Cell Doctor News. October 2018

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Why I Avoid Stock Photos

The most dangerous thing may be not criticism but applause. If you love the applause, you start to freeze for fear that the next thing you do will not bring applause … CONTINUE READING

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Why You Should Use Altar™ After Every Vampire Procedure

The active ingredient in Altar™ is SBD-4. SBD-4 is a patented extract from the root of the plant Angelica sinensis, which grows in the high altitudes of China, Japan, and Korea. SBD-4 has been demonstrated to do some rather remarkable things … CONTINUE READING

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Possible Treatment of Erectile Dysfunction Post Bicycle Injury

*** The following is a transcript of a webinar for the Cellular Medicine Association from Sept.12, 2018, with Dr. George Ibrahim. The full transcript can be read and heard by logging into the membership sites.

Typically, this (erectile dysfunction from a bicycle injury) happens oftentimes in younger guys where erectile dysfunction would never even be thought of. They are, by definition, usually very active, because they’re riding a bike … CONTINUE READING

© 2018 The Newsletter Pro. All rights reserved.

 

JCPM2018June27.BeautyMathResearch(face&labia).PRPTuneUp.FDAWarning.Altar™Story.HandsOnClasses

Topics Discussed Include the Following…

[note, these weekly meetings are usually only held with our CMA members, we occasionally post the meetings for any provider who may wish to enjoy with the hopes that they may both find benefit to their patients and that they may consider joining us]

*Beauty analysis math & science of face & labia.
*The Beauty & the Beast
*New review paper of the aesthetics of the labia
*Tune Up your PRP protocol from a basic science paper
*FDA & PRP
*Strong warning about profiting from PRP kits and teaching PRP procedures [don’t]
*The Story of Altar™
*Up-coming hands-on classes with live models

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Transcript

Beauty Analysis. Face & Labia…the Math of Beauty

If math applies to the face, does it apply to the labia?

Charles Runels: So first, let me say congratulations to Dr. Alinsod, who just published another paper. We definitely want to get to that. I think let’s start by teeing that [research up] with some ideas that I think are widely accepted about the face. This is a website that is put out by Dr. Marquardt, who did some studies about what [mathematically] makes the perfect face, which you kind of have to think, “Well obviously, we were all made to be beautiful, and so, is it okay to decide what’s perfect?”

We’ll get to the labia. But I think most people are accepting that there are certain ideas that we recognize to be beautiful, although of course our affection for each other changes the beast into the beauty in the fairy tale. And of course that happens … It’s a metaphor for what happens when we fall in love with each other.

We know genetically we’re usually attracted to someone whose eyes are of similar color to our mother or something else about the face [that may be genetically determined by our brains]. There are certain mathematical things that go on, as Dr. Marquardt has shown with much of his research.

For example, the upper lip is usually about half the width of the lower lip [in the face of those we consider most beautiful]. I’ve put a link to this, or I will put a link right now into the chat box. Most of you guys are aware of this, because if you’re doing our Vampire Facelift, because I talk a lot about Dr. Marquardt’s work. He was an engineer before he was a physician, and did a lot of really accurate measurements with calipers before we all had computers on our desk and then translated that over. If you look at what he actually talks about here, how if you go all the way back even to, you can see, in former times …

It’s worth browsing this website because even if you look at artwork from ancient days, on every race, every race every continent, you’ll see the artwork very carefully closely matches what we talk about is beauty. I bring that up not just because many of us are doing the faces, but because it’s a major idea that is coming about in the cosmetic world, as most of you guys know. Dr. Alinsod just published something, and I’ll let you take a look at it, and I’ll provide a link to it. Let’s see. Let me pull this up for you. There you go.

So this just came out. Dr. Alinsod and Dr. Güneş … I suppose I probably said that incorrectly … published this paper where they talk about the ideas of aesthetics for the genitalia.

It’s interesting that in the days of Fifty Shades of Grey and such, in my opinion that, we can readily … The reason I started with talking about the face is…

it’s very unlikely anyone had any problems thinking about the idea that certain measurements [of the face] might be genetically embedded to our perception of why it [an individual face] might be beautiful.

And yet, when you swap that same idea [which also applies to the] figure and the breasts, when you swap it to the labia, people start to balk.

There’s a very strong political movement, both pro and con, and some of the thought leaders like Dr. Alinsod are trying to play a scientific role and leadership role and taking lots of heat for it, and teaching the world that maybe if it’s okay to think in that way with a face, it’s okay to think about it [in regards to] the labia. And so, in this review article, he talks about surgical and non-surgical ideas relating to aesthetics.

The references are very helpful, and I will put a link to this in the chat box right … Actually, it will be on the page for the recording for this once the transcript is posted (click to read).

But the couple of ideas that I would point out, and then I’ll open the mic for discussion. The things that caught my attention were, first of all, how strongly some of the ideas are opposed

and then just in general how [in following] the idea of making things more beautiful, we have stumbled upon how it [creating beauty] also is making things more functional.

Another reference concerning the math of beauty

Dr. Goodman was on one of our previous journal clubs, where he talked about his research showing that women actually have better orgasms and better sex when you do some of the things we’re talking about now, when it comes to just [improving] the appearance [of the labia in the eyes of the woman]. Let me swap something over. I want to show you an example from my practice. Let’s see here. So this is from the Vampire Wing Lift™ website, which if you’re doing the O-Shot®, you should have also a listing here. If you don’t, let us know about it. But if you go on the before-and-after photos, there are several here that were supplied by our providers.

Here’s from Carolyn [Delucia, MD, FACOG], and you can see there are others over here. But the one I want to bring up is this one, because I know the woman. She’s actually one of our providers. If you look at this, you’d think, “Wow. This is a lot of volume loss,” and you might think the rest of her body may look not so young by looking at her labia majora.

 

Click to see the after photo<–

The truth is this woman was so fit that if she … If you saw her at the gym, you would think, “Okay, that’s a 60-ish-year-old woman, and that’s the way I want to look when I’m 60-ish,” because of course when women lose the fat in their body and stay lean, they also lose it in the cheeks [which is one of the reasons we do HA fillers and the Vampire Facelift®].

But what hasn’t been talked about is they [lean women over 35 years old] also lose it [faty] in the labia majora. And so, simply by adding volume back, with the combination of PRP and an HA filler, we’re able to easily restore this more youthful look in a very quick procedure. Now of course, Dr. Alinsod talks about surgical ideas as well in that paper I just showed you. I highly recommend this book, which also has a … And this will be the bottom when I post the transcript in the video for this webinar. I’ve already put the links here. But this book has a section on both the surgery as well as PRP and radiofrequency and laser and all the rest.

So, it’s not just for surgeons. I’ve never seen this price. It’s usually $230. I’m not sure why it’s dropped in price like that, but it’s a good time to buy it. I think I’ve talked enough.

Let me see. If anybody else wants to comment before we move to the next topic, please let me know. But I want you guys to know about this because it’s one … I would show it to your patients. Give them permission to do whatever feels natural to them. We’re not taking people and making them feel self-conscious about their body, as some might imply.

We are taking people who want to make all parts of their body well and functional, not just their bicep or their spine or their brain. Or why should we think about optimal brain function, optimal flexibility, cardiac, VO2 max, anaerobic threshold and not think about sexual function? It’s a pretty obvious, rhetorical question that some people have trouble with. So, empowering your patients by giving them links to our references, and I will post the one I just showed you at … If you go to just any of our websites, like you go to OShot.info or Vampire Facelift® or any of them, you’ll see a research tab at the top.

Even on Vampire Wing Lift®, we have actually a paper showing benefit from that procedure, Juvederm with PRP, combined in the labia majora. So there it is right there. Okay, so, I don’t see any hands up. I see Dr. Harrison on the call. I’m going to unmute you because Dr. Harrison told me about a really fascinating paper about the basic science of PRP. So, let me pull it up so you could talk about it. I’ll put a link to this one, as well. Let’s see. Why don’t I just go ahead and put that. I’ll put this one in the chat box as well.

All right. So there’s a link to get it.

PRP Tune-Up

click to see PRP basic science research<–

So here we go. I’m going to unmute you, Dr. Harrison. Are you there, Dr. Harrison?

Dr. T. Harrison [Theodore Harrison, MD MBA ABAARM]: Yes, I’m here.

Charles Runels: There you go. Talk to us about this paper.

Dr. T. Harrison: Well we thought this was a really interesting paper. One of my Canadian colleagues sent it to me about a week and a half or two weeks ago. We have a little research group here in Victoria, British Columbia, where we have our little lab. We do a few experiments from time to time on different PRPs to try to find out what makes the best and how to make PRP and stuff like that. So when this came across our computers, we thought it would be interesting to see what these guys said and see if there was any way to make it practical, because this is a lab paper from Argentina.

It’s not very practical the way it’s presented here. What these guys did essentially was they took PRP, and they use a double-spin method for making PRP, which is unfortunately not described in the paper. But it’s referenced to a previous paper that they did, so you can find out how they did it. But anyway, they took PRP, and they did a couple of things to it to see if they could make it better. The first thing they did was they took it down to four degrees. They put it in a refrigerator and they got it down to four degrees for half an hour.

Then they tested it to see, with the various growth factors, and there are some pictures there about they tested migration and embryonic cell growth and how it affected it and the like. Yeah, you can see right there. Those pictures there are the first ones from the cold. The top graph is cell growth, the middle one is migration, and the bottom one is new blood vessel formation. They found that if you took just the … Well the control there on the left-hand side, that’s just fetal bovine serum. So there’s nothing in it.

Then the middle one is PRP releasate, which is to say, they took PRP and they activated it with calcium. I think maybe they tried thrombin too. Then the third bar from the left is washed PRP releasate. That is, they took PRP, and they did a second spin so that all the platelets formed a pellet now at the bottom. Then they removed the plasma from it, and they washed it with some kind of lab solution stuff, not really necessary in my opinion. But then they reconstituted it and activated it after exposing it to cold.

Then you can see what the results were. They got more migration, they got more angiogenesis, and they got more human embryonic cell growth from it. Also in the references, they have a good reference to the paper that gives good overview of what cold does to platelets. And essentially, what happens is, when platelets get cold, they get a lot more sensitive to activation, and they’re pretty sensitive to begin with. I mean, almost anything can cause a platelet to activate. I mean, I made a list once and it had like 20 or 30 things documented that cause platelet activation.

The only thing that keeps this from turning into a clot in five minutes is the fact that there are anti-activation proteins circulating in the whole blood. So that if a platelet accidentally tripped off, it just doesn’t set off the cascade and clot your whole vascular system. But, the fact is that they got a lot more results when they took away the plasma, and they got a lot better results when they made it cold. The second thing they did was take away the plasma.

Now, I’d heard a lot before that plasma helped PRP or helped the platelets in PRP. But these guys have some pretty interesting results here that show that if you take the plasma part away, the PRP actually does better. This is the washed platelet releasate part that they have there.

Dr. T. Harrison: Have there. So that was kind of interesting too. It doesn’t look … I can’t really tell from their data whether they cause lysis or not by doing these things. We know that lysate performs better than PRP by itself, and I guess I should define a couple of things here. Everybody on the call I’m sure knows what platelet rich plasma is and platelet poor plasma is. But there’s also a couple of nuances. There’s platelet releasate and platelet lysate. Platelet releasate is what happens when you make PRP, and then you spin it down and you add calcium to it. And then you spin it down again, and take off the remains of the platelet. So all you have left is the plasma, and what got dumped into the plasma from the alpha granules and delta granules after it’s activated with calcium, or something like that. That demonstrably performs better than just PRP by itself.

Now, platelet lysate is what you get when you take PRP and you spin it down, and you take all the plasma off, and you lyse the remaining platelets. So in that case what you get is a hodgepodge of everything that was in the platelets. I mean, it lyses the platelet cell membrane, but it also lyses the alpha granules, the delta granules, the lysosomes, the mitochondria. I mean everything that was in there just gets dumped into the mix. But what happens, this results in much higher concentrations of the growth factors and cytokines. And the research so far tends to go toward lysate being even more powerful than PRP, or PRP releasate as far as growing human embryonic stem cells. I mean human embryonic cells, our concern.

So these guys did the cold, and they found that that made the releasate more powerful, and they took away the plasma, and they hypothesized … and that made things better too. Again more immigration, more angiogenesis, more human embryonic cell growth. And they hypothesized that there were inhibitors in the plasma that were keeping the PRP releasate, the regular PRP releasate, from it’s full potential, you might say. And then when you got rid of the plasma, and then activated the cells and or lyse the cells, then you didn’t have these inhibitors anymore, and that’s why the plasma-free PRP I guess releasate you’d call it worked better.

And then they did one more thing. They also tried adding cryoprecipitate to the PRP to see what that would do. And they made the cryoprecipitate by basically freezing their PRP, or spinning down the PRP, taking off the plasma, and then freezing that plasma. It’s basically fresh frozen plasma. But they froze it for 24 hours. And then they warmed it and centrifuged it again to get the precipitate, which is mainly fiber and fibrinogen, von Willebrand’s factor, and a few more proteins like that. And so they took that precipitate, and they added that to their PRP as well. And they didn’t quite document so well what happened there, but it does seem like these proteins form a matrix which allows better migration. And it also has a little more effect on proliferation, though I think it didn’t have much of an effect on angiogenesis at all.

So basically they got three different ways they could make PRP better. You know, make it cold, take away the plasma, and add cryoprecipitate. So, I dunno, for office purposes, making the cryoprecipitate’s probably not very practical. But the other two are probably pretty easily doable, so we ran a little experiment ourselves here. Basically we took some PRP and we took a 3 cc syringe of PRP and we wrapped it in an ice brick. You know, one of these bags full of something that freezes really easily that you put in the freezer and then you put in a cooler or something. We just wrapped that around the 3 cc syringe, froze it, and then we took out the or empty 3 cc syringe, and we put in a 3 cc syringe full of PRP, and we took the temperature to see how long it took us to get down to four degrees. And it took about four and a half minutes to get the temperature of the PRP down to four degrees, same temperature as they used here.

And then we ran it through the hematology analyzer to see what happened there. And we found there was probably a little lysis. But not much else happened. It didn’t look like they were activated yet at that time. So for practical purposes, it looks like you can make PRP cold in about four and a half or five minutes. So that might work in the office pretty well.

And the other thing of course is just taking the plasma off, so it doesn’t inhibit the growth factors and cytokines that are released when you make releasate, or when you make lysate for that matter. And that’s just easy to do. You just after your second concentrating spin, or maybe during your second concentrated spin, you just spin it hard enough so the platelets form a pellet down at the bottom. And then you just take off all the plasma. And then you can reconstitute it with water if you wanna get a lysate. Or with D50 if you want to get a combination lysate releasate. Or maybe with normal saline if you wanna just get a releasate out of it.

So that’s pretty easy to do too. So from a practical point of view in the office, you could do about two thirds of the things that these people did to make their PRP more effective. And you can see from the graphs, that they got anywhere from 30% to 50% improvement in their PRP results when they did these things. So it looks like it might be pretty effective stuff.

This is only one study, and I hope other people will do other studies that’ll confirm this. But it is pretty exciting that you can increase your PRP effectiveness this much with some pretty simple things that you could do in the office.

Charles Runels: That’s very fascinating, and I was not even aware of this paper, so I’m sure everyone’s cheering you for, and just the fact that you told me that you went and counted by reading the research 30 different ways to activate platelets, I’m impressed and very grateful. My impression is that if anyone studied this paper in detail, they would have to come away understanding platelet rich plasma in a deeper way whether or not they adopted the techniques or not. You know, just the reading of the introduction to me was encouraging. Just as a reminder, as they go through as their intro for the study, the safetiness of it, and they go just these three words: recruitment, proliferation, and differentiation of stem cells. We all know that, but just to be reminded, all those things are happening, especially to those on the call who are new to platelet rich plasma. That’s what you’re doing. That’s a powerful statement.

And then on this next page, as you were mentioning, they say surprisingly, I think that’s an understatement to say that in something called platelet rich plasma, the plasma’s actually decreasing the effectiveness of angiogenesis. And they talk briefly here about why that could happen and give a reference. Anyway, you’ve done such a wonderful job of talking about it, I’m not going to muddy the waters anymore. But could you expand more on, having read this now, has it changed your practice as far as your daily … and you know Victoria Canada, like when you take the boat from Seattle up to that beautiful, amazing place right there. Is that where you are?

Dr. T. Harrison: Yep, that’s where we are.

Charles Runels: Wow, I was there once. I don’t see how you get any work done living in such an amazing place. It’s so beautiful there. I would just be outside, gawking all the time. So how has this [research under discussion] changed what you do? Or has it?

Dr. T. Harrison: Well, we haven’t really tried this on patients yet, but we’re definitely going to, because it’s really easy to just put your PRP in a freezer brick for four or five minutes. And it only adds a little bit of time to the preparation, and it’s pretty easy to take off the plasma after a second spin, and then reconstitute it with something. Now the question that we have is what do we reconstitute it with? Because we did a study earlier this year, which we presented at the AALM Conference, where we took PRP and we diluted it 50/50 with different concentrations of dextrose. Because we’re really interested in prolotherapy and using this in joint. And dextrose has been the main deal for prolotherapy for many, many years, ’til people started using PRP. We thought the two might be synergistic, so we decided what would happen if we added them together?

So we did different dilutions, from basically to sterile, distilled water, all the way up to D50. And we mixed them half and half with PRP, regular PRP, to see what would happen. And of course when we mixed it with water, we got about 80% lysis of the platelets. So it was almost a perfect lysate. Not quite, I don’t know why those last 20% of platelets didn’t lyse, but they didn’t. And at D5, D12.5, and D25, we got about maybe 15%-20% lysis. There seems to be something in dextrose that platelets are sensitive to. At least some platelets are sensitive to.

But when we got to D50, and we added one cc of D50 to our one cc of PRP, we still got 20% lysis, just like we had with all the other dextrose concentrations. But the other 80% of the platelets activated. The lower concentrations of dextrose did not activate the platelets, but at D50, all the platelets activate. The rest of the platelets activate. So you get a combination of lysate and releasate at that concentration. So that’s what we’ve been using for prolotherapy.

Charles Runels: Interesting.

Dr. T. Harrison: Now, for other uses, I’m not sure whether that would work or not. It certainly gets you activation, and dextrose is good for platelets, because platelets use dextrose. They eat it. They feed off it. And when you give PRP normally, the platelets don’t just dump all their alpha granules and die. They continue to live for about five to seven days, and they release further alpha granules in waves. So it’s not all the alpha granules that get dumped. And when you activate with calcium or with thrombin, it’s only the first wave. Because the alpha granules contain both pro-angiogenesis factors, and anti-angiogenesis factors. They are pro-inflammatory and anti-inflammatory. And they have both pro coagulation and anti-coagulation factors in them.

So it wouldn’t make any sense to dump all the pro’s and anti’s at the same time. And so they don’t. You get a first wave that’s probably mostly the pro-inflammatory, pro-coagulation alpha granules, and then you get a second wave, maybe within the next day or two, that has the anti-inflammatory, and maybe the pro-angiogenesis ones, and then so forth. They go through five to seven days of releasing new waves of alpha granules as they do their job. And it ends up the last wave is gonna be the anti-angiogenesis as they knock off all the little blood vessels that they made that they didn’t need anymore once the healing is all finished.

But when you make regular PRP and inject it, that’s what you get. The platelets stick around, they release their alpha granules in waves, it’s sorta like the normal healing process. When you make a lysate, all those guys just get dumped together. The pro’s and the anti’s and everything else, from the lysosomes and mitochondrian. It just all gets dumped together. But it seems that the much higher concentrations of growth factors that you get from that outweighs the presence of the anti-coagulants and the anti-angiogenesis. You know, the other factors that would normally work against the new migration growth, cell growth, and all that sorta stuff.

So, so far at least, it looks like lysate’s the most powerful PRP preparation. And so we’re thinking maybe we outta cool it, or maybe we oughta wash it, and then cool it, and then reconstitute with water, and see how much of a lysate we can get from doing that to get the maximum potential out of the PRP.

Charles Runels: Wow, what a wealth of knowledge. You should be teaching. It sounds like you probably are, but if you ever want to teach our procedures, I would certainly show up as a student to see how you’re thinking about it. One other question. If you look at this just as a reminder, and you’re doing this, when they talk about how PRP is used in regenerative medicine, it mentions of course muscle damage which you guys are doing as doing prolotherapy, I’m sure you’re treating that already. So if you were, as we’ve developed our O-Shot® techniques around the pelvic floor and the vagina and the urethral space, if you were treating a woman who had dyspareunia and had pelvic floor tenderness, or if you were just treating incontinence and using PRP in combination with an Emsella machine, where in theory, you’re causing strengthening of the pelvic floor, in those two cases, if you would … Because the thought is, of course, that perhaps you could inject the pelvic floor if you’re trying to strengthen it and then do your m-cellular treatment with the electromagnetic stimulation of the muscle, and maybe get a better result than if you did just one of those alone.

Note…we offer an icon on our directory to identify O-Shot® providers who also offer Emsella, radio-frequency, or laser in conjunction with the O-Shot® procedure. If you are offering these combination therapies, please let our office know so we can add the icon to your name on the directory (support@cellularmedicineassociation.org).

Where would you inject, and how would you treat your PRP before doing something in the pelvis or vagina, where the idea was treating either dyspareunia or pelvic floor laxity, to help incontinence?

Dr. T. Harrison: Well, if it was for stress incontinence, I’d be fairly cautious because, you guys have run into cases where basically, you caused urinary obstruction from people injecting too much PRP around the urethral area. And since this is more powerful PRP, I’d want to sort of proceed cautiously there, using this sort of enhanced PRP stuff.

Now, for pelvic muscle floor, I don’t think that would be so much of a problem. And if you inject along the top of the vagina, out to the sides, along the course of the urethra using these more powerful solutions, you might actually be able to strengthen the whole pelvic floor that way.

Charles Runels: Or, if you were, say, treating pelvic floor tenderness, a trigger point injection for dyspareunia with pelvic floor trigger point reproduction of the pain, you would do … When you say that way, would you do your lysate with water and cold technique? Would you expect that to work better?

Dr. T. Harrison: I think I would expect it to work better than just plain PRP. Yeah.

Charles Runels: Yes.

Thank you. That’s helpful. To think about the overflow incontinence just to … Thank you for bringing that up, just for the rest of the people on the call, if you haven’t heard of that, we’ve had so far, I know of three cases. In every case though, the reassurance is that the volumes injected were 7 CCs or more, and so it’s yet to happen with our recommended 4 CCs. If you look, inject 4 CCs, it may not sound like much, but if you injected say … Imagine injecting, if when we do the face, we just inject one, it’s a pretty large volume. So, our thinking is, it’s probably more from a volumetric fact, but I appreciate your caution, would maybe if you had more platelet-rich fiber matrix formed, because of changing the consistency, perhaps that might cause it as well.

The other reassurance is that, in all three cases that I know of, that it within a week of an overflow obstruction basically from having created artificial hematomas, is really what you’re doing, it resolved, and the people did very well with the eventual resolution of their stress incontinence.

It’s pretty scary, though, when your person comes for stress incontinence and then they have to wear a diaper for weeks, because they’re dribbling all the time.

So, people don’t usually like that.

Dr. T. Harrison: Yeah, and the other thing you want to remember with using at least the plasma-free technique here is, you’re not going to get a fibrin clot, because you’ve taken all the fibrin, fibrinogen, and stuff away, so if you’re using it for maybe things where you want the PRP to all stay in one place like the O-Shot and scalp type things, where you don’t want it just wandering off, and diffusing really rapidly, you might not want to do this.

Charles Runels: Interesting. Yeah. Very good.

What a wealth of knowledge you are, I would want to spend the next two hours talking with you.

One of our physicians, Pamela Kulback, who’s one of the interventional radiologists in our group, typed in the question, about using, perhaps, the centrifuge. That is itself cool.

Do you know of such a device? Or do you have something in your-

Dr. T. Harrison: Oh yeah. We don’t have one, but refrigerated centrifuges, well they’re a bit expensive of course, but they’re easy to come by. All the labs have them, and you could do it that way.

The thing is, if you put the PRP in a refrigerated centrifuge, you would refrigerate it before you removed the plasma, because the plasma is still in there when you do that, and you might pre-activate some of the platelets when you did that.

So we prefer the technique of getting rid of the plasma first and then making it cold, so that we don’t have the plasma interfering with stuff while it’s in the centrifuge.

Charles Runels: Beautiful!

Well, stay on the call because we may want to pick your brain again. I think that covered the research we were going to talk about today.

FDA Approval of PRP

There was one question on the membership site that brought up the FDA question again, so I just want to remind everyone where I put that, of course thankfully, the FDA doesn’t drift all the way up to Victoria, but some of us have to think about that, so I’m going to open this where you guys can see where it lives.

FDA & PRP click to read<–

And again, this will be posted to all the membership sites. But I’ve kept this page as up-to-date as I can (if someone finds another paper, let me know) but I’ve put here actual articles by the FDA where they have talked about, in very specific terms, they do not regulate platelet-rich plasma.

In the United States, they do regulate the devices and I think you’re safest in the US by using a device that is approved by the FDA to prepare plasma to go back into the body.

Now, in other countries, maybe that’s not such a big deal, assuming you have the depth of knowledge you just heard displayed.

There actually are people in the US who have a different level of laboratory that they’ve had approved by the FDA, essentially, the FDA has come in and said, “Yeah, you’re able to do this.”

But unless you have that in the States, I’d recommend you use one of the kits.

So the short of all this, and again, I have multiple references here, where the FDA is talked about … this isn’t second-hand knowledge, they’ve done articles for the New England Journal and their own website, and I have a video that explains at least my idea about it, and a transcript.

