Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
In early 2010, a salesperson called on me, John Deeds, and showed me a brochure about a centrifuge approved by the FDA to prepare PRP. He said, “Use PRP like Juvaderm®. You get new volume and new blood flow, and there’s never been a serious side effect.” … CONTINUE READING
Is the O–Shot FDA–Approved?
Of the female sexual dysfunctions, dyspareunia will most disturb a woman’s relationships. A woman can accommodate a decreased libido and anorgasmia, but she will often completely avoid any contact when she suffers from dyspareunia. But, when it comes to treating the various female sexual dysfunctions, anorgasmia offers the biggest challenge to cure. Testosterone helps … CONTINUE READING
When a Patient Isn’t Pleased With Their Results
As far as I know, anyone who was unhappy with a procedure that I did (going all the way back to 2003 when I first went to an all–cash practice) was refunded every penny that they gave me. That feels good to me. It’s better than if I still had their money. … CONTINUE READING
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.
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.
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?
Chapter 15 (O-Shot®) Chapters 16 & 17 about radiofrequency and laser
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.
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.
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.
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.
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.
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 meif 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.
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…
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.”
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 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.
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.
Charles Runels: All right. So we had quite a few interesting questions over the past few weeks so let’s just jump right into it. The first one, Dave Harshfield sent me some guidelines that he keeps up with. He’s the head of an orthopedic groups that does a lot of regenerative medicine and he and others have [inaudible 00:00:22] to me these latest updates that came up by the FDA. So I thought I should show them to you because they should be very reassuring to you about what we do.
So here’s the question. If you haven’t gotten this question [inaudible 00:00:35], you will get it. Like I said, we’re going to cover about the FDA, we will cover a couple of marketing things, and then I’m going to go over a receipt that you can you when you give back to people who may not be happy. Everyone’s not going to love what we do and I have a receipt that makes people happy, it keeps you legally clean that I’ll show you. Then we’ll go over some resource that has to do with Platelet Rich Plasma scaring. Plus a few other questions. So let’s see. There are quite a few of you on the call and hopefully some of you can participate with helping answering some of these questions.
Is the O-Shot® FDA Approved?
But first, let’s talk about the FDA and how to answer this question about “Is the O-Shot FDA approved? Is the Platelet shot FDA approved? Is the Vampire Facelift FDA approved?” So the beginning of the answer to that question is that the FDA does not control your body fluids. Doesn’t control your hair, your [inaudible 00:01:42], your saliva. That belongs to you. Your fingers, your toes. The FDA is the food, drug, and device administration. However, if you [inaudible 00:01:52] enough to the material that it quits being your body and becomes a drug, then the FDA does have jurisdiction and the FDA has jurisdiction over the devices you might use to prepare the blood.
So, the analogy I use and some of you have heard me say this in my classes is that if you have suture material that you’re going to use to suit your surgical wound with, you couldn’t just buy material at the sewing machine store. You’d have to use material that was approved for use in the human body. But once you have that device for suture material in your hand that’s now approved by the FDA for using in the body how the wound is sutured is determined by the surgeon who’s sewing the wound. It’s not the jurisdiction of the FDA. They do not govern medical procedures and they do not govern body parts.
So how the FDA delineated what they will govern is with a phrase called “minimal manipulation.” They just came out with these policies. You see that’s stated for immediate release November the 16th. So just last week, they came out with this and this is important news and it’s, I think should be encouraging news for most of us.
So comprehensive regenerative medicine policy framework. Now this gives a pathway for those of us who do skin cells to move forward. But the thing’s most [inaudible 00:03:32] procedures [inaudible 00:03:34] involve the Platelet Rich Plasma and we want to know what’s the FDA doing about this. Now they put on [inaudible 00:03:45] medicalassociation.org, which is our umbrella organization, and look in the recent post, you’ll see FDA physicians for Platelet Rich Plasma stem cells. So here, I have a video and some papers have already been out for quite a while about the FDA. Some of the research articles are up in [inaudible 00:04:04] journal talking about the difference. But I remember one time, the FDA considered regulating eggs so [inaudible 00:04:14] an egg was [inaudible 00:04:16] to be more than minimal manipulation and thankfully the gynecologist said and [inaudible 00:04:20] specialist said no, that’s not right. You shouldn’t be regulating eggs. So the point I’m making here is there’s a blurry line between what’s minimum manipulation and what isn’t.
Here is where I put a link to the most recent position paper. So when you click on that, you will land on this page and you can read the [inaudible 00:04:41]. But if you slide down to this page and click on this one right in your final guidelines for … Let me make sure I get this right. The same surgery procedure, exception, questions and answers regarding [inaudible 00:04:57], if you click on that, it takes you to this. This is where they talk about Platelet Rich Plasma. If you slide down, the exception I’m talking about is how do you decide what is an exception to the minimal manipulation. What do you have to do to it before it becomes a drug? If you slide down to number 13, they tell here “Platelet Rick Plasma and other blood products are not considered even in the ball game … ” You don’t even have to think about an exception because that’s your blood and so blood products, the FDA should, in my opinion be regulating some things. They should definitely be regulating the devices, in my opinion, that we use.
If you’re going to do something with blood and then put it back into someone’s person, that should be carefully regulated by the FDA. Those who might somehow want to make a homemade version of that without understanding what they’re doing or realize that you can spend a lot of money and have a laboratory that takes it to a higher level that most physicians have. But if just somehow you’re going to modify a laboratory kit and do things with mechanisms that were made to analyze blood and somehow just decide you’re going to do that and use it to put blood back into someone’s body, it’s just not good medicine. But assuming you’re using a FDA approved kit to prepare the Platelet Rich Plasma, here it is in black and white. Okay, the FDA considers that to be blood products and they are all hands off about that. So hopefully that answers that question.
Now a real quick marketing thing that you guys … Some of you’ve done and others have not. I’m going to type it into the chat box. If you go to [inaudible 00:07:03].com/cellmed, this is probably the best marketing tip I can give you. If you click on that link, it takes you here. [inaudible 00:07:17].com/cellmed.
By the way, this is really, I think, nice software that anybody can set up on their own that allows you to schedule your appointments for your office even if they’re paid in advance. It allows you to schedule appointments before you even get paid and will integrate with your personal calendar so that’s your software tip for the day. If you put something on there, it looks on that before it decides if you’re free and you can set up all sorts of rules like if you’re going to be off on Wednesdays at three or whatever. So we can use this software to schedule with the [inaudible 00:07:55].
And right here, [inaudible 00:07:58] orientation, the people who fall out of our group and tell us that they are not seeing the phone calls, without exception, there are people who have not done this free [inaudible 00:08:12] where we spend an hour on the phone with you and your marketing person or your marketing person alone and we will do this as many times as you need to until you’re seeing results. It’s free. It’s part of being in the group.
No extra charge for it. We want to see you successful and we’ll give you a tour of the website. A lot of times, there’s tools on there. It goes marketing tools, pre-written notes and providers just can’t see it all. They get overwhelmed of all the emails I send them and just get confused.
So we have three full time people with business degrees in our office that have all been with me at least a year and they are not just experts at this business but they’re experts at how our providers are doing those and they’re just waiting and eager to help you because they know [inaudible 00:09:12]. We have more money for research, we have more money for supporting you guys, not just [inaudible 00:09:23] with marketing and supposed to help you educate your patient. So we’ll put in a plug for that.
Does PRP Cause Scarring?
Let’s go to some science real quick. So these are the questions that I’ve received a few times in the past week. Some of these comes in waves and this past week, I had a wave of questions about Platelet Rich Plasma causing scaring. I think sometimes things get out there on the internet and [inaudible 00:09:55] something on the blog or something, I don’t know what happens. I would think you would just to go pub med and search for scarring. I’ve done this multiple times over the years just to make sure that I’m not telling people wrong. I just put the link to that in the chat box. But obviously our first rule is “do no harm.” The truth is that we all hurt people and we don’t mean to but I had two people crash their car just driving to my office. People can’t get out the [inaudible 00:10:31] without getting hurt. They sure can’t go to the doctor’s office and the best of physicians hurt … We hurt people sometimes. But we want to as much as possible, of course, round down at night and know that we have not hurt people.
So part of the beauty of Platelet Rich Plasma is [inaudible 00:10:50] and I’ve tried to keep up with this, if you hurt someone with Platelet Rich Plasma, if you do with Rich Plasma, you actually have an incredible case as the first case in medical history as best I can tell. So when it comes to scars, for some reason, occasionally laypeople worry that somehow the Platelet Rich Plasma’s going to cause scarring. This is a general thing to worry about because it causing tissue growth. So you might wonder as a physician even or weaker physician or a specialist, you might wonder will this cause scarring. I think it’s [inaudible 00:11:32] for you to see here and if you can quickly [inaudible 00:11:36] through, this is 50 papers that have been published. You can scan through these papers and what you’ll find is Platelet Rich Plasma treats scarring. You’ll see that it being used to be keloid and split face studies use to treat scarring from acne scars, pox scars, surgical scars. It remodels the [inaudible 00:11:55] to make it become more normal.
To a layperson, you could describe scarring as basically tissue that’s healed together, but it’s healed the way that the tissue no longer has a configuration. All of these studies, this is the first page. I think it’s three pages. So it goes on for three pages worth. All of these studies are demonstrating an improvement. There’s burn scars, laser treatment, adhesion scars. You can see that there are also improvement. You can’t prove [inaudible 00:12:37]. It’s easy to put the positive and the negative. What it can do is show you 50 papers that show that PRP help scarring. I’ll find one that shows that it causes scarring. So if someone finds it, show it to me.
