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Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout

Topics Discussed Include the Following…

*Penile Rehabilitation post prostate surgery
*Shock Wave Therapy
*
Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout
*Peyronie’s disease treatments
*Radiofrequency
*Priapus Shot® (P-Shot®)
*Safety in the Office with COVID
*O-Shot® for Urinary Incontinence

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

Transcript

Charles:

About two years ago, I was teaching a workshop at my class and a urologist was there, who was head of the department at a prominent hospital/university. And in the process of talking about some of the procedures and some of the ideas in the group, I mentioned Dr. George Ibrahim. And when I did, the response I got was like I was talking about, I don’t know, St. Peter or [inaudible 00:00:51] or something.

Charles:

So, our guest today, Dr. Ibrahim, has a lot of respect. He was teaching urologist at Duke for quite a time and then opened a private practice. Like all of us, he was in the fire, paid his dues, and then none of us want to stop. And so he’s built up multiple located … I think he has two locations now where he does our procedures and continues to teach for us. But it’s really been interesting to learn from him because the combination of his ideas about urology and combined with his ideas about our procedures have been unique and helpful. So I think without any further delay, let me just pull him onto the call so he can answer some of the questions that have come up and talk about some of the ideas that have occurred to him during his work. So let me just get him on the call right now.

Dr. Ibrahim:

Dr. George Ibrahim

Fine. Hello Charles.

Charles:

There you are. Yes. Thank you again for being on our call today. Lots of people are on the call. I put out a sort of a teaser, let people know that you would be here. So, quite a crowd today. And a backlog of questions from people about things that I want your opinion about. Just so you guys know, Dr. Ibrahim and I spoke briefly yesterday, but most of the stuff that I’ll be asking, I’ll be as curious as anybody about what his thinking is. We haven’t had an in-depth discussion for a while. So, why don’t we just start off with the list I have here of topics that occurred to you that might be helpful. George teaches for us. And so he’s alert to the problems and the challenges that come when you introduce these procedures to your practice as well as to the science and the discussion that’s going on in the medical literature and among our group.

Charles:

So, I have this list of potential topics. You can just start wherever you want, and I know everyone will be interested in your ideas. I can list them all for you if you want. The first thing I had here was dyspareunia, if you want to start with that one, because it’s such a hard problem. To me, that’s the worst of the sexual dysfunctions for women because they can fake arousal or even accommodate lovingly without a high sex drive. And an orgasm sometimes is not necessary. Women with pain will start to avoid their lovers. So let’s start with that one since that’s such a tough one

Dyspareunia

Dr. Ibrahim:

Well, Charles, thank you too so much for your introduction. I do appreciate you give me a chance to be here with you. This is an honor, and I hope we can make everybody’s time worthwhile. So to get straight to your topic, I really think that without addressing a female’s hormonal balance at that time of her age, you’re not going to make much headway. Borrowing a history of breast cancer that’s ER positive, there’s really no reason to not optimize the female’s hormones, everything from the lubrication that it brings to bring it back, the vaginal walls and helping with the tissue paper aspect that you see once a woman goes through menopause. These are the kinds of things that I really think, unless you’re going to be able to do that, you’re going to have a hard time.

Dr. Ibrahim:

I do think that the O-Shot can help, but unless she’s got some [ } on board, and that can be done topically and regionally. It doesn’t have to be done systemically, but I think that’s one of the first thing that at least that’s what I always tell one of these kinds of women that have suffered from this problem.

Charles:

Yeah. I like to stress to people that so far in spite of several years of campaigning for it, I like to stress to people that it’s really all we’re doing, these [PRP/cellular] procedures, is just making that local tissue healthier, but there’s so many other parts involved in the sexual response from the spinal cord, to the psychology of our thoughts, to the hormonal [inaudible 00:05:24] you that has to do. Without hormones, we can’t even make collagen or have blood flow. Hormones make our heart pump. So, there’s this system, and I’ve been campaigning that we talk in systems analysis the way we talk about a neurological system and a cardiovascular system. And the reproductive system is not the same as the orgasm system or the sexual response system. So, stressing that to our patients so we’re not over promising them a magic shot, but helping them, although it can be like magic sometimes, but helping them understand there’s this whole system we have to think about.

Dr. Ibrahim:

Absolutely. And with testosterone going to zero in almost every one of the menopausal women I see are almost undetectable. There’s no way that there’s going to be any desire or lost. And while you might be able to help with the lubrication, without that mental stimulation or desire, it’s not going to be a fun experience. It might not be painful anymore, but it’s hardly enjoyable from what I hear from my patients.

Charles:

So talk to us about how you think about, so you first start with optimizing their hormonal status. And there’s so many … The diagnosis, I’m almost regretting now starting with this because the diagnosis of dyspareunia is so complicated. But, maybe a fairly quick overview of how you think about that diagnosis, everything from dryness with breast cancer to surgical problems, so that maybe at least give an outline for the people on the call.