So anything that has to do with the FDA and PRP, we are in good standings.

The one thing that I would be careful about that I see going on and it’s nothing unethical about the intentions, but as far as the FDA goes, you could get slapped around some, is, if you are a physician and you are doing these procedures, and you are also selling therapy kits to physicians, as in, you are teaching usually, and you are either directly or indirectly profiting from selling PRP kits, in my opinion and in the opinion of the FDA (so I’m giving you a very gentle warning), the FDA has shut down sales people who teach what to do with the plasma because you’re teaching what the FDA has not said the device is able to do, they’re [FDA] only saying the device can make the plasma. The FDA doesn’t approve specific use for it.

WARNING! So if you’re profiting from the device, and you’re teaching something that no one’s proven the device is capable of doing, whether you’re the salesman who’s selling and teaching, or you’re the teacher who’s teaching and selling, you should be looking over your shoulder, because the FDA could come slap you around in a pretty dramatic way.

But other than that, as far as using it, if someone else is selling it to you, they’re profiting from the kit and now as the physician, you’re deciding what to do with the blood or the blood products, the FDA is very plain. They’re not at all bashful about telling you, they have no interest in telling a doctor what to do with blood, as long as you’re not manipulating the tissue to the point that it becomes a drug, and part of the point of a lot of these articles is that, when it comes to stem cells in the US, once you do a certain amount of manipulation, it gets reclassified, and now they are very interested in what you’re doing with it and again, unless you’re in a study, you should look over your shoulder in the US.

So that’s the quick version of that.

We’re coming up on the end of the hour.

If anyone else has some questions they want to throw in, I’m getting close to our topic list here.

This, we just posted, I’m not going to waste your time getting there again, but with [inaudible 00:40:24], I posted a video, actually had a interview with the guy who patented the ingredient … a cancer researcher at Harvard, then a cancer cell biologist at Berkeley, it was shocking to me when he told the whole story about how this product came about. I knew there was a lot of thought in it, but I didn’t know that it had directly six years of research on that level and a $2 million NIH study behind it, initially for the study of wound healing, which of course is related to cancer, as it involves cell growth.

So you can find that … I’ll put a link to the video, but it’s a really beautiful thing to hear him talk about his research and the team that worked on the main patented ingredient that’s in here.

I feel blessed that we [member of the CMA provider groups like the Vampire Facelift® and Vampire Facial® and O-Shot®] have the exclusive on this.

Here’s where to buy Altar™ at wholesale prices<– (only available at wholesale price to our CMA members)

So it’s an idea to use post-treatment for the face, for the labia, (even for the penis) and I just wanted to remind you that it’s there and we also have classes coming up,

Next classes with Dr. Runels teaching procedures and marketing<–

Next classes world wide with faculty of multiple specialties<—

so if you want to check that out, and I think after that, that’s all I have to say today.

I can’t tell you how grateful we are, Dr. Harrison, for that amazing discussion about platelet-rich plasma. That’s just maybe the most detailed, informed explanation maybe that I’ve heard of the research on these calls so thank you for being on the call.

Okay so I don’t see any other questions, so I’m going to shut this down. You guys have a wonderful week.

Good-bye

Next Workshops with Live Models<---
Relevant Links

Beauty Analysis Facial Topographical Map<–

A review of aesthetic gynecology<–
Next Workshops<–
Optimized PRP<–

FDA & PRP<–

 

 

 

 

 

Cellular Medicine Association
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JCPM2018May30.DocumentingPenis.HowLongBetweenLaser&OShot.BellsPalsyTx.ParkYourPodcast

This sample of our weekly journal club is posted as an example of part of the benefits our joining our provider groups. We do these meetings weekly...every week and feature physicians and their amazing research from around the world.

Topics Discussed Include the Following…

*Documenting the Penis
*Documenting the Penis by text (in a private way)
*How long to wait after the O-Shot® before getting a Vaginal Laser treatment?
*Treating the Bell’s Palsy with the Vampire Facelift®
*Where to park your podcast
*Emsella

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Transcript

Documenting the Penis

Charles Runels: Welcome everybody. Looks like we have a great turnout today. Let’s start with this question just it’s about where to find the questionnaire for men. It’s a good reminder that we should be doing something to document an objective measure of what’s happening. Moving to the O-Shot® and the Priapus Shot®, so I’ll show you where to find it for both. When you log into the Priapus Shot® membership site, and you click on the how to do procedure button, and then you scroll down. There’s an erectile scale, so it’s objective measurement of erectile function. It’s commonly used by the urologist and there it is right there. Erectile dysfunction intensity scale.

Then when you open that, it gives you a scale of from one to five, for five questions. So the lowest you can get is one on every one– times five, the most you could get is 25, so that’s where you would download that. Now, if you don’t want to, well let me take this back.

Online, Text, Documenting the Penis

If you want to continue to survey them, old school way would be to do this the day you visit with them, and then on follow up visits, but if you wanted to have it done automatically, then you’d go back over here and we have, so you go back to the dashboard and then you click on patient survey.

We will administer that for you. I recommend you do both. Do something on paper the day you visit them, and do the procedure and then follow up, but then also all you have to do is put in their name and cell phone number, and then they’re surveyed in a HIPAA compliant way with some open ended questions, also you can see we have a drop down menu so we look to see which kit you used, and other things like are they on testosterone. If someone put something really strange in here, then we have a way I can use birthdays, and the day they saw you, and you could reconstruct it and contact them, but the good thing is I can give you your data. What your patients are doing, and this will help us design future studies.

Even though it’s not double-blind placebo, there’s a fair number of data points being collected, so we can publish this in a prospective survey kind of thing, and that same erectile dysfunction scale was part of this, so questions one through five questions where they’re graded one through five. That’s where you find it, on the how to do page, and then scroll to the bottom and you can download it. Then on the same thing for the female side, there’s female sexual distress and female sexual function index, which takes a few minutes. Female sexual distress is the quickest. Female sexual function index probably takes, if they’re thoughtful about it, five minutes or so, but we can administer those also by survey. Then give you that data. So that was a good question.

How long to wait after the O-Shot® before getting a Vaginal Laser treatment?

Let’s see. This was a good, oh, well I’ll come back to that. Let’s go ahead and do this question. How long does a patient need to wait after the O shot for getting a Mona Lisa vaginal laser treatment for vaginal atrophy? By the way, you guys, you can type into the question box if you want to contribute, you can just raise your hand and I’ll unmute your mic, or you can type into the question box if you have a question or a comment, and I’ll either read it or unmute you so you can talk. This is a great question. As part of the answer to this, someone asked me for a detailed video recording that they could show their patients after they had a procedure done.

The O-Shot® procedure, so I’ll show you where I put it and I’ll recommend that you guys do your version of it. I’ll show you where it lives. Right here. If you go to the O-Shot webpage, the main site, and then recent posts, I put a podcast blog right there. So you can just click on it there, and actually the transcription is done, I’ll have that posted by tomorrow morning, but I recommend you take my transcript, and read it, and do it your own video or your own podcast, and put it on your website, and modify it based on your observations and philosophies. You’ll see I go into what to expect whether you’re doing it for like necrosis, and I go into some of the ideas about using other methods like radio frequency, the Emsella with the electromagnetic contraction of the pelvic floor.


If you are interested in Emsella, send message to the company to get a discount for being a member of the O-Shot® provider group…

if you purchase, then let us know and we will put an icon by your name on the O-Shot® directory so that women know that you offer a combination therapy of the O-Shot® procedure combined with the Emsella treatment…
here’s where to let us know…
Support@CellularMedicineAssociation.org


So back to this question, if you do the O-Shot® the day of the procedure, you could do the O-Shot® immediately after any sort of inner treatment, so you do vaginal laser, or radio frequency, and the same visit, same day, immediately afterwards you could use PRP. Same thing if you were an Olympic athlete, you’d use PRP to help recover the muscle function immediately afterwards. If you go to PubMed and just read about PRP, one time it was outlawed by the Olympic committee because it does seem to help recovery with muscle function, but then they decided to allow it.

You could make the argument that it may even help the day of using an Emsella or the electromagnetic treatment, but if you do the PRP first, then the energy’s going to denature the amino acid proteins, just like if you took insulin and shook it, or you cooked it, you denature the amino acid chain and uncode that chain so it no longer, it just becomes another protein. It no longer is a chemical messenger like the amino acid peptide or hormones like growth hormone and insulin are, which is of course why you cannot take them by mouth because the digestive system, as you guys know, breaks amino acids apart so now it just becomes like you ate a hamburger, so you can’t take insulin as a pill or growth hormone as a pill because it denatures or scrambles the message.

In the same way, if you did an O-Shot®, so the question is how long does a patient need to wait after the O-Shot® before you do the Mona Lisa, but what you can assume is whenever you do the Mona Lisa, you’re going to undo first of all the amino acid messenger chain, that are the small peptides, that are released from the platelets. Then second of all, of course the laser is going to cause damage, which is the intention of fractal sort of puncture wound as if it were doing a laser version of micro-needling. And then you have recovery or healing of that. So if you’re doing heat and you have pluripotent stem cells that have migrated there because of your plasma it appears to me that you would probably undo that as well, that growth.

I would say you would do the Mona Lisa whenever you thought the effects of the O-Shot had taken place. If you flip the order, you go Mona Lisa and O-Shot immediately afterwards on the first day, but if you do Mona Lisa first I would want to wait at least six weeks, preferably eight weeks so that you have most of the benefit of the O-Shot before you did the laser. If you look at the wound care studies that Sclafani did with PRP most of the effects were there at eight weeks with full effect at 12 weeks post treatment with PRP. I would want to give it eight weeks or else I’m attenuating the results of the O-Shot.

Using the Vampire Facelift® help Bell’s Palsy

Okay so, we covered this one with the short vagina last meeting, let’s see if anybody has, nobody has a question yet. There was a really interesting question someone had about, yeah. So Catherine Stone (check her out here) is one of our [amazing] providers in New Zealand and she also keeps an office in London, one of our teachers, she teaches a beautiful class there in New Zealand.

Dr. Catherine Stone

She teaches along with Dr. Kirshni Appanna.

Dr. Kirshni Appanna

She says, if you, well she talks about Botox [as a treatment for Bell’s Palsy], but she comes up to Bell’s Palsy, “I treat a lot of residual Bell Palsy and facial asymmetry patients this way using Botox. Once their Palsy is established how about PRP for Bell’s Palsy? Would you only use it the first six months or you think is long term?”

Where to inject, so this is a great question. One of us needs to publish this because so far three people have told me that they saw benefit years after the Bell’s Palsy.

I’ll pull this up just so you can see. The only reference I saw to it in the literature was someone who put this out where they used mononuclear cells and platelet plasma which there’s two variables–after 26 YEARS of being plagued with this condition.

Read about treating Bell’s Palsy of 26 years duration with PRP<–

But, we’ve had three different people tell me, and I’ve actually seen this as well, a Bell’s Palsy improved years afterwards. One of the people works in my office as a matter of fact had, not a Bell’s Palsy but facial surgery that left her with numbness that’d been done over ten years before she came to work for me.

I did the Vampire Facelift® for a cosmetic result and then anecdotally she noticed that the sensation had returned to her face. So, I don’t know when the time limit is for this to happen, but it appears to be that it can happen after, not just the acute phase, but months or years after the Bell’s Palsy has occurred. If you actually just look at the research, what’s been published, there’s a fair number of studies showing plate rich plasma helping regenerate nerve tissue. I think it’s because we know it’s affect on attenuating all the immune response, it’d be nice to get to these people immediately when the Bell’s Palsy occurs and see what would happen and someone needs to do that study.

There’s so much research that needs to be done based on our observations but there’s no downside and a huge upside so I would say try it and of course it’s in the distribution of the facial nerve, I would just, but there’s no downside of just putting it everywhere. I would just put subdermally everywhere. We actually used to do this eight years ago when I first started doing the Vampire and using PRP cosmetically. I would use more of it, I’d basically tried to fill every part of the face subdermally but most people found that, or some people found it a little much so I became more selective and strategic about where I place it.

But I think in the case where you’re trying to regenerate nerve, I would just consider it, putting it everywhere. Or, if you want to be more specific you put it in the distribution of the facial nerve. Okay, let’s see, we didn’t have as many questions this time, i think that pretty much covered the questions that showed up on the website. See if anybody else has any questions. We may shut this down early. The, let’s see I don’t see any other questions.

I’d like to cover when we do these journal clubs, I like to cover research that we’ve done and hopefully somebody will build on that and something about marketing. As far as marketing goes this time, I think that there was one question that came up about building out a link to sell the Altar or whatever you might want to sell, creating a link that goes on your website. I actually covered that a few workshops or journal clubs ago, it might help if I just show you how easy it is to find things that are actually on one of our pages. If you go, I’ll go in and I’ll show you. There’s a search box and if you just type that, whatever it is you’re looking for, so let’s say that we’re on this page, and by the way our Altar shipped this week so hopefully you guys are seeing that.

Where to park your podcast<–

Get to the page. Yeah. There, so whenever you’re here, you just put in the search box whatever it is you’re looking for so it’ll pull it up on any of the posts. We have many pages on these websites. Let’s see if there’s any other questions. Not many questions this week so we may just shut this down. Okay so I think that’s it. My big marketing tip, well big but I don’t know about that, but the marketing tip I have for you this time is record an aftercare, either podcast or video. For podcast I use Libsyn.com L-i-b-s-y-n.com. You can record a podcast or a video for the actor here. What to expect before your procedures, you can put that on your websites because a lot of people look at that before they have a procedure done and you’ll find that people come to you and have the procedure done because they saw your aftercare instructions. So tonight was a quick one, I don’t see any other questions so we’ll just shut this down. You guys have a wonderful week.

For workshop that includes marketing including podcasting (if you’ve attended this before, then it’s free to return)<–

 

Next Workshops with Live Models<---

Relevant Links

Apply to join each of our provider groups<—

Treatment of Bell’s Palsy with PRP (why the Vampire Facelift® could help this condition after 26 YEARS)<–
Nerve regeneration with PRP<–
What to expect after the O-Shot® [Orgasm Shot®] procedure<–

Doing your own podcast<–

Altar™
Vampire Facial® Research

Cellular Medicine Association
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JCPM2018April4.PenisPump.Needed?FreePress.PumpIncreasesO2.DrDelucia&FreeTVAppearance.DrGoodmanOnInnovation

Topics Discussed Include the Following…

*Can you pump too much? Do you really need a pressure gauge?
*Where to buy a penis pumps wholesale & how to adjust price
*Do you have to use the pump after the Priapus Shot® procedure?
*Other side effects of the pump.
*Dr. Delucia & The number one reason doctors do not get free press?
*Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration
*Briars, Woods Walking & Medical Innovation
*How to measure web traffic. One of my secret tools.
*A way to get a free appearance on your local TV station
*Dr. Michael Goodman talks about innovation in medicine & funding research

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Transcript

Penis Pump Research

Next Workshops with Live Models<---

Charles Runels: Let’s start by talking about penis pumps. I received two pretty interesting questions in the past week about penis pumps. One of them had to do with … Oh, by the way, we’re also wanting to speak a little bit about amnion research, and an article that came out today giving us some free press about the O-Shot, and about how to use that press, to leverage it for your own practice.

First about the penis pump. This is a sampling of some of the research that’s out there about penis pumps (click), and some of this research answers questions that were posed to me. One sent me a photograph of a penis where they did a Priapus Shot, this story, guy has an erectile dysfunction score of about 15 or so. So he has some function, but it’s not like what it used to be.

So he comes in for a Priapus Shot® [procedure]. After the shot, the pump was applied. Then, when they took the pump off, the patient had some looked like vesicles on the glands’ penis, filled with clear fluid, three of them, and some increased bruising, more than what would be expected from just the injection. The question was, what might’ve gone wrong?

My first question was, what pressure was put on the pump? This provider had … By the way, there was no permanent damage, so I’ll just go ahead and tell you the ending of the story is good. But the provider, rather than follow our protocol, which is that you apply a negative pressure of 7-10, provider had found somewhere on the internet the recommendation of a pressure of minus 15. The cause of that, that’s what created those vesicles and the increased bruising.

Can you pump too much? Do you really need a pressure gauge?

Along those lines, I wanted to show you one article that shows that over inflation, as you might expect, there’s one of many. There’s case reports out there of people doing stupid things like hooking their penis up to the home vac system, and it just gets ripped off. Obviously, we’re not going to do anything like that in our office. But this is just a simple case where a 66 year old gentleman used a vacuum erection device, but he bought one without a pressure gauge.

I think that’s really dangerous to have people using something that you cannot measure. They get overzealous, maybe there’s loss of sensation already from diabetes or injury. They can’t tell what they’re doing. If you do a Priapus Shot®, by definition, you’ve probably put some topical anesthetic or maybe did a block, and so they don’t have the pain as a feedback.

I think it’s really dangerous, in my opinion, to either use or recommend that someone use a pump without knowing what they’re doing. Now, if you go back and you look at the research, which this is representative, but there’s others I’ll mention shortly. You’ll find that it is, if it’s done the proper way, this has been a therapy that’s been around since 1974 or so, and it’s known to be a safe and effective treatment. Provided that you use it intelligently, just like almost everything we do in medicine, there’s a sweet spot in less is less effective, and more is damaging.

Same with this, and if you’ll go back to the old protocols that people were using, they were going sometimes up to a pressure of 15. It starts to sound like people comparing notes with lifting weights or something. Where is it better to do high intensity heavy weights for short repetitions or small weights with high repetitions? It sounds a little bit like people comparing notes at the gym.

I think there’s still room for thinking about this, but there’s couple of papers in the Journal of Sexual Medicine that you can go look at. The patent, which I think was very tightly edited by Irwin Goldstein, where it showed that using a vacuum pump increases the effectiveness of Viagra and Cialis. Men taking those therapeutic medications get a better result if they use a pump, intelligently, which makes sense. You’re just basically stretching out a water balloon to make it easier to blow up, but if you look at the old protocols involved, sometimes going to pressure 15, but most people think now, if you’ll look at the protocols being used in penial rehabilitation therapy where you also find a lot of this pump research.

Rehabilitating the penis post prostate surgery. The usual protocol’s a negative 7-10, and some guys, they seem to be really sensitive, and that’ll complain of pain at three or four, that’s okay. Just something that increases the erection equivalent or maybe slightly more than what would be experienced with a normal erection using the vacuum pump. That seems to be the place to where people see some improvement.

There was also this article, and another, looking at … Yes, this one. This is the journal of sex … Wrong one, I’m sorry, excuse me. This one.

Yes, so this was The British Journal of Urology, nice paper where they took people who had Peyronie’s disease scheduled for research, 31 people, and over a course of 12 weeks they had them use a pump twice a day. Half of them canceled their surgery, because just the mechanical makes sense. You have the scar tissue, stretch it out every day, a couple times a day, it might straighten it out, and it worked. When I talked to Ronald Virag who published the most recent, I think, landmark study about using PRP for Peyronie’s, which you can find if you go here, you go to our website, priapusshot.com/peyronies

By the way, I think this relates very nicely with the work that Andrew Goldstein did for us, with lichen sclerosus, because it all relates to the PRP down regulating the autoimmune response. If you go to, let’s see. If you just go /peyronies, which I recommend you give this website to your patients, because I put on here everything that I could find in the literature that had been shown in a really nice study to help with Peyronie’s. One of which was the Priapus Shot, which we can now say now.

If you go to just click on the references, so give them that, PriapusShot.com/peyronies so they will include all of those things in their protocol. For example, there’s a higher incidence with smoking. They’re sort of undoing the things we do if they don’t quit smoking, or at least try to do that. Not this one, this one.

Yes. Wait, this is not the Ronald Virag, it’s another nice study, but this isn’t the Ronald Virag study. Definitive study is … Yes, this one. This one. This is the one that I love.

Dr. Virag, who I think is amazing, he’s a legend, because he was the first guy to think of doing the TriMix injections, vascular surgeon turned ED expert, because of that idea. Here in this study, he showed that using PRP works better with fewer side effects than Xiapex, really nice research including some objective data using imaging. I’m kind of going in a circle here, but if you talk with him, which I have, shared the podium with him a couple times. If you talk with him, he’ll say in practice he combines PRP with the pump.

Circling back to what the original topic was, we have a pump study showing that mechanical traction helps Peyronie’s disease. Then we have this really nice study showing that PRP helps Peyronie’s disease, and when you talk with Dr. Virag, he’ll tell you that in practice he combines the two. Of course, when you’re doing a study, you just want one variable, but in practice, that combination is really nice, which is what we’re promoting when people come to us. Back to the pumps, you need to know what you’re doing, in my opinion.

Where to buy a penis pumps wholesale & how to adjust price

I think you use a pump that has a pressure of somewhere between … that you could measure, and then you have them put that pressure somewhere between 7 and 10. Now, I’ll show you where some people have trouble finding this, for some reason, so I’ll show you where I have a link. Where you can buy it wholesale, penis pumps, and I’ll tell you how some of our people are using this to create, not only a better outcome, but more profit, which is really nice when you can help people tremendously, and also the combination of doing more creates more profit. Let me get to this and show you.

If you go, sort of coming in the back way, so let me have one more click before I show you what you’ll see. When you login to the Priapus Shot membership sight, and then when you land, you’ll be on the dashboard, which is the next page I’ll show you. Here. Then when you click on the how to do the procedure part and scroll down, unless it’s somehow fallen off the page, which somehow computers do that sometimes, I’m not sure why, but if you scroll down, there should be a clicking link here somewhere where you can buy that. That’s it.

That is a wholesale, place to buy wholesale pumps. There’s a hand pump, an electric pump. This pump, not saying that you should have to use this, but I like this pump, because it’s a heavy duty metal device, and it has a pressure gauge on it. But, what some people are doing to increase both profit and outcome, is ordering this electric pump, which has a retail value of around $500, give or take.

If you go, this is the wholesale sight of this website, if you go to the retail sight, this has a perceived value of around $500. So some are buying this at wholesale, giving it to the patient, and charging, instead of our usual 18 or $1,900 for the Priapus Shot, charging them $2,200, but you’re giving them a device that’s worth $500. The overall perception of value, and the real delivery of value is actually more. This works well, because you can just set this.

One guy who came to me who had some nice results, he said he just set this and read the Wall Street Journal for an hour a day. I know that’s more than most people wanna devote to a pump, but the point is that if you set it at a nice low … and he used the pressure of seven and had really great results before he ever got his Priapus Shot. I feel like I need to talk more about this, because this is something that sort of freaks people out, and they’re not familiar with it. The other thing that I would tell you is that most people, if you get somewhere around 2-2.2, this is the diameter of the cylinder.

It’s going to fit most people, and seldom will people need the other tube, so maybe you buy one of those to have it on hand, one of each of these, but if you keep the tube to the 2.2 on hand, most people will fit one of those. You kind of see what you’re dealing with, and if it’s the average sized penis, you give them one of those, and give them this. Most of us are giving them a pump as part of the procedure, and just figuring it into the price. Anyway, that’s all there for you.

I kind of cut that deal for you guys, and if you wanna see the retail side of that, this guy Dr. Kaplan, Joel Kaplan out in San Diego. I went and checked him out, I like to meet people personally and see them. It’s interesting, if you go to his “office” it’s a huge warehouse literally stacked up 30 feet high with penis pumps, and about five people manning the computers. He’s making so much money with these pumps, because he delivers a nice product at a good price, but this is the patient side of it, which I like them being able to get to, so I don’t become the pump service repairman.

Whatever pump you give them, I like it to be something they can get … if something breaks on it, they can just order another cylinder without calling your nurse and turning her into the pump mechanic. If they want to get a different size something, because they grew, which happens sometimes, or whatever, it’s all on here for them to measure and do all that. This is the company from which you’re getting the wholesale version of this, it also gives them a way to see that you’re actually giving them something. I said $500, it’s 495 for this system that you’re giving them, or depending on what you’re attaching to it.

Somewhere between 4, 500 bucks, roughly, that you’re giving them, along with your procedure. All right, so that’s one problem, and you have research that shows the pump is helpful mechanically for Peyronie’s. If you go back to PubMed and you look at this, because the other question I get is, “Do we have to do the pump?” I actually had three questions this week about pumps.

Do you have to use the pump after the Priapus Shot® procedure?

One was, “Do we have to do the pump?” No, you don’t really even have to do the shot, right? They could just watch game shows and not have sex, but if you want to get the best effect of this thing, if it’s Peyronie’s, we have good science showing that it could be helpful as a standalone. If you have erectile dysfunction, we have studies showing that it could be helpful.

If it’s done intelligently. If you have prostate surgery, we have good studies showing it’s helpful, and if you want to read that, you just go to PubMed, and put in penile … That’s not PubMed, let me get back to PubMed. You put in “penile rehabilitation,” and a lot of science about how to recover post prostate surgery, and you’ll see that almost all of these protocols involve some combination of Cialis, low dose daily with a pump used daily.

Now, let’s just stop and quit thinking science for just a minute and just think commonsense. I’m a big fan of Richard Feynman, because he had two Nobel Prizes in physics, but he wasn’t into the limelight. He would actually use a fake name when he was going to lecture at universities, because he only wanted the mathematicians in the room. He didn’t want anybody showing up just because he had a Nobel Prize in physics, but he was a big fan of commonsense.

You do the math, but then you stop looking at the math, and you think what I’m looking at, is it commonsense? If you think about what we’re doing, as far as just mechanically allowing a balloon to be easier to blow up, then it makes commonsense that it would be helpful. Now, the other thing, can we take the commonsense thing one more step? There was a time, not so long ago, that I can actually remember, being 58, I can remember as early teens, 12, 13 year old, trying to figure out how to make muscles grow.