But how does this relate to what we do? If you do a procedure, let’s say you do a O-Shot and someone says their pain is worse, what do you do with that? For example, one of our providers is actually on the call, and I’m going to unmute her mic later, told me she had a patient who had back pain after an O-Shot. But when she got the asking, the woman had after the O-Shot, she was so excited about it, she and her husband had [inaudible 00:13:25] sex and she had injured her back. So the point I’m making is that if you see a magic trick, if you see a [inaudible 00:13:33] or a magic show [inaudible 00:13:36] appears so what you know is that something you’re not something about that situation.
So when someone tells you that their pain worsened with Platelet Rich Plasma or their erection got worse, it means that there’s something happening that we’re not seeing because Platelet Rich Plasma does not damage tissue. So the case of the erection getting worse, as far as I know, the cases about resolved when the person quit using the pump. So it wasn’t the PRP. I was the overuse of the pump. If you hear that complaint after a [inaudible 00:14:15], have them to stop the pump for a couple of weeks and them maybe start it back every other day or half the pressure.
For the O-Shot, I occasionally hear that people’s orgasms go down. I wish we had more data though so my guess is probably one in 500 something but I do occasionally hear someone’s orgasms seem worse. I only know of one where it never occurred and I don’t have an explanation for that. But you can make an easy case for why it might happen in the beginning because we’re vaguely created artificial hematoma. What happens if you have a hematoma on your arm, the sensation is not as great in the beginning. So why do some people have hypersexuality and more sensation and others have less? I don’t have a good explanation. But that’s my best guess at what’s going on and why it usually revolves [inaudible 00:15:14] it resolves and then they recover, get it back to baseline, or most of the time better than baseline.
So we have a consent form. We actually recently updated the consent forms. Our consent form’s always been strong but they used to always be more organized, more strengthened, and now we read part of this procedure. So you’ll see things listed that you’ve never seen. A long list of complaints and things that we’ve seen, we’ve added to the long list of complaints and we still include a line that says, “This is not a FDA procedure,” because some people still thinks the FDA approves procedures. So in the consent form, we say that it’s not. I’ll show the consent form list. So if you go into oshot.info and sign in … So when you get there, it’s going to look like this. I’m going to just pull it up really quickly. Then we’ll answer several more questions and then we have a [inaudible 00:16:25] promised to show you.
So you log in. This is the back side but when you log in, you’ll see something that looks like this. This is where I’m really begging you guys. The more the survey data we get, the more we’ll understand, I think, how often some of these things happen and what’s the [inaudible 00:16:44]. Once again here, you’ll see the legal when you go to legal. Our new consent form is there and this is me describing the routine, which I’ll get into now and how to use it. So there’s the consent form and we’ll just finish this out now as far as the scarring goes. As far as I know, saying that you damaged something with Platelet Rich Plasma is similar to saying that you have suffocated from oxygen because logically, it’s hard to understand since Platelet Rich Plasma remodels things back into a normal [inaudible 00:17:22].
But here’s the consent form and I’ll put up … You see it’s pretty straight forward and you can see there’s as long line of things. Basically, it just listed everything we could think of that a person complain of because do we say that PRP doesn’t cause fatigue. We haven’t done 10,000 people with a [inaudible 00:17:45]. But we do have almost 10,000 papers. Let me just pull this up again for you guys to realize. If you got to pub med and put in Platelet Rich Plasma, I think it’s interesting to see the body of knowledge. When I started doing this eight years ago, this used to be 5,000 personnel [inaudible 00:18:08] and just [inaudible 00:18:10] exploding.
So back to the video. There. So you can see we put the pen and we also put that we don’t really know. Something can happen we’re not anticipating. I can conservatively say that if you look at the number of people we have, the number of procedures we’re doing, we’re at 2,000 procedures by now easily, just O-Shots alone. The region company alone says [inaudible 00:18:44] PRP kits for a year so the number of procedures that PRP is phenomenal. Millions of procedures done yearly. Yet when you look at pub med, you cannot side one serious side effect. Not one serious thing that’s happened except recently when they had something bad happen in the eye. I can find the [inaudible 00:19:08] report [inaudible 00:19:09] mixed something weird with PRP [inaudible 00:19:13] and it got an infection. But you can’t blame it on the PRP. It sounds like some sort of home [inaudible 00:19:19] or something.
As far as the PRP procedure, [inaudible 00:19:24]. So when I show people this consent form, of course I sit with them and I tell them that these are things to go wrong and we don’t really know. We’ve done thousands of procedures and so [inaudible 00:19:38] at all. There it is. So that’s the consent form. Now back to this [inaudible 00:19:45]. Let’s say that someone does not get … David just put something here. Let’s see what he says.
Okay, so, here is me at one of our workshops talking about why I’ve given money back. As far as I know, anybody that I’ve ever seen since I went to cash procedures in 2003, I gave … [inaudible 00:20:22] PMD stats, so 15 years ago … You know as far as I know, anyone who was unhappy with a procedure that I did, I returned every penny that they gave me.
People get nervous when I say that, but, most people are not dishonest. Yeah, people have stolen from me, people steal from me [inaudible 00:20:40] sure. I run my life … Although I don’t make it easy for people to steal from me, if I base my whole life on keeping people from stealing from me, it would not be a pleasant experience, and I would not be able to freely give as much, or offer as much. If people are mostly not … If they were mostly dishonest … If most people were dishonest, Walmart would be out of business in one week, because they have … Since opening, they had that 100% money back guarantee for anything you return.
Why I Give All Money Back ANYTIME ANYONE is not happy with the results…
Even when I did weight loss, and I would have 3 weight loss classes [inaudible 00:21:18] did a lot of weight loss there at one time. I had a guarantee that you could have every penny back you had [inaudible 00:21:28] doctor fees up to 365 days from starting the program. And once or twice a year someone would want all their money back, but, having that made me more careful about who I took care of. I didn’t want to take the reverse side of that equation, I was careful not to take money from people I didn’t think I could get well, but I would take money from some, and still do take money from people occasionally.
Here’s the interesting, other flip side of it, or aspect of it is that if you are ethical, and as far as I know everyone in my group is ethical, or I would have asked them to leave the group … But, I feel like we have a very ethical group, and if you are ethical, then you will sometimes hesitate to take care of people if you’re afraid it won’t work. But, if you have in your heart of hearts that you know you’re not going to keep their money if it doesn’t work, and your cost of goods is relatively small, so that you’re going to make your money back on the next procedure, then what happens is you are actually more willing to take care of the harder cases.
Just make sure you don’t care of all hard cases. Just mix it up so that you mostly take care of the easy cases that you know you can get well, and occasionally take care of people for free, as we all do, or take care of the hard cases when you know your likelihood of getting them well is less than 50%, but you have enough mark up on your cost of goods that you’ll still be profitable in the next procedure.
So, you can hear me talk more about that there if you just log in and go to Legal, and here’s the receipt that we use. And, again you can get your … This is sort of my disclaimer, so you should … My attorney requires me to say to you, I’m not your attorney and you should have your attorney look at this. But this is what we use in our office, and it’s very simple, just two lines.
So, when someone has an outcome that’s not what they wanted, then I tell them come in and Let’s talk about it. And I’m very sincere about that, and I try to see what else might help them. If it’s not something that I have to offer that would help them, then I say “I’m sorry that this didn’t work for you, and there’s no way I want to keep your money if you’re not happy with what happened here. So here, let me write you a cheque.”. And I write them a cheque for a full refund, every penny of it, and then I have them sign this. So it says “I’ve had no adverse consequences from the … Whatever procedure … On this date. Because I’m not realizing the benefit, subjective benefit, I’ve been offered and accepted a full refund of this many dollars on this date.”
They sign it, and my nurse signs it, and we’re done. And then everybody’s happy, they don’t feel like I ripped them off, and I’m not just giving them a receipt, as you can see, I’m making it so that we’re legally also clean from each other. And, I very ethically, put my full brain, and all of my volition into helping them find another alternative, because they would have not given me this money if they didn’t have legitimate [pain 00:24:45] that’s bothering them.
And by doing this, some people have this idea erroneously that if you return money it’s making you subjective to a lawsuit. Not so, again I’m not your attorney, but all the attorneys that specialize in med spas and medical care that I’ve spoken to say not so.
Any time you are doing your best to not harm people, whether it’s medically or monetarily, you are making yourself less likely to have litigation. I get a dirty letter or an email from someone who’s angry about one of our providers, in every case it will be that the provider … Not only did the person not have the outcome they wanted, it’s that they didn’t get their money back, and they feel like they were ripped off.
So make use of the receipt, it sits right here on the Legal page to be downloaded. And make sure that you do mostly a high likelihood of success procedures, which are listed on these recent post on the CMA, and our How To Do web pages.
So that’s the receipt. What else am I needing to cover. I think that’s the main things from [inaudible 00:26:09] the things [inaudible 00:26:11] by email. I have a few more questions, but let me handle some from you guys for a second. Let’s see. Actually, David let me … let me get to that in a second, because I have another question here that I want to cover.