Dr. Ibrahim:

I think that the biggest part of the pain that a woman [inaudible 00:07:06] has and comes to fear when it comes to sex after menopause, is that the vaginal epithelium has become so atrophic. And without a nice beefy, robust, lubricated, thicker vaginal wall, so the vaginal walls, any kind of sex is going to be painful. And that’s where I’m going with it all.

Charles:

Okay. So when you do your procedure with the O-Shot, because you know you can have the dryness for breast cancer or you can have a pelvic floor tenderness, you can have an episiotomy that’s tearing, not mentioning the things like ovarian cyst and uterine fibroids, but the things that we can address with an O-Shot, can you talk how you might vary the how you do the procedure with a woman who has tenderness that it’s in a particular spot versus just overall dyspareunia from say dryness?

Dr. Ibrahim:

What I’ll typically do, if she is in menopause and she has been away from any kind of estrogen production for a few years, I’ll try to see if she’s against doing systemic hormones to see if she would do around about three to four weeks of topical extra dial. A lot of folks like to use a combination of estriol and estradial. I think estradiol is much more powerful, but I try to get them to do about three to four weeks prior to doing an O-Shot, telling them that it’s going to make, the O-Shot’s ability to repair tissue and strength the things and all the magic that the O-Shot does, a lot more [inaudible 00:08:49] better blood flow in the face of the O-Shot if she can do some estrogen for a while ahead of time. So I’ll try to get you to do that for about a month. And then I’ll go ahead and do the O-Shot.

Dr. Ibrahim:

And oftentimes, especially in women that have been in menopause without being on estrogen, I will oftentimes warn them ahead of time, “Look, we’re going to see some results from one. It might be phenomenal, but don’t hold off on doing a second one within two to three months after the first one to augment the effect of the first one.” Especially, again, if she’s not been doing estrogen.

Charles:

Okay. So, I know you have an upcoming class and I want to put this in the chat box so you guys will have access to it before I forget to do this. And Dr. Ibrahim, as I mentioned, was a highly respected teacher of surgical procedures. And I’ve seen him teach there in his office. And he’s patient and articulate and cordial and inspiring. So I highly recommend his class if you’re looking for some hands-on work. And he’s squeezed it into one day by leaving out the aesthetics part and focusing really heavily on the sexual medicine for both men and women.

Charles:

I know this, in your course, you’ll talk some about radio-frequency and laser technologies. And I actually got a question today about Emsella. Maybe just expand upon your ideas about things to do along with when it comes to the machines. Because I know people are either have them or contemplating them. So radio-frequency, laser and magnets, could you talk about how you work those into your protocols?

Dr. Ibrahim:

Absolutely. And before I do that, I’m going to put the plug in for the workshop. It’s going to be March the fourth. We’ll just squeeze everything into one day. Fortunately, I’ve had COVID and my first vaccine, so has my physician’s assistant, and the majority of my staff. But, we’re going to do what we have to do. That all being said, I do use enhancement. Patients are given the option. Some patients only want to get another shot or a Priapus Shot®. Some have heard about some of these other methods. I’m not here to do a commercial for any particular device.

Combining Shock Wave with the P-Shot® Procedure (timing)

Dr. Ibrahim:

I chose a laser over radio-frequency but I’ve seen both of them were great. I just chose not to have two devices that accomplish basically the same thing. So, I use a laser, but I’ve no … It’s done essentially the exact same way as radio frequency. And I use that often when I’m doing my O-Shots. And then with men, even if they don’t want to sign up for an acoustic wave treatment series, are pretty much always we’ll do some acoustic wave treatment just prior to injecting them for their P-Shot because I think that the [inaudible 00:12:04] trauma that we’re producing and increasing the blood flow from that acoustic wave treatment absolutely helps keep the PRP in place and excite the growth factors to do the jobs that we’re hoping that they’re going to do.

Dr. Ibrahim:

That all being said, my staff loves doing these workshops. And we’ve missed it for all the travel restrictions this past year. And so we’re itching to get back in it because they have fun doing it. They love seeing me teach because I know that’s where I used to do it. You may say I’m always my most excited and happiest when I get to teach. And so it’s always a fun event.

Charles:

Beautiful. Yeah. So if you guys are interested in that, click the link now because the link goes away when the webinar’s over and then you’ll have that page open. So, you will sometimes do a shockwave therapy at least briefly, even if they haven’t asked for it, just prior to a P-Shot. Let’s say that they go for it and they say, “Money’s not an object, I live down the street, Tom’s not a problem,” what would be your Cadillac treatment for a man with, let’s start with Peyronie’s disease, what would be your protocol?

