remember at least some of my story, I’ll tell you some really great news I got earlier this year. You know I have Aortic Valve Stenosis (as does my father and at least one uncle now - it’s very genetic and tied to Lp(a)). I also have very high CAC for my age (in the top 1% for age when I was 41, ten years ago). I have been trying to get onto a drug trial for an Lp(a) lowering drug for ten years and never got on one because I had not had a heart attack yet. Infuriating.
But almost a year back I idly asked ChatGPT about Lp(a) drug trials in my area, and it spat out details and contact info for one that was specifically for people with AVS! It’s run out of Tufts in Boston. Long story made short I am FINALLY on a drug trial for Pelicarsen, which can lower Lp(a) by up to 90%. And when they gave me the coronary CT scan to get some baseline info for the trial, I asked the doc to tell me my CAC score when he had it.
It was only 234! Higher than the 135 or so I had a decade ago but that is a VERY low rate of progression, less than 5% per year where the average is 15-20% per year. Honestly I told the doc I would have been less surprised if there had been a zero at the end of that 234. It’s a low key miracle. I suspect my taking aged garlic extract all of these years (which is supposed to lower CAC progression significantly) helped a lot.
Anyway I’ve gone from the highest 1% of CAC for age to just the highest 6%. I’m not even in the top 5% anymore! I literally wept when I got that news because for the first time in a decade I could actually believe that I might live to see my 70s. Fantastic news.
Thanks again for the response and have a Happy New Year!

[Nocturne]

Nocturne: "Cangetit.." is right, you need to perfect your injection technique. An ache, swelling, a lump, and a bend away from the site are just what I get when I inject outside the corpus cavernosum.

Thank you for this info, this is what I suspected! We’ll see what my doc says but I suspect he will have me drop back on dose significantly and I’ll see if I can improve my injection game. And see about getting that P. to remedy things if they go off the rails again!