So this one has to do with hair. I’ll just let you look at it. The question that was sent to me. So it says “Hi Charles, I’d like to pose the question for [open mic 00:26:43] discussion.”. By the way, this is a … If you cannot make one of the [open mic 00:26:46] discussions, this is the way … This is a nice way to send it. Just email it, I’ll cover it when we do the webinar, and then it gets recorded and transcribed. So “I’d like to pose a question, what’s the latest on adjuncts for treatment of hair loss with PRP?”
Treatment of Hair Loss
A couple years ago we were using [ACell 00:27:03], vitamin D, and vitamin B, and still this is the recommendation. So, the .. Of course, [Dr. Harrison 00:27:12] reads the research, you guys read the research. The question is am I hearing anything from the grapevine because I’m in the nice of position of being able to get email from all you guys, that are brilliant and out there working, and so it makes me switchboard, and I’m always taking notes.
What I can tell you is I am not hearing any great new recipes. Most people have dropped the [ACell 00:27:35] out of their recipe. Now if you go to our [inaudible 00:27:39] website, on the How To Do page, we have a recipe if you want to use it, from some of providers [inaudible 00:27:45] where they mix vitamin D, and B complex, and other things.
But the [ACell 00:27:51] bothers me because it’s an animal product. You know, it’s a pig bladder matrix. And I was in a research protocol where there was cross immunity to a small pox vaccine that was grown on cow … Cow pox, and we were testing a genetic [recombinate 00:28:10] version, and I had someone who showed up with a myocarditis from that cross-reactivity. And they eventually stopped the study, so who knows how many of us got myocarditis back in the day, when that was the way to vaccinate for small pox.
The point is that, I can tell you that there’s [inaudible 00:28:28] paper showing no side effects from using PRP. I can’t tell you that about [ACell 00:28:33]. I don’t like what it does to the possibility of something going wrong, and, I just don’t use it anymore.
So, I did pull up a couple of papers here, and I’ll just let you see some of them, to let you see … What’s … These are, I think, representative of many more. So, if you look at this … The word is out, is what I’m getting to, is that it does work, and people are mostly using it as a [inaudible 00:29:10]. The … As far as [inaudible 00:29:15]. They mix … They’re doing it in combination with laser for the hair, you know the laser caps. They’re doing it in combination with … With Minoxidil, or Finasteride, as you can see here.
But in this study, these are people who failed topical Minoxidil and Finasteride, and then they gave them PRP, and they had a response. So, in this group, they went 3 monthly sessions followed by 3 [inaudible 00:29:43] monthly sessions, and that’s what I usually see. Some … Once a month [inaudible 00:29:49] 3, and then every other month, then once every 6 months. It gets a little bit more variable after those first 3 treatments.
Here’s another paper. And again, so in micro … so instead of injecting, they’re doing micro-needling with PRP versus topical Minoxidil. So I get that question a lot. Should you micro-needle it or should you inject it subdermally, or what do you do with it? And I just do everything. I’d goes … I block it by doing a little ring block, which is on our website. And then I do subdermal and then micro-needle [inaudible 00:30:28] to play with the core on top. That’s how I do it. And when I see the people who come from the hair clinics [inaudible 00:30:32], that’s what I’m seeing them doing.
Now those who are hair transplant surgeon, I heard lecture at one of the venues, said women are very responsive. He just treats them once and tells them to be patient. So I haven’t seen this study yet, that says that one treatment, the patients needs to wait six months to a year. I haven’t seen the study that shows one treatment and then wait a year versus a treatment … [inaudible 00:30:57] a lot of times three and wait a year.
So who knows who can do that. We’re over treating the need to do the next two. We just need to do one treatment, wait in women. But the common thing with women, that seems to work best that I’m seeing it do … subdermal injections, micro-needle on top, PRP on top of it, put them on 2% Rogaine, tell them to be patient. And yes, most people are doing that, followed by another treatment in [inaudible 00:31:26]another treatment after that. That’s what I’m hearing is the protocol and I don’t see any other magic mixtures. It’s still out there [inaudible 00:31:36]scalp studies and they’re showing nice results even for alopecia [inaudible 00:31:40] it works better than trying Tryptizol alone, so that’s for hair.Let’s see … Some of the websites had some questions too so let me get back to those.
So this one says, “Is it okay to use a laser light for treatment on patients who had a P-shot or hair restoration?”. I think that a topical laser light to help hair growth is of course something you could do starting immediately and that has been shown to help as a stand alone, and so, I haven’t seen it with PRP, with laser cap versus no laser cap but it will make sense that if either one of them works alone it might work better combined because this is not a heat treatment. It will be different if it were [inaudible 00:32:36]sort of laser like[inaudible 00:32:39]laser or pixel laser where you’re actually [inaudible 00:32:44] tissue like a [inaudible 00:32:45] with vagina, in that case you want the heat to go first followed by the PRP immediately and I would give at least four weeks before I do another PRP treatment or another laser treatment because you have to give … I think the pluripotent stem cells time to develop, and the soft tissue studies I see they seem to max out at about twelve weeks with most of the time eight weeks.
[inaudible 00:33:16]obviously studies that demonstrated that [inaudible 00:33:21]where with orthopedic procedures it’s a much longer time to maximal benefit with soft tissue I think you’ve achieve most of the benefit in eight weeks. Four weeks is the minimum amount of time that I would wait before I re-treated with laser because I think that’s undoing the progression of the benefit of PRP. So that’s that question. Let’s see what else we got.
Is Platelet Rich Plasma as Good as Platelet Rich Fibrin Matrix?
Got some more questions here.Okay, here is some. So this is a interesting question that I [inaudible 00:34:14] let’s do this one now. The question is ” Is there an advantage of platelet rich plasma over Platelet-rich fibrin matrix?”. And this to me a play on words or [inaudible 00:34:30] because everybody’s PRP turns into Platelet-rich fibrin matrix when it’s injected. Platelet-rich fibrin matrix is just the PRP growth factors con jelled into plasma and [inaudible 00:34:48] peptide chains that are in the[inaudible 00:34:53] are causing this [inaudible 00:34:53] to cause this matrix formation and that’s what causes the wound healing. But then some document out there that somehow that needs to be made in the syringe before it’s injected and the truth is that if [inaudible 00:35:07]in the tissue the inject PRP is exposed to collagen. The way I describe it to patients that’s the [inaudible 00:35:13]around the scab when you scrapped your knee, that’s what’s holding the tissue together when you’re healing a wound. Some people who sell kits that [inaudible 00:35:26] that matrix in the syringe seem to indicate that maybe that’s what needs to happen, I’m not so sure that’s the case.
The question then becomes, do you get adequate activation if you let it activate after you’ve injected and the platelets are exposed to collagen and then put in the matrix or do you leave it exposed to PRP and the collagen in the syringe and then inject it.[inaudible 00:35:55] has cure that comes with Calcium, so you’re activating the PRP before you [inaudible 00:35:58][inaudible 00:36:00]has cure that comes with HA that we can’t use here but it’s available in other places where there’s no FDA, where it comes with an HA which activates the PRP so you’re making the matrix before you inject it. Here we add calcium by the cals [inaudible 00:36:18] before we inject it and the ratio is .05[inaudible 00:36:23] 10 percent calcium chloride to [inaudible 00:36:28] of PRP or in other words divide the volume of PRP by [inaudible 00:36:32] and that [inaudible 00:36:32]volume of calcium chloride ten percent you should add.[inaudible 00:36:37] I do think you should[inaudible 00:36:43] you’ll get about, when you[inaudible 00:36:48] and you get closer to 100 percent activation if you add calcium chloride before you inject.So we’re activating [inaudible 00:36:55]substitution everything else we’re putting at 65 percent activation[inaudible 00:37:00] to that question is we are all making platelet-rich fibrin matrix anytime you use[inaudible 00:37:07] it’s just how you make it[inaudible 00:37:10].
Okay let’s see, we’re answered that one last time. Some of the videos [inaudible 00:37:23]behind the camera. Yeah that’s true, I’m sorry about that.[inaudible 00:37:29]I think if you look at the videos [inaudible 00:37:30] you can see everything by putting the videos together [inaudible 00:37:34]there’re sections of the videos[inaudible 00:37:40]and the truth is the people who come to our hands are [inaudible 00:37:43] do take it a different level. There’s something in particular you’re trying to see that aren’t available please let me know [inaudible 00:37:53]everything that’s build to be known by how to do it is there so if there’s something you’re not seeing tell me and I will shoot another video to take the place of the one the spot that you’re not seeing.Even though every second’s not visible every part is important about to do it should be visible. Okay so I think that’s all the questions on that one.
Let’s see, we may about to wind this down.We went through that one last time.We answered that one last time. Okay, I think that’s it let’s go through and see if you guys have question then we’ll shut this down. Let’s see Doctor [inaudible 00:38:33]has some prior questions.[inaudible 00:38:40]I’ll just let you have at it. Are you there?
An Orthopedist Talks About PRP
David: I’m here.
Charles Runels: Beautiful so, thank you for[inaudible 00:38:54]the interesting questions, tell us what you’re thinking and let’s just[inaudible 00:38:59] what is on your mind if that’s okay.
David: [inaudible 00:39:06]I wanted to tell you that[inaudible 00:39:18] my son with whom I’ve done PRP, came home with[inaudible 00:39:23]surgery for twelve years longer going through more [inaudible 00:39:29]
Charles Runels: Hey David, I’m hearing some really interesting stuff just breaking up a little bit and it sounds like a lot of experience to share with us,there anyway you can get closer to the mic or fix it where we can hear you a little better because it sounds like [crosstalk 00:39:49] this could be very valuable.