Charles:

Because here’s the thing, I get the questions all the time. We’re still working on getting enough research out there. We have some. People act like we have none, sometimes our critics. We actually have a pretty good list of papers now over the past five or 10 years, talking about our stuff. I’ll just give you the list for the Priapus Shot. And it’s not a thousand papers, but that’s a pretty impressive, I don’t know, it’s probably 20 papers out there talking about PRP in the penis now. But there isn’t this goal [inaudible 00:13:52]. It’s like if you run a 100 yard dash, you know when the race is over. But the effort to convince our colleagues that PRP is a viable option where it becomes standard of care for every urologist and every family practitioners treating Peyronie’s erectile dysfunction, there’s no discreet line that’s, okay, now we all start to do this.

Combination Therapies for Peyronie’s Disease

Charles:

So, even more so if you start combining, okay, what’s the best algorithm if you’re going to combine it with shockwave. And there isn’t no published study that says, “This is the best, and this is what the recipe should be.” So when I get those questions, I’m always curious to what your protocol would be for someone with unlimited funds, unlimited time, how would you treat Peyronie’s?

Dr. Ibrahim:

That’s a great question. And I’m thrilled that you told people we all have different recipes for cooking a pound cake, basically. Because the science isn’t out there and I’ll give you my rationale reasoning for doing it. They’re offered the choice off easily. Again, just the Priapus Shot® or the acoustic wave treatment combined with a Priapus Shot®, when they choose the combination, which the vast majority do. Part of that, the reason is we make it much more attractive for them to do it as a package financially. But more importantly, I know that we’re going to see a better end result, have a happier patient. And I’ve said this, especially in my aesthetics practice, nobody is ever upset by spending more than they plan to spend if they get a better result than they thought they were going to get.

Dr. Ibrahim:

And so with that in mind, and just assuming they’re planning on doing both acoustic wave and the Priapus Shot® at the same time, for Peyronie’s, right off the bat, tell them this is not going to be a one and done situation. “Peyronie’s, Mr. Jones, that’s going to be something that we’re looking at. I want you to be scheduled for at least two of the Priapus Shot®.” Again, there’s the financial incentive that it’s not two times one cost. And I will typically start by doing the acoustic wave treatment. And I identified the plaque for our medical assistants who are the ones who deliver the acoustic wave treatments. And they’ve been very, very well-trained because my grasp of the penile anatomy and everything. But I have them concentrate a lot of the acoustic energy on the plaque itself.

Dr. Ibrahim:

And typically, we’ll have them do three acoustic wave treatments in a row. Mostly depending on how far away they live, typically a week apart. And when they come back to their third or their fourth acoustic wave treatment, right after they’ve had the acoustic wave treatment, I’ll do the Priapus Shot®. And just if people are taking notes, men who have acoustic wave treatments do not need to be numbed, but if I’m going to be doing a Priapus Shot®, I’ll go ahead and place my penile block before they do the acoustic wave for one reason, impatient. This guarantees that the guy sat around for at least 20 minutes letting the block sink. Number two, if I missed one of the nerves, they’re able to tell the medical assistant, “My right side of my penis is completely numb but I can still feel it on the left, and she lets me know when I come back in there and augment it.”

Dr. Ibrahim:

So I’ll do the first Priapus Shot® in the middle of the acoustic wave treatment. And then I’ll do the last or the second Priapus Shot® following the same day of the final acoustic wave treatment and then see how they go from there, telling them ahead of time, we’re probably going to have to do some kind of maintenance afterwards, meaning maybe one acoustic wave treatment a month and maybe a Priapus Shot® once or twice a year, depending on how they are or what kind of results that they get from their Peyronie’s. And one more thing before I go much further. This is one of the times where I’m very insistent on the penile pump or the vacuum erection device.

Charles:

[crosstalk 00:18:10]. That was my question.

Penis Pump Tips

Dr. Ibrahim:

Yes. Okay. We have templates that every patient gets, and it has a video and it has their instructions because they’re going to forget 90% of what you tell them in the office. But the first line of the penile pump instruction is, this is frustrating. You’re going to feel like you need a third hand to hold down your scrotum while you hold the cylinder and the other hand holds the pump. You’re going to figure it out. But I always try to teach them how to use the pump. At the initial conversation, set the time that they show up for their [inaudible 00:18:46] wave treatment and a P-Shot, they have already used the pump. The last thing I want them to do is to go home after a Priapus Shot®, I’m not going to let them do it while they’re still numb. So then the next day they try to do it and if it’s the first time they’ve done it, they’re going to be a little sore. And so it’s much better to teach the guy how to use the pump and become proficient in it before you start your other treatments.

Charles:

Let me just jump in with a couple of amens here. First of all, I want those of you who haven’t seen this, I want you to see that there is a study from the British Journal of Urology that’s been out now for a decade that shows that people who had scheduled surgery for Peyronie’s disease, 51% of them canceled it with a pump alone. And so you’ve got some science to back that up, but there is some frustration with the pump. And George is the first that I’ve heard come up with a great idea that’s like a lot of great ideas, simple after someone thinks of it, is that oftentimes the complaints people have as side effects from the Priapus Shot, they’re really blaming the side effects of the Priapus Shot on their misunderstanding of the pump. So having them do that for a week or two or some amount of time before they get the shot helps them sort that out and less likely to think that the procedure went wrong. And that’s how you’ve done it for a while, right?