There were still people, at that time, who thought that lifting weights was somehow not good for you. If you go all the way back to the ’50s, it was actually … athletes were discouraged from lifting weights. But you had physical therapy post stroke. Physical therapy post stroke, after an injury, trying to recover strength.

It wasn’t until the 1980s, when I was in medical school, that the first article came out that actually said, “Yes, anabolic steroids actually make you stronger.” If you go back before that, they were saying that, “Well, maybe it’s just water weight, they’re not really that much stronger.” But the athletes all knew that was wrong, and I was working as a trainer in the gym, and we’re looking at people lifting the whole side of the gym, so I knew that was not right. Commonsense said it was not right.

Now, back to penises. If we have something that seems to be working for rehabilitating the penis, so if you use that analogy with weight training, why wait until the injury? Is what I’m saying. You don’t wait ’til you have stroke to go get rehabbed with your muscles, you lift weights to try to maintain strength so you don’t fall and break your hip, or you go walking, or some sort of weight resistance, so you don’t wind up like astronauts, where your bones break for standing up, which happens to the elderly.

Back to this. I think that the old will become new. Penis pumps were a thing before we had Viagra, I think they’re becoming a thing again, as we start to rethink how physical therapies might help penial help. Okay, that’s me just kind of trying to think like one of my heroes, Richard Feynman, with commonsense, without looking at the literature. But go read the literature, think about it.

The questions I got were, this week, three of them, “Do you need the pump?” The answer is, you don’t really need it, but you’ll probably get a better results if you use it intelligently. The one exception of that is probably if you have loss of sensation, just anecdotally, what I’ve noticed is those guys, if their only complain is loss of sensation, you’re maybe better off without using the pump. I figured this out, or noticed it in multiple patients.

Penis Pump Research (click)<--

That also makes sense if you’re trying to grow fragile nerve endings, perhaps the mechanical stretching may not be so helpful. That’s the exception to that things we’re using the pump for. The other question was about … Should you use it? My answer is probably yes.

Can you over use it? Do you need to get something with an actual gauge on it? Yes, I think you do, and this guy claims he’s got something that’s FDA, a device that’s been evaluated by the FDA, to where you actually have an accurate pump on it. You don’t want to get blamed for somebody else’s impotence, which is what happens if they over pump, consistently.

Other side effects of the pump

The other side effects are that their skin can become darker, so you just tell them that, and it will reverse if they stop pumping, and they can get some edema if pump for a long time, even if they don’t over pump on the pressure. Should you use it? Yes, for everything, maybe except for loss of sensation. Get something with a gauge on it, and I’ve shown you where to get it wholesale from our website.

Now you have a protocol that you can follow. There’s also a nice little video here that kind of talks you through it. Normally what I do is, I’ll do the shot, I’ll get the pump going, most people are afraid of them. I de-stigmatize that thing by calling it yoga for your penis, and that seems to, I don’t know.

Maybe one of you guys should do that penis yoga, but I think that seems to kind of calm them down a little bit, and I recommend that they not try to hide it. Just take the thing out and pump it up when you’re watching TV with your sweetheart and try not to make it into some big giant secret. The worst thing about porn is people keep it secret from their lover, and then it takes on this mystical thing that turns women into porn widows, where their husband’s off jacking off to porn. Where it loses power and usefulness, I think, when it becomes more shared.

Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration (click)<–

Okay, so I went off and made lots of circles there, but that’s my ideas about the pump. Now, let’s see, what else did I promise you guys? Maybe I should open up … Anybody want to comment about that? That’s on the call, I know there’s some people on here that have done really nice work and had lots of success.

If you just click the button, I’ll unmute you where you can talk to the group, I have a really nice group tonight, and you probably want to comment more about the pump thing. Okay. The other thing I promise we talk about is just to show you guys where some of the amnion research lives. Oh, you know what?

Free marketing for the O-Shot® [Orgasm Shot®] procedure

Let’s take a break from the research for a second and show you some free research thanks to one of our many amazing people, Carolyn Delucia, who is on the call. I’m gonna unmute you Carolyn, ’cause we have two crazy good articles. Before I unmute her, let me just show you, this is a gift from Carolyn, who’s created a really nice relationship with this lady who’s been writing about our stuff, I think, very intelligently. Here’s one that came out March the 11th, about the O-Shot, and here’s one that came out, check this out, April the 2nd about vaginal rejuvenation.

Wait, let me click on this thing. I went down too far. It talks about many of the things that we do, so this is a … I think an intelligent way and a balanced way that doesn’t over promise things. So, this is another nice thing to show your people, and so, how do you show people?

But before I get to going here, maybe Carolyn can talk a little bit about not just the procedures … I just un-muted you, Carolyn, but maybe just kind of some words of wisdom because she’s been teaching for us. She’s managed to get some amazing press. Part of it is because she’s in a nice town, but part of it is that she hustles and she knows how to talk with the press. Okay, are you there, Carolyn?

Carolyn Delucia: Hi everybody. Kind of shocking to be unmuted here but that’s okay. We love you, Charles. When it comes to getting press, I’ve been very fortunate to have gotten by accident noticed by one of the … Daily Elite, I think, was the first one, and once that happened, I was invited to give opinions on many articles. I think that the point there is if they ask you, say yes, and answer their questions quickly, and they are kind enough to alert you when they actually publish something that you have said, and it gives you, without any merit, truly an expert status, which is kind of comical, but we do these procedures day in and day out, helping our patients, and never really expecting anyone to notice, but if they do, it’s a way of letting everybody else know that this is available, and it’s been my soapbox for quite a number of years now.

Charles Runels: So, can I bring up something because … I won’t interrupt you for too long, but I want you to address a couple of times as you talk.

Carolyn Delucia: I’m done.

What’s the number one reason doctors do not get free press?

Charles Runels: So, one of them is this. There is an unspoken rule among physicians that is a really scary rule, and I’m going to speak it out loud. Here’s the unspoken rule: You don’t really have a right to be in the spotlight until you’ve published for many, many years, and maybe you have a professorship or something somewhere, and if you jump around, and you get a lot of attention before that happens, maybe you might be breaking a rule. Now, there’s no one who comes in and arrests you for that, but there’s uncomfortableness about that, and do you think I’m making that up, or what’s your experience, and how do you deal with that?

Carolyn Delucia: I think that the only reason why, without tons of publications, that I’m able to speak on this topic is that everybody else is afraid to, and I feel that women have got to know that these treatments are available even if it’s before all the literature comes to fruition, and I think that keeping it secret and not speaking of it and not being … I think for OBGYNs, mainly, our issue is that it’s not yet approved or officially condoned by the American College of OBGYN. So, with that, it’s making everybody a little bit uncomfortable to try it, and to speak of it, but we’re seeing such amazing results, and internationally, the literature is there. Whether I’m publishing it or not, I can certainly refer to plenty of literature defending these procedures. Whether they’re completed in the US already or not, they exist, and the results are in the great promise that we see in our patients.

Charles Runels: So, let me-

Carolyn Delucia: So, I don’t care.

Briars, Woods Walking & Medical Innovation

Charles Runels: So, I want to point out something, and let you elaborate this, and I want to pull in Dr. Goodman because he’s on the call, and as you know, he did some of this research, and was in it before we were in it, and I think the ways …

I always imagined myself when I was six. I used to go bird hunting with my dad, and we would go … Down in Alabama, the forest is so thick, and there’s a lot of … I don’t know what you call them up north, but we just call them briars down here, and those briars will just literally rip your skin, and I remember my dad walking ahead of me, and stepping on things, and knocking the briars out of the way so I would still be cut enough to where I’d feel like I went to the forest, but he sort of blazes the path for me, and so I feel like we, the people in this call, are blazing that path, but I think Dr. Goodman was kind of the daddy up there that took a lot of the heat before we got involved.

But before I pull him onto the call, I want to say that there was something key to you’re saying more in tone than in words, but you hinted at it in words. You believe in this, and you feel like women need to hear it, and I think that part of what makes what we’re doing important, maybe, to somebody is that you know this is at least working for some people, and there is some research and a growing body of research. Some of the anchor stuff actually done by Dr. Goodman, who I’m going to hopefully speak up in a second. I’ve got him muted for now, but they need to know, and because we’ve seen families and lives change because of it, we’re sort of willing to take some hits, and we do take hits, right?

Carolyn Delucia: Yes.

Charles Runels: We do all take hits, and we bleed. Metaphorically, we bleed, and the people on this call, I think, have a right to say, “At this point, we’re still in the early innovator stage, trying to get the research.” By the way, I was on the call today with Johnny Peet, and I think we’re going to very soon blast off with placebo study with incontinence. Andrew Goldstein is proceeding. I just kind of revived our recruitment for our double blind placebo shot for the O-Shot for orgasm, and our group is contributing literally hundreds of thousands of dollars to helping make some of this happen. I haven’t paid Dr. Peet anything yet, and he thinks he can do that one fairly economically, but the point is we’ve got some funds. Our group is financing a lot of this because there’s no pharmacy to kick in, and we’re risking taking the heat.

So, I think the thing that was in there that you, being humble, didn’t emphasize much, but the biggest thing to be talked about in the press is, one, getting a little attention, but then having the courage to actually do it. So, my hat’s off to you. I think part of the reason Italians ruled the world twice is Italian women so I mean, you’ve got the courage [inaudible 00:30:38] to do the thing, right? So, I’m doing to pull in Dr. Goodman and see what he has to say because I’m …

Now, one other thing about these words. I know Dr. Goodman, for every reason, has a right to the rejuvenation. I think that Dr. Matlock actually may have a trade mark on this rejuvenation word, and we just launched a website called Vaginal Reconstruction. It’s going to be just for our surgeons in the group that do the O-Shot, and it’s going to be … It’s in the preliminary stages, but I have plans to drive a lot of traffic so people aren’t confused about what’s surgery and what’s rejuvenation.

One of my big favorite authors is Thomas Moore, who wrote Care of the Soul, and he has a book about writing where he says [In Thomas Moore on Writing], “Everybody sort of has their own personal dictionary.” So, my grandmother always called a car “fliver.” I don’t know where that word came from. We all have different meanings for word, but the thing here is that when people have a lot of time and energy and money invested into a word, it’s an important thing, and for example, when I started using the word “facelift” associated with an injection procedure, I caught a lot of criticism from the surgeons who wanted facelift to mean just a facial surgery, and I understand that. I mean, I have a crazy respect for facial plastic surgeons. That is not an easy thing to put a face back together after you go through a windshield, and I would never pretend to do that, but I sort of took that word and made it mean something else, and then I thought anything lifting the skin away from the skull should mean facelift, and so there is some emotion tied around this word, I think, for a good reason.

So, I’m going to unmute Dr. Goodman, and just recognize him as someone who took the heat before I even knew this was a ring to get into, and he was getting punched up and doing some research. So, I’m going to unmute Dr. Goodman, and he will have-

Charles Runels: Hey, Dr. Goodman. Are you there? Michael? Hello? Dr. Goodman?

Okay, so are you there? Okay, so we’ll see. Maybe he’s not able … Maybe his microphone’s not working right now, but anyway, so anything else you want to say, Carolyn?

Carolyn Delucia: I think you’ve said it all, Charles. I really do. I think that the most important thing is that women are aware that these procedures are available, and that is not a cure nor a promise, but it may be a help, and I think that the main point is getting the word out, and that’s been my journey.

Charles Runels: Yeah. So, thank you for speaking up, and thanks for being courageous. Now let me see if I … If you don’t mind, Carolyn, can I just leave you unmuted, but let me see if I can give you guys a couple of tips on what to do with this because now this is here. It’s talking about lasers. It’s talking about surgery, and it’s talking about, of course, the O-Shot so it’s all here, and even though I take heat, the good thing I’ve learned to do, although not as well as I would like, is to realize that even bad press can at least bring attention to it, and if you’re okay with bleeding a little bit, and it brings attention even if you catch criticism, it’s okay to let that go.

So, what do you do, I guess, when you have this? How do you take this, and turn it into patients coming into your individual office? There’s a system I have. First of all, you want to look at Alexa, and see if it’s worth noticing. So, can you see that pop-out screen, Carolyn, that shows-

How to measure web traffic (one of my secret tools)

Carolyn Delucia: No.

Charles Runels: Okay, all right. So, you guys can’t see it. Okay, so I’ll just show you. If you go to alexa.com … I guess the first thing that I like to do is to make sure someone’s listening. If I look at a website, whether it’s good or bad, and it turns out it’s someone’s little blog that nobody’s reading, it doesn’t really matter if I post something to it. I’m not sure this allows … I don’t think it does, but most of the webpages where something like this happens, it allows you to comment. This one allows you to make a question, answer a question, but usually, there’s a place to comment, and why take the time to comment if it’s a blog that no one’s reading?

So, I use alexa.com. You go to A-L-E-X-A.com, and then you can just copy the address from where you were just at, and put it in here, and it will give you the traffic. So, here’s the traffic on this website, and it’s ranked 27000th in the US. That’s really very high. That’s very, very high so that’s worth noticing. So, that tells me that if there was a place to make a blog post here, that people are going to read it, and then that gives me a free ad perpetually after that. Is there … I’m going to show you an example if you Google “vampire breast lift” because I’ll give you an example of another article that Carolyn did where a lot of us got some press out of it. So, breast lift Cosmo is the one that really allowed us to make a lot of comments. Power to Cosmo for Cosmo …

So, if I told you, you could get an ad on the Cosmo website for free, that would be worth huge amounts of money because to have a display ad on Cosmo would cost you many thousands of dollars, but when Carolyn got this article about the breast lift, at the time, I don’t know if it’s still here, but at the time … Let’s see if they’re letting you do it. Well, it went away, but usually, they let you … There was a place to make a post.

The point I’m getting at, if there’s a place to post a comment, you do it, and you do it in such a way that it’s not an ad. You just make an intelligent comment on the article, and then you will have basically a display ad on that website, but before you do that, the first test is to go to Alexa, and see if people actually visit that blog. So, Cosmo, if you do an Alexa thing, it’s not showing you, but it comes out at 1000, and 27000 is this one. If you do say, for example, Botox Cosmetic, it’s about 130000 to 150000 in the US. Our O-Shot is usually about 50000 so we’re not this much traffic, but we’re much better … Anyway, there’s a lot of traffic so it’s a respectable site, and you would make a comment if that’s possible.

*Next step is that you then take that link for it, and you just write an email that goes very simply something like this, and this is what you send to your patients, “Hello, I thought you might be interested in this procedure that helps urinary incontinence. Here’s a nice article about it. If you or someone you love,” always put you or someone love, “has this problem, and is interested, please give us a call or shoot us an email,” …

*and then you put a link to the page. It’s that simple. You don’t have to become Thoreau. You just write a very simple article like that, and post it, and then you can take that same thing, and I’ll show you how you can put it on Facebook very easily.

You just copy the address, and then if you want, you can just click the Facebook link and it puts it there, but if you want to very quickly make something more individualized, you just go to your page, and watch what Facebook has the … See, I’ve already done this, but I wanted to make a more intelligent comment about it, if you put the link in there, it pulls up the page, and then you can just make a comment about it into that box, and you’re not seeing the pop-up box, but it pulls up a pop-up box, and I’ll just show you an example, and then when you post it, now you can see. I just typed in an example right there, but I could’ve put something like, “Come see us about this procedure,” or whatever suits your personality, but all I did was in this, right here, I posted the HTML address into that space, and then it pulls up the picture, but it allows me to type something else there so that’s how you do it. I better take this away. That’s how you do it to Facebook or Instagram or wherever.

So, for me, it’s an email that’s two or three lines as if I were writing it to my mother or my girlfriend or sister or something, and then with a link to the thing with a plea for them to either call me, or let someone they love know about it, and they will think about that. It gives them the chance to help their sister or their best friend or whatever, and they will forward it to them. Okay, and now you’re using the national press to promote your practice.

A way to get a free appearance on your local TV station

*One last thing, and this one’s a big one if you have the courage to do it. Then what you do is you should have in your pocket, in your cell phone, the phone number of the health reporter for the news channel in your town, and then you call them, and say, for example, when this hit Cosmo, if you would’ve called your local channel and said, “Hey, there’s a thing in Cosmo about the vampire breast lift,” and you’ll notice they said this was the most looked at thing on Cosmo that month, but think about it. What could possibly pull more traffic than the word “vampire” and “breast” and Kim Kardashian during the Halloween season? I don’t know what other perfect lining up of things you would have to do to be able to generate traffic.

So, all of those happen. You got crazy amounts of traffic, and so, at that same day, and this is your step-by-step thing so I’m about to give you the next step. First, it’s a two line email to your people linked to the thing, asking them to call you or to forward it to someone they love that may have the problem. Second, you post to Facebook or whatever social media you’re doing. Third, you call the local news reporter and you say, “Hey, that thing that just happened or that’s on Cosmo, I’m doing that,” because, if you notice, the news reports on the news …

It’s really funny. You watch CNN, they’re talking about what the Fox News people are saying. Fox News is talking about what CNN and NBC is saying, and you’re watching the people on CNN, one reporter interviewing another. When did that get to be news when two reporters interview each other? But you see it all the time, but the point of that is that the news is hard up for news. It’s hard to think of something new every day, especially in your local town where there’s just not as many people to make things happen. So, when you give them something that is timed to the national press, that’s the point of all this, they will usually gobble it up, and they will call you for more things if you have the courage to do it.

All right, so, anything else you could say about that, Carolyn, and then I want to get back to the science a little bit.

Carolyn Delucia: No, not at all. I think that’s fantastic. Great advice.

Dr. Michael Goodman talks about innovation in medicine

Charles Runels: So, still have you unmuted, Michael, if you could hear me. I’m not sure if you’re there or not, but I’d love for you to jump in here about some of this research that we’ve talked about. Anyway-

Michael Goodman: Charles?

Charles Runels: Yes? Hello?

Michael Goodman: Can you hear me?

Charles Runels: Yeah! There you are! Beautiful!

So, back to this article because I don’t know if you heard me because I couldn’t hear you, but I’ve been bragging on you because I know that you must’ve taken a lot of heat back in the day. Talk to us some because I know I’ve heard Andrew Goldstein talk about that first paper you put out about how some of the cosmetic procedures made physical sex better. Talk to me some about the … And you’re too humble to talk about to talk about your courage, but at least some of the conflict you had to deal with, and give us a little sage advice because you’re the guy who was taking the briars and who created the path.

Michael Goodman: I heard you earlier, actually. I was in the garden sitting, my spring lettuce-

Charles Runels: You’re making me hungry.

Michael Goodman: Yeah, I had my headset on. For some reason, I didn’t connect so I came inside, and I’m on the-

Charles Runels: Thank you.

Michael Goodman: So, I can hear you now, and thanks for all the comments earlier. As far as early on, the journals and organized medicine really don’t like to things that happen outside of the university, and happen outside of officialdom. So, way, way back when [Camden John 00:44:58] and Harry Rich and several others and myself started doing advanced operative laparoscopy, and we’re dealing with ectopics in the late 70s, and doing hysterectomies and ovarian cystectomies and so forth in the early 1980s, and we tried to publish our first series back in ’84, I think, it was near ’84, none of the journals would have anything of it. In fact, the Green Journal called us cowboys, and basically wouldn’t hear of what we were doing.

We had the audacity of operating at a conference through a scope, and removing ovaries through the scope, and Harry Rich and I doing hysterectomies through the scope, all of which is just sort of standard practice today, and it was the same thing when plastic surgeons started to do breast augmentations for cosmetic reasons, and it’s exactly the same thing today, and it’s interesting. There is a decent amount of evidence based research in the Aesthetic Surgery Journal and in Journal of Plastic and Reconstructive Surgery and in the great journal, the American Journal of Obstetrics and Gynecology, and then certainly in the Journal of Sexual Medicine, there’s tier one evidence about changes in sexuality and in body image in women undergoing vaginal aesthetics.

It’s evidence-based that yes, there’s improvements in body image, and yes, there’s improvement in sexual satisfaction, and it’s all there in the literature, but ACOG really won’t hear of it, and when they quote the literature, they don’t quote any of these articles, so it’s pretty selective. That’s, you know, Charles, you run into that, and a lot of us who have done things, who have been in community medicine rather than in academic medicine. I have an academic appointment, but I’m a community physician.

Those of us that are community physicians, our voices aren’t heard as much. The interesting thing, when you look at results from procedures or results from treatments, everything has to be evidence-based. I’m definitely someone who believes in evidence-based medicine, but I’ve come to realize that anecdotal information is not chopped liver. The reality is that certain things will never, unfortunately, get the stamp of approval of evidence-based because there’s no money for funding.

That’s where the Cellular Medical Association comes in, and where it’s been, where you’ve been so helpful in that, is providing some funding money. When you take a look at things like treatment of PMS, you know, the official treatment of PMS is either risperidone, which is an anti-anxiety medication, or SSRI antidepressants. Those are the only things evidence-based that work for PMS. Why? Because there’s no studies that talk about caffeine avoidance, and talk about exercise, and talk about progesterone therapy.

There’s no studies that talk about progesterone therapy because nobody’s going to pay for them. They’re not patentable, and that’s what it sort of ends up being. If you have something that’s patentable, you can get money for research and you can prove whatever you want to prove. So much of the stuff in the literature is not comparing one treatment with another, but it’s just evaluating that singular treatment.

I mean, I’ll quit now while I’m ahead rather than use up all the air time, but I think what you’re doing as far … What we’re all contributing in as far as doing studies about the effect of the O-Shot®, and these treatments that no one will put money into because things aren’t patentable. You can’t patent the use of platelet rich plasma in Gräfenberg’s area and in the clitoris, and so there are not going to be studies unless someone like you or someone else takes the plan and says, “No, we’ve got to, let’s put some science into this.”

There’s always battles to be fought, and unfortunately, medicine is going into such a place where it’s sort of run by insurance companies and doctors have very little say and end up being employees, and it’s really hard to spend time with women and understand what their goals are, understand what’s bothering them, understand what their goals are, and try to meet those goals. One other thing, Charles, you still there?

Charles Runels: Yeah, and don’t feel restrained with time. You may not realize it, but you know, your thoughts are very encouraging to us as we just got through speaking. Carolyn’s been … I hope you guys know each other. I think you do. You know Carolyn Delucia, right? You guys know each other?

Michael: I don’t know if we do. Carolyn, do we know each other? I don’t know.

Carolyn Delucia: I don’t think we’ve ever met face to face. I don’t think so, actually. We’ve been at a lot of conferences together but never actually met.

Charles Runels: I’m glad you guys are meeting at least this way, because it does take … It’s scary sometimes, to be doing what we do, but yet we do it because we know that some of our women will be helped profoundly by it, and we try to do it intelligently so that we … We’re doing it in such a way there’s minimal harm always, of course, first do no harm. But it’s scary, and Carolyn has been hauled in and taken some blows, and out there. So, it’s good for us to hear, back in 1984 when I was still in college, that you were out blazing trails and yet you survived it, and you’re smarter and tougher because of it, so it’s good to see, and it’s very encouraging to me and I think probably to the others.

Carolyn Delucia: Absolutely.

Charles Runels: Of course, it’s not me doing it. There’s nothing I could be doing. I’ve become mostly a facilitator of conversation and a note taker and basically a pipe for the money to flow through to the research and the marketing and the lawyering. Anyway, I don’t really take credit for any of it, but just being maybe an admirer of people like you and [Bill Say 00:51:56] and all those guys who were out there taking the hits when I was still wiping my snotty nose.

Michael: [inaudible 00:52:04] a major role [inaudible 00:52:06] that we’ve taken with Andrew Goldstein, and Andrew and I have been friends for a long time. There’s no way he would have been interested in this and taking his ability to write up a good [inaudible 00:52:23] and get things published. That wouldn’t have happened without your facilitation. What I was trying to search for before was operative gymnasts, that’s what we called them in an editorial in The Green Journal, operative gymnasts, because-

Charles Runels: Operative gymnasts, like people who do flips on the balance beam?

Michael: Operative gymnasts; back in those days, laparoscopy was used for diagnosis only and tubal ligation, period. The fact other things were being done through the scope was heresy, but a lot of things start that way. You know, we were talking about the term vaginal rejuvenation.

Charles Runels: Yes, talk about that.

Michael: Yeah, I go way back with that term. The term initially, as you noted, the term initially was put forth by David Matlock, and I don’t know how many on this call know David. I’ve known him personally for about 15 years, and Davis is the penultimate marketer. I mean, no, maybe not the penultimate. You may be at this point, but maybe back in the day, you know, David has an M.D. and an MBA, a masters of business administration, and this was back when docs were not supposed to market at all. It was just sort of bad form to speak about your own practice and to market.

David had the audacity to try to patent the term laser vaginal rejuvenation. He was unable to patent it. I think he was unable to trademark it also for various reasons, but that term, vaginal rejuvenation, was, when David was talking about it, had nothing to do with machines, had nothing to do with radiofrequency, had nothing to do with laser. It was doing a surgical vaginal tightening operation. It was a modified, it was pretty much what we’re doing today with some modifications. It was a modification of a posterior colporrhaphy by adding in a levatorplasty, adding in the bulking of the scar tissue underneath the vulvar vestibule and perineum and distal vagina.

Where the laser came in, and that was his kick, where the laser came in was he was using a touch laser fiber as a surgical tool. Now, laser vaginal rejuvenation has nothing to do with the fractional CO2 lasers or erbium lasers that are used today. That’s not what laser vaginal rejuvenation is. It’s use of a touch laser fiber as a cutting tool. You can use a scalpel, you can use a scissors. I use a radiofrequency needle, same difference, it was use of a laser as a cutting tool for a surgical procedure.