David: Let me open the[inaudible 00:39:52]in my computer and maybe that’s better. Can you hear me now-
Charles Runels: That’s better, whatever you just did made it way better. Maybe you could start over if you don’t mind.
David: Yes I had replaced my laptop so was using my other screen.So as I said, I’ve used my son and my wife as guinea pigs for PRP and stem cells recently, but I’ve had 12 years of orthopedic experience. Is that coming through over the email?
Charles Runels: It’s perfect now, and it’s very valuable. We’re interested in those 12 years of experience.
David: So I’ve got 12 years of experience of using bone marrow concentrate amniotic material, PRP in all forms and fashion from every vendor, and as you know, I recently converted from being a cutting surgeon to being a non-cutting surgeon and moved into the alternative realm. I recently got back to Tucson from the AMG meeting, so we kind of focused a lot on the cosmetic side as well as peptides.
Results of my son’s tennis elbow, he’s had five years of tennis elbow after Hurricane Rita and using a chain saw to cut down two trees in his backyard, and came to me and said, “Dad, can’t you possibly un-retire enough to operate on my elbows?” I said, “No [inaudible 00:41:09].” I said to Austin, “I’m gonna inject ya in my clinic with this new PRP I’ve got. We’ll see what happens.” Well, in five months, he called me, and I won’t use the profanity, but he says, “You got a blanking cure for this. You need to advertise it. [inaudible 00:41:22].” I used your technique and just used it on his elbows.
One thing he did tell me, he says, “That hurt like hell.” He said, “I can’t recommend it to anybody unless you find a way to make it not hurt so bad.” We’re looking into nitrous oxide, we’re looking into topicals a little bit more, and whatever. I just don’t want to interfere with the [inaudible 00:41:45] of the platelets, so any suggestion you might have on that, that you can publish for us it can help us be humane would be good, his orthopedist worked on a [inaudible 00:41:55] and we don’t care too much, but I think it’s better for the cosmetic world for us not to hurt people.
Charles Runels: Yeah, sure. Well that’s a lot of … keeping going because in 12 years you’ve got more to share than that, keep going.
David: I don’t want to burn up the hour, but the …
Charles Runels: No, no it’s good. I’m through with all the questions, I want to learn from you.
David: Well, I also reported on my wife’s recent O-Shot and that she did unbelievably well for ten days and no leakage whatsoever, we’re married 46 years, two kids, a 45-year-old, a 34-year-old and we’re physiologically young, but she’s had some incompetence, she’s got a [inaudible 00:42:36] some other things, that I said, “Look we need to try this, this isn’t so much for orgasm and libido, it’s for your … whatever, I wanna find out what happens.
She was dry for ten days, with no problem with jogging and trampoline and everything else, which was a big change. And then she kind of had a regression back. She says, “You know I think I may be actually leaking more now after ten days.” So I kind of just [inaudible 00:43:03], sometime I don’t much, whenever I get it back a little bit, just wait. And I ask her finally and I said, “So are you still leaking?” And she says, “You know I’m not.” And so I think as you said before you got to look other places for problems sometimes [inaudible 00:43:24] we’re so used to in medicine, the most critical people around for our own selves.
Charles Runels: Let me see if I can explain, again we need the ultrasound studies to prove this. We have two … excuse me, we have three now [inaudible 00:43:38] radiologists in our group and hopefully they’ll do these studies for us, but here’s what I think you just described. So if you think about it when you do the procedure, you obviously, there’s no time for cell growth you get those [inaudible 00:43:56] and all that. My best explantation for what I have … resolution of confidence immediately, which doesn’t happen to everybody, but happens a lot is that we are forming that [inaudible 00:44:10] matrix and it’s acting like liquid sling and stopping the [inaudible 00:44:15] immediately.
Of course, that’s like what happens to the scab on someones knee, this is what I explain to patients, you know it could go away immediately but it may not, which is making the hematoma, and [inaudible 00:44:28] resolves though, the actual tissue growth doesn’t really start until at least when you’re doing cosmetic work, you can’t see that much until around the third week with like at 12 week.
So what could’ve been is that the matrix was there, stopped it, which is great and I love when that happens even though it sometimes [inaudible 00:44:48] it tells you, you put it in the right place. But then it could go away and when it came back that’s the true cell growth. Now the other thing that just to add to your story and again, I’m making this up, I think this is probably the right thing based on what I’m seeing and about the science of it, I could be wrong and I’m the last person to say everything I’m telling you is right. We need to do the research to figure it out, but your story you just told is very common.
The other thing that’s common is that sometimes it will go away, but sometimes it’s just better, but it’s not all the way gone in that [inaudible 00:45:27] and when that happens just repeat it, it’s so common for it to be better after the second shot even the sex part, sometimes the urine gets better and the sex isn’t better after shot two or three. It’s so common I’ve even thought about just making it a standard protocol that everybody gets two shots because, that to me seems unfair since many women would be improved or as well as they need to be and are, most of them actually around 60 percent last time I surveyed, 60 to 70, depending on the problem.
And then it jumps to 80 to 90 plus after the second one. So it kind of seems unfair those people, the 60 to 70 percent to require a second shot or make them pay for a second shot and may not need it. So having said all that I think that’s my best bet about what happened with your wife, I just wanted to throw it in, but keep going with your experience … we want you to teach us, because here’s the thing the [inaudible 00:46:23] were ahead of us with the PRP and if you’ve been doing it that long you have other things to teach us, so go for it.
David: Well I can tell ya I probably started doing these alternative methods with [inaudible 00:46:33] this and I still … up till February last year [inaudible 00:46:37] this trauma. I mainly, sports, but a lot of trauma. I never had another non union [inaudible 00:46:46] fracture after putting PRP or [inaudible 00:46:49] or bone marrow concentrate in those fractures. It was very, very helpful also with skin cut bridge [inaudible 00:47:00] skin loss and muscle loss, that helped tremendously. What got me to that comment was if you do, do a second one, do you fully or do you charge a reduced price? Or do you give it to them, how do you handle it?
Charles Runels: Okay, so that’s a good business question. I don’t like to tell people, well this is the standard thing that everyone should do, because you’re the one looking at your patients. But I’ll tell you what works for me with most of my patients, if they have a nice result, their [inaudible 00:47:41] is mostly gone and they’re happy with it, but they think, I think it would, I may want another one, most of those people want to pay you again, they realize that it worked, they just want to see if it works better. They want to pay you and so they should, let them. If you want more, you should pay me again. But, I would insist on it if they’re attitude or their, if my feeling about them, their communication to me … it’s not [inaudible 00:48:16] that they feel like they go their value for their money, then I’ll do the next one for free.
[inaudible 00:48:24] it’s not a four hour procedure, it’s fairly quick and our cost of goods are reasonable enough that you’re still profitable, so that’s where I am on a case by case basis. [crosstalk 00:48:38]
Don’t make that decision until it’s been at least eight weeks. And really chances are that they may get better at 12 to 16 weeks if they’re not better at eight, still kind of pushing it. To me it feels kinds of, maybe not so far to them to make, 16 weeks that four months. So do I really want to make them wait for a third of a year before I decide if I’m going to retreat it when they’re leaking down their leg, knowing if I retreat it, it may go away and so it’s sort of judgment call, but one things for sure I would make them wait at least eight weeks because I might need to subject them to another procedure or draw their blood and all the things that go with it and whether their paying me or not there’s some cost of goods and some time involved, break times valuable too. So I would tend to wait at least eight weeks before [inaudible 00:49:34] did work.
David: Excellent, with respect to, to my bias coming from orthopedics and coming from PRP and moving into bone marrow and [inaudible 00:49:44] back into [inaudible 00:49:46] and PRP I think I consider I can say pretty … opinionated that stem cells in some form of fashion, I call it stem cell signaling, just so we don’t get [inaudible 00:50:04] with our big brother but the signaling factors and growth factors that come out of stem cell in my opinion are probably big brother and PRP his little brother and we know that there could be 600 drug factors in the stem cells, PRP or bone marrow and there’s probably 300 drug factors in PRP so maybe it’s not that big of deal, pretty even. In somebody that’s a little bit more aggressive, for example my wife had Hallus Rigidus, which is loss of the cartilage in the metatarsophalangeal above the big toes and ready for either fusion osteotomy to remove the cartilage around or arthoplasty and she was on the surgery this time last year, I chose to go forward [inaudible 00:50:55] as a guinea pig my first case after getting back to California and studying lipogenic stem cells and I injected both of her big toes.
The chronology of that is that four and a half months of bated breath she got me and says, “I think my right toe is better, and if I’m not.” She says, “My right toe is definitely better and my left toe is better.” I know exactly when I did this, because I did it a week before the election a year ago and she is now admittedly, somewhere around 75 to 85 percent better in the bad toe and 95 percent better in the good toe and she is extremely happy, I don’t have any claims about regrowing cartilage or anything like that. All I know is symptomatically she can wear high heels and boots and she can jog the hills in Austin, Texas and she can go into yoga where as she could not pull forward, she was putting [inaudible 00:51:52] and everything else on her big toe four times a day and she was miserable. She grabbed me by the throat she said, “Look you’re supposed to be smart, do something.”[crosstalk 00:52:01]
Charles Runels: Obviously that’s anecdotal, but it’s traumatic. It’s not just anecdotal, because you know better than I having been in the ortho world. There’s hundreds of papers, probably thousands of papers in the orthopedic literature backing up exactly what you just said, so it’s not like you’re just pulling that one out of your hat.