Dr. Ibrahim:

Absolutely. And ever since we started doing this way, the number of callbacks, I don’t like using the word complaints, concerns has dropped dramatically. Because there’s rarely a concern after a Priapus Shot®, but the pump, if they don’t use it correctly, they over … I literally take a black sharpie and mark out a good portion of the dial and say, “There’s no reason to ever go past this line.” You don’t even have to go all the way to this line, but don’t ever go pass it because some guys would think, “Well, if one’s better, then four must be even much better.” And they would overpump and then it would not be good.

Charles:

Yep. So, another, Dr. Ibrahim, on the call. I’m going to unmute him. He has a question. Actually, I’ve got a pretty good line of questions here. So, let me see, where do you get … Here we go. Dr. Ibrahim, you’re unmuted. If you want to go ahead and just ask your question. I can read it if you don’t have your mic on.

Dr. Ibrahim:

Okay. The only questions I see are links. So I don’t know what kind of question [inaudible 00:21:41].

Charles:

Well, I can read it to you. I’ll just read it out. It looks like maybe his mic is not working. He just wants to know the ideal candidate for the P-Shot, what medicines are you giving after the shot like you putting on daily Cialis or something, any over-the-counter things you’re doing? I think that’s it. So medicines afterward, over-the-counter things, and what’s your ideal candidate for the procedure?

Dr. Ibrahim:

I don’t mean this flippantly, but I think all of us, we all know if you start with a really good canvas, you’re going to be able to get a nice painting. The ideal candidate is the guy who barely needs half [inaudible 00:22:21], I’m assuming, the P-Shot. Somebody who’s got great vasculature, good blood flow, great neurologic issues going on, they’re not smoking, they’re not overweight. But that’s not reality really, but that’s the ideal candidate, is the one that he’s not up to the performance he was at 22 but he’s still doing a good job. That’s the kind of guy I love seeing walk in the door because that’s going to be the home run.

Dr. Ibrahim:

The much older guy, the 78, six, year old man with history of renal problems, terrible Batchelor disease, diabetes, [inaudible 00:23:01] and all that. As far as over-the-counter stuff, and that is not what I give them, it’s what I tell them not to do. We have another handout telling them no [inaudible 00:23:15] and we list as many as we can because people don’t know that Excedrin is aspirin. And telling them, none of those for a week ahead of time. And for at least a week, if not more, after we do the procedure.

Dr. Ibrahim:

As far as a low dose daily Cialis … Now that the PD5 drugs are generic basically, it’s a lot easier to tell somebody to do it. I typically ask them right off the bat, have they ever tried one of the other or any of them? And a good many will say, “Yeah, I tried Viagra and I couldn’t stand the headache, but Cialis tended to not work as well, but I didn’t have the … I was [inaudible 00:24:02],” or vice versa. And I will write for some [trockies 00:24:08] just because that’s what I got used to back when these drugs were not completely generic and you couldn’t really write for pill form and get away with it. So I do have trockies that have either and/or Cialis or sildenafil in them, that I will tell them, “This could help you with everything that’s going on here.” And the biggest part of that is helping to increase blood flow. And I do tell them, especially in the beginning, it’s not a homework assignment they have to do, or they can tell their wives, “Yeah, it’s a homework [inaudible 00:24:40].” They must do but I wanted to have as many erections as possible after a Priapus Shot® as they can have to stimulate the blood flow.

Charles:

Yeah. That’s my aftercare instructions too, go home and have sex. Let me just quickly rattle off what I tell people the easy and hard cases and you expand on it, correct it, a different opinion, whatever. This is not a place for everybody just to try to agree. We’re swapping ideas. I tell people, “Avoid the person that a thousand or a million times zero is still zero.” So I tell people, “Avoid treating or at least make it a small percentage of your treatment, so you don’t get to discourage, the person who can they do Viagra or they do TriMix and just nothing happens. They never get in the morning erection, they’ve had diabetes for 20 years because they probably have vascular disease all the way, iliacs to the heart, aorta, whatever. So, and all we’re doing is treating the penis.

Who NOT to Treat with the Priapus Shot® Procedure

Charles:

Although I have heard people say they get great results with some of these patients, keep them to a minimum so you don’t get discouraged. And if that’s your first three patients with a P-Shot, you’re going to be discouraged. I try to avoid the person whose main goal in life is to grow their penis to some significant amount more than what GOD gave them, because it’s hard to make that person happy. I want the person who has Peyronie’s … The thing is our easy list is still everybody else’s hard list. I want the person who has Peyronie’s because I have a high success rate. I want the guy who had prostate surgery, who’s now been dismissed by the surgeon. Here’s where I really want you to help refine my ideas or correct them or expand them.