That was there, and I remember John Miklos and I had an open discussion at one of the vaginal aesthetics meetings many years ago, where he was beginning to use the word vaginal rejuvenation. At that time, I spoke up against that saying, “That’s a can of worms.” For example, I’ve talked about this before, if you have a 65-year-old woman and she’s maybe 12, 13 years post-menopause and she hasn’t been on hormone therapy. She’s a widow, and her poor vagina has become very atrophied, she barely can put her little finger in there, and she’s met someone and she wants to have sex, and you work with her with vaginal estrogens, and you work with her with dilators, and over time, you get her vagina back so she can have sex, you’ve done a vaginal rejuvenation.

[inaudible 00:56:31] with the word vaginal rejuvenation is that it’s become a marketing term, and no one knows what the hell it means. If you ask 10 people what vaginal rejuvenation is, you’ll get 10 answers and unfortunately, patients feel that vaginal rejuvenation is going to cure their ills, whatever they are, whether they’re sexual ills, whether they need tightening, whatever it is. Vaginal rejuvenation is such a nonspecific term, and I still … Because it’s so nonspecific. I mean, what does it mean to you, Carolyn? What does it mean to you, Charles? What does it mean to everybody?

It’s not specific. Does it mean surgery? Does it mean levatorplasty and a full perineoplasty with elevation of the perineal body? That’s very different than using DHEA suppositories or estrogen in the vagina for your rejuvenation, and that’s very different from using, from resurfacing tissue. You resurface the face, you can see those changes. You’ve gotten rid of acne pits, and you’ve gotten rid of blemishes and so forth.

What does resurfacing of the vagina with laser mean? What does it do? What is resurfacing of the vaginal mucosa with radiofrequency? What does that mean? How often? We do it [inaudible 00:57:54] times, a month apart. Where did that come from? Why shouldn’t it be more? Why do we just do it two? How often do we do it? What kind of results do you get? Unfortunately, I’m seeing patient after patient after patient, well, just two patients after patient, I’ve seen several patients that have put out several thousand bucks and say, “You know, I felt a little different for a few months. Maybe there was something there, and it really didn’t do much.”

They put out a couple thousand dollars for vaginal resurfacing that really didn’t suit their needs. That said, I’m talking to doctors who say, “You know, my patients love it. I’m doing diVa,or I’m doing ThermiVa or I’m doing one of the other Vas, and the patients seem to be happy, and the greatest thing is they keep coming back and the money keeps flowing in.” But, are we really helping patients? I think sometimes we probably are, but the term is so nonspecific that we really have no idea what we’re doing, and it’s very hard to get any even anecdotal, even a compilation of anecdotal results, because one person’s rejuvenation is not another’s.

Charles Runels: I have a suggestion about what might, what I think might be evolving, and I have a lot of respect of course for you and the other guys like Dr. Matlock and Dr. Bill Seay and those guys that blazed the trail. But I think what I’m seeing is that you’re exactly right, rejuvenation has become more like, instead of the specific thing that it was intended to be, it’s become more of a, as you said, almost meaningless umbrella that can mean whatever is being done.

The reason I have this pulled up, I have a suggestion based on data. I like to look, and this, I’m giving away one of my secret weapons here. I’m a big believer in, how do people think about words? That word Vampire Facelift was not haphazard. I had the procedure, but I thought about the name for it for about a week of studying numbers to learn about words. I’m giving you one of my secret weapons, it’s called Wordtracker. You go, you log in to Wordtracker. It costs you a little bit, but you log in and you can put in a word, and you can see how many times people are using it.

I have a suggestion based on this. If you look at vaginal rejuvenation, it’s been used about 33,000 times in the past month, in the United States, of people looking for something. Now, these numbers talk about competition, so for example this is the number of Websites where it’s in the title and it’s in the text, and there’s a back link coming back to it, so just the word vaginal rejuvenation.

Now, notice this number, 33,000 in the past month, and then here’s some related ones. Here’s, and I’m telling you, this is worth gold what I’m showing you guys, now if you put in vaginal reconstruction, I don’t think there’s anybody that can make this into something other than a surgery. I don’t think anybody’s going to imagine I’m going to reconstruct, although maybe on a cellular level, I think … Not maybe, I think we are on a cellular level reconstructing things when we use platelet rich plasma and when we do energy therapies. But, I don’t think anyone’s going to ever evolve into thinking reconstruction is anything other than changing the mechanics and the surgical procedure, and it’s a pretty amazing vein of gold.

Now what I mean by vein of gold is this. In the early days, when Bill Clinton was elected president, there were only 33,000 Websites on the planet. If you made a Website that had to do with anything that a lot of people were looking for, you were the sole source of a lot of people looking for that thing, and they would be dropping dimes in your pocket or coming to your door, whatever it was you wanted them to do.

Now, there’s a Website for almost everything, and there’s very few veins of gold left out there where not many people are talking about something that a lot of people are looking for. This is one of the tools I use to look for those veins of gold. If you look at vaginal reconstruction, it’s not 33,000, but it’s still over 5,000 people, and there’s only two Websites with that in the key word, and one of them is ours, VaginalReconstruction.com. Then, these numbers are crazy good, because the higher the number the more competition, and this number is only 3.12.

If you look at this last one we were looking at, at vaginal … If you remember, if you go back to vaginal rejuvenation, I’m giving you marketing advice here, but maybe not just marketing, but ways to educate our patients. Rejuvenation, and so if you look at this one, that same KEI number is almost 100. The other one is only three, and that means that there’s a whole lot more people trying to capture this amount of volume.

Even if the volume is less but still significant, if there’s not many people catching it, you’re going to get a lot of traffic. I have given as a gift VaginalReconstruction.com, which costs me I won’t say how much, but it had a noticeable number of zeros behind it, and I bought that domain using our funds from the O-Shot® to create a Website just for the surgeons. Now, there’s always a selfish reason in everything, so if you go to VaginalReconstruction.com, this now belongs to us.

I’ve just put something as a placeholder until we develop it, so I got a little something from Red, and something from Michael, and a textbook, and another textbook, and a little bit from Carolyn up there in New York. But, my rule is going to be only surgeons who do the O-Shot® can be on this Website, so it also feeds the O-Shot® side of people who don’t do surgery. But, it’s a way to capture that really low KEI number so there’s the significant numbers of people who are looking for vaginal reconstruction get funneled to the excellent surgeons in our group.

So, that’s what we have going, and what I’m suggesting is that you can decide yourself what vaginal rejuvenation means, but I don’t think anyone’s going to ever get confused about what vaginal reconstruction means, and that if you start using that in your posts, if you’re a surgeon, I’m going to make that, if I’m able, into a word that starts to dwarf the 33,000 that’s used for vaginal rejuvenation, or at least approach that same number. That is my intention to make that happen, so I’m kind of showing my cards to this group because this is a group that’s all friends and in the same thing. We’ve gone over an hour, so I think I’ll probably shut it down here. Hopefully that was useful to you guys.

The last thing on my list that I promised was to show you where it lives, the research that has to do with the Amnion. I’m not going to talk about it much, because I’ve already gone over the hour, which I don’t like to do. But there’s a link, you know what? I’ll just put it in the link under the recording from this thing. But we have, on the cellular medicine site, a really nice list of the research that has to do with Amnion. I’m interested what happens with you guys as you start to maybe use that as a combination with your PRP and your hard to treat cases.

I better shut this down since we’re over an hour. Thank you very much, Carolyn, and thank you very much, Michael. I don’t know if you realize it, but it’s a huge encouragement to us to hear about how you blazed a trail and continue to do so. You guys have a good week, thank you.

Carolyn Delucia: Thank you, thank you.

Charles Runels: Goodbye.

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Q&A.Build a Web Page in 5 Minutes, treating rippling with the Vampire Breast Lift®, Hair Growth

Transcript of the Video…

“Rippling” with breast implants…

Charles Runels: So, let’s start with a question. I’m going to start off with a question that comes up quite a bit concerning the Vampire Breast Lift®. And it’s a nuisance problem that happens either … so the question is from Dana Kirk out of Texas. She says, “I’m considering the breast lift to improve the rippling effect that women have following breast augmentation.” Most notice it usually in the lower pole or the lower lateral quadrant. And, it’s true. You can do things to try and make that better using either AlloDerm graft or sometimes people just replace the whole implant.

So, here’s a couple of ideas. Let me show you some pictures. Best way to answer that, I think. So, let me swap what we’re looking at. This is … I don’t know if you guys can see that. Can you guys still see what I’m showing you? Anyway, so this is one of our providers, actually, who had this nuisance, double bubble. And, not so much a nuisance, but still somewhat a bother, the cleavage was a little bit further from the midline than you would want. And even further on this side than the other.

So, what I did was I took two syringes of Juvederm, and, basically, used it like a liquid Allo graft. And pulling the tissue away from the breast … and I’ll show you a diagram in a moment how that works. But pulling the tissue away from the breast, and then putting two syringes of Juvederm Ultra Plus here, and one syringe of Juvederm Ultra Plus there. And, by the way, this was after a second surgical procedure. So she had this done by an excellent breast surgeon, and had it repeated, and this persisted. And, so, this was three months later. And, so you can see, not only is this rounded out now, but this is better and that continued to … it’s now been over a year and continued. And she went from wearing this bathing suit to hide the double bubble, to wearing that bathing suit.

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So, that’s what’s possible. And I’ll show you where to see in even more detail as far as rippling goes. If you go to … if you just actually Google Vampire Breast Lift®, once you just pick up Vampire Breast Lift® … because a lot of these articles picked up one of my patients who had rippling. And you can see this is what she had, and I did the same thing. She wound up taking two syringes here because there was so much volume loss. So two on this side, but it took only one to take care of this rippling. These are saline implants. But you can see there’s almost just skin on top of tissue.

So, the technique here is important. And if you got to our website here … I’m on the Vampire FaceLift® now, on the members side. This video … and it’s also that same videos on the breast lift where I show in detail how to do that. And you never have to worry that you’re puncturing the implant. So, it’s actually one of those nuisance things that we have a solution for, and much, much more satisfactory than going back under the blade. So, thank you, that was a good question. We get that a lot, so it’s nice to finally have the answer to your own video.

Vampire Hair Growth…

Now the other question I got today had to do with hair growth. And I’ve left this here … again, I’m on the Vampire FaceLift® how to do page, the member side. And I have here a pretty detailed recipe for vampire … for growing hair using PRP Vampire Hair Growth. And I put a link here to the Acell site. I should probably take this down because most people doing this now are not using ACell as part of their injection. I’ve talked about this some before, but I worry about cross-immunity using animal products. I know there’s no serious sequelae that I know of that have been reported, but, still I was involved in a smallpox study once where we had to stop the study because people were getting subclinical myocarditis from the cross-immunity.

And so I’ve become more wary of this. I’ve left it here because people ask me about it. The ACell people market their product. It’s an acellular matrix of pig bladder. They market their product more for wound care, anyway. And the research that I’m seeing coming out for hair growth is impressive and growing, but it’s used with PRP alone.

Anyway, someone asked me about what my protocol is. I’m mostly just using PRP as a stand alone, now. But if you want the recipe that includes other things that may be of help, it’s right there. Now, as a help to you guys … I haven’t posted this yet, but I’ve got two videos in the queue from two separate experts in hair. This Dr. Mario Stephan has been doing hair for many years. I think he’s had over 20 years. And he shows how to do the block, and he shows how to do hair. And then here’s another one of our providers up in Calgary, Canada who’s a prominent teacher there. And I’ve just kind of had this in my back pocket. But I will post this to the websites for you guys to review if you want. You can see they’re both a couple of months old. I just haven’t posted them yet. So, that’ll be on the membership site. I’ll put it on the facelift website. So, that should answer all the questions about hair.

There was … let’s see. So we had that question. There wasn’t any questions about O-Shot® this week from our providers, but I had a couple questions about marketing that I thought were very good. And it’s things that I don’t normally cover except on my hands-on workshop. But I thought I would go ahead and answer it. And it has to do with how to make a webpage.

How to Make a Web Page in 5 Minutes…

So, this is how I would make a webpage in literally less than five minutes. So, if you’re looking at … you’re just staring at the internet and you’re looking at anybody’s webpage … let’s say that you want to make a page about … I don’t know. Let’s just pick something that’s not even our stuff. Let’s pick Botox. And you live in San Diego. And you’re thinking, “What does the top page look like?” So, if you Google Botox in San Diego … so, this is the first step to making a webpage in five minutes.

Next workshop where I teach more marketing ideas like what y

Okay, so, step one. You Google what it is and the city you live in. If you don’t live in a major metropolitan city, put in the closest metropolitan city to you and maybe even your state, but at least the closest city. Step two is you scroll down, and the first thing you’ll see usually is ads. You scroll past the ads, past this where Google is directing you to places. And you start looking for the first website that is not … you’re looking for the first website that is an actual provider.

So, you’re not in competition with Yelp. This looks like the may be … so the second one down looks like it may be an actual provider. So we go to … we click on that. Okay, so, what you’re looking at now is the cheat sheet. Because what you’re looking at is what Google thinks is the top website for someone doing Botox in San Diego. So, how do you take that and create a webpage that, preferably, beats this one?

So, I would start by doing step two, which is you now … I’m looking at this, and the browser I’m using is Firefox. I like it because, as a programmer or website builder, it works more functionally for me. But when you want to see what Google likes, you want to get Chrome. And so you just Google Chrome web browser, Chrome browser. Because Chrome, by the way, what is a browser? All a browser is is something that takes computer code and turns it into something like this, so it looks like a newspaper or a magazine. But if you look at the actual code that is creating this, it’s something that only a computer person can basically read. So Chrome and Firefox and the others are just computer programs that turn code into a magazine page, basically.

But, if you want to make something that Google likes, you want to see the world through Google’s eyes, and that is Chrome. So you would go to Google Chrome, and then you would download that for the next step, of course I’ve already downloaded it, so I’m going to pull up my Chrome browser and I’ll swap over and let you look at it through Chrome for the next step, okay?

So we’re still doing this step by step. So we found the webpage that looks like what you want to … That comes up first for what it is you want to do. So now I’m going to the Google Chrome thing, and we’ll put in that same thing. Actually we could have just started with Chrome. But there’s the web address, and now we’re looking at it through Chrome’s eyes.

Now, here’s the next thing you do. You go back one, we’ll hit the little back thing. And, let’s do this again. So I’m going to Google Botox and San Diego. All right. Now, if you go all the way down, at the bottom here, Google is telling you other things that people pop into the search engine when they are looking for Botox in San Diego. They’re giving you the cheat sheet. So if people are googling Botox San Diego prices, maybe you want a webpage that’s about your price. If they’re googling Groupon, in my opinion don’t really want the Groupon people, but maybe you make a page that’s called Botox San Diego Groupon, and then you talk about why you don’t like Groupon.

But these are the things they use, so we’ll get back to that. Those are, when I say they use, these are the words that people often type into the search engine when they are looking for Botox in San Diego.

So what we did is we found the first one that wasn’t a company, we found the first provider and it’s that. Now the next part, I’m going to have to expand my thing here where you can see better. So I’m going to show you my whole screen and let you see what I do next. So don’t let this freak you out because it’s going to look a little bit scary, but I’ll show it to you step by step.

All right. Up here in the left hand corner, hopefully you can see my arrow swishing around. In the left hand corner you see view, I clicked on view. And then if you go down you see developer, and you see view source. View, developer, view source.

Now if I click on this, it changes it. This is the actual code. We’ll go back and look at this for you. So that was … That’s the code that was making that pretty page we looked at a minute ago. But it’s given you what … So Chrome is the software that turns this into something that looks like a magazine page. So Chrome and Firefox or whatever browser you’re using, are just software programs that make this look like a page.

But this is what it’s doing for you. There’s the title, and so if Google likes that, maybe you should make your title Botox, San Diego, maybe put La Joya in there. Anything that’s true you might add to it. And that little straight up and down line right there, you don’t have to know how to make it but if you want to know, it’s above the backslash on your software. But we’ll get to that.

So then if you scroll down, you’ll usually see something that has, you don’t have to read the code, you just, I’m looking over here to the left for something that says description or keyword. So you see this where it says description? So there’s her description.

And what this does, it shows up in the little search box thing, so offers same day appoint- late appointments for Botox plus great specials and deals in San Diego. Get the inside info with our Botox buyers. That’s a huge thing. People, Botox is an emergency. It’s often a true emergency. People are thinking, oh my grand baby is going to be born next week by Ceasarean section and forgot about my Botox, I need to get it today because it’s the only day I have before the delivery. That sort of thing.

So if you’re not offering same day appointments for Botox, you’re losing patients like crazy. And this person’s smart enough to know that and put it in the description. And late appointments. So there you go.

And then if you look down here somewhere, not always but usually you can find some key words. I’m just looking, there’s a description. Let’s see, what else do I see? Organization. This looks like these are key words right in here.

Okay, so you just note those things and you put them … What we’re going to do is take this and copy it. Watch this, I’m going to copy that. And let’s go back to looking at it like a normal person looks at it.

Okay, so this is the source and this is that. Now I’m just going to pull up … All you have to do is have whatever you do to write a letter. Whether it’s Word, or if you have a Mac and use Pages. And we’re going to make a new document.

So a new document. I’m just in Pages, this could be Word, whatever you like. And then we’re copying that description. Okay, and I’ll go back over here and I’ll get the title too and throw that in there.

So first of all what is a website? I want you to start thinking about your website like … This was the same title that I showed you how to get a moment ago. Think about a website as just an electronic filing cabinet. That’s it. It’s electronic filing cabinet. So let’s go back and look at this and see how your filing cabinet is organized.

It’s a lot easier to build a webpage in five minutes if you understand what they are. So looking up here at the address, your domain name, think of it like the name of your filing cabinet. So this person’s domain name is LJCSC. Which is kind of cool that they’re able to get a five letter initial. Those are kind of hard to come by now. But LJ for La Joya I guess, Cosmetic Surgery Center. So LJCSC. That’s the name of her filing cabinet.

Now the first part here where it says face, that would be the name of a folder. So you can make a folder that is about face, and if you’re a gynecologist you can make a folder that’s about whatever. About hysterectomies or dyspareunia or whatever you would like to treat. And then the next thing is the name of a page in that folder.

So that’s it. First part is the name of your filing cabinet, and then the forward slash. The second part is the name of a folder, and the third part is the name of pages in your folder. That’s all a frickin’ website is. Just a filing cabinet.

Now, with that in mind, let’s talk again about how you’re going to make this page in five minutes. So back to what, and I’ll tell you want to do with this in a moment, but you’re making, you don’t have to be a coder. You’re going to make your domain Doctor whatever it is, XXX.com, forward slash, Botox, forward slash. Or if you do lots of things for the face use face, that’s what she used. And then put Botox.

And now, this is the name of your filing cabinet, this is the name of the file in the filing cabinet, and this is the name of the page. It used to be, back when Clinton was elected, when Clinton was elected there were only 33,000 or so websites in the world. It’s hard to believe now that recently they’re just so … You would get a domain, you would get all the search engine traffic just by having a name that was the right thing, so it was much simpler. Now it takes a combination of things, but I promise you, if you do what I’m telling you now, you can rule a city and most times rule your state, or within a 200, 300 mile radius of where you’re sitting using the techniques I’m about to show you. It is important how you create the web address, so the person, you’re not going to have to make the website, but you’re creating the document. You’ve probably figured that out by now, that you’re going to send to the person who’s going to build it for you.

If I just give you this blank page and say, “Okay, you need to make a webpage, or type out what you’re going to do with a webpage,” most people … I don’t like looking at a blank page. After doing websites since 1998, however many years that is, I can stare at a blank page now and do okay with it, but I still prefer to start with something. That’s what we’re doing. We’re starting with what we know Google loves and we’re creating something that’s going to turn out to be personalized. Your domain name will be different than hers, but you’re still going to use the Botox. Look at this, she used Botox-her name of her city, so that might be a good thing to do too, right? No reason why you can’t do that same thing if you live in San Diego. You can see why Google’s going to like that.

Back to what we’re doing over here, the document we’re creating is going to be Botox-San-Diego, or New Orleans, or wherever you live. There’s your title. Only, instead of La Jolla Cosmetic Center, of course you’re going to put the whatever, Dr. Jones Clinic. I would go ahead and add in, remember that cheat sheet we looked at a minute ago, there’s no reason why we can’t outdo this person. Let’s go back over here and look at that cheat sheet. Here, so this is where we started, so the cheat sheet was this down here at the bottom. Which one of those … Why don’t we take that, let’s just copy all these into our document. Here’s sort of my philosophy, you write for people, but you don’t write for Google, but you use words that Google likes. I guess that’s a little counterintuitive, but that’s how I think about it. Let’s get that crazy thing out.

All right, so which one of these might we put into our description? It liked Groupon, prices. Even if you don’t use Groupon there’s no reason why you can’t put it there and just say in your page that, “You don’t do Groupon,” but give them a reason why you don’t. We could put … Why don’t we put, prices? It likes the word, injection. It’s got San Diego, Mission Valley. Why don’t we put San Diego in there too? Now, where would this title show up? Again, if you look at the … If you go back to here, her title was whatever it was. Hold on a second, we’ll look at it. The title’s important. Her title was here, right? San Diego, La Jolla Cosmetic Surgery. We pulled that from the code. You didn’t have to, because you can see the title. When somebody Googles something, that’s what they’re looking at, the titles. Your person who’s going to build your website for you now needs to know what you want the title to be.

What we just did over here is we created a title that included things that we got … Well, I put San Diego on there twice, didn’t I? We included things we got from her, because we knew Google liked her website the best, but we added in something we got from the other words that Google likes, okay. I’d probably put a little thing right there. No, I’m not. It’s hard to say. I would put something there, but that’s not what hers did. Sometimes the least little thing like that can make a difference. Okay, so now we have a very well thought out title that’s going to show up over here and help bring attention based on what we know. All right, so we’ve gotten a title, we’ve gotten a description, we’ve gotten keywords. Now we still need to write the webpage, so how are you going to do that?

We go back to this lady who’s beating them. The next step is going to feel like not a good thing. It’s going to feel like it’s somehow illegal, or not proper, but it’s okay and I’ll show you why after we do it. What you’re going to do now is you’re going to go … I’ll let you see my whole screen again. Go back to my main screen and up to the top we’re going to say, “Edit, select all,” okay. You can see now we’ve highlighted her whole page basically. Then you go, “Edit, copy.” Now, as soon as I click the copy thing, you had a flashback to the sixth grade when you were taught you’re going to go to the principal’s office and be extremely embarrassed if you copy somebody else’s work. We’re not going to copy her work, we’re just going to use it as a guide. Let’s go back to our pages thing and then we’re going to say, “Paste.” It’ll take a second because it’s a lot of stuff.

Now, let’s paste it in there and we’re going to make it better than what she’s done, but we’re going to use her website as a guide. I would start off with, this picture is not a picture of the doctor. Actually, it’s a picture, see, of a patient. It’s a pretty picture. I mean, she’s got her shirt open. You can see her little bra right there. That’s kind of a sexy picture, but people want to see the provider. They don’t want to see a picture, in my opinion. The first thing I would do is get rid of this and you’re going to want to put in the place of it a video that you make about Botox. What would that look like? I’ll show you some of our people that have done … Been to my class and what they’ve done. You just … Let’s go back over here. Let’s see. Let me just see who pops up here. I put, “O-Shot video.” I’m going to go down till I find one of our people.

Okay, here’s one of our providers. I’m on YouTube, I want to be on his website. Let me see if I can find that one. Here’s an example from one of our providers who’s done well and if you look at her … This is her O-Shot page, and she’s been to my class, and obviously successful before I met her, but you can see on her page at the top of the page is a video of her talking about the O-Shot. Then there’s another one of her doctors that works with her talking about the O-Shot. That’s what I mean. You just shoot a video and I have on the membership sites, in the marketing side, I have videos that tell you how to make a video. Of course, I teach that in more detail in my workshops and we practice it, but people want to see the face of the person who’s going to do their stuff and they will judge you more by a video and the people who don’t connect with you will go away, which is a good thing. But, many of them will connect with you for many reasons. People who would never connect with me will connect with you but they don’t have an opportunity if there’s not a way to connect with you. The best way to do that is a video. At the top of this, I’m just going to put a placeholder that says video that you’re going to make. Many of you will hear me say that and not do it. Let’s go back to the page. I just put video. I’m telling you the top people in our group, do videos. If you’re not sure of that, go to the membership site. Look under marketing and watch one of the videos or come to my workshop. You can watch that and get started with it. It doesn’t need to be fancy. You can have someone hold an iPhone. Most of our people, that’s what they do. Somebody just holds an iPhone and you talk.

You put a video there. This is the copy of the page that she did. That one thing is going to make your site perform better. People ask me, “Well, how do you do … ” Can you not hear me Kathleen? Is no one hearing me? Can you guys hear me? You guys type in the chat box, if you would, if you hear me ’cause I, Kathleen said she can’t. Okay, all right, you guys can hear me now. Okay, so must have faded out there for some point.

Back to how to do this thing, thanks Kathleen, I guess I missed it whenever I was faded out. Now, let’s look at this and see what’s good and what’s bad. Let’s see, we can take that out. Botox, professional, okay so here we’ve got a quotation, let’s just take this out and put in here testimony. She didn’t even put the person’s name, just said it’s a real person. I would prefer that you get their name. Get somebody that you’ve helped and put their real name there. There’s another place where you can out perform.