David: [crosstalk 00:52:31]It’s really about [inaudible 00:52:32] fractures.
Charles Runels: Along those same lines, I know that most of the people on this call, many of them do treat orthopedic cases, most do not but what you’re saying is very relevant because it all has to do with tissue healing and thinking [inaudible 00:52:47] timeframes and what’s possible and what isn’t and that’s why I’m bringing up this picture that many of you guys have seen before. This from that, which is fairly extensive hypertrophic scar from Cortisone that had been there for a year to this a year later and it still looks like that seven years later, this was six years later, I did this in 2011.
This Juvederm with PRP with no stem cell transfer just recruitment of stem cells from PRP, from the Juvederm as a matrix on which to build the new growth. So if this is going on when we do O-Shots and P-Shots and faces then obviously … and it should be. There’s some intelligence about the process that’s beyond our skillset as far as what we’re actually doing with that needle.
And the other thing you brought up about the malunion … horrific thing that happens sometimes. I had to cases that came to me when I used to do clinical trials with [inaudible 00:53:58] from one woman who had been operated on six times they were considering an amputation, operate six times on her shoulder. They just couldn’t get her humerus to heal and she had an IGF-1 that was less than 60, it was almost in the dirt. She literally out of desperation, because someone told her to come see me and then I had another case with a woman who had an external fixator that had been operated on three times and in the process of doing that research [inaudible 00:54:38] stem testing for growth hormone deficiency, which you know is measured by a [inaudible 00:54:43] which is one of the well factors in PRP. That’s released by the [inaudible 00:54:48]. In both of those cases I put them on six weeks of growth hormone replacement, got their [inaudible 00:54:56] back to normal sent them back to the surgeon. And it’s anecdotal, but in both of these cases the next surgery went well.
David: That’s awesome. My last little caveat and then we’ll stop, which has to do with the recent, it’s recent in the U.S. but not recent worldwide is peptides and we’re dealing with peptides in our PRP and in our stem cells but there are peptides now that can be used in conjunction with what we’re doing to target specific formalities that we’re treating generically with our PRP, which is good but there might even be better results we can send a messenger, via a 15 amino acid of peptide that’s in conjunction with some of these cells and [inaudible 00:55:49], because I am pursuing this like a mad dog right now academically to learn more about it. I’ve got about 25 or 30 years between my masters degree and all that stuff is old and there’s a big gap in my knowledge. But I’m gathering as much as I can, as quickly as I can so I can see where this fits.
Charles Runels: Let me add to that as well because when you [inaudible 00:56:13] it other people think that, not the people on this call, but the people we speak to, our patients think, oh peptides this sounds like something you put in their cream. Well insulins a peptide, [inaudible 00:56:25] a peptide, it’s why we have to have an injection, we can’t take it by mouth, because we would digest it. Where we can take estrogen by mouth, because it’s a [inaudible 00:56:35] hormone and it’s not broken apart by the acid in the stomach. Of course everybody on this call knows that, I just want to point out as you did. There are hundreds of peptide proteins made by the pituitary glands, so when we say peptides it’s not some second rate little “hokie” thing. We’re talking about powerful, hormone like messengers that attach to cells and tell them to do remarkable things and the idea that you can have that [inaudible 00:57:05] already there, packaged up for you in the perfect combination in those platelets is pretty remarkable. We don’t have, it’d be nice to know, which ones do what and understand it the way we do things like growth hormone and [inaudible 00:57:24] and insulin, but if we can make it work why are we trying to figure out which ones are doing what.
I just want to put in my hooray for peptides and we emphasize this is not second rate stuff, this is powerful stuff and it’s what we’re doing when we’re using PRP. The hours up, thank you very much Dr. [inaudible 00:57:48] I’m gonna see if anyone else has a question, if not we’re going to shut this down. I don’t see anything else, so. Thank you guys for showing up, I’ll post this video with a transcript, it will be up in a couple of days, well may be Monday with the Thanksgiving holiday. Thank you for [inaudible 00:58:05] and I think we’re really doing some good things for the planet. You guys have a Happy Thanksgiving.
Charles Runels: All right so we’ll get started and we’ll go through questions that have been posted on the various websites.
Let’s start with the vampire facelift. By the way, after we finish these questions, I’m going to go over a very quick and easy way to create an email that your patients will love to receive and it will help them both attach to you and want to come see you for the things that you do that will help them. We’ll do that after we cover some of these questions.
We’re on the Vampire Facelift® website. “Hello, does calcium chloride help create better results with vampire hair? Also do you have a contact we can order from? Finally, how much do you mix with the PRP and do you just draw the PRP into a syringe and then draw the calcium chloride up after it, and has it been injected with mix or do you mix it differently?”
I just posted an answer to the activation question. If you go to our company website, cellularmedicineassociation.org, and then you look down here where it says, Questions and Answers activate, and I spent some time right here talking about the different reasons you should and shouldn’t activate, and when you do and you don’t, versus hair versus face, O-shot and P-shot and such. So it’s all right there.
As far as mixing it goes, I like to use a stock bottle so if you have, if you already have plasma in the syringe and you take that syringe and you put a needle on it and you stick the needle into your stock bottle, of course you’ve contaminated your bottle because you put a needle that’s attached to blood on one side in the syringe now into your stock bottle the calcium chloride is in. So I’d pull the calcium chloride out of the stock bottle into a sterile syringe and the pull the PRP up into that syringe that has the calcium chloride in it exactly right when I’m ready to do the procedure because you need to be ready to use it.
Let’s see what else you have. As far as from where can you order it, if you go to our dashboard, you’ll see the dashboard is here. Then if you go to, down here somewhere, it should have where to order everything. Let’s see. That’s all different procedures, ways to do it, well maybe I didn’t put it there so I need to. I get it from Mcguff in California, and I’ll pull it up for you right now. Mcguff compounding pharmacy. There. Mcguffcompoundingpharmacy.com.
So let’s see what other questions we had. On the vampire facelift site. By the way if there are questions from you guys that are attending just push the button and I’ll unmute your mike, the noise gets pretty bad in the background so that’s why I don’t have it unmuted at this point. Lets see, are there frequently asked questions for each procedure that we can use? Where are they located on this site?
So the way I’ve tried to structure … so there’s two sides to the membership sites, or the websites, and they all work the same. There’s one side, so vampirefacelift.com/members, that’s for us. Then vampirefacelift.com with nothing behind it, that’s for the patients. The all have the same format. So there’s O-shot.info, that’s for the patients, there’s oshot.info/members, that is for us.
So when you say frequently asked questions for each procedure that we can use, where are they located, the best place to send people if this is for frequently asked questions by a patient is to send them to the main website. I tried to anticipate the questions. If you look at the number of times this has been edited, you can say, click in here and try to edit the page it will tell you how many times I’ve edited it. It’s probably going to be hundreds of times, we’ll look at it here in a second. But what I do is every time somebody asks a question I try to put it into the website and embed it there so then hopefully they see it. Oh, only 65 times, so of course this is third version of this website but on this particular page only 65 revisions. So those revisions aren’t to make things look pretty, most of the time it’s changing a word, adding a link, you can see there’s a video that needs to be redone. Sometimes something dies. You can see I added a Wikipedia article. I add thins so that every, if someone asks me a question hopefully we anticipate it and hopefully next time they won’t ask that question. So that’s where the frequently asked questions live on the websites.
They’re also put, on most of the websites, on O-Shot®, P-Shot®, I think it’s on the breast lift, you can see I added a review link. Oshot.info/reviews. Here’s a tip right now for getting free advertising, like crazy. I tell people this but still less than a dozen of our providers do it. If you go there to reviews tab, that’s where people ask questions and hen we answer them. Well if you answer a question here, and you can see ,I don’t know I think there’s 300 or so posts or something like that.
So if you go in and you answer, Dr. Posey answered someone’s question right here, then people see that and you can see it links to whenever you answer a question. Whenever you answer a question it links to your profile, so Dr. Seilar answered a question and, from one of the patients, and when you click on it, it takes you to know more about him. There you go, you’re on his website. And when people who go to these pages, they always want to read the reviews, so there’s your way to both find the frequently asked questions and to just throw in a couple of words here and there, taking part of the conversation, and people will see it, they’ll be impressed, and they will come find you. And for some reason, like I said, that’s still very uncommonly done by our people even though it’s a way to get amazing, amazing advertising without really having to do anything as far as money goes.
So here’s another question. Dr. Runels with the current available information, what’s your top PRP harvesting centrifuge in terms of initial cost, for patient cost, ease of use, especially commenting on the clips, insight, [inaudible 00:08:12], TruePRP, they left Harvest out and there are others.
So this technology is changing, the prices are changing and when I look at analysis of the blood itself the numbers are all over the map depending on who paid for the testing. What I can tell you is that I know of failures and, oh they also left region off this list, I know of failures and wild successes with all of the things on that list. My recommendation to you is to get your best price with the best service. If you ask me what’s the best, a Chevrolet or a Ford, I would say that I would never buy a Ford because I had a Ford Pinto when I was 16 and it broke down and so I’m angry at the Ford Motor company since I was 16 years old because they took my money for a lemon. Ford Pinto was the one that would explode when you got hit I the back. But that’s my personal bias, they ripped off a 16 year old boy and I will never forgive them for it.