Charles:

I want the guy who’s had prostate surgery, who had erections before the surgery, who’s now been dismissed by the surgeon and he’s not happy with what’s going on. And then add in the P-Shot to the usual penile rehabilitation of a pump and daily Cialis. And I want the guy who’s got an erection, but it ain’t what they used to be, but he’s got something. He takes Viagra. He takes TriMix or he’s trying to avoid getting started on it. And then with that person, I’m going to be able to maybe cut the dose in half. He’s okay if his penis gets a little bigger, but it’s not his main primary goal in life. Expand on that, especially the penile rehabilitation, where would you correct me or expand upon what I just said?

Dr. Ibrahim:

[inaudible 00:27:12] I’m going to start with the first thing you said about … The example I used with my staff, and not necessarily in front of the patient, but they get the idea of why I don’t take that patient home. The patient that walks in and they’re so excited to see me, “I’ve heard so much about you Dr. Ibrahim, nobody’s ever been able to help me with this. I’ve been to so many different dah, dah, dah, and nothing’s ever worked.” And I’m thinking to myself, “And you just met the next doctor that’s probably not going to work [inaudible 00:27:39].” And I’ll listen, but nine times out of 10, it might be somebody I choose not to take or I start from the very beginning with all the, I can give you no guarantees, dah, dah, dah, kind of deal.

Dr. Ibrahim:

The thing about size, I do feel that there’s too many folks that, I don’t want to say members of our club, but I’ve seen too many other providers that offer the Priapus Shot®. And the biggest thing on their website is how we’re going to magically increase the size of your penis instantly. And I let patients know when they’re coming to see me, I go, “You’ll notice I don’t make any mention on my website about increase in size whatsoever.” I go, “We might see an increase in flaccid size. We both know that there can be an increase in both erection and flaccid sizes, but I never use that, is, “That’s why I’m glad you came to see me. I want to help you gain more size.” [crosstalk 00:28:46] If it happens, I tell him, “We’re both going to be excited, but that’s not how I’m going to measure your success. We’re going to the prostate surgery.”

The P-Shot® after Prostate Surgery

Dr. Ibrahim:

Absolutely. I was a big prostate cancer urologist, but that was my forte. And I didn’t do it at the time. But if I was dropped back where I was teaching prostatectomies, men would go home with a penile pump for no other reason, to continue to get more blood flow because they’ll stop having those nocturnal erections a lot of times because of the damage to the nerves. Even when the nerves are spared, it’s going to take some time for them to fully recover. And a lot of times they’ll never recover because as I was taught way back when, when we didn’t do many nerve sparing, that the nerves are part of the prosthetic capsule and nerve sparing is cancer sparing.

Dr. Ibrahim:

So, today, especially with the robot, many more men are left with their neurological function intact. My biggest question I ask them at the beginning is, how has it been since your surgery? And if it’s anything less than six months, I go, “Okay, well, what I’m going to do for you is not going to hurt anything, but you might want to wait and see how you are at six months because you might get all your recovery back.” But the question is, do you get any kind of blood flow when aroused? And if they’re like, “Yeah, but it’s just [inaudible 00:30:19]. It’s not hard enough.” I go, “Okay. All right, good. I can work with that.”

Dr. Ibrahim:

But if the answer is nothing, then I tell them, “Okay, well, I’m going to be able to help you. There’s no question.” And by that, I’m not telling them yet because they don’t want to hear about injections, but I’m thinking in my head, “All right, I’ve always got TriMix in my bag.” But if the [pitch knob 00:30:40] doesn’t work or depending on what other kinds of [inaudible 00:30:46] they might have going on, I might just say, “Let’s just help you out and get right down to the business. And let me show you how to do these injections.”

Charles:

Yep. Okay. All right. Let’s see. My thing’s blowing up with questions here. I’m just going to look. Let’s see if Sarah’s microphone will work. She’s got three or four questions. If not, I can read the questions to you. Sarah, are you there? Okay. All right. Let me just read her questions. So do you have the patient pump the same day as the shot or have them wait until the next day?

Sarah:

Hey, [inaudible 00:31:25], can you hear me now?

Charles:

Yeah. Go for it.

Sarah:

Great. So, one is, how much time-

Charles:

Where are you Sarah? Just got a hell of a snow a little bit.

Sarah:

I’m in Denver. And Dr. Ibrahim and I were in a shockwave treatment or shockwave treatment together. I don’t know if you remember Dr. Ibrahim. Sat next to you. Anywho, my question was, when you do the P-Shots in the middle of your shockwave therapy, how much time after the P-Shot before resuming shockwave treatments. It seems like the protocol has changed over the years.

Dr. Ibrahim:

And I do remember that workshop. So, nice to hear from you again.