This crow’s feet, brows line, persistent expression, whatever, comma, that looks kind of salesy to me. What I would do here is just say list things that you treat. Basically, problems. As soon as you want to possible certain things, I should call it problems, as soon as you can, because people get Botox because something bothers them. They want to see, on your list of problems, their problem. Now you’re really kicking butt, because you have a video here where you’re talking about the procedure, you realize this would apply to any procedure or product, now, you have a testimony, then you have a list of the problems that you treat. So, with Botox, maybe it’s migraines, crows feet, gummy smile, what else you treat? You get the point, droopy brow, one eye smaller than the other, whatever advance techniques you do, you put them there.

Then, same day recovery, that’s interesting. Same day treatment I would say, but same day recovery, whatever, they seem to like it, and then book a free consultation. I don’t really do free consultations, but if you want to do that, that’s fine. I would say book your appointment with a link to wherever, whatever software you use to book appointments. I’ve been using Calendly, I’ll show you that. You go to, and I’ve had good results with that, but there’s lot of software out there. Calendly.com. They have a really nice software for booking appointments online.

I think you get the point, basically, you, back to review what we’ve done, you Google it, you find the top one that’s a doctor or provider, you take their title, you take the key words, then you tune up the title using the key words, you use, if you can, a very similar address, thinking about what a website is. Using your domain name for the name of the filing cabinet. Next name is a file, then next name that. So, under face, you might also have Ampar Facelift, whatever. You just tune this up. You keep, well, obviously that’s a generic Botox picture and before and afters that you could keep, if you’re doing Botox and using Allergan, which you should always be doing, getting it from Allergan at your local provider to keep everything clean and legal.

There you go. Then, these before and afters, I’m not sure if that came from the Allergan website or not, but they do have stock photos that you can use. Use yours, if you can. If you did that, with any web page, I haven’t got to where to send it yet, but I’m getting to that next. If you did that process with any web page, now you have a Word document, or whatever you word editor document that you have, and now the next process is you’ve got to have somewhere to send it.

Let’s go back over here and I’ll show you options. There’s several options. One is, first of all, what kind of website do you want. I still think the best thing to build it with is a WordPress website. WordPress, in the old days, WordPress was not so secure, it could be hacked more easily, it was basically a blogging software. But that’s not true anymore. It’s very secure, and something like 40, I don’t remember the exact numbers, but it’s something like 40% of the websites online are now WordPress. It’s secure, but the thing it does, because there are so many WordPress websites out there, it does a couple of important things in my opinion.

One is, it allows you to create a post without having to call your web design person. I can show you how easy that is, very quickly. Let’s say that I wanted to make a new page for the [Oshot 00:37:18] website. All I would do is log into it. Look over here to my different browser, hang with me. Firefox is what I use to do this with. Won’t matter with you if you’re not, if you’re just posting and not programming, but I prefer Firefox. So back in, this is me logged in to the Oshot member’s site. So if I wanted to add a page, all I have to do is click Add New Post, and be patient. It’s going kind of slowly, for some reason. Then type in the title, type in what I want to say, and it works just like your Word document. So I could say example, and then I could say here blah, blah, blah, this is my example.

I could put in whatever pictures I want by just clicking on add media. If I need to upload a file, I can just upload a file. Let’s just take the media library and we’ll just put something up there, just to show you how easy it is. Pop that in. Okay. Then I’ll publish it just so you can see how easy it is. I’m going to click and publish it. Okay. Then, I’ll let you look at it. It’s that easy. Basically you just type it in like you’re typing a Word document.

There it is, came up. There you go. So that’s how easy it is to make a web page. Easy, easy, easy. So, obviously, I need to take this one down so let me take it down. But, if you’re website, so why would I not want you to do this? If I’m building websites, here’s some tricks. Oh, I haven’t told you how to get this done, let me just discard this for a second, then I’ll show you how to get it done. So I want to discard, move to trash. Okay. Gone.

This is just a list of stuff I’ve posted. Whenever we finish these webinars, I’m filming it. I just take the recording, and I post it just the way I showed you. But, while I’m, before we go further, I’ll show you where you can get this done. So, go to Upwork.com, this is my favorite place to go, and when people, you can hire people here, they’re legit, they get graded like a Uber driver, so if they rip you off they know they’re going to not be able to do business here.

I recommend you use somebody they’re from the U.S. or the Philippines. Philippines seem to understand us well. People from India are kind, I have more trouble with the language, but they’re kind and brilliant. You get but, you, this is where you put out a bid, people for work for you, when they are working, their screen, when they have to log in through Upwork, and that starts the clock. They’re either pay you, or you pay them by the job or by the time they spend working on it. You can get some really nice work done here and that’s what I recommend.

Charles Runels, MD
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Q & A. Lichen Sclerosus, P-Shot® & O-Shot® easy & hard cases


Transcription…

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Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.

I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.

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Let’s see what else is going on. I want to let you guys that we’ve put out some … We’ve put out a press release about some of Dr. Posey’s research about the O-Shot® (Orgasm Shot®) procedure and treating lichen sclerosus …so you may get some questions [from your patients] about that. I thought you might want to know more about what you should treat and what you shouldn’t treat if you’re doing lichens sclerosus. She’s actually on the call so I think I may undo her mic so she can tell you some of her thoughts about this research and how to know when to treat this and when not. She does a class and you might qualify to begin that class and that’s classroom … That’s a good thing. I’m going to unmute your mic, Kathleen.

Here we go. You there Kathleen? Hello?

Treating Lichen Sclerosus with the O-Shot® Procedure

Kathleen Posey MD, FACOG: How are you doing? Yeah, I’m here. Can you hear me?

Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.

Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …

The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.

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With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.

About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.

Charles Runels: This one?

Kathleen: No, go to the last picture. Keep going. Another one.

Charles Runels: That one?

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Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?

Charles Runels: Yes.

Kathleen: You see that, Charles? That band?

Charles Runels: Yes.

Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.

I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.

Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-

Charles Runels: Yeah.

Kathleen: That to that, to that.

Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.

I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.

I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.

The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …

Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.

Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?

Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?

Charles Runels: Yes.

Kathleen: Charles?

Charles Runels: I can. I can hear you.

Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.

Charles Runels: That don’t need the retreatment?

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Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.

Charles Runels: Yeah. Okay.

Kathleen: There’s another picture, a previous picture.

Charles Runels: This one? This one?

Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.

Charles Runels: This one?

Kathleen: Yes. Yes. Can you hear me?

Charles Runels: What point do you want to make about this one?

Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.

Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.

Kathleen: 12.

Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.

If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.

Kathleen: Charles, I’d like to-

Charles Runels: The other thing while I was on the subject. Go ahead.

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Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.

Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.

Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.

Easy Vs. Difficult Cases to Treat with the O-Shot® Procedure

I wanted to just list out while I’m at it and talking about the O-Shot, what I would consider to be the easy things that we treat versus the more difficult. I get a lot of questions about follow up and when do you retreat or not retreat and that sort of thing, so just wanted to recover that. Here’s our easy one. Nothing is 100% but these are the ones I think where over 80% of the time either after the first shot or the second one, you’re going to have an extremely happy patient. Maybe over 90% of the time in some cases, would be [inaudible 00:16:47], decrease orgasm, and someone who’s already able to have an orgasm. This would be the lady, she can have one but it’s not like what it used to be. Decreased orgasm but can have orgasm.

Then, it would be urinary incontinence and someone where things are intact, where bladder’s not falling out into the room. Even urgent continence, we’re seeing some great results. It’s usually a mixed bag for both, but then [inaudible 00:17:43]. I know that’s a basket diagnosis, but I mean even in the ones where it’s uncertain ideology, that doesn’t mean we don’t try to work it up. The person who’s had a work up and no one’s really sure what’s causing it and they’re still hurting, that for some reason that person seems to do well with us often. The one with pelvic floor tenderness, trying [inaudible 00:18:19] injection, you inject a trigger point with PRP so pelvic floor tenderness for mesh pain. I know you’ve got some ideas about that. I’ll let you talk about that in a second.

Mesh pain and the more difficult ones, the ones where if you’re new, I wouldn’t even try these people for the first two or three months, you don’t get discouraged, I treat these people but I think in these cases our success rate is maybe closer to 50% and maybe even less, 40% depending on the person’s age and other factors. It would be never had an orgasm in their life. I think those ladies are a little more difficult to treat. A person who wants to have penis and vagina orgasm. They can have one from a vibrator, but they can’t have one with sexual intercourse. Of course, we don’t have control of the penis of that equation. Both of these two ladies, we have successes, quite a few successes, but I think that our success rate on these ladies is probably less than 80%.

Can you comment some on this mesh pain? Are you still there Kathleen?

Kathleen: Just, yeah I’m still here. Can you hear me? Hello?

Charles Runels: Yes, very well. I can hear you.

Kathleen: I’ve done it when they had perianal pain from the nerve endings around the rectum, and I’ve just injected it all around the rectum. I’ve just injected it all around the rectum and it seems to work real well. Isn’t the doctor in Europe – [crosstalk 00:20:12] yeah, isn’t she putting PRP around the pudendal nerve to ultra sound for mesh people. The lady from Spain.

Charles Runels: I heard a couple people talking about doing an old school pudendal nerve block. There was one study where the mesh was taken out and then infiltrated the field with PRP, but no one has done the study yet, showing our procedure helps it. Although, we’re seeing that even injecting the anterior vaginal wall where the mesh is. You’ve has some experience with how the mesh becomes wrapped around the pudendal nerve or something; can you talk about that? [crosstalk 00:21:00] Or something you read in –

Kathleen: One of my patients is a general surgeon at [inaudible 00:21:13] and there was an autopsy on a mesh patient, and the mesh was all entrapped with the pudendal nerve when they did the autopsy. But, even taking it out, it just has to come out in pieces. It’s so difficult. From my understanding, from that pain, injecting PRP around the … I wouldn’t do it. There are some people, that I think, do it. In Europe.

Charles Runels: [crosstalk 00:21:45] When you do it, is there some worry about injecting?

Kathleen: Yeah, just the anatomy. There’s too much you can screw up. I just don’t have the experience with ultrasound and looking around the vessels where the pudendal nerve is there.

Charles Runels: When we do pudendal nerve blocks … We did those in labor and delivery years ago. I’m hearing that just that will calm it down. Is there something about that that makes you nervous? I would have thought that was a pretty safe thing to do.

Kathleen: I think that’s safe. I’ve just done most of my deliveries with epidurals and not pudendal nerve blocks. No, I think that would be safe.

Charles Runels: Okay.

Kathleen: I would like to see what they’re doing [crosstalk 00:22:40].

Charles Runels: While I’m at it, I’ll make the list for the P-Shot® … What? I’m sorry what did you say?

Kathleen: I didn’t say anything. Nothing. I didn’t say anything.

Charles Runels: Oh, okay.

Easy vs. Difficult Problems to Treat with the P-Shot® Procedure

So, while I’m at it, I thought I’d do a list to the easy wins for the P-Shot®. So that would be decreased erection … And a reason for making this list, again, is all of us want to take care of people and not just take their money and make them well. When I don’t get someone well I give them their money back. I try to mostly take care of people I think I can get well. If you’re mostly taking care of the hard cases, I’m losing money. I recommend that you mostly take care of the easy wins, especially in the beginning, so that you don’t become discouraged.

I’ve seen a couple of our providers, just right out of the box, try the really hard cases. If the first two O-Shot®s you do are in women who’ve never had an orgasm in their life, and they don’t work, you lose confidence in the procedure. So stick to the ones that we know have a high percentage of success.

For the Priapus shot, we have decreased erection, but can still get an erection. In other words, on that erection scale from 5 to 25, they’re above 10, at least somewhere in that neighborhood. They’ll bump up about seven on that scale from your shot.

Peyronie’s disease. The interesting thing is, our easy win is most other physician’s hard win, so you still can be a hero and do wonderful things for people if you stick to the easy stuff.

[inaudible 00:24:35] Closed prostate surgery to help with recovery, but it’s in the person who could get an erection prior to surgery, of course. You do the whole protocol, and that’s on our Priapus shot website. Where you include both for Peyronie’s and the prostate surgery, including the pump and maybe even low dose Cialis as part of the protocol.

Again, lichen, we’re going to get lichen too. Lichen sclerosus, not planus … Although, I think you treated some lichen planus didn’t you? Kathleen?

Kathleen: Yes. Yes.

Charles Runels: [crosstalk 00:25:26] We had that anecdotal initially; I should put this up here. I treated a woman with extremely severe scleroderma, and they can have horrible problems with intercourse. It was a life changing thing for her with one procedure. Lichen sclerosis in men is an easy win.

The hard wins for men, I think, if their main reason for getting the shot is for penis growth … Although, sometimes that can be very rewarding. It can be frustrating, often times, in the men who has the most urgency about growing. So the men who has the three inch erection responds, in my experience, less dramatically than the guy with the six or seven inch erection or a five inch erection.

It’s a percentage of growth than the absolute. So if there is 10% growth on the smaller penis, it’s less noticeable results. Then the person who has long standing diabetes or whatever cause of erectile dysfunction, basically he has no response at all. [inaudible 00:26:55] There’s no response at all to Viagra or TriMix, and that person who probably has some vascular disease proximal to the penis is not likely to get well.

Those are my easy wins and hard wins for the Priapus shot and want to stick to these easy wins in the beginning.

Anything you’d add to that, Kathleen?

Kathleen: Nope. I think you got it.

Charles Runels: Okay.

How to do your own webinars to educate your patients…

I always like to cover something with marketing too. Let’s see if I have any new questions from the [inaudible 00:27:32]. There weren’t that many on the websites on this time around. Let’s see. I don’t see any coming through.

I think there is something meant to be noticed about, as far as the marketing goes, what I’m doing right now. This is a wonderful way to create interest before I was part of this amazing group of physicians. I would do webinars, just like this, for patients.

Back in the day, before I started doing the internet, it wasn’t webinars. It was a conference call. I would record the call and put that on the website. So, if you, as a marketing idea, the best marketing is to teach people how to be well. If you put out an email to your patient, whatever it is you want to talk about … Maybe it is dyspareunia or erectile dysfunction, or urinary incontinence, or something that we’re not even talking about here; maybe it’s something to do with the way you do Botox. If you want to do a webinar like this, the software is very simple to do both setting this up, as well as recording it. Then you have something that can go on your website and play, and play, and play.

I thought I would show you guys where I do this. I know you have to log in to go webinar.com to get here. This is the software … GoToMeeting.com or GoToWebinar.com and they have plans that are not that expensive. Then, you send out an email to your people, you schedule it … and what you’ll find is, that even if just one person shows up, that the content you deliver is on a different level than if you sat down and just said “okay, I’m just going to record an audio or a video about urinary incontinence.”

Then when you’re done, you have the video and you can tell your webmaster to put that on your webpage somewhere. It looks like this. Most of you guys have seen this, but when I do these webinars, I put the recording either on the membership site or I put on our Cellular Medicine Association website. It just sits there to play.

This is probably the best advice I can give you about marketing to your patients. If you teach people about the disease and how to get well, then they will trust you to take care of their disease. If you go through the trouble to teach them how to be well, then they’re much more likely to trust you to take care of them.

So, the short version: teach people about the disease and they will trust you to take care of their disease.

It’s really an amazing time that we live in that we can just, almost no money, wherever you are on the planet, you can just sit down and have a conversation like this with your patients. Then when you’re done, you have a video that you can play for them perpetually on your website.

I think that’s all I have for today, unless you guys have other questions. I’ll put the transcript for this up within the next 24-hours and a link to the book that I recommended, and I’m always honored that you’re here.

Thank you for the help, Kathleen.

Kathleen: Thank you too.

Charles Runels: Alright, you guys have a good day. Bye.

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Transcript of Video/Webinar

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Charles Runels: Okay, let’s get started. The first question, we’re on the Vampire Breast Lift website, is actually a comment from Wendy Hurn.

Vampire Breast Lift® Questions…

She says, “I have performed several of these procedures to date and have amazing results around six weeks. My own, which is performed nine weeks ago, was amazing. Fullness and firmness with cleavage area many have commented upon. After breastfeeding in the past, I am delighted, so can pass this on to my patients with confidence.”

Thank you very much for writing Wendy.

This is one of those things where it almost seems too good to be true. I’m always grateful when our providers encourage each other. One thing about this when you do these procedures, just be sure you realize there’s a correlation and there’s causation and if you hand out 1,000 Tootsie Rolls to women who walk down the sidewalk, there will be some of them who get breast cancer. If you called it a Breast Lift Tootsie Roll, they might blame it on your Tootsie Roll. I think you can make a very strong argument that PRP is perhaps protective against cancer. We also have the strong research that if you look at the research part of the vampirebreastlift.com.

If you look at the Research tab, you’ll see there’s very good, very strong, research showing that when you mix PRP with fat and transfer it to the breast, there is a trend towards less cancer and there has been two really strong studies showing no increased risk of biopsy or recurrence rate in people who have had breast cancer and then being reconstructed, so it appears to be a very safe thing, but I would still do the same things that you would do for documentation if you were transferring fat to the breast. Most people know you transfer fat to mix it with PRP, so do those same protocols, just make sure the woman has been two things. Make sure seems been recently screened and that whoever keeps track of her breasts says that she’s good to go and number two, make sure you get a good consent form.

Second thing, but hopefully one of you guys will eventually do the research. I think that if you did, if you look at this trend towards less cancer, I think if you did a study where you injected the left breast of a thousand women, you would see a higher rate of breast cancer in the right breast. We don’t know that yet, but that’s what I suspect.

Next one is a question from Dr. Climikoski.

He says, “I have a patient who’s had breast implants and has loss of nipple sensitivity. Her primary concern is to regain the sensitivity back. She asked me, ‘What percentage of people that receive the Vampire Breast Lift do in fact have significant improvement in the sensitivity and are pleased with the results?’ If you provide me with an idea of this percentage, that would be helpful, as I’m a new provider for this procedure and don’t have my experience to draw from. Thank you.”

The answer to this one, I think, is … Again, we don’t have the research. In my practice, it is very near 100%. I’ve actually never had a failure when I was treated someone for loss of sensitivity after implants, but if they had extensive reconstruction, then all bets are off. When I talked to our providers, I hear everything from 50% are improved up to near 100%. I just wouldn’t promise this benefit if it’s for someone for extensive reconstruction, and with everything you do, I highly, highly, highly recommend that you offer a money back guarantee. When I treat this, usually it’s a woman who’s coming for improvement appearance and this is something she wants in addition to that. And so, she’s still happy if her sensitivity isn’t back like she thought it was, maybe, when she was 17. I’ve yet to have a woman tell me it did not make things better than before the procedure.

PRP Science-Techniques (what if the needle clogs?)

Next question is a woman who had … She just wrote this in to me. She says, “I had a 30-year-old,” this came an email but I thought we’d cover it here, she says, “I had a 30-year-old for her O-Shot. We used the Eclipse to spin the blood. My patients PRP was irregular in consistency and had clumps of what I thought had to be platelets. The 27 gauge needle and the syringe, for that matter, clogged a few times. I tried to force out the clumps from the syringe, but I’m wondering why this could’ve happened. Any comments appreciated in advance.”

There’s two things that could be causing clogging. I’ll tell you what they are and I’ll tell you how to deal with this because it can happen to everyone. First, it could be actually the platelet-rich fibrin matrix. I have seen clod up as quickly as two minutes out. This is why when I do this procedure, so in other words when the platelets are in the syringe, just sitting there, they can wait for about six hours in theory and still be okay to use, but once they’re activated; thereby, exposure to thrombin, calcium chloride, calcium gluconate, hyaluronic acid filler, or being excreted from the syringe back into the body exposed to collagen. All those things can cause the platelets to now degranulate, release the growth factors, and then the fluid of the plasma becomes congealed to hold the growth factors in place.

This is called platelet-rich fibrin matrix. It looks like goo inside your syringe. You may want to spend a syringe, activate it, and then just let it sit there and not use it so you can see what this looks like. It looks like little string or a little rubber band or something with a precipitate that forms in the syringe. It’s only probably 10%, 20% of the volume of the syringe will be clotted, but it makes a nice little linear precipitate in the syringe if you just let it sit and congeal. That’s what you’re making.

Now, if there’s turbulence and you’ve activated it can look clotted up in little clumps and that is what you’re seeing if there’s a delay. If you immediately take it out of the centrifuge and you see some little stringy things, maybe that’s platelet-rich fibrin matrix, but I’m not so convinced that sometimes it’s not some of the actual gel itself. I’m told that that’s not the case, but I’m not so clear that what that is and it could be the gel. In any case, I’ve never had it clog the syringe unless I’m slow about getting into the person’s body. When you’re drawing it out, use a … I use a 18-gauge needle to pull it out of the tube and then I have 25-gauge needles, literally within reach, so if I’m sitting there doing the O-Shot or whatever procedure have 25-gauge needles close by. If it starts to gel up and I can’t get it through the needle, then i just grab one of those and swap it out or sometimes you can just swap it before another 27 and whatever matrix is clogged the needle will be stuck in the needle, so when you get a new one, you can keep going. That’s the way to deal with that.

Try to have your patient all the way ready before you ever activate the platelet plasma when you do the O-Shot. Have 25-gauge needles within reach and fresh 27s and you should be okay. Oh, one other thing about the gel. We’ve had a few cases of urticaria. I’ve seen about, well, I’ve seen one myself in the face and I had another man who had some urticaria after Priapus Shot. In both cases, it went away with a Medrol Dose Pack. I’ve had two cases of urticaria reported to me by our providers. One after the face and one after an O-Shot where the woman got some urticaria of the inner thighs. All resolved without sequela using a Medrol Dose Pack.

If you look at the medical literature in some of the orthopedic literature, they talk about this happening and postulate that perhaps there’s a urticaria reaction that some people have to their platelets, but perhaps it’s from the gel itself. I just bring this up as a possibility. I don’t know why it happens, I just know it happens and that’s how you treat it. Maybe some of you guys can help us do that research.

Anything you would add to that Kathleen?

Kathleen Posey: No, but I actually think … I agree with the 25-gauge needle. I actually think I’ve used the 25-gauge needle more so than the 27 because the gel does really get thick and it makes it harder to push.

Charles Runels: So you use the … just routinely use the 25 for the anterior vaginal wall?

Kathleen Posey: Yes.

Charles Runels: While I’m here, just for those who may watch this video because this is all will be recorded and I’ll just post this to where people can see it. This gives a really nice simple diagram about where the material goes. I wonder sometimes if people are using enough. If you use the gel tube, I think you should probably spend three for each side of the breast. The price is set to where you can afford to do that. Basically, 15 milliliters of PRP for each side however you make your PRP. Some of the … I don’t know who knows, but I think some of the people who report not seeing much result are not using enough of this stuff. Let’s see. I think that’s all we had on the breast lift. Let’s look at some of the questions. By the way, anybody on the call who wants to ask a question, just click the raise your hand button and I’ll let you just say what it is you want to ask. Now, we’re on the O-Shot. That was the breast lift. Let’s go down the unanswered questions. By the way, if you ever want to ask a question, this is where to post it. Some of these have gone unanswered, but oftentimes our more experienced people will jump in there and answer a question. This is the way you get more than one opinion.

Priapus Shot® Questions…

Okay, so Dr. Ness has two questions. He uses the EPAT for erectile disfunction, along with PRP, after the fifth treatment and before the sixth. Should we inject PRP more often, say after every treatment? Also, has EPAT been used on women to augment the O-Shot? We’ll do this first question. I actually had an email from one of our urologists this morning. I’m seeing several variations, but most of the variations involve using PRP after the first treatment and after the last treatment, whatever your protocol is.

There was another research paper came out this past July in the Journal of Sexual Medicine showing that this works, but there’s no one that has done, okay, this protocol versus that. We’re still trying to figure this out. There’s a research paper for someone. Obviously, there’s two variables there, how you inject the PRP, or where and when, and how you do whatever physical therapy you’re doing.

More O-Shot® Tips…

I don’t know if anybody has anything to add to that, but the bottom line is that do whatever your normal protocol is, and then do your PRP after the first one and after the last one. Same thing with any sort of these physical therapies, lasers. Whether it’s shockwave therapy or it’s … and your frequency. I know you have the Thermi-Va, Kathleen. When are you adding in Thermi-Va when you do O-Shots?

Kathleen Posey: Well, I add it when they want to have improvement in the labia majora or want to decrease the size of their vagina. What I have noticed consistently now, having done enough of them, I really think when you decrease that distance between the clitoris and the vagina and/or urethra, the orgasms get stronger. I think, I’ve done enough now to know. The patients are telling me now, the ones that have had the Thermi-Va with the O-Shot, that the orgasm has gotten even more intense than the O-Shot, so I think that’s an added bonus.

I wish somebody would do the research to prove that it’s that distance because there’s such a problem when somebody has a baby and things get stretched out AP-wise. What you’re really stretching out is that length between the vagina and the clitoris, and then you’re constantly, as a gynecologist, “I used to be able to have orgasms with penis in vagina. Since I’ve had children, I cannot have orgasms with a penis in vagina.”

I’ve even seen C-section patients that haven’t had a vaginal birth, they’re still stretching out. They still have [inaudible 00:13:19]. They’re still having problems. I think, basically, probably gravity, but they do over somebody’s lifetime take away from your ability to have different types of orgasms.

Charles Runels: When it comes to you, do you do Thermi-Va and then O-Shot immediately following on the first visit, or how do you do your series when you’re combining those two therapies?

Kathleen Posey: Most of the time, I do the O-Shot and the Thermi-Va at the first visit, but sometimes it just depends. If they come in there and just say, “I’m here for the O-Shot,” I do that, and then after I do my exam, and I find they’ve had three kids, and I feel like they could benefit from the Thermi-Va, I give them the pamphlet and talk to them about that. So I’ve done it different ways. I’m not real consistent on … because there’s usually three treatments of Thermi-Va, and I’m not real consistent when I do the O-Shot with it. It can be the third treatment.