But maybe you didn’t have that experience, maybe you love Fords, same thing applies to centrifuges. Cut your best deal, all of these kits work, and hopefully our research will show, for example Magellan gives you five times baseline, do you really need that or not? Maybe? Or maybe not. I can give you a more specific thing but it could be out of date by next week so talk to them , cut your best deal.
Let’s see, Thomas asked, do you have any experience using antioxidant serums just afterwards?
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Section 2 of 5 [00:10:00 – 00:20:04](NOTE: speaker names may be different in each section)
Charles Runels: Antioxidant serums just afterwards the Vampire Facelift. The facial or essential oils. I use a HA mist, seems to work well. Sometimes can cause peeling, but not sure if it’s the mist or the facial. What I can tell you, with the facial, whatever you like to use on the face, whether it’s peptide creams … I always like, I’m still an old school 0.1% Retin-A, not Retinol, like Retin-A prescription strength 0.1% cream. Whatever it is that you like, after you do that Vampire Facial, you’ve opened up the skin and you’ve created thousands and thousands of little puncture wounds, so that this material can now be absorbed. So that’s your answer. Whatever you like, use it.
And I find it’s a good time to get people back on a regimen, because they want to protect their investment. It’s like when you check out of Best Buy and they say, “Well do you want the warranty?” Same thing, they’re checking out of their Vampire Facelift, you say, “Well, you really take care of your investment here, and what you’re doing to take care of yourself. We should have you on this, and this, and this.” And I like the Retin-A. And so even if someone has used Retin-A in the past, they may have used it inconsistently, and that motivates them to start using it more consistently.
“Can you give us guidance on hair restoration, and how to know where there are active hair follicles, and where the PRP will work? Is it necessary to do the microneedling?” I don’t think it’s necessary, but I think if you said, “Okay, you have one chance to make this person’s hair grow, and If it doesn’t work we’re going to, I don’t know, run your car off a cliff.” You would probably do everything you know to do, which would include subdermal and microneedling. Doesn’t take that much longer, the cost of goods are reasonable on the expendables for the microneedling device. So I usually do … I do think it’s necessary to do the subdermal, and close behind this on the microneedling, but I always like to do both.
As far as how to know where there’s active hair follicles, you can see where the hair is thin but still present. Obviously you want to treat that. And then there’s this margin where the hair seems to go away. I think it’s worth, if someone has a reasonable hairline, you know, they’re not like a cue ball, if they have a reasonable hairline, I think it’s worth just treating all the way to where the hair line used to be. And I say that because we’ve seen absolutely shocking results in some people where hair grew back where we weren’t expecting it, and others where nothing happened. When I talk to our providers who do hair for a living, they’re hair transplant surgeons, and one guy even wrote textbook on hair … They still can’t tell me how to predict who will respond and who won’t. But the general consensus is to do a series of three, four to six weeks apart. If after the second treatment you see no results, stop, give them their money back, it’s probably not going to work. Thankfully, that’s usually a minority of people.
So, thoughts for using cannulas for PRP. I don’t. And the reason I don’t is when you use a cannula, what do you have to do? You have to make a puncture wound, and then you have to put the cannula through that wound with the idea being now when you extend deeper into the tissue, the cannula avoids further trauma. The thing about PRP, if you’re putting your needle in much further than the puncture wound itself, you’re probably causing unnecessary bruising already, because one of the beauties of PRP that it hydrodissects. You don’t need a needle. For example, with Juvederm, you can’t just inject it and expect it to spread out. It’s going to make a big glob, unless you fan your needle. That’s not so with PRP. You just get the level beneath the dermis and inject, and it just hydrodissects and spreads out as if you were pouring water on the floor. For that reason you don’t need a cannula because when you put the hole through the skin to make the hole for your cannula, that’s as deep as you need to go to inject the PRP, so you don’t really need it. If you like using with a Hyaluronic Acid filler, that’s fine, go for it, but I find it’s about half and half with our providers.
Next question is, “I have a patient with mild acne pitting, with slightly darker skin. Do I set my speed faster and the depth deeper with the microneedling? How many treatments? Expectations?” As far as speed and depth … First of all, with speed. I have a blender that has one switch, on and off, and that’s it. It’s got a steel rod, so I think you can throw nails in there and grind it up. But it has one speed. You’ve seen these blenders that have 16 things: puree, frappe, soupe. How many different words can we use to describe something just spinning around? And it’s bull. Total bull.
I actually talked to the man who invented the Dermapen. And he said they only put three speeds on there because they knew if they didn’t put three speeds, someone else with a pen would brag that they have three speeds. What they found is, as fast as it goes works the best, because you want to make puncture wounds, as many as you can, as fast as you can, to get it over with. So the speed is just whatever you’ve got, plug it in, make sure the battery’s charged if you’re using a battery operated device, and make the depth whatever depth you need to get it to to cause punctate hemorrhaging. Which is going to change, based upon where you are on the face, and whose face your treating.
How many treatments and expectations. Expectations is … That’s like an hour lecture, but as far as if you’re referring to the mild acne itself, then expectations are tremendous. If you do a series of three treatments, six weeks apart, four to six weeks apart, most people are going to love it. So hopefully that answers your question.
Next question, “How do you correct when there is a deep dimple just below the middle of the lip in some patients? Do you use more Juvederm on adjacent sides to get more lift?” A deep dimple just below the middle of the lip in some patients … So, I think I’d need to see a picture, maybe you can post a picture of what you’re thinking about. I hesitate to say much about that without seeing a picture. I will say though, and as a general rule, if someone has a dimple, or a defect, or a pit, or whatever you want to call it, if there’s a place that needs to be filled and it’s deep, as you say here, then I’m probably going to use an HA filler to correct it, and then polish it off with PRP. PRP alone probably won’t work as well, but I guess deep is relative, so to really answer that intelligently I would need to see a photograph.
So I think that’s all of the new questions on the Vampire Facelift, we were a little bit behind on that one. There’s two on the Priapus Shot website. First one says, “I recently attended a Vampire training course in Las Vegas with Dr. Zimmerman, and I had a question about the penis pump. How much pressure? I found that some information says more than 4.5 can damage the penis. I believe that the course recommendation was seven to ten. Do you have any papers that document the most appropriate pressure?” That’s a good question, and I would need to go to the research. The dogma that I’ve heard from urologists and from going on the blogs where the guys … There’s a subculture of people just using penis pumps.
I compare it to what went on back in the ’70s with weight training. I was a teenager in the ’70s and when I went to buy a book on weight training, there was one in the library. And no one knew who Arnold Schwarzenegger was, he was just a weird guy to most people. He was winning these weird contests called Mr. Olympia. And coaches were still telling guys that weight training could make you clumsy. If you go back to the ’60s they recommend to athletes to not lift weights. The point I’m making from all that is there was a subculture. Even physicians came out of this, physicians in the 1980’s
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Section 3 of 5 [00:20:00 – 00:30:04](NOTE: speaker names may be different in each section)
Charles Runels: Even physicians, get a load of this, physicians in the 1980s, late ’80s was the first time that physicians published a paper saying that anabolic steroids actually made you stronger. Up until then, they would say the bodybuilders, that was just water weight. They weren’t really strong. All I have to say, there can be a subculture of people who are basically experimenting on their bodies. You can sometimes be ahead of the physicians about what works, and athletes, especially, are prone to do that. I think, to a certain extent that is happening in the subculture of people who use penis pumps. You can go and find some of those blogs. Like, if you Google, if you Google my name, sovietisms I’ll come up in some of these penis pump blogs. Let’s see if I can find one. If you read the protocols, or following … I’m not saying that’s where we learn how to be … Here we go, the PhalloBoards Penis Enlargement surgery, phalloplasty. This is proboards… phalloplasty.proboards.com. This is all about growing penises. If you go on these blogs, the common dogma seems to be 10 – 20 minutes at a pressure of somewhere seven to ten.
Honestly, I don’t know. I will look at the research and see if I can get you a smarter answer. That’s the number I hear from the urologists and the blogs. More than that, you just create edema, bruising, and you can get damage. Let’s see, what was the other question. All right, let me add to this one other thing that, I know some people use pumps without a pressure gauge. I don’t recommend that because sometimes people, I’ve found, they’ll either pump it up too much, or they will think they’re getting a good pump, and then give them a pump with a gauge on it, they say, “Oh, this is more than 10 [inaudible 00:22:16].” Without that, you really don’t have any objective measurement of what you’re doing. By the way, there was another paper published in The Journal of Sexual Medicine two months ago showing that using a pump, this was in an animal model, we have them with people, but there was another one with an animal model showing that this helps with peyronie’s disease.
Dr. Grow, I have two questions regarding two patients. Patient One, middle-aged man, non-smoker, moderate erectile dysfunction, and he does react to Viagra/Cialis. During intake there seemed to be no psychological etiology. Had a P-Shot two months ago, with [inaudible 00:22:58] PRP, no improvement whatsoever. He said he used the pump daily. So far my patients have always some kind of improvement. This one had none. What is your advice about the P-Shot? Maybe two? What about the cost? Two things I would recommend. First, as far as the cost to the patient, I have … I posted a video about why I always do things for free if they say nothing happened. How I do it, why I do it, but that’s the bottom line. If someone says “Oh, it worked but I want more benefit.” Then I charge them for the next one. If they say “Nothing happened,” then basically, as far as they’re concerned, I stole their money if I stop right there and don’t give their money back, that’s the way I think about it. Maybe it’s not the way you should but it’s what they think. I respect that. As far as I know, anyone who has given me any money, since 2003 when I went to all cash, they either got better and were happy with what it did, or I don’t have their money anymore.