Sarah:

[inaudible 00:32:11].

Dr. Ibrahim:

So I heard a couple of different questions. One was, sounded like, when do we resume pumping after the P-Shot and then what was the one about … What did you say about the GAINSWave [inaudible 00:32:24]?

Sarah:

Do you have them take any time off after your first P-Shot prior to resuming your shockwave treatments?

Dr. Ibrahim:

Okay, good. I’m glad you asked that. I don’t. So if they’re set up for their acoustic wave every week and I do their acoustic wave treatment on the Wednesday that they’re coming in normally and I do their Priapus Shot® that same Wednesday that they’re scheduled to get both of them, the following Wednesday, a week later, they go ahead and they get their acoustic wave treatment. If it was two days earlier-

Sarah:

Okay. Thank you. [crosstalk 00:33:02] the function of the P-Shot to have that trauma, that soon after huh?

Dr. Ibrahim:

Well, typically because I’m doing the first of the Priapus Shots during the acoustic wave series of 56. That first one, I typically would do right in the middle of the series at number three or four. And then I don’t do the final one until after their last treatment.

Sarah:

Right. Okay. And do you do your shockwave treatment first and then the P-Shot after that on that third session?

Dr. Ibrahim:

Yes. I do the acoustic wave first with my rationale being that [inaudible 00:33:45] what trauma that we might be causing helps the Priapus Shot and its growth factors stay around the area and focus on the parts of the penis that we want to rehab.

Sarah:

Okay. Completely agree. In that same training that we went to in Florida for GAINSWave, at that time, they were saying, wait four to six weeks after that first P-Shot before resuming treatment. But, you don’t think that’s necessary before resuming shockwave treatment.

Dr. Ibrahim:

Correct. And I don’t have any literature to support what I’m saying. And I can’t imagine they’ve got any literature.

Sarah:

I don’t think they do [crosstalk 00:34:26].

Dr. Ibrahim:

I know that the results that I’ve had doing it the way that I described have been fantastic. And have I done hundreds of these doing the protocol that they showed us, I don’t know, it might’ve been just as good. But, I’m not going to mess around with what’s working for me. But, I’m an open mind. If somebody tells me that they have compared such durations and differences, I’m all ears.

Sarah:

Okay. And then regarding the second question about pumping, I [inaudible 00:35:01] Dr. Runels that you generally recommend, I think you would have them pump perhaps immediately after the P-Shot at the appointment and at that same GAINSWave treatment or training, they recommended differing pumping to the next day because of the potential of having some bleeding and that traumatizing the patient. What is your protocol, Dr. Ibrahim?

Dr. Ibrahim:

Okay. So when I learned it, when I was at Fairhope, we were pumping immediately afterwards. I’m doing a penile block on these guys now, so I don’t want them pumping until they’re not numb. Because, like we said, at the very beginning about the pump, one of its problems is the pump causing pain and bruising and issues. And if they’re totally numb, they don’t know what’s going on. I think, especially when I’ve done the acoustic wave prior to doing the Priapus Shot®, that there’s enough trauma now. And let’s just wait till the next day when they’re not numb to resume pumping.

Sarah:

Yeah. Interesting. I used to do the block and have completely for the last year, just continued that. I use a really good topical and the Pro-Knox and they do amazing. But, just throwing that in there.

Dr. Ibrahim:

In fact, I’d love for you to contact me and let me know the source of your topical, because as we all know, it’s not the lidocane or [inaudible 00:36:33] or benzocaine or whatever. It’s the base that makes the biggest difference in a lot of these pharmacies. That base is a closely guarded secret. I’ve got some great ones that work on the [inaudible 00:36:45] because I haven’t found a good one for the penis in your right. You might not have said it, but I’m thinking in my mind, “I’ve done thousands of penile blocks.” And the goal is to get near the nerve, but I’ve hit the nerve enough times to where I’ve caused some residual discomfort from doing the block.

Sarah:

I have too.

Dr. Ibrahim:

Yeah. Which-

Sarah:

But I actually learned the technique from the block from you from one of your videos. And yeah, I’ve gone through many derivations because I do aesthetics as well for topical numbing. And I’ve just within the last year found one that I feel like is a home run. So I’m happy to share that with you. And then my last question is, are you injecting any exosomes versus PRP in the penis?

Dr. Ibrahim:

I am. And that’s a topic that that Dr. Runels and I left off, especially, some of the agenda. I do.

Sarah:

Great. I do as well. So I’d love to chat with you offline about that.

Dr. Ibrahim:

Wait a minute, I will say this out loud. I am a huge fan. A huge fan.