Charles Runels: I recently talked to Dr. Alinsod about this too [he does something very similar] and I know, Dr. Posey, you’ve done a lot of these. How long have you been doing O-Shots now, three years?

Kathleen Posey: Four.

Charles Runels: Four, yeah, so you’ve had … and I think probably more than anybody on the planet, your experience with lichen sclerosus combined with PRP is you’ve probably seen more patients than anyone. I don’t say this is for gospel because no one’s done the research, but when I speak to other providers, including Dr. Alinsod, they will sometimes do Thermi-Va, then another Thermi-Va, and then the last one of Thermi-Va, they’ll do Thermi-Va followed by O-Shot, or they’ll do ThermiVa and O-Shot on the first one, and then another Thermi-Va, and then, if they’re doing well, on the last one they just do a Thermi-Va. If they’re not as where they want to be, they’ll add an O-Shot to that last Thermi-Va treatment.

As far as the business part of this goes, a lot of our providers, when they come in, they’ll offer the O-Shot at the regular price, and then if they want to add in the Thermi-Va, they’ll cut the price of the Thermi-Va treatments in half, and sell it all as a package. Anyway, that’s become extremely exciting what people are seeing combining those two.

The general principle though that you never break, I think, is that you don’t do a heat, energy type treatment immediately after the O-Shot or the heat denatures those amino acids, small peptide, chemotactic factors, so you can do them both in the same day, but if you do both, you always just do the O-Shot after the heat therapy. I know you know that Dr. Posey but some of the new people may not.

Kathleen Posey: I have one thing. Can I add one thing

Charles Runels: Yeah, sure. Please do.

HUGE TIP (Small Vagina & Thermi-Va)…

Kathleen Posey: I just treated a patient this week that the Thermi-Va people sent me: Had seen a plastic surgeon in New Orleans, decreased lubrication after chemotherapy for colon cancer. She was in her 40s. No exam. So she gets here, and she’d gone from having intercourse three times a week to barely being even one. It was very, very painful.

Her vagina was so small, and they had done the Thermi-Va, so they were making it smaller, so all her symptoms got worse after the Thermi-Va. Actually, a lot of her pain was in the posterior fourchette. I just treated her this week, but I gave her another shot because I said, “Look, I’m going to see,” but you really have to select the patients and do the exams. If the three of us says, “Okay, I’m going to increase lubrication and decrease pain,” well, if the problem is your vagina’s too small, you’re going to make her worse.

She was worse, so the plastic surgeon complained to Thermi-Va. Thermi-Va says, “Well, where’s her exam?” They go, “Well, I didn’t do one.” They lived in New Orleans, so the plastics doctor called me and said, “Well, will you see her?”

You just really have to take each case individually because she was crippled because of a really small vagina. I don’t know if the O-Shot helped her. I did the traditional O-Shot, and I treated her with pain. I just wanted to throw out all these pain symptoms. I did another one today, which was episiotomy pain, and it’s helped her. She’s a year out and this is her second time. I do do the O-Shot, as well as treat where the pain is.

Charles Runels: Yes, all those are good tips, excellent tips, actually. I’ll just add to that that there probably should be, and maybe you can help us think about this, a … What’s the right word? Sort of a chart where you can picture down the one side is all the therapies, and then across the top are all the different problems, and you pick which do you do? Do you do radiofrequency or laser or PRP or dilators or hormones or whatever? And you can picture a pretty extensive chart.

I agree, not everybody … I don’t even use the word “tight” or “loose” vagina. To me, it’s all about matching your lover, and not everybody needs a smaller vagina, and when it comes to pain, for some reason our O-Shot just seems to be amazing, even when the etiology isn’t always known. But I want to emphasize what you said, if they can put their finger where it hurts, always put a cc of PRP there, and then do the regular O-Shot in addition to that. For example, your lady that had the episiotomy scar. My experience has been that, after an episiotomy, they’re usually good to go. So she lasted a year, and now it’s come back and hurting her again?

Kathleen Posey: Yes, it lasted a year. What she had was an episiotomy scar, and then some scarring around her posterior fourchette as well. It hadn’t come back as bad, but she just said, “I don’t want to have painful intercourse. It worked so well before, just repeat it.” I looked, it was a year ago. That was her second shot.

Charles Runels: Beautiful. That’s encouraging. So it wasn’t all the way like it was, but it wasn’t-

Kathleen Posey: No.

Charles Runels: … it had started to come back. There’s that negative feedback loop that can just make anybody avoid sex, especially, I think, women who have pain, and so breaking that feedback loop is so important. Just anecdotally, another patient I heard about from one of our providers, who’s-

Charles Runels: Just anecdotally, another patient I heard about from one of our providers who stays here with, usually with O-shots, she said she had a lady who had an episiotomy scar that had, not only hurt, but would bleed and tear ’cause the skin was so thin. The tissue was so thin, for years. And, no creams and all sorts of things had been tried with no result. And in this case, it took three injections 8 weeks apart, before the bleeding and the pain was gone. So, 8 weeks, pain’s a little better but not gone. Another one. So a series of three O-shots. So, I’m thinking in some cases the tissue may need more than one procedure.

And then lastly, I know we don’t have it here yet, but I know in Europe they have HA that’s made for the vagina. And then I’m wondering in those cases, it might be helpful to do both. So, like we do with our vampire user HA posteriorly with pure AP on top of it to help build that tissue posteriorly when we have an episiotomy scar. All thought they should not be used anteriorly unless it’s under an IRB protocol because of the risk of granulomas. Okay, let’s do the next question. Anything else you could add to that, Kathleen?

Kathleen Posey: No, that’s fine, thank you.

Charles Runels: Okay, let’s see. So, Cindy Crosby says, “My first question is piggy-backing of a question I read in the previous post. If there are there any post-op instruction pamphlets for vampire clients, please email. Second, I had an O-shot and the client had two large babies with two episiotomies. The anatomies very difficult to maneuver. The urethra’s approximately four centimeters long, it’s in the middle of what appeared to be a build-up of scar tissue. Has anyone experienced this and what was the solution?”

I’m gonna turn this one to you Dr. Posey.

Episiotomy Scars & Pain…

Kathleen Posey: Well, I agree, these can be tough. I would put a red rubber catheter in there and find out exactly where her urethra is. And therefore you would know where to put the PRP. Those are hard because, she probably had a cystocele and if you’re not used to looking at them, you’re not gonna know your anatomy because, it gets very distorted. That’s-

Charles Runels: Mm-hmm (affirmative). So, I think you told me once about a lady who did not get benefit for incontinence and then you brought her back and put in a catheter and then things. Describe for them what you do.

Kathleen Posey: Right, I mean that lady had, I mean you don’t want to say a looser … We have a large vagina had cystocele rectocele I put it where I thought it should be the first time. And she just said it didn’t work and she got on the O-shot website, said my name … This is a long time ago.

Charles Runels: (laughs).

Kathleen Posey: Trust me, okay. She got on and said, “This is horrible.” And I think they gave her a discounted rate. So I brought her in, and I said, “Look, but it didn’t work, you’re going back on.” And she did.

Charles Runels: So you brought her back and repeated it, and she went, and she got better. And so, what you did was put in the catheter? Tell me exactly what you did.

Kathleen Posey: Yeah, I took a small red rubber catheter, you put the other end up on the abdomen, so you don’t get pee everywhere, and then you see exactly how distorted that urethra is, because the urethra is distorted in that patient. And it takes the vagina with it, okay. And so you have to see where to put it. And sometimes it can go off to the left or the right, it isn’t straight in the middle. And that was her problem, it had gone off to the side, and so I just put it in never never land.

Charles Runels: So, in the second procedure, your intention is to put the lumen of the needle in between where the catheter was and the outer service of the vaginal wall? Is that what you did?

Kathleen Posey: Yes, which was probably part of the cystocele and it’s gonna look like it’s scarring, it may not have a normal look by itself.

Charles Runels: Beautiful, very helpful.

Methotrexate…

Okay, let’s see. Dr. Tuttle, “Dear Dr. Runels I have a new person who wants an O-shot, so a daily load dose of methotrexate. Will O-shots still work? Will we get enough PRP, will it work in the presence of this suppressant drug?” She’s using the Emcyte machine.

Okay, so. The general rule I follow is: Would this person recover from surgery? Could you do surgery on them? And if the answer is yes, so can you do it with HIV? Yes. Could you do it with a profound thrombocytopenia? No, not a good idea. So, I don’t know … What’s your thoughts on this one, Kathleen?

Kathleen Posey: I don’t know, but the only P-shot that didn’t work at all was on an 82-year-old with a platelet count of 75,000, and I did two. But I don’t really, I don’t know. I would try it, it’s worth a try. I’d give them money back if it didn’t work.

Charles Runels: Yes, see that’s how I do it. And if you’re new to this, you’re listening to this talk, the first two months, I would just do the easy cases. And of course nothing’s 100% but you have a really high success rate. If not the first shot, the second shot, you’re gonna get it at least 80, 90% of your people well. If you’re treating incontinence with good pelvic floor integrity, dyspareunia, lichen sclerosis, those people are going to get better- people who can have an orgasm but it’s not as strong as it used to be.

If you’re treating someone who’s never had an orgasm in their life, that’s a hard case. Or something like this, where you’re not sure what’s going to happen. I agree, you’re not going to hurt her with this. She would heal, you could operate on her, but is it going to affect this procedure? I don’t know. So this would be a more uncertain case. I would be more hesitant to take these cases until I’ve been doing them. Otherwise, if you do something that’s hard and your first two don’t work, you lose confidence in what you’re doing.

But, on the other hand, I will often take someone who I don’t see any logical reason why I’m doing harm, and then I take them, exactly what you just heard Dr. Posey say, under the condition … I just tell them right off the bat that, “You know, I hope I can get you better. And I’m willing to try this. And if I don’t get you better, I won’t keep your money.” And worst case scenario, you lose a little money but you’ve learned, and you haven’t hurt them, and you’ve helped them find a solution, and you’re still profitable in the next procedure.

Let’s see, I think we just had a question typed in. Okay, yeah, so … Okay, here we go, thank you. So, Dr. Carp I’m gonna unmute your mic, Dr. Carp, so that you can talk with us. Hold on just a second.

Go for it, you there?

Dr. Carp: Yeah, can you hear me?

Charles Runels: Yes sir, perfectly.

Dr. Carp: Yeah, I do all kinds of surgeries on patients with methotrexate, you know, the significance. So I wouldn’t be concerned in the terms of a complication with injecting it. I don’t see how it should have any impact on the expected results with the PRP.

Charles Runels: Beautiful. Thank you for that. When you do your surgery, you don’t anticipate it affecting them healing. So I’m not doing operations every day, so I don’t know that. So, you wouldn’t expect it to have an effect on wound healing. So therefore, we’re both thinking that one variable should not change what the effect of the O-shot would be.

Anything else? Because I know you’ve been doing this awhile, too. Any comments on any of the other questions that we’ve fielded that you want to add to?

Dr. Carp: Not really. I think that, certainly as was pointed out, if they’ve had some uvula-related issues in the rectoceles, et cetera, it does make it more difficult anatomically.

Charles Runels: Mm-hmm (affirmative) yeah. I think it’s never an embarrassment to turf … I love that we have a gynecologists and a urologists as part of our group. And to those in our group who are not, if they see someone where the anatomy is not what you’re used to seeing, I would feel free to … You know, I’ve referred people to Dr. Posey, she’s about two and a half hours from me. And people that … For example, when the clitoris is phymosed down, that’s not something I should be tackling. And so, I send them her to a gynecologists.

And so I encourage those in our group to look at the others in the group that are close to you, so that we can work together.

Let’s see, there’s another. We’ve covered breast lift, the O-shot, there’s some questions that have accumulated about the priapus shot. Let’s go through some of these. Let’s see, okay.

“I was just wondering, can you freeze PRP and then thaw it later before activator procedure? We did a P-shot today, we used pure spin, which do about 20 CCs, and we used 10 of it, so we had some left over and didn’t want to throw it away.”

I know some of the ophthalmologists are putting in the fridge and using it for eyedrops for dry eyes, and using it for a couple weeks at a time. Maybe the answer to this is yes, but I wouldn’t want PRP that had been frozen … You know there’s enough profit built into our procedure that you could afford to spend a kit later. If you wanted, what I would say instead of this is that, there are those in our group that, when they use a priapus shot are using more material.

The only reason these volumes came about is back when I started doing these procedures, back in early 2010, so eight years ago, a one tube of Selphyl, which is what I was using at the time… so, my cost of goods was pretty high. So it was based on what I could find, the amount that could spread through a penis, and I found 10 was what it took to actually infiltrate the entire corpus cavernosoum of an average-sized man.

But others in our groups are using more, so I would say instead of wasting it, just double the volumes and use the whole 20 CCs if he’s average size or larger, and you should get a result. The only place I would say not do that, between the O-shot and the P-shot, is absolutely do not do that with the anterior vaginal wall because, I know of three cases now where our providers got a little overzealous and had an overflow obstruction. It went away and the person winded up doing well, and good results for their stress incontinence, but they went from stress incontinence to an overflow obstruction to wear a diaper for three or four days because of too much volume.

I think anything more than 4 or 5 CCs in the anterior vaginal wall is probably too much. But in the penis, go for it.

Anybody want to add something to that?

Lichen Sclerosus in the Penis…

Okay, so Dr. Leonardo says, “How do you treat lichen sclerosis on the glands? The video does not address this. Do you perform the same injections with the P-shot or would you micro-needle it?”

You know, Kathleen you’re treating a lot of lichen in the labia and around the clitoris, what’s your … This is just a larger clitoris, right? Or you could say clitoris is a smaller penis. What would you say? How would you answer this?

Kathleen Posey: I would inject it right in the areas of the lichen sclerosis, wherever they may be.

Charles Runels: Yep. I would too. I would feel … In a normal priapus shot, you would just kind of … I imagine the glands of the penis, literally like a sponge, and of course the underside of it that’s connected to it is the corpus spongiosum, so it does behave like a sponge.

But I agree with you, if there’s a sclerotic area that you can see or the patient can feel subjectively and put their finger on. I would go intradermally, as best you can, into the sclerotic area and treat it like you would sclerosis anywhere else.

I think, again, we just put out the first paper, I guess it was a couple years ago, and this last paper in the American Academy of Dermatology in January of this year. It’s not like we have some huge body of literature about the best way to do this. It’s part of the reason I like these calls because there’s smart people in this call, and you guys can help us figure out what the best way is. But that’s my best idea for now.

Anybody have anything else? Okay.

Penile Implants…

“I have a patient who has IPP. What is the injection recommendations, techniques, for lidocaine? PRP amounts of each … Locations along the shaft and the depth … In addition, has cold syndrome, for numerous reasons …” whatever.

Okay, so there’s a link here that takes you to a recording when it comes to the penile implants. That, when I interviewed Dr. Joe Banno, who’s one of the urologists in our group … And the biggest thing that I would say here is two things.

I would not use the vacuum pump, and I would not try to inject the shaft at all. And I would consider long and hard whether to even do it at all. Because if their implant fractures that night when they have sex, you could be blamed for it.

But if you do this, and Dr. Banno and I would do this, and most of our providers would do this … I would keep it just to the glands, and come in laterally like you do with the regular P-shot with just the bevel going into the carona of the glands. And just infiltrate the glands, and let that be it. Nothing else, or I think it’s too risky.

Anybody want to add anything to that?

Anyway, watch this video for more details. It’s only five minutes but you’ll get it straight from one of the urologists in our group who teaches. By the way, Dr. Banno teaches urologists how to do implants. It is his specialty. And he has told me that he started making the priapus shot as part of his pre-op before he does the implant because he’s getting more rapid healing and better results, as far as that sensation, and not having that cold feeling.

Any other questions? I think that might be the last one that was turned in. I know we’re only 38 minutes in, but I didn’t come here to try to teach anybody anything. I’m just trying to give us a forum. And our intention is to do this every week because the questions accumulate. And that way, someone other than myself can help think about them.

Anybody on the call have anything else to say or question to ask? Because now is the time and I’ll unmute you and we’ll have it out here for people to comment on.

And I’ll post this video, so who knows? Maybe some other people in our group … We’re pushing 2,000 members now in 40-something countries. We’ve got so many specialties and multiple medical schools, lot of smart people just like you guys are. So, maybe we can get other questions or other ideas.

But anybody have any other questions?

Okay, well I’m on stand-by and I hope this was helpful. And I’ll post the video, and we’ll try to do this every week. So if there’s something that comes in between, this will be the place to get it answered.

Honored to help out, and you guys have a good week. Bye-bye.

Cellular Medicine Association (CMA). Who we are <–

 

Bell’s Palsy, Obtaining Free Press In Your Town, Getting Ready for the TV News

Charles Runels: I thought it may be helpful to start offering suggestions about what I’m reading, and what others in the group are reading and writing, so that our weekly meetings become not just sharing our procedures but approach being something like a journal club or a reading club, book club. That’s why you see what’s here on the screen now. I just got this in the mail. I bought it before it was published. It just came today, so I’m extremely pleased with this. The reason I’m so interested in centrofacial rejuvenation is something if you know, if you’ve attended my class. That is the most important part to improving … It’s the number one place to improve the appearance of going back in time in appearing younger. It’s the eye to the mid-cheek.


Some of the procedures in here are surgical. Chapter eight has some beautiful diagrams offering midface volumization with fillers. It talks about the anatomy, and highly recommend this book. I’m putting a link to it in the chat box, and I’ll put a link to it on the page where I put the recording, but very well done. Other chapters are helpful in [inaudible 00:01:53] videos. Part of what brought this up is I had a question today. I had some cosmetic questions. Let me pull those up. Then I’ll field questions from you guys. I copied this out of a email that came to me. Number one, “Why use none activated platelet-rich plasma on the face? Can we use activated prp and when?” Again I’m going to put it here and recommend that you guys check it out. This question, I’ll cover it again because it’s helpful.

Finding the Answer to Questions

If you go to Cellular Medicine, actually I want to just show you where a lot of these questions live. I’m happy to go over it, but if you have a way to search and find it very quickly without waiting for me to answer, then that would be a better thing. Some of you guys don’t know how easy it is. If you go to CellularMedicineAssociation.org, and you just put in the search box right here, so you can say activation. Hopefully, I’ve got that in there somewhere. There you go, so it’s like an index. I don’t have something that says index but it will pull up … Because I’m having all these transcribed, it will pull up any transcription that has that word in there, and so that’s a good way to search for things.

You could also go to the membership sites, so if you went to VampireFacelift.com into the member section, and this is the backside so you wouldn’t see this. You would land on, I’ll show you. You would land on the dashboard, so it would look like this right here. Then see where it says, “Post,” you could just click and you post. There should be a search box. I guess there’s not. I need to put one on this one. Most of the membership sites have the search box, so my bad. I’ll put one there. You could also go through here and look at just there’s the titles, recent comments, and there’s key words. This one needs a search box. Anyway, that’s the two places to look on our main website, the Cellular Medicine Association.

Looking at recent posts, and you’ll get the most recent stuff, but on the membership sites, the other place to look, it’s just look under the directory. I mean go to the dashboard, and then look under webinars. There’s the dashboard. No, not taking you back. Anyway, that first dashboard where we were at, it’s a directory, workshops, forums, and then there’s a page for webinars. Then at the bottom of every page there’s a question and answer session. You can see there’s a place to post it, so go in there. The good thing about doing that is you get answers from other people, not just from me if you do that. There’s one about calcium chloride. “Does it help? When do I use it?” Then you can see well, here’s the answer and it takes you to a recording from one of our webinars.

Activation or Not Activation of PRP?

I like doing it that way because it makes sure, it give everybody a chance to contribute, so it quits being about Charles. I’ve been fortunate enough to play around with plasma for eight or nine years, but newer people in our group are also doing that and have different expertise so it’s helpful. Here’s the answer to the question of why use nonactivated platelet-rich plasma. The reason for not activating it is the calcium makes it hurt more. Calcium chloride just hurts. The other reason to not use it as in activate the plasma is that you do get around 65% activation without activating it because when you put the plasma, inject it into the tissue, the exposure of the platelets to the collagen of the tissue itself activates it as it would in a normal [inaudible 00:06:47] if you had an injury and the platelets come outside the body, it activates the [Thorman 00:06:51] cascade, exactly the same thing.

Next Hands-On Classes with Live Models<---

You get 65% activation if you just take the inactive platelets in the syringe and inject it subdermally or intramally, and it doesn’t hurt as much. It seems to work well enough for the hair and the face. Most people are not activating. The reason we changed that and activate with the [Priapus 00:07:16] Shot, and with the O-Shot, and with when we’re trying to regrow nerve as with decreased sensation in the areola of the nipple, is because we’re thinking that because it’s more therapeutic type effect, and because we’re trying to maintain the material in a smaller space. Geographically we want it to stay close to the urethro so in a very small area the calcium makes it activate more quickly and more thoroughly. That’s the reason. No one can fault you for activating it with the face as well. It’s just a cop out to make it not hurt as much.

Can you “use prp in the vaginal lining?”

Number two, “Can you use prp in the vaginal lining?” I have used it everywhere, and I see one of our gynecologists is on the call, so I may get Kathleen Posey to comment on this too. Can you use prp in the vaginal lining? You can pretty much use it everywhere as best I can tell. I can’t find any ill effects except in one case where it was injected into the eyeball trying to do something with the retina, so don’t give anybody a shot in the eyeball. Otherwise, I have injected circumferentially. I’ve injected in the labia minora, the labia majora, posteriorly. Anecdotally, we’ve had two people in our group see help with rectal incontinence in a severe postpartum tear. That was years out and still saw some improvement in rectal incontinence. We’re using it all over.

The only reason I quit putting it completely around the vagina circumferentially is that in the beginning it was so costly I was trying to avoid injecting more places than needed because it cost us so much to make the plasma. I found, so 80/20 rule, I could get actually all the results I needed by just injecting around the clitoris and along the anterior vaginal wall thinking that’s where a lot of the sensation is as in Grafenberg, not just the spot but the whole urethra being sensitive, the Skene’s glands, that’s where a lot of the sensation takes place. It’s also up there near the inner part of the clitoris and all the nerves [inaudible 00:09:45], just a lot of magic happens there.

Not so much the anterior vaginal wall, there’s not that much lining there. I mean, excuse me, there’s not that much sensation there. Having said that, I’m going to see what Dr. Posey has to add to that. Then we’ll get back to the face, the best way to treat nasolabial …

Charles R.: … that and then we’ll get back to the face, the best way to treat nasolabial folds. So if you don’t mind, I’m going to unmute you, Kathleen, and see because I know you’ve done a lot of these. Are you able to talk, Kathleen? Are you there? You may not have a-

Kathleen P.: Yes. Hi. Hi.

Charles R.: Good to hear from you.

Kathleen P.: Hi. You too. I have injected it there not a lot [inaudible 00:10:26] end up with some left over, I’ll inject it in the labia minora, the labia majora. And it just depends, if they’re having pain in that area, I’ve definitely used it a fair amount and it does help decrease the pain.

Charles R.: In the lateral vaginal wall, you mean?

Kathleen P.: I have a little-

Charles R.: He didn’t really say vaginal. He just says vaginal lining, doesn’t he? I’m sorry. Go ahead.

Kathleen P.: Yes some … Yeah. I’m more doing it in the posterior vagina. I don’t know if it hurts sticking it in lateral because the vessels and stuff. I worry about hematoma. I wouldn’t go too deep if I were to inject it there.

Where to go to create an “interview video” for your website

Charles R.: Okay. You know what? While it’s on my mind, if you will do this, Kathleen. And I’m going to put it here so others may want to. If you go … so far I’ve only done this with three, excuse me, two of our providers, but I’ve never made it public. I’m trying to make it … I’ll show you what I’m doing. If you go to the O-Shot® website and you on the … over here on the recent posts, you can see I’ve talked to Dr. Goodman about some of his surgical techniques and how he thinks about orgasm and how the different procedures he’s using and I’ve just recorded it and put it there for patients and doctors to learn from. There’s nothing … becomes a very good explanation of the surgeries for potential patients as well.

So back to … oh, you can’t see it. [inaudible 00:12:04] where you can see what I’m talking about. There. So this is a post on the O-Shot® website and it just comes in recent posts and I’ve done that … I’ve set it up to do with [inaudible 00:12:21] and we had some … we weren’t able to record it well and I’ve done it with another one of our providers, but I’m going to put here … it’s so hard. Everybody’s schedule is so busy, but any physician who has … who wants to be interviewed, I see it as a great way to … cellular … let’s see …  it’s a great way to get the word out about what we’re able to do and, just as importantly, what we cannot do and how we’re thinking about the science. And here’s where to set that up…

Schedule a time to record a video interview (schedule the 30 minute phone conversation)<–

So I’ll show you what happens when you set that up and where to go. So if you take that and put it into … and I’m hoping you’ll set this up, Kathleen, so I can interview you because you got so … I’ll pick your brain a little bit at a time when we do these webinars, but you got so much information about lichen and the other stuff.

Okay so if I put that in there, it takes you here and then if you go to 30 minute phone meeting, book that, and we may actually be on the phone longer than that but just … and you can see you can just click that and pick a day and that fits your schedule and then I’ll record it. You don’t have to have PowerPoint slides. You can if you want, but any doctor in our group who feels like they have a message they want to deliver that would be helpful to doctors and/or patients. I like the interview format because it gives me a way to showcase our physicians and, because I’m seeing a lot of the questions that come by email and such, it gives me a way to get a more balanced answer to these questions rather than me doing all the talking, which is just not the way it should be. Okay, let me get back to these questions. So if … I’m going to put that in the chat box too and, hopefully, you’ll set that up, Kathleen. So anybody else can call because you got so much … how many years have you been doing this now? Three? Four?