As far as what to do, what else you might do, I do think it’s worth doing this again. I would do it in combination with our whole protocol. If you go to priapusshot.com/peyronies, even though this man doesn’t have peyronie’s disease, the protocol that I put here works for erectile dysfunction as well. For example, using the pump has been shown to help with erectile function. We’ll need less Viagra. Let me add this too. If you go back to think about what we’re doing here, this happened to me once. Someone said “Nothing happened, nothing happened.” So I told my staff and then they delivered that message to me. “Okay, have him come in.” As he was getting on the table to get his repeat Priapus Shot, I said, “Now you’re taking Trimix aren’t you? Have you changed the dose on it?” He said “Yeah, I’ve cut the dose in half.” That’s a win, that is an expected win. If someone’s using Viagra or Cialis, which this man is, it could be that he’s getting the same kind of erection that he did with half the dose of his Viagra or Cialis. That’s the best we can do.
You have to remember to ask them that and also remember to tell them that when you treat them, that we’re not giving you an 18 year old penis, we’re giving you your penis five years ago which is going to be … you’re going to cut your Cialis dose in half or your Trimix, if that’s what you’re using. Anyway, the other things you can do to support it, just like if you had surgery, you have your cholecystectomy and the next day you’re doing LSD, smoking two packs a day and drinking Jack Daniels, you’re probably not going to heal very well. I’m exaggerating obviously but the point I’m making is, there are things you can do to support healing and there are things you can do to interfere with healing. The things that you do that … those things are exactly the things that would support of interfere with platelet rich plasma because we are triggering the healing response.
Here’s the whole protocol for Peyronie’s and for the same thing works for erectile dysfunction. If they’re not on Cialis then I wouldn’t feel the need to start that. But, post prostate surgery and for Peyronie’s disease you might want to because Cialis actually has some biochemical effects that could help prevent the peyronie’s from progressing and cutting off the mechanism might actually help with the reversal of it as well. The research backing all this us is at each link, there’s a video, we’re going to talk about it. You can actually give your people this website, priapus.com/peyronies and suggest that they follow it. I then have sources for them to buy this stuff. On Amazon.
Let’s see, I think there was one more part to that question. I think that’s all that question. Patient number two, who used cocaine and Viagra during his holiday, experienced some kind of pain during sex, ignored it. In the days that followed, sexual sensitivity dropped massively. Urologist and neurologist seen no abnormalities. Neurologist did, actually nothing. The urologist performed an ultrasound. They sent him to a sexology psychotherapist. They could not do anything. According to the patient, there’s no mental cause here, otherwise that, almost never getting erect anymore, which puts a lot of negative pressure on him. The only possibility to get an erection somehow is with tensing his pelvic muscles and straightening his legs. He asked if a P-Shot would help him and how many? I told him I would ask you because of the rapid onset and [inaudible 00:28:40] P-Shot at this kind of onset.
So, if you took out the drug stuff and the story about straightening his legs and tensing his pelvic muscles and standing on one leg and saying three Hail Marys, I would say the next thing I’m about to tell you, I would do. But, with this particular person I would steer clear and just say “I’m not sure if I could help you.” There’s just this red flag feeling when I hear odd things and history of drug use. I’m not saying that this is the most horrible thing and makes people unreliable. Still, cocaine goofs with your ability to have sex. If he’s using cocaine and I give him a P-Shot and six months from now he tells me “My P-Shot’s not working.” Now I have to be the freaking drug police and ask him if he’s still using cocaine. I don’t like to do that. I’ve worked at a drug rehab center, I think I’m good at rehabilitating drug people, very good actually. I don’t like to do it in concert with Priapus Shots. I would want him off of this for a year before I would become his erectile dysfunction-
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Section 4 of 5 [00:30:00 – 00:40:04](NOTE: speaker names may be different in each section)
Charles Runels: Before I would become his erectile dysfunction doctor. But anyway, let’s assume he’s not doing the cocaine and he doesn’t have the story about straightening legs and pelvic muscles and doing three Hail Mary’s to get an erection. In that case, if it were just a history of trauma, and some loss of sensation, I would tell him, lets do two P-Shots, eight weeks apart and not use the pump. For some reason, I’ve found people that have loss of sensation, they do better if you don’t use the pump, if that’s their main thing they’re trying to treat. Not use the pump, two treatments, eight weeks apart and see if he doesn’t get better.
After the second treatment, have him wait a full twelve weeks before we decide if it’s worked or not. So that’s going to be shot, eight weeks, second shot, twelve weeks. So that’s going to be 20 weeks, but these are nerves. They don’t grow like your hair and if you don’t wait that long, you don’t really know what you’ve done so setting that up is to be the deal. I’ll even write it out and have him initial it so he understands what you’re doing. But that’s for people who don’t use cocaine it goofs up your ability to have an erection so I wouldn’t play with it.
O-Shot® with Mid-Urethral Sling
Okay, so those are the two knew ones on Priapus shot. Let’s see there’s … on O-Shot. Here’s the only new one. Dr. Kline said “Can the shot be performed on a patient with a mid-urethral sling in place and if so, does the place of the injection need to be altered or the amount of PRP placed in the urethra?” I actually think, if the shot were done when people do mid-urethral slings, they would probably get better results and more rapid healing. But, we would need someone like Amy Brenner or one of our gynecologists who does slings to tell us the answer to that. I know there was one study done where using the O-Shot in concert with removing mesh gave a really beautiful result and resolved pain. So, the other thing to think about, no matter what the surgery is, say it’s mesh, sling, hysterectomy, all of those things … Well, hysterectomy and mesh, that study’s actually been done. But, one study using PRP with hysterectomy helped healing. I just told you a study taking out mesh helped the pain, helped the healing.
If you’re creating with PRP, something that is normally made with injury to help the healing process, then with any surgery, you can make the argument that using PRP would help the healing process. Therefore, there should be no problem with using it the next day, the next week, the next year. Using PRP should help and there’s no real contra-indication. The only thing is that if I were not the surgeon, I wouldn’t want to be the one doing it post-op until the surgeon released the person and said “Yup, they’re out of the woods, no sign of infection, everything’s working great”, so I don’t get blamed for some post-op complication.
The only other new thing that came up, which I already answered here in words, but the problem is, is amnion stem cells or not? Well, technically, amnionic membrane is a rapidly growing stem cell-like material, but stem cells are alive, or they are just proteins. And the amnion that you’re buying that has been micronized in a syringe or comes as a powder is not living cells. It’s just the amnionic tissue that’s been dehydrated and then Gama radiated and reconstituted so there’s no … Well actually first it’s reconstituted and then Gama radiated, so there’s nothing alive in there. Otherwise you have to worry about catching some disease from the person who contributed the amnion. So there’s no living cells. Now there is [inaudible 00:34:39] who supplies us with the amnion that we sell to our providers as a distributor/wholesaler. They give us a price that’s at the wholesale price. They have a different product that is true, living tissue that is much, much more expensive and it’s not available to us yet. I’m not sure we’ll even need it, but it’s coming. That’s a true living cell. Amnion is not, no matter where you’re getting it.
Now these amino-acid protein chains, or peptide chains, are very, very powerful. That’s the growth hormone, it’s just a peptide chain that codes … You know there’s two types of hormones, there are the steroid-based hormones like testosterone or estrogen that are cholesterol derived. And then there are the peptide chains that are proteins. So that’s why you can’t take insulin by mouth, but you can take [inaudible 00:35:43] by mouth. The acid in your stomach breaks the peptide chains that are in insulin and it just becomes amino acids. As far as your body knows, there’s no difference between eating a hamburger and taking insulin by mouth, because once your body chops all those peptide chains up into individual amino acids, you just have amino acids like in your meal.
But, if you take a steroid like estrogen by mouth, then the acid doesn’t break it apart and it’s absorbed in tact. The point I’m making, is that the peptide chains, even though they’re not alive, they’re very powerful. It’s what’s released from the platelets. So you have peptide chains that are released from platelets, they’re the [inaudible 00:36:35] and all the things that make PRP work. And some of them are exactly the same things made by the pituitary gland, like Somatomedin-C or [inaudible 00:36:41] released from the pituitary gland. Well, growth hormone is released by the pituitary gland and then it causes the tissue in the body, like the liver, to produce Somatomedin-C or [inaudible 00:36:52]. Over two hundred peptide chains are made by the pituitary gland. Over two hundred that we know about so far.
So I think there’s no way to know everything that’s going on when you take these peptide chains from amnion, but what we do know is we have years, much more than with PRP, we have many years of research with amnion showing that these peptide chains have healing properties. I’ve posted some of that research to, I can’t remember which website I put it on now, but I’ll put it here too so it can be found. I think I put it on on the Cellular Medicine, but I recently posted … cellularmedicineassociation.org and then look over the recent post, Amniotic Membrane, Research. So here’s some other papers and actually some of these links open multiple links. So, for example, this one opens multiple papers. Some of these links open ten papers, just with that one link. So that’s some of the relevant research.
Okay. Let’s see what other questions. I think that’s all the new questions on the O-Shot. The Breast Lift, there was one here about sensitivity. “I have a patient that’s had breast implants”, and then after this one I think let’s stop and let me show you a quick, easy way to create an email that’s interesting to your patients and will bring them to you for the things you know how to do. This is one of my hacks, it really kills it. It’s easy, it’s fun, you’ll like it. It makes you smarter. And it brings people to your office.