Charles:

So, Sarah, just so you get an idea of what we’re thinking. There are things like the exosomes and STEM cells and things that I’m most afraid to pronounce out loud. And it has to be thought about in terms of, of course the way Dr. Ibrahim does in terms of where you are and who’s the person and what’s the powers that be is saying, and is there an IRB and all that. And so it’s the kind of thing that I like to keep those conversations less broadcast so that people don’t get the wrong idea and get in trouble by not following the same kind of guidelines that George is following. So, I think the best way to find out his ideas about that is to show up in his class. But I appreciate your questions very much. I’ve got a long list. I’m going to jump to the next person, but thank you for jumping on the call. Okay. Did I lose you?

Sarah:

Nope. Thank you so much.

How to Vary the Injection of P-Shot® When Treating Peyronie’s Disease

Charles:

All right. All right. So another, I think his mic isn’t working, but we’ve got another question here from Dr. Eric [Byman 00:39:17] who says that he would like to know how … And this is a frequent question. I’m glad you asked this Eric. How do you vary the way you’re injecting your PRP when you do the P-Shot and how you’re doing, I think you touched on briefly, how you’re doing the shockwave when you’re treating Peyronie’s or do you?

Dr. Ibrahim:

Okay. For me, yes. All right. If I was not treating a plaque specifically, I would deliver almost all the PRP along the … Yeah, I do between three to five max sticks on both sides depending on the endowment. And then a little bit in the glands. I think the glanular part of the Priapus Shot is more for sensitivity because obviously the glands does not play any role whatsoever in erections. It does get a little bit more [inaudible 00:40:20] a little bit bigger, but that’s not where the meat is. When it comes to Peyronie’s, I’m going to take maybe a third of the entire amount of PRP that I have. I’ll split what’s left after that third to do this half injections. And then I will directly inject the plaque two to three to four times, depending on its size, directly with the PRP.

Charles:

Okay. Thank you. So we have another question that I’ve never had before. A lot of these questions … By the way, I’m putting into the chat box the address of someone, let’s see, who is … Dr. Peter Metropolis just gave us the address and phone number for a pharmacy. Thank you, Peter. For someone who has a cream that he’s found to be helpful doing the Priapus Shots. So you guys might want to try that one. The question is, someone got a TriMix … Let me just see if I can unmute the person who asked this, because this is complicated. You may have follow-up questions. Okay. Dr. Lydia Dennis, let me unmute you because this is one I’ve never heard before. Dr. Dennis, there you go. You should be able to speak if your mic is turned on. If not, I can read this.

Charles:

Okay. I’ll just read the question. Six year old guy with erectile dysfunction, previously on TriMix. I’m not sure what that means. But, was he on it when he came to your office or he stopped when he came to the office, but he was previously got a P-Shot on January the seventh. And two weeks later, says the TriMix no longer works. The penile pain, no pain or bruising after the P-Shot still having spontaneous morning erections. I don’t know how to explain that. My first guess is that maybe he’s overusing the pump and he’s waking up with an erection, but his TriMix isn’t working. I don’t know. Can you think of a way to explain that one?

Dr. Ibrahim:

Okay. I pulled my TriMix out of my refrigerator and I know it was fresh. And I ask him how many units he’s doing at home. If it’s an inordinate amount, I might not start with that. But I’ll then inject it myself [crosstalk 00:43:03]. Because they say they inject and gosh knows, are they doing it right, where are they doing it, and has that TriMix been sitting out for how long, how old is it? Always, that’s part of another handout that we have, letting people know that TriMix begins to lose its power both with time and temperature. So you might’ve kept it cold but if it’s four months old, it’s not going to be nearly as potent as it was today. You opened the bottle the first time. If it lays out on the counter for three hours, same thing. It’s not going to be nearly as potent as when you pull it straight out of the refrigerator. So, before I believe that it’s not working, I’m going to try it myself. [inaudible 00:43:48]

Charles:

All right. So, I’m not sure Dr. Dennis’ mic is not working. So, hopefully that’s helpful and seems to make sense to me. When someone tells me for example that PRP cause damage, it’s like saying you suffocated on oxygen because PRP causes tissue to become healthier. So it doesn’t mean it’s not happening, it just means there’s something else going on that has to be figured out. It’s not likely the PRP has actually damaged something.

Dr. Ibrahim:

Yeah. It’s like the people who tell you they’re allergic to Benadryl or epinephrin. Okay. Well, we all know what’s happening there. You’re getting sleepy. Benadryl or epinephrin, your heart’s racing, but they’re not allergic to it. If somebody is blaming the P-Shot, well, it’s also the person that was having problems to begin with, but now you get to be the crutch and he can blame you for it rather than himself for his inability. And I’ll tell the person, “I’m doing the best I can. I know where I’m putting things. I get to teach other physicians. I’ve been doing this as urologist for forever, but I’ll be glad to give you a list of folks that do a similar procedure that I do. And they may be able to help because I don’t know if I can.” Because at the end of the day, we all know you can’t help everybody, especially if they’re looking for a reason for something not to work.