Kathleen P.: About four.

Charles R.: I know no one … I don’t know anyone who’s inject … who’s treated more people with lichen sclerosus [using the O-Shot®] and you’ve got a strong surgical background too, as strong as it comes so let’s set that up. I’m overdue to do that. Okay, so back on topic. I’m just going to leave your mic unmuted there, Kathleen, and get back to finishing these questions. Let’s see. Go back to here.

What’s the best way to treat nasolabial folds–PRP, fillers, or threads?

Okay. So now for a face question. What’s the best way to treat nasolabial folds? With therapy or threading or with filler? I think this one is … let me pull up a picture. Let’s see if I … I think a picture would answer it better. Let me find a picture I have permission to use. Because this is definitely a case a picture’s worth way more than me babbling on and on.

Okay, here. So if this is the problem that you’re trying to make go away, the question was: is it better to use fillers or plasma or some sort of thread lift or surgery? There’s lots of different things. What can you do for that? So the main principal I follow is that this cheek area is more important than whether there’s a line present here or not. You’ll see nasolabial folds in children, but this is not necessarily an age line. It become a sign of age, when relative to the rest of the face, when you see that this … let’s see if I can draw on this. Let’s see what I can draw. Good. Okay. So when there’s a stripe, there’s a heavy strip, you can see it kind of goes like that there, with this being flat over here. And when you see that, it’s not the line that’s making people look older and you can kind of see the appreciation of a line right there, but not so much visible there sort of like a dash line. There’s definitely a line there under the eyes and then there’s this line and then this looks relatively flat. When you see that, that’s a person for whom either fillers or platelet-rich plasma is going to help.

If I’m trying to decide which will be appropriate, then I go by how much volume loss is there. If there’s quite a bit of volume loss here, the chances that I will maintain … the shape will look beautiful if I just fill it up with plasma, but the chances that I can maintain that shape become less good than if there’s a lot of volume loss here. If it’s someone who’s never had anything done and they’re … if you’re looking for numbers, if they’ve never had anything done and they’re 40 and up, then they’re probably going to need some fillers there, especially if they have a thin face. If they’ve got a full face and they’re younger or even if they’re over 40 or 50 and they have a full face, sometimes you can get by with the plasma alone. But the bottom line is that adding volume here is going to pull this up and round it out so there’s not a heavy stripe here. And then even if you have a line here, it’s going to be less distracting and not really age causing.

And so that’s kind of how I judge it. So I either use plasma plus prp if they can afford it and they have a fair amount of volume loss or if they’re … if I use prp alone, it’s usually in someone where the volume’s pretty close to where it needs to be and they kind of just want to be fluffed up and usually that’s … they’re 35 or under or they’ve had some work done already or their face is already full just because of their body weight. So most of the time, I’m using both. As far as the threads go, if you do the threads, I would still consider doing this because now you’re doing something similar to a surgical “facelift” but relative to the bone, even though you’re pulling this fold out, you’re pulling the tissue close.

Charles Runels: Even though you’re pulling this fold out, you’re pulling the tissue closer to the bone. You’re really collapsing the face relative to the bone and though the line looks better, you have some risk of causing skeletization and not that round, full feeling look that’s in a younger face.

In the end, all three, the answer to that question is, they all three work. That’s the way I decide. I would seldom use a thread without using fillers or most of the facial plastic surgeons now, almost all of them, even if they do a surgery and pull the skin back, they’ll do it in culmination with fillers to maintain the shape so you’re not just chasing a line. You’re creating a younger shape. I think that answers that question.

I think there’s another one here. Anybody want to add to that, just click the button and I’ll unmute your mic for you. Let’s see. Let’s get back to that question. I think I answered it, just to be sure I did all that. Yeah. That answers that question.

There’s one in here that some of our callers. That’s a good question. Why do you not have a dashboard similar to the others with supplies and videos with a facelift like the other procedures? It’s just simply because I’m the one that’s doing it. I apologize. I just haven’t done it yet.

What they’re referring to is if you’re on the facelift, the dashboard is not as organized with O-shot and P-shot. It’s all still there, but you just have to look around for it more. I’m actually trying to recruit someone who can help me with the websites. I’m still doing them all myself. I started doing websites in 1998 and I can’t find …

So far, I haven’t found anyone that suits me. They’re either over-qualified because they’re actually writing code, which is what I need or they’re under-qualified and they can’t write it. If anybody knows a good web design person that wants to move to Fairhope, then send them this way.

Treating Bell’s Palsy with the Vampire Facelift®

Let’s see. Any other questions? There was one that popped up on the Vampire website from Dana. Let me pull that one up because I answered it. Here it is. I went ahead and answered it, but let’s cover it here because it was a good question.

Dana says she had a beautiful 56-year-old patient who had general aesthetic questions. This is really important because I’ve never covered this in a webinar, by the way, so I’m so grateful for this question. She said, “She’s not new to injectables, but has not received any kind of treatment for the last six months because she has left-sided Bell’s Palsy.”

“Previous management for her palsy’s included prednisone, anti-virals, acupuncture. Her friends think she’s showing improvement. Although this wasn’t the reason for seeing me, I’m wondering if PRP might help with the Bell’s Palsy. When you search on ClubMed, it appears not only to be safe, but possibly helpful.”

Research papers showing the regeneration of nerve with platelet rich plasma<--

Yes, is the answer to that. I haven’t counted, but I know at least two people, maybe three, that have told me that dramatic improvements. As you know, Bell’s Palsy can come-and-go, so maybe it was just luck of the draw treating a lot of diseases that wax-and-wane, who knows?

I think the logic is there when we have something that’s an anti-inflammatory and is an immune enhancing-type therapy. It makes sense that it might help Bell’s Palsy. Also, it’s a nerve re-generator. The last time I looked, it was about 60 or 70 papers about that. This is an important thing that I’ve never talked about so thank you for that question.

I would get a really good consent form because obviously if you’re not treating Bell’s Palsy, if you just gave her a Tootsie roll, it could get better or worse and has nothing to do with your Tootsie roll. In the same way, there’s always a chance it may worsen even though the science indicates it should get better.

I’d get a good consent form, which we have on the websites now that we’ve even enhanced our consent forms. If you haven’t downloaded them lately, download one. We’ve also made an Amnion version. There’s a Vampire facelift and there’s a facelift with Amnion. There’s an O-shot and O-shot with Amnion for those of you who are considering adding that to your procedure.

If I were giving her the Rolls Royce treatment, I would consider an injection. Do the Vampire facelift and add some Amnion to it. She’d have the best we know how to do.

Should you stop anti-coagulants before doing the P-Shot® or the O-Shot®?

Let’s see if there’s any other. Here’s another question. Any reason to stop anti [inaudible 00:25:46] prior to P-Shot® or O-Shot®? Here, I’d treat this like an injection, not like a surgery. Most people who are on anti-coagulants are on them for serious reasons.

I had an internist mentor who always said, “The most dangerous medicine an internist ever prescribes is Coumadin.” You can make the case with just a baby aspirin itself. The last time I looked, something like 35,000 people per year bleed to death from gastric hemorrhages from aspirin.

They’re dangerous drugs. People are not going to be on them for frivolous reasons. Therefore, I usually just don’t even get into it. I just hold pressure longer. Tell them they have more bruising. The bruising is also PRP. It could enhance the effects. We’re just going to hold pressure and I do all procedures as I normally would.

The only thing with aspirin, if it’s possible for you to stop. I know that’s not the question, it’s anti-coagulants, but if it’s possible to stop aspirin or non-steroidal a week or two before, that’s better because it’s going to interfere with your platelet function.

Platelets have a longer half life than a week, so I wonder sometimes about that time frame, but that seems to be the standard recommendation is to stop for a week before and to stop steroids, if you can. I do the procedures and I hold pressure.

I was going to, if there’s not any other questions. Let’s see.

Kathleen Posey: Actually, Charles, I have a question.

Charles Runels: Go for it.

Kathleen Posey: I wanted to say, I did do one Bell’s Palsy patient. She had tremendous improvement, even after a year. But, my question has to do with …

Charles Runels: Wait a sec. You got beeped out for some reason on the sound. You said she had tremendous improvement and then what came after that?

Kathleen Posey: Even after a year. She had the Bell's Palsy for a year and still had some residual left. It was able to take away the residual palsy, which to me, was amazing.

Charles Runels: Beautiful. I’m glad that Dana asked that question. Thanks for throwing that in. Go ahead. You had a question too?

Treating Interstitial Cystitis with the O-Shot® Procedure

Kathleen Posey: I have a question about interstitial cystitis. What’s been the group’s treatment plan on that and how successful do you think that is? I mean, I’ve done a few, but I’m running about 50/50. I was just wondering. I mean, just do a regular O-shot? I mean, that’s what I’ve been doing.

Then, also, the same patient had an urethral caruncle. I put PRP in there. I actually think it grew, but anyway. I told her to go ahead and have it surgically removed, which the urologist was refusing to do but the pain was so related to that caruncle. I just think it needs to come out. Just wanted to know if you knew anybody else that had experience on the line with UC?

Charles Runels: I think what I’ll do. I’ll tell you what I’ve heard, but I think what I will do after this call, is I, as usual, I will send out an email to let people know the recording is there. I’ll ask for more comments from our urologists and gynecologists who are treating UC.

To tell you what I’m hearing is, I’ve had now three separate … Well, two urologists and one uro-gynecologist call me excitedly to tell me about multiple patients in all three practices, not just one, but multiple patients, who became completely well after many years of suffering with pain.

That doesn’t mean, of course, that everyone they’re treating is getting well. I don’t think the placebo effect on someone who’s tried everything under the sun and can’t get better and finally they get well with your one thing. My guess about it is that it’s multi-factorial and what’s working with us, is those that have …

Charles Runels: … the factorial and what’s working with us is those who have some sort of chronic inflammatory/infectious process going on with the Skene’s glands but I’m completely guessing with that. The others may have something that has to do with the bladder itself that we’re not reaching with our procedure. How we dissect out the subset that responds versus that don’t I don’t know but I keep offering to finance a study and if you want to do that and try to … Let’s try to work up a protocol and get it approved, someone in our group needs to do that study. I’d like it to come from a gynecologist or urogynecologist, which I’m not, so that it’s paid more attention to. To help you with it, I’ll post it and try to drum up more interest and let’s talk to each other about it so I appreciate you bringing that up.

Let’s see what else we got. I think that’s all the questions.

How to Get on Your Local TV News

I always like to do a little marketing tip or two. We’ve had a few people lately … Let’s see, I’m not sure what you guys were looking at, let me get you back looking at the web page. Just one minute. We’ve had people on the news, quite a few lately actually, and along with that one was on a radio show. It’s not always TV news, one was on a radio show yesterday and so two really nice luncheons lately. I thought I would pull them out and tell you guys both how to make this happen in your own town and the advice I give people when they call me and say, “Okay, give me tips about what to say on the news.” Then if you just know it’s here the next time I’m still always happy to talk with you. If you know it’s here the next time you get that call you can go refer to this.

I’ll fix it where you can see what I’m looking at. Here’s one of our doctors, she’s a gynecologist, Dr. Singer, and she’s doing the O-Shot and you can see she’s come out of sometimes with the laser treatment. Now, first I’ll start with how you get on the news itself and maybe I’ll just tie it kind of step-by-step what to do. First I would get the name of the person, just your local news channel. You want to call the news and say, “I’m a local physician and I just want to be available for comments or help any time you’re doing a health story that involves whatever you do.” For Kathleen it would be women’s health. If you’re an anti-aging doctor you could say anything that has to do with aging in men and women, whatever you want to be known for.

Then you say, “May I speak with your health reporter?” Here’s the thing. You would think, well they would laugh at you and say we’re too busy. The truth is it’s very, very hard to come up with news and I can prove it to you. Just watch the news and see how many times one news reporter is interviewing another news reporter, it’s very often. How does that make news if they’re interviewing each other? They are really hard up. How many times do you see one … They call it breaking the story. One news channels breaks a story and then all of them talk about it for the next week. It’s hard to come up with something new and interesting every day. Then when they do a lot of times they need an expert to comment. If they have someone on speed dial, and this is what you tell them.

Get to Know your Local Health Reporter

First you ask to speak to this person and you say you want to make yourself available if she ever has a story and needs a comment on or off the record. You tell her or him that you always answer the phone and then you give them your cell phone number and you tell your staff, “If you ever get a call from this news you want to be told immediately.” They are not to take a message, they are to get you to the phone immediately because if you don’t take the call they’re usually on a really tight schedule and they will call someone else and you’ll miss the chance for … I literally have millions of dollars of free publicity just because. They’ll tell me, “You know, I was going to call so and so.” I just ask them and they’ll say, “Yeah, I was going … My deadline, I’ve got an hour to get this done and if I hadn’t answered I would have just been out of the story.”

Tell Your Staff to be ready

You tell your staff … Make sure they have your short list, you probably have that already. “These are the people you’re to never take a message.” My short list is my children, my parents, my sisters, my attorney, and anything with three letters; the IRS, the FBI, the DEA, anything that has three letters get me to the phone. That includes CBS, ABC, NBC, and any news reporter of any kind, doesn’t matter how big or small, bring me to the phone. Then after you get the news reporter on the phone you just tell them that, make yourself available. Now, if you want to make news, if you want to be on the news for free you try to tie it to the national press and I put … If you go here, I think I’ve got it on here, let’s see.

Tie to National News

If you go to the marketing part of this … Anyway, it’s somewhere on here. There’s a webinar about how to take advantage of the national press and marketing … Let’s see, what is it? Insurance practices, avatar, anyway somewhere on here. You’re right, it’s easier to find the O-Shot but the thing is if they have … Let’s say that the press does a story on some new treatment for incontinence, it could be any treatment. Well, you call them up and you offer to comment on it, on your local station about that treatment. Of course, you’re going to talk about your O-Shot too. I actually changed the Health Department policy in my county after someone had an injury in Atlanta, the swimming pool. They had no Health Department inspection here back in the 90s and I said, “Let’s do a story,” and we did a story about how there was no Health Department inspection. It would not have been a story had there not been a recent death in Atlanta from their dirty swimming pool.

You watch the national news and when something happens nationwide that relates to what you’re doing you call your local channel and you offer to do a story about it. That can include national press about our stuff. When this hit the news recently, this one. This is a local station but we have clearer … When we hit the national press I will send out an email. When the email comes out and says … Let’s see. Back in October we made a Real Magazine Website and plugged in others about the Vampire breast lift. When that happened you could have called your local TV station and say, “Hey, the Vampire breast lift was just on [inaudible 00:37:53] website or Allure,” whichever one you want to mention or both, “And if you want to do a story about that I do that procedure here in our city.” Then they will interview you often because you have a local comment about a national matter so that’s how you get in.

Getting Ready to be on the News

Now when it’s time to talk how do you get ready to actually be on the news? Here’s some quick tips and you’ll know where this is. It also applies if you’re just going to be, say, giving us a talking somewhere, and it helps you plan the talk. Here’s the tips on that and I think I’ll type them out for you. Let me pull this up because it’s simple but it’s really helpful. I’ve been on the news more than I like to think about in different countries, in Serbia and London and New York. Anyway, the bottom line is this is the process I go through before I’m going to be interviewed.

I first think about … I imagine not everybody in TV land, not everyone. I imagine one person that I love and I pretend that person is watching and I forget everybody else. If it has to do with men’s health I imagine my son’s watching. If it has to do with women’s health I imagine my mother or a woman that I love and I pretend like that’s the only person and that person is on the other side of the television. That couch is my language so that I don’t sound salesy, I don’t sound anything except sincere and engaged and eager to communicate what the message is. That gets the frame … That is so important and I’m not just saying this. This isn’t something I’m just talking about, I literally do that every time I’m in front of a camera or a microphone if you’re being interviewed by the radio. I was interviewed on Shade 45, which is, it’s a rapper station.

That’s the only time I’ve ever been interviewed where I was the most conservative person in the room. They were talking to me about orgasm and it was a call in station and so it was pretty interesting. It didn’t matter, I was still imagining not talking to everybody out there, being interviewed by radio stations in South America where they have a translator or in Columbia, Mexico. Every time I just think of one person that I love and it’s the only person that matters. Then how do you, what about the content, what do you have in front of you? I think about the problem that my thing is going to solve and I imagine that person with the problem.

Let’s say I do a talk about the O-Shot, then I’m thinking about incontinence or orgasm or whatever it is that is to be the expected topic. Then, and quit speaking about me trying to be pretty or smart or say all the right things, it just becomes about me trying to communicate to that one person I love on the other side of the camera. I know this is all a mind game but it works and it’s the reason you’re there or you just go home. We’re here to solve problems for people and so, not to try to be pretty, they got movie stars that do a lot better job of that than I do, be funny or entertaining. I’m a physician, I’m there to teach people how to solve health problems so that’s the mind frame you get and I forget about the rest of it.

Then I think, and this one’s key I think. I think of key words and phrases that I think would be helpful. Let’s say that … And I write this down and then look at them before I go on camera. Let’s say if it were O-Shot I might think, I would think of the words O-Shot, I might think of the words relationship, relationships healed. I might say psychological pain, you get the point? I would make a list of all the friend … I would day provider group, that’s protected, be careful about seeing someone outside the group. Two and three word phrases that I would want to try and weave into my conversation and realize, no matter what they ask. Ask me about the weather. You say, “Well, is it hot outside?” I would say, “You know, it’s unusually cool down in Florida today, which is exactly what happens to relationships when sex doesn’t work.”

Ask me what color my car is. It’s black. “You know, that’s exactly the mentality people have. They have a black, depressed mood when they don’t get sexual relationship fulfillments in their marriage.” My point is, no matter what they ask you you can weave these phrases into the conversation if you have them in your head before you go on. Then I always thank the person, usually I’ll thank them up front for … It’s not a long thank you, it’s a … Because people get bored by, “Thank you so much for having me.” Nobody wants to hear that crap. What I would say is, “Thank you for being brave enough to talk about sexuality on your show because many people are afraid of that and we know how important this is for relationships.”

You throw little kudos to the host for being brave enough to talk about uncomfortable things and they always like it obviously because they can’t brag on themselves. Then it sets the tone and they know their viewers are looking up to them with a little more respect because of something you said. That’s kind of my, that’s my … Then oh, last thing is you want to invite them to do something; contact you, you want to make sure you have the website because here’s the other thing, here’s the bad, I’ll show you the bad news. Here’s the bad news. If you don’t do … This will go away in about 24-48 hours unless you post the recording. Anyone [inaudible 00:44:51] her TV show. It was good for a boost, it lasted less than a week.

The doctor show will last less than two days. A good news report, and I’m watching the traffic on a website. A good news channel … Actually, sometimes the doctor show you can’t even see the blip because a lot of people aren’t watching daytime TV but a good, very populated website will last two, three days and then it’s gone away so why be on the news if it only gives you traffic for 2-3 days? Once you have it then you take these videos like this and you post them on your website. You see where it says … Oh, I had a link copy. Anyway, there’s a way to actually embed this onto your website and hopefully Dr. Singer has that.

Now, every time a patient on the website that says, “Oh, this lady is [inaudible 00:45:47] enough to be on the news,” and then they hear her explain it in an engaging way with her news interview and it just sits there and educates patients day after day, year after year. Then, that’s when you get some traction and that’s really when you go on the news. It’s not you get a little grip. If that was all you got, honestly, I don’t know if I’d waste my time. That footprint that stays out there and gets showed by all of us on the website, that goes … Oh, are you all seeing what I’m seeing? This can be shared and embedded so that that sits on her website and that is what keeps owning on educating people.

I think that’s it unless somebody has more questions. I think we’re going to stop it there, see if there’s any other questions. The take home do for this one, for today’s thing is that we’re going to try to drum up some more talk about the chronic interstitial cystitis because we’re at least three years overdue for doing that study. If you want to get on the news, at least let yourself be known, make introductions to the health reporter in your town. Then when something happens nationwide you can call, they already know who you are, he or she does, and they know to call you if they have a need for a comment. Then there’s the book that I recommended if you’re doing faces for, that’s newly published about the mid-face because I really like the way he talks about that.

Let’s see if there’s any other questions. Thank you guys, it’s always an honor to have when you spark people interested in what we’re talking about. I’ll post a recording if that’s helpful. Goodbye.

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FDA Positions on PRP & Stem Cells & Approval of Procedures

Here’s a summary of the FDA regulations concerning PRP…

Here’s a nice summary article with wonderful references…
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Here’s an abstract summary of the above article…
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Here’s where the FDA plainly says that PRP is not under consideration for regulation..
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and here’s the most recent position papers<–

New England Journal Article about Stem Cells…
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Training for physicians…
Urogynecological (click) <–
Men-Urological (click) <–
Facial Aesthetics (click) <–

Q&A.The “Capture & Heal” form, treating acne scars, treating dyspareunia, our current research…

Next Workshops with Live Models<–
International Society for the Study of Women’s Sexual Health (ISSWSH)
Cellular  Medicine Association

Transcript

I’m just back from an ISSWSH meeting, which I highly recommend that you guys do if you haven’t been yet. Here’s their website for the Fall course. Maybe once every year or two I recommend. You can see the content is pretty amazing. These are the handouts that they had. I thought I would just run through some of the highlights of the lecture that Andrew Goldstein gave on dyspareunia.

Dyspareunia

Dyspareunia, as you guys know, to a gynecologist, it’s like saying back pain to a orthopedic surgeon or an internist—the etiologies are so numerous that it’s almost the name of a symptom not a diagnosis. Although there was an article, an editorial, in the Green Journal Obstetrics and Gynecology about three years ago now where the editor said, “We’re not treating it as well as we can, and often times it really does go undiagnosed.” But even with that being the case, it’s worth looking at in more detail, the different diagnoses/etiologies

I’m going to unmute your mic, Kathleen, because I know you’ve been to this meeting (ISSWSH). You are going to have things to say about it. It would be very helpful to talk about it, I think. I don’t know if you’re able to talk. Can you hear me, Kathleen?

Kathleen Posey: Yeah, I can hear you. Can you hear me?

Charles Runels: Yep. We’re recording this because even though not so many compared to speaking, not a huge percentage of our people make it to the call, usually it’s in the neighborhood of 20 or 30 people out of over 1,000 people, I think it’s really worth thinking about pain/dyspareunia.

The good news is that often times when we have pain and it’s not easily diagnosed, our O-Shot® procedure seems to be working. Whether it’s healing damaged tissue or if it’s causing a decrease in inflammation like it does with lichen, I don’t know. But I thought we’d run through these known causes. I don’t pretend to be giving this presentation the way Andrew Goldstein gives it, but I’ll hit the headlights, the highlights. Hopefully, you guys can hear the lecture for yourself sometime in the next year or so.

This is the textbook that he helped edit about dyspareunia, which I highly recommend that you go through this. Eventually, I think there will be a chapter about an O-Shot. You can find this on Amazon.

This is the one, the version that he wrote for patients.

These are the known causes [see video]. Talk about this for a second, Kathleen. What on here do you see us helping with? Obviously, we wouldn’t try to treat fibroids with an O-Shot, but talk about this list for a second, and just the diagnosis of dyspareunia in general. Can you see it?

Kathleen Posey: Yeah, I can see it. I basically put PRP wherever the pain is. I map it out. I rule out the things like yeast infections, chlamydia, endometriosis, PID. I treat them just like we would treat those, but usually when there’s no reason, I just get out that Q-tip or just my index finger and say, “Where’s the pain? Does it hurt here?” Then I put the PRP.

Actually, a case I talked about a couple weeks ago was a anal cancer in a 40 year old that had radiation and complained of menopause and decreased lubrication. She went to a plastic surgeon who did Thermi-va on her, which only made her small vagina smaller. But mainly the pain was a posterior fourchette. I did put the PRP and did an O-Shot® because I do both. About two to three weeks later, her pain got better. That’s my method.

You can look at all these diagnoses. We know how to treat most of these things, but it’s the unknown ideology of the pain that I think the PRP helps. It doesn’t always. I had a classic vulvodynia around Hart’s line that was real painful, and she really didn’t respond that well, but that’s just one out of the many that I’ve treated. I’ll still try it on another patient like that, too. I wouldn’t limit it to that.

Charles Runels: Beautiful. Let me add to what you just said.

First of all, I agree. Most of the people, by the time they get to us for an O-Shot®, the patient’s already, before they are willing to pay cash, they’ve already been to other physicians and had lots of tests done. The good is that most of these things, if they were there, have already been treated.

The other thing I would add, which I know you do this, Kathleen. I know you treat some people for free, as do I, and that we’re both careful not to keep money if people don’t get well. I highly, highly recommend that everyone do that. If you’re treating pain and someone doesn’t get well and you keep their money, they feel like we stole from them. Even though we’re not used to giving back copays or whatever, insurance doesn’t refund money if we don’t … Obviously, we know we can’t get everyone well, highly recommend that if you treat someone for pain, and they don’t get well, either repeat it or refund their money.

By the way, the reason I’m talking to Dr. Posey for those of you that don’t know, you’ve been involved with the group right now for quite a few years. She’s been teaching it to other gynecologists. She’s a gynecologist, board certified, out of the New Orleans area, who has recently presented some research where she treated lichen sclerosis with a combination of surgical procedures and PRP, and teaches that method. A lot of experience seeing many thousands of women over the years as gynecologist and very well-trained, busy surgeon in the day. Back in the day, I know you were a high … Anyway, lots of experience.