So, let’s answer this one last question. “I have a patient who had breast implants and has loss of nipple sensitivity. Her primary concern is to regain the sensitivity back. She asks what percentage of people who have received the Vampire Breast Lift do in fact have [inaudible 00:39:03] improvement in sensitivity and are pleased with the results. If you can provide me with an idea of this percentage, that would be helpful.” So, I have had 100% with this. I’ve probably treated, I don’t know, I’ve been doing this fairly regularly for eight years now, and when I’ve surveyed and asked some of our providers on another call what their experience has been, I’ve heard everything from 80% to 90%. I don’t like saying anything is 100%, but for run of the mill, loss of sensitivity for implants or breast feeding, it is very, very, it’s more than 50%, I think is a safe thing to say.
For breast reconstruction post breast cancer, not so good. I don’t even promise them anything. It’s more about aesthetic treatments when I do that.
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Section 5 of 5 [00:40:00 – 00:58:14](NOTE: speaker names may be different in each section)
Charles Runels: Okay. I think I’ll show you my little email hack, and then let’s call it a day. So, let’s say … Here’s the process, let me pull this up for you and we’ll [inaudible 00:40:15]. And I’ll just demonstrate it. This is how to write … This is how to write … an email, very quickly, that you people want to read.
Okay, so I first start with what I want to sell. The market, what am I marketing? In other words, let’s say it’s the O-Shot®, as an example. So, I don’t want everybody to come see me for an O-Shot®. All I want to come see me for the O-Shot® are people that I can really help, like if someone’s got … They need a hysterectomy because their cervix is hanging out of their vagina, they don’t need to come see me.
But there are certain things that I do know how to help. So, let’s say that one of them is dyspareunia. So instead of talking about … I always have to think about how to spell that word. So instead of talking about my O-Shot®, why don’t I talk about one of the problems that I do know that I have a high success rate for? Dyspareunia.
Now I know this is like back pain, there’s lots of things that cause dyspareunia. So, we could just pick one of those, but I’m just going to leave it at that for now. We can say dyspareunia post episiotomy, let’s just say dyspareunia. Actually, why don’t we say dyspareunia post-partum. Post-partum, and just make it more fun.
So, this is what I know. Dyspareunia post-partum, we’re the bomb, we’re the O-Shot®. So now, so that’s step one. Number two, and then we’ll just follow this, and I’ll show you how to do this. Literally, five minutes, you’re done with an email. That just kills it.
So number two, you say … okay, so first it’s the what do you want to market? Next, is what problem do you want to solve with the thing you’re marketing? And I’m trying to move this down to number two because that really should be number two. So, make this number two. Ugh, it won’t go. Okay.
So, what problem? Dyspareunia post-partum. Now you’re going to go to PubMed and go to Google, and see, you’re going to find some research. And this is where it gets fun because you should be wanting to read this anyway if you’re treating it. So, let’s just Google it first. We go Dyspareunia post-partum.
I’m telling you, I’m giving you the keys to the kingdom. This works so very, very well. Okay, so definition, not interesting. Okay, this looks like a full text clinical trial that’s underway, but clinical trial’s probably not finished, so … I’d like to find something that’s done.
Okay, episiotomy and the development of post-partum dyspareunia. Done. Apparently, Google likes that. So this will save me from doing the PubMed thing. And let’s just quickly scan it, see what it’s saying. Now here’s the thing. If you have a patient, or if there is someone out there, not even your patient, is dyspareunia post-partum. They can look at this, smart women, they can look at this, figure it out … But even though they’ve figured it out, sort of, they’re not sure if they’ve really figured it out.
And they would love to have a physician think about it with them, and tell them, “Yeah, this is what it means.” And they would even better like it if it’s their physician who’s thinking about it. So, let’s just scan this really quick. Episiotomy, common surgical procedures, a study, episiotomy [inaudible 00:44:11] 39%. [inaudible 00:44:13] sex life, largely unknown. Three months post-partum. More severe dyspareunia … Okay, the aim, assess the impacts, development of post-partum.
So, materials and methods. Let’s just scan it. [inaudible 00:44:32]. Interview, questionnaire, so these are questionnaires, visual analog scales, so we’ll skip down to the results. Of the 200 hundred patients that participated, 100 had vaginal delivery with episiotomy, 100 had C-section all were primigravida. In ages 22-24 years old, okay, characteristics, average incontinent scores, dyspareunia was present. 21% of of group one and 8% in group two. So significant increase in the presence of dyspareunia. So that’s the conclusions right there. Present, not present, so there we go.
So now, situation, whatever [inaudible 00:45:34] dyspareunia. Okay now, here’s how you write the email. Let’s go back to our list, we’re going to need this link right here. So I copy that link to the research and let’s get the numbers down here. Was it 21% versus 8%. Okay. So now, let’s write our email. I like to do Ulyssis, but you can do whatever, I don’t like all the extra stuff in my way when I’m trying to write. So hello, and then you’re going to put first name. Dyspareunia, painful, painful intercourse can put a huge strain on family and relationships. Recent research looked at the percentage of women who suffered with pain after delivery, and found that the percentage jumped from 8%, if there’s a C-section to 21% or about 1 in 5 with vaginal delivery. Now, can you see now you’re talking to your patients like who they are, smart people. And you just learned something. The solutions, my cursor just jumps around, solutions to this problem can be very unsatisfactory. We’ve found that the O-Shot®, procedure can be helpful in most women. Okay. If you know someone who suffers, of course this someone could be the woman reading this, maybe she knows her mother, sister, best friend has problems. If you know someone who suffers with this problem, would you mind letting them know about possibilities of seeing better. I’ll just stop there. Possibilities with the O-Shot®. Sincerely, okay.
Now, you can take this and copy it. However you send your emails, alright, we’re almost done. I don’t know how we’re doing for time here. However you send your emails then. I like using Ontraport.
So you can see I have my contacts sort of sorted out into lots of different categories. For now, you should probably just have one list that your emailing to, but, I have a list of O-Shot® patient inquiries. So about 6,000 people. So we’re gonna send an email to all these people and try to get them to come see you.
So I’m showing you how to write an email. So now selected all those people and this is how you finish off the email. Use [inaudible 00:51:03] contact, whatever you use it will work the same way. So email for me, and then let’s say new, I like to have a promise embedded in the subject, so, 21% of women would be interested in this after childbirth. Okay? Now I take that, what we just copied that we wrote. And again I like using it in whatever your favorite editor is. Now I need to put in the first name and how this works with your software, it’s going to be very similar, but now we need to put the website. So I can say click to read the research. Then you come back up here and find that paper, so back over here, and you just copy that domain name, and then come back to where you’re writing your email, you still with me?
So, click to read the research. I’m showing you how to write something, and the reason people are not going to put this..they’re going to read your emails if you send them emails like this. What I just did was I copied, paste that into that link and I always want it to open up a new window. It’s just a little hack I do to that makes people stay with you.
So they all work the same, they’ll have a little chain link picture, you highlight whatever you want the link to be, then you click on the chain link and you place the domain into the box. And then make the target a new window and then you save it. Alright?
And the we want people to go to the O-Shot® procedure and find you guys, so I am going to the directory for the O-Shot®, O-Shot.info/ actually, I’m just going to put the O-Shot® webpage and then web coach. Now, that’s it. And then you put name, its helpful I think if you have your signature as a picture so you can add your signature in. So, we’ll find my signature, put that in. And even if you have someone else do this, at least if you understand how this can be done you can create the content and have somebody else do this. I think its good to put your phone number and then always put a P.S.
I like putting the little reverse arrows if I want somebody to click on something, because they see that and it slows them down.
Okay, so lets go back and look at what we’ve done. Now I’m going to send it here in a second here in a second and let you see the final. So we first thought of what we’re going to market. Then we decided it was going to be the O-Shot®. And we decided a problem that thing we’re marketing would fix and we picked dyspareunia post-partum. When we googled it we found some research, then, we wrote by an email, just letting people with the problem know about the research and offering your solution, see number 1. So that’s where you put the link. That’s it. Then you send it. Alright so lets go back here, and the other thing before I send it, is I like the text to be at least a font of 16, because people reading this on their Iphone and a lot of them are like me and need reading glasses, they can’t see the little letters. And it’s nice if you put a new picture so people remember what you look like, remember they’re not really thinking about you that much, they’re thinking about their own problems. They don’t really care that much about you. So putting a picture there helps them remember you. And then we send it.
Before I send it I will often make sure to make sure that they do work. So you can see now if I click to read the research it opens a new window, it takes me to that research. And then if I move to the O-Shot® I made that window just taking them there so they will find you and I then I should find the science here and I send them to the research page. Make sure that one works. Yep, were on the research page. So it’s ready to go. And that’s your formula so you go ahead and send it. Hopefully some of these people will actually come see you. So save and send. I think with that we are right at the hour and hopefully you guys got something from the questions and my little tip about how to send out emails to people who actually want to read. Those will rarely go into the spam folder and you’ll get about a 30% opening rate, consistently, if you do what I just taught you. Alright I guess that’s it. Let me see if there are any questions and we’ll shut this down. None? I don’t see any questions so thank-you guys, you guys have a good week and I’ll post a recording to this to the CMA website.
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.
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.
“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.
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.
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