Charles:

So, I have enough left on your outline to keep us busy for many hours. I’m going to try to get through as much of it as it can. And again, I’m always grateful to pick your brain on the ratio of knowledge and experience to cordial and easygoing with you is out the roof than nobody else maybe that I’ve worked with. So I always enjoy picking your brain. All right. So next on our list is … But, if there’s something you feel like you want to jump in, go for it because I don’t want to structure it so much. You don’t have a chance to just run. We have experienced people on the call, but we also have quite a number that are new.

Charles:

So if you have any quick tips, maybe we could jump to that now. With the COVID things going on, your ability to continue to make a living, it’s really interesting. I’ll get some people that are in the group that are just prospering like crazy, more than ever, truly. And then others that are dropping out. Literally, it breaks my heart going broke and closing their office. And it just breaks my heart because think about the irony of that; a doctor closing their office because people are getting sick. That’s something wrong when that happens, but it’s happening. And so help us talk to that person. How can you continue to do business and prosper, even though people were getting sick? What an ironic question, but help us out with that.

Dr. Ibrahim:

That’s great. And this should be brought up for folks who aren’t doing some of these things. Part one, when patients start to cancel an appointment or want to reschedule because they’re worried about COVID, staff, they have been very well trained by my office manager on, “Mrs. Jones, please, this is going to be one of the safest places you can be.” First of all, everybody in the office is used to washing their hands before they see anybody. Wearing masks and gloves is part of what we do day in and day out. That’s before COVID ever hit and we had to worry about PPE. We already had it all.

Dr. Ibrahim:

Number two, you’re not going to be in a waiting room with other folks. In fact, you won’t wait at all. And you’re going to pull up into the parking lot. You’re going to give us a phone call. And then one of my staff will check them in over the phone, make sure that we have a current payment, credit card, usually. They will actually even run the credit card for the anticipated, what the visit is going to be for telling them that there might be an adjustment depending on what we end up doing up there so that they’re not going to have to sit around. Their followup is going to be scheduled either before they’re ever seen, or once they go back to their car. They’re on the phone, again, with the MA. So the contact that they’re having with us face to face …

Dr. Ibrahim:

Because there was a time in North Carolina when I was limited to, I can’t remember if it was six minutes or something that I could be in the room at one time. And patients began to love it. They would walk in. They walk straight back to the room. They’d get on the table. I’d say hello to them. This was not for brand new patients. Brand new patients is a different story, but these are people who we’ve already had a relationship with. And we just get right down to business. And I’d apologize for not being able to spend more time with them, but the new rules made it. So I had a bit of time I could be in the room.

Dr. Ibrahim:

Now things are relaxed and we can spend a lot more time, but a lot of patients began to love it. So, we continue now to check our patients in and out before they ever get either up in the office or they come in, they’ve already been checked in and then they go back to their car and we finished the checkout without them sitting in a room, without other people hearing about their business. The privacy aspect’s been a lot better. So, we’ve done very well. We had two months. It was horrible and I was worried about who’s going to … I’d have to let go. And I’m happy to say nobody was let go. The new method has been a phenomenal forced change that we’ve had to do and it’s come over very well amongst our patients.

Charles:

Thank you for that detailed explanation, because it really breaks my heart to see doctors going out of business because we have more sick people. And I’ve put up here something that makes sense, but I want people to know there have research to back up what makes sense. So here we have published. You can see this was in the January 1st issue of what you would expect. People who are stuck at home are getting depressed and there’s been multiple research papers out about that. They’re getting depressed, there’s more abuse, there’s more substance abuse and physical abuse and child abuse, but the people that are having sex are doing better.

Charles:

And I’ll put this up here because, especially in the beginning of COVID, but it continues to this day, people are almost embarrassed about talking about the fact that we take care of sexual problems as if somehow that become unneeded because people are sick with a virus. It seems to me it’s more needed than ever. We need comfort. We need love when things are tough and we’re the people that help make that happen. So can you expandable, have you seen some of that or what’s your idea about … My point is nobody needs to make an excuse about going to work and talking about sex, even though people are dying.

Dr. Ibrahim:

You know what, I’d never would’ve thought to bring that up, but you’re absolutely right. Just to carry out that in, on the aesthetic side, now that everybody’s doing Zoom meetings and they’ve got 4k and high-def cameras looking at their face from two feet away, anything and everything above the nose, people who are doing that have never done it. Because the other is what you just said about the sex part, with so many families that have both spouses working, but now they’re both working from home and they found themselves in an environment where sex is okay at two o’clock in the afternoon, they want to do it. And a lot of couples coming in together. In fact, I’ve never had more couples at one time. Usually it’s one of the partners, almost always the female, that gets started and then the other one comes in after the fact. But I’m seeing more and more new patients enter as couples to optimize their sexual intimacy together because they’re spending so much more time together. And yeah, that is something that I would not have thought to bring up, but I see it a lot now.

Charles:

So we only have seven minutes left. Thank