Back to this list. Back to the list. The endometriosis, obviously, you wouldn’t treat it. The psychological, that hopefully is going to be teased out with your conversation. I wouldn’t try to treat psychological, obviously, with PRP. But let’s get to some of these pictures, though, because I think a lot of our providers don’t really know what to look for. I know that you’ve seen quite a few people who are being followed by a gynecologist-

Charles Runels: Some of these women, saw gynecologists who never diagnosed the pathology the gyn just went for the pap smear and never stopped to look at what was going on.

You just mentioned … This, by the way, is his algorithm for pain. I don’t show this, obviously, expecting anybody to memorize this whole thing from my overview here, but I just want people to realize there’s some thought that goes into figuring out pain. They’re not just willy-nilly treating someone without making sure that someone, if they’re not a gynecologist or a dermatologist, that someone hasn’t thought through a differential diagnosis … If there’s a rash for example, it should be biopsied. Someone should be thinking about that.

This first one is a big one. There is a pain disorder that’s associated with low testosterone. This is stressed over and over when I talk to people who treat a lot of vaginal and vulvar pain. The vagina and the vulva needs testosterone to stay healthy, and there’s a actual syndrome associated with pain and birth control pills, which almost always drops testosterone levels. Some women are susceptible to that, and some are not, but that’s something to think about.

This vestibulodynia of different ideologies is a whole subject in itself, but interestingly, I did meet a woman at this last ISSWSH meeting who had a woman with long standing vestibulodynia that was of this [neuroproliperative 00:09:01] type that responded to our PRP. Somehow it decreased that inflammatory whatever makes things go on here. This is a whole area for research that we need to take up, talk about. But obviously this is not a healthy looking vestibule. When you have this erythema around Hart’s line, then it’s worth thinking about testosterone creams. I think it’s worth trying our PRP as a way to modulate that.

Again, I’m just skimming through this just so you can see this should be thought about. This is that Hart’s line that you just heard Dr. Posey talk about that one. That’s inflamed, and this responded to using testosterone and estrogen creams.

Our O-Shot® is not the cure all, end all, be all, but I think it’s an extra tool that can be used in the thoughtful treatment of these problems, so I just-

I just wanted people to get a look at what some of this neuroproliferative. Vestibulodynia is a horrible problem. Basically, someone stays inflamed to the point that then if the inflammatory agent is removed they still stay inflamed.

A lot of times, they’re treated with creams that have some sort of propylene glycol or paraben in it that causes the inflammation. You’ve got inflammation, you treat it with a cream that actually causes a chronic inflammation to the point that when it stops, sometimes they’re left with a continued process that turns into this.

I think that was the main thing. The other thing to think about is here’s the pelvic floor muscles. Normally, these have been treated historically by palpating, as you heard Dr. Posey talk about, palpating and finding the place where a person’s tender, just like you would look for trigger points in a tender back and in the same way that physiatrists are now injecting PRP to treat this.

When you find that tenderness, you can now inject PRP. That will usually hurt worse for about a week and then it goes away. You have anything to add to these pelvic floor injections?

Kathleen: Not really. I’ve never really done them. I refer to pelvic floor PT, but I will say that even of the lichen sclerosus patients I’ve seen, a lot of them have pelvic floor dysfunction. You just touch them and their levator ani muscle just almost goes into spasm. It’s interesting, a lot of women when they’re touched, they wanna squeeze that butt together and I’m telling them, “Look, put your butt down into the table.” There’s a lot of comorbidity there with vulvar pain and then these muscles getting involved is what I see.

Charles Runels: Just to add to that, we do have people in our group who work with the pelvic floor therapists. I know you have them in New Orleans. Our little town doesn’t have one. But that’s a good referral source. One of our people actually had a pelvic floor therapist put a satellite office in their office actually they had a good working relationship [inaudible 00:12:30]. His O-Shot helps her therapy work better. That’s worth looking into.

The way that he established that relationship is he just had her bring one of her patients over and he treated the patient with the therapist in the room so she could see what was involved. Then she went back and did this therapy as she normally would and had a nice result. It’s a way both to help their therapies work better and to help everybody’s business. Let’s see.

Kathleen: At the conference in Boston, they talked about putting Valium in the vagina.

Charles Runels: They did.

Kathleen: Did they talk about that at all?

Charles Runels: They did. It didn’t seem to be as helpful, at least the feeling I got from the lectures, as using Botox. That was something that was talked about.

We don’t have the research showing that our PRP works with pelvic floor trigger points, but it should apply, since that research has been done in the physiatry literature with back pain.

They did talk at ISSWAH about trigger point injections of Botox and they mention diazepam and suppositories, but Botox seemed to be the first choice on the menu (before diazepam).

100 units is what they talked about using, which would be one bottle of cosmetic Botox. Some are doing it under anesthesia. I know Andrew Goldstein was saying he likes to use it without general anesthesia so he can tell better about where to put it.

Let’s see. I think that was the main thing I wanted people to see was just that. Oh, yeah. He does a vulvar vestibulectomy but he says he does a whole lot less of these than he did in the beginning of his career when people were not using testosterone creams.

It was really talked about a lot, especially in someone who’s on birth control and how common it is that that gets dropped in people who develop these pain syndromes, not just this vestibulitis pain syndrome. But this is a last resort, obviously, but it’s something that’s done just to know what’s out there. It can be done if somebody develops this pain that just won’t go away.

I think that we’ll find that there’ll at least be a subset of these people that get better with our O-Shot. We’ll see. I think that was the main thing I wanted to show. I don’t feel like it’s my place to just put all this stuff out since it’s their intellectual property, but I just wanted people to see that there’s a lot of stuff out there and it’s worth, I think, attending one of their meetings. It’s called ISSWSH, International Society for the Study of Women’s Sexual Health. Maybe go there once every couple of years and get a good update.

Amnion with the Priapus Shot® Procedure

Okay. We didn’t have as many questions this week as we normally do. We had one question that showed up on the Priapus shot website about has anyone used PRP combined with amnion with the Priapus shot. Some of us have, but I don’t think I have enough experience yet to tell you that it’s working better. I think it would be worth trying if someone didn’t respond and you were treated Peyronie’s disease especially if you’re trying to heal scar tissue, or someone just wanted to get the best that you knew to do.

Again, amnion is not stem cells, it’s where you’re harvesting the proteins from the amniotic membrane and then they gamma-radiate it. There’s nothing living in there. You just have the cellular proteins, the amino acid peptide chains that code for wound healing. That research has been done. I think just as a general help, I always like to add in a couple things that have to do with marketing and something to do with business.

Press. Men’s Health

We got a really big hit that’s worth talking about when it comes to the Priapus Shot® procedure. If any of you guys are doing this, it’s worth talking about. Dr. Gaines is in our group and he popularized the Gains Wave™, which is combining the Priapus Shot® with shockwave therapy.

You can see the guy in the Men’s Health article talks about the Priapus Shot® itself, or the P-Shot®, and it’s a very complimentary article, somewhat sensational, but he’s an entertainer. This is “Men’s Health,” this is not “The New England Journal.”

Obviously, we don’t make claims we can’t fulfill and you want to have a consent form and make sure that your explanation is not the same as “Men’s Health” magazine, but Lord knows we get huge amounts of negative press that’s absolutely uninformed and factually wrong. Someone wants to make this a little bit entertaining by talking about his penis he claims was 10 inches when he put it in the pump, I don’t know, maybe it was 10 inches. Who knows? But I’m not one to dispute him.

It’s a nice article that at least can start the conversation and maybe lead to you helping some people who need your help for their erectile dysfunction. That article’s there if you just Google “Priapus shot in Men’s Health.” Some of us are combining the shockwave therapy when people want it. Just so you know, if you look on our director, PriapusShot.com/members/directory, I added a logo so that if you’re using shockwave therapy people can find you.

Also, I know Dr. Posey uses the- That right there, that’s our shockwave logo.

Our Directory and Helping People Find You

If you are doing shockwave therapy and want the logo by your name, let me know and I’ll add it.

If you go to the O-Shot® directory, we have a logo now if you’re doing radio frequency. I think what’s gonna happen is as the research becomes more available, as we do more research, then people are going to want different flavors of our procedure based on their problem. I know there are some things that one of these machines, like Dr. Posey just mentioned, someone who had dyspareunia had a small, constricted introitus, that’s not the place to use your radio frequency device.

But you can see I added this. This is what I added, Kathleen, to indicate you’re doing radio frequency. If you want one of those by your name, just send it to support. I’m gonna put it in here…

support@vampiremarketing.zendesk.com.

I just put it in the chat box. You just send that and let us know and we’ll put the little thing. This means you’re treating lichen, this means you’ve put five people in our research project or a survey, this means that you’re using radio frequency device, and we have one for laser’s too. I need to update.

This is the legend so that whomever’s using this directory knows what these little symbols mean. I just added this last week, so I need to add that to the legend so that people know that means you have Thermi-O or radio frequency device.

So, let’s see Dr. Desmond Ebanks just put something in the chat box. So, the automatic pump he uses, I don’t, the guy talks about this pump like it’s the bomb. Who knows if that’s part of his journalistic license, but he talks about this pump as being a pretty intelligent thing, so I’ll ask Dr. Gains what brand of pump they’re using.

Let’s see whats the other question…
which shockwave device do you recommend? As far as the shockwave device, what I have right now is the E-Vive. There are others out there, I think they’re all made by, or most of the main brands are made by the same company. They’re kinda re-branded, depending on who’s selling it. So I think a lot of it comes down to who you want to work with. And who’s having a good deal, and good support. But right now, I have the E-Vive, which is the one Eclipse sells, in my office.

Treating Acne

Let’s see, Dana Kirk just said here, okay, so here’s the question from Dana. She says, “Often the Vampire Facial®’s being administered for acne scarring often have some leftovers. Anyone injecting into the larger pock marks? If so, is it worth activating?”

Ok, so this is a good question about acne. When I treat acne, I use micro-needling. But two tips on that….

First of all, if it’s in their budget to do Juvederm. If you think about what happens to the divet, or say the divets in say a basketball, if you put more air in it? The divets become more shallow, just from expanding the ball. So even before you treat the pocks marks, or treat the acne scars, if you’ll use some Juvederm, if they can tolerate it, as in, do they have any room for some improvement in the cheeks, and if it’s a female, almost always they do, unless they’re obese, they’ll have some. You can add to their cheeks and things look better. And the acne scars are already smaller (before you actually treat them). At least the ones in the cheek area.

Then, micro-needle with PRP (Vampire Facial®), but also go intra-dermal and sub-dermal with your PRP, subsize/undermine the scar, just like you would if you were treating acne scars before we had the Vampire Facial®, so taking the bevel of your needle and sub-sizing the scar releases it some. I

Inject a little PRP sub-dermally, inject some intra-dermally, and then micro-needle on top of it. Intra-dermally as in blanching the skin.

And all those combined will get a really nice result. Usually I treat them every six weeks for three treatments, and they love it.

As far as activating it for the face, I usually don’t (I used to do so). Because I don’t think it adds to it enough to warrant the extra pain. In the face. But I do activate the PRP in the O-Shot®, the P-Shot®, and for loss of sensation in the breast.

The Order to Do Shock Wave, Radiofrequency, & O-Shot® or P-Shot®

So Sherry, I don’t see your question, it just says … maybe you can type it again. Okay, wait, here it is… “Does it matter which order you do the p shot, the shockwave therapy, and did the p shot … okay….”

So, the way I think about the energy, whether it’s shockwave, laser, or radio frequency, the way I’m thinking about it is, if you’ve ever used, say, insulin or growth hormone, if you just take, if you buy Omnitrope or a growth hormone, or Genitropin, whatever brand. These are small amino acid or peptide chains. It will tell you not to shake, to gently stir when you put the water in. Just shaking the vial, it mechanically shears the amino acid protein chains, so it’s like taking the words of the sentence and just chopping them up and turning them into letters. And now that amino acid chain no longer acts as a small peptide signal. Right? So these amino acid chains act as signals that plug in to receptors on the cell, and that’s how growth hormone, that’s how insulin, it’s how all those amino acid chains work.

Over 200 made by the pituitary gland that we know about. Peptide chain signals. So, imagine if you did that, I have no research to back this up, but imagine if you injected a peptide chain, and then now you hit it with shockwaves. In the same way, imagine what happens to an egg when you put it in a skillet and fry it. Obviously those peptides or those proteins are being changed.

So the bottom line is, I like to use the energy, whether it’s shockwaves, lasers, radio frequency, whatever it is. Use that on the tissue first. And then immediately afterwards, same visit, then apply your PRP. Now if you want to, if you did the shockwave yesterday, or last week, or three weeks ago, or a month ago, and you wanted to do PRP after that, that’s fine, you’re not hurting anything. And if you want to, if you did the PRP three weeks ago and now you want to add the energy, you can. But in my opinion, as soon as you add the energy, you are probably shutting down whatever growth was taking place, from the PRP that you put. So it’s like you’re stopping, it’d be like you just watered a seed, the stem cells are [inaudible 00:25:26] stem cells that you just put there. And now if you’re trying to generate more growth by damaging tissue, now you’re crushing the little sprout or whatever tissue is growing. You’re crushing it or injuring it, in my opinion, if you didn’t do the shockwave therapy before it has a chance to mature.

So I would try to do them back-to-back on the same visit. And not do anything else mechanical to disturb the growth of the pluripotent stem cells until at least six weeks out, maybe even eight. To give what you did a chance to work.

So if you did the P-Shot® three weeks ago, yeah, you could do the shockwave now, but you’d probably be stopping whatever further benefit might have occurred from that original P-Shot®. It might be better to give it at least another three weeks before you did the shockwave therapy.

How Your Losing the Chance to Take Care of at Least 30% of the People who Visit Your Website…

Okay. Let me give you guys, I don’t see any other questions that are up. I want to give you guys one quick marketing tip, and then unless somebody has another question, we’ll shut it down.

This one has to do with when people get to your website. It is something you can ask your web designer for. This is my old internal medicine website. And this is just a form and here’s the scenario that will happen. And this is why this form is so important. You don’t have to make it, I just want you to know it exists, and this is a ten minute job for your marketing person. And if you don’t have one of these, you’re losing about at least 30 to 40% of the traffic that you could be getting to call your office.

So let’s say that you’re in, let’s say that you’re, you do an o shot, or you do a vampire, or you just do a pap smear on someone. And they go back home, and they go to Thanksgiving dinner. And they tell their mother, sister, friend, cousin, whatever, how wonderful you are. And they say, oh, what’s their name. And they say, oh, it’s Dr. Posey.

So now they take out their cell phone, or they remember the name and tomorrow, day after Thanksgiving, they google you. And they wind up on your website. If all you have is stuff for them to read, they read it and they go away. And there’s very good chance that a week from now, they’re not thinking about you. It’s all done. They will never become your patient.

If you put something on here that they can have for free, that costs you nothing, not a free consult, it’s gotta be something that costs you nothing. If you put something on here that they can have for free, and we’ve all done this before, that’s worth something to them, but costs you nothing, somewhere between ten and 30 percent of the people who land there will do that.

And then, now you have their email address. They start getting your newsletter, and a certain percentage of those will eventually become your patients. So it gives you a chance- this is not the main way you get your patients. Most of your patients are gonna be word of mouth, or someone googling you. But this plugs the hole, and it will increase the number of people you have by about 20 to 30 percent, that come in through your website, by capturing those people who would have never called you, had you not created this form.

And the way you ask for it, is you decide something you’re going to give away, first of all. It could be, and I, it should be a podcast or an email, or downloadable book. It doesn’t even have to be your podcast. What I’m giving away here is a podcast where I’ve just recorded for an hour the benefits of walking. So it says, number one weight loss melt secret, free immediate download. So that takes them, you ask them for the first name and email address, and when they give you that, now they’re on your email list, every time you send out an email, they get it. And as soon as they do that, and you can sign up for this so you can see how it works, as soon as they enter that data, they’re taken to the place to download that.

So, it could be an email, excuse me, it could be a podcast or a video that you made. I know Dr. Posey made one on incontinence. So it could be free video on the treatment of incontinence. In exchange for first name and email. And so you tell your, here’s what you say to your web person, if you want to do this, you should write this down. And this works for Constant Contact, A-webber, Ontraport (what I use most), Mail Chimp, all those different places.

All those different places, it all works the same. And you can go online and figure how to do this yourself, but it’s a 30-minute job at most for whoever does your websites for you. You say you want a form and you want it to be in the right upper-hand corner of your website. On the homepage at least, maybe on all your pages, but at least on your homepage. And it should offer the thing that you’re giving away. And it should only ask for their first name and their email address, that’s it. If you ask for last name, you’ll lose about half of them. So first name and email address.

And then you let them know that you’re putting out a new health lessons every two weeks. Don’t call your newsletter a newsletter. Nobody really cares about your news. Give them a name that implies some sort of benefit. So I call this Health Lessons. You can call yours whatever. And then tell your person to put that on the form.

If you supply them the link to the thing you want to give away … You realize also on Amazon, there’s a lot of books for free. You could literally find a book that you can read on Kindle for free and give that away. But I recommend you find something either audible of a podcast or a video. Preferably something that you did. And that’s it. That one thing is gonna increase the production of new patients by your website by 20 to 30 percent. Now we talk more about this sort of thing in my workshop where I teach marketing, but there’s your freebie right there that is just some of the best stuff.

Okay. Let’s see if there’s any other questions and then we’ll shut this down. We didn’t have a lot of questions on the websites. Okay. I think that’s it. You want to add anything? And thank you for helping us, Dr. Posey. I know you’ve had a lot of … I think more experience with treating lichen with PRP than anybody.

Do you still treat the clitoris even if the woman is there for urinary incontinence?

By the way, the way I think about this, it’s all the freaking O-Shot, it’s just we’re varying the way we do it. Just like you do a hysterectomy and you vary the method based on who you’re taking care of. It’s all the same thing. But Dr. Posey made a good point and this is worth remembering, because some people asked me if they’re there for incontinence, do you still treat the clitoris? Or if they’re there for sex, do you still treat the anterior vaginal wall? Or if they’re there for lichen, do you still do the rest of the O-Shot? Or for pain, do you still do the rest of the O-Shot?

There’s two reasons why you treat all of it. One is people lie about sex. Everybody does. And so if someone says they’re there for incontinence, maybe they’re not. Maybe they’re just too embarrassed to tell you. Or maybe they’re living alone, single and they don’t want to tell you they have a lover. Whatever reason. Maybe they just decided it’s not your business. And of course, you would want to treat the clitoris if you’re treating for sex, but you would also want to treat it for incontinence because if you look at the anatomy, the clitoral tissue actually comes around and forms some of the structure for urinary incontinence.

Also, it could be that those nerves of micturition that come down through that area are helped and our clitoris is acting like the wick to help rejuvenate those nerves of micturition. We do know that we have people with urgent incontinence that are getting better as well. And we’re not sure exactly why.

So I always treat the clitoris even if it’s for incontinence. And of course, if you read Grafenberg, the urethra is very erotic in women and you would definitely want to treat (even if there for sex). Also, you have the female prostate gland or the Skene’s glands, so you would definitely want to treat the anterior vaginal wall, not just the clitoris if you were treating for sex because the urethra is such a sexual organ as well.

And if you’re treating lichen and you’re hopeful that it’s going to get better, and you’re down there anyway, why wouldn’t you go ahead and treat the structures that have to do with sex so that that can be recovering at the same time you’re treating the lichen itself?

One big plug though, if they have sclerosis or phimosis, where you cannot pull that clitoral hood back, which many of them do, then you can go ahead and treat them, but make sure that you don’t stop there and you refer them to Dr. Posey or someone else in our group who knows how … If you don’t know how, someone else who knows how to free up that clitoral phimosis. So if you can’t retract the clitoral hood all the way back to see the shaft, if all you can see is the tip of the glans or if you can’t even see the glans, then they need a surgical consult from one of the people in our group so that that can be exposed and be more responsive. It’s hard to have good sex if you can’t get to the clitoris.

Okay. I think that’s enough rambling. Anybody else have any questions? If not, I’m gonna shut it down. Thank you for your help, Dr. Posey. Thank you guys for being here. I’ll put a recording up by the end of the day.

What can you measure with a ruler that gives a clue about a woman’s ability to have an orgasm?

Kathleen: I just wanna say something that I hear … I mean it’s going off on a little bit of a tangent. But to me, a lot of times, they want the O-Shot because they want that penis and vagina orgasm. And yes, it does help that somewhat, but I’m really … I look at a lot of vaginas, and I’m really paying attention to that distance between the clit and the vagina and/or urethra. And it really … You oughta start looking at it, Charles, because it varies with women. Some of them, it is like five to seven inches.

Charles: Yeah, it’s huge.

Kathleen: When I talk to those people, they have never had a penis and vagina orgasm. It might be something to really examine the person before. And if you really talk to them about why they really want the O-Shot, I’m seeing 70 percent of them really want that penis and vagina. And it’s being advertised or said it’s gonna make them have that. Just be careful because if that distance is a long way, yeah, the orgasm will get better. But to bring you to surgery, in my opinion.

Charles: Let me add to that. First of all, what you said is backed up by research. And that research I think is actually on our O-Shot website. But there was MRI studies showing that the further the clitoris is from the vagina, the harder … It was a correlation between … It was done about two years ago. You know this research, so you’re seeing it actually in your patients.

But there was a study where radiologists looked at women who can easily have orgasm and those who have trouble. And the distance from the clitoris to the vagina correlated with ability to have orgasm. And the size of the clitoris correlated.

Now, her conclusion was that she showed it, but there was nothing to do about it. Actually, we do know some things to do about it, putting someone on testosterone is going to make the clitoris larger. And it could be that doing our O-Shot® procedure actually helps, even though it’s not going to make that distance shorter or smaller, it could perhaps make it more responsive. But there’s also always a place for surgery, and there are ways to do that that you specialize in and others in our group to bring things closer together.

Now, and I’ll also say that of the things that we treat, trying to help a woman achieve penis and vagina orgasm, who is able to have it with a vibrator, is one of our more difficult problems. I think our success is probably in the 30 to 40 percent range in that group. Where if you’re treating incontinence in a younger woman, stress incontinence is probably closer to 80 to 90 percent.

So I agree that something ... And it brings up another point in that I recommend, especially in the beginning, that people stick to the problems that we have the high success rate, so the provider doesn't become discouraged. I know you were very motivated and trusting it. But way back, years ago, when we didn't have so many people doing this and we had less research to back it up. But anybody, even with our current researcher who is just starting out, they should probably avoid treating, I think, until they have some success under their belt, the people who never had an orgasm because those are the people who are more difficult and probably they're always gonna need testosterone on top of what we're doing, I think.

And the people who we just mentioned trying to have an orgasm with penis and vagina sex, they're more difficult. Stick to the stress incontinence, the dyspareunia, the lichen sclerosis, the women who can have an orgasm and wants to be stronger, those are our more easier cases. And in all cases, always, always, always, in my opinion, if they don't get well by the end of 12 weeks, then either offer them another treatment or give them their money back because we can make a profit and take good care of people without having to have people feel like we ripped them off.

Anything else, Kathleen?

Kathleen: I didn’t mean to say it wouldn’t help because I do think it helps and I do think you can even … I think the O-Shot, by putting it in the vagina, does shorten the distance a little bit. And maybe millimeters like what the P-Shot is doing. And it can get better, it just can’t … When you really see a big long distance, I would ask them and then I would just say, “Your orgasm is probably gonna get stronger, easier to obtain, but it may not help that.” I don’t know, it’s hard to give them a negative … I wouldn’t give them a negative embedded command. Just watch it if they’re there for penis and vagina orgasm.

Charles: I’ll tell you what I tell everybody. It’s good advice. And what I tell everyone when I’m leaving the room is I’ll say, “You just spent whatever amount of money it is. And for that much money, you have to love it. And if you don’t love it, I want to know about it.” Because of course, I’m gonna be following up with them. But what I found when I follow up with some of the people … So when people contact me and they tell me they’re not happy, I refer them to the doctor who took care of them because I’m not their doctor. So I don’t need to be involved. But it’s helpful for me to know who took care of them. Then I call the doctor and talk to them and see if I can offer help.

But back to this thing about satisfaction and setting expectations. I think that what I’ve seen happen sometimes when people are not happy is they never let their doctor know. Because maybe they’re afraid they’re gonna hurt their feelings or there’s gonna be some sort of conflict or something. I think it’s helpful to actually tell your patient, “I want to know. I want to know if you don’t love it because I want to take care of you, and I don’t want you to feel like that our energy and time and your money has been wasted.” And that really helps a lot, both with you getting them well and helps prevent them sliding away disgruntled without you ever knowing about it.

And in the process, you can say what you just mentioned, Kathleen, that if it’s a more difficult case, it’s worth telling them, “This is something that a percentage of,” if you’re dealing with someone who’s trying to have an orgasm with penis and vagina sex, “This is something that doesn’t work as well. We have a much higher percentage with treating stress incontinence, but we do have successes that by our surveys, are in the 30 to 40 percent range. If you want to try it, we’ll do it. But I want you to love it. And if you don’t, let me know. And we’ll either repeat it or we’ll figure out something else, including, I won’t keep your money.”

And in the end, although you give back money occasionally, you wind up making many more people happy and making more money and you sleep better at night.

Okay, I think that’s it. Thank you guys for your attention ’cause this thing … What we’re doing here, I think, is really changing medicine and I’m the facilitator between all you guys thinking about it and all the feedback and all the good research. So keep it coming and I’ll try to keep pouring our money back into it.

We have two double-blind placebo studies going on now. We’re having a little trouble filling the orgasm study (click to help), so I’m gonna put out a link to that again. So if you guys know people who live in the Washington D.C. area … Bottom line though is we’re investing into the research. We’re investing into supporting our group. And I think you’re gonna see medicine change a lot in the next five years from what we’re doing. Okay, you guys have a good day. Thank you, Dr. Posey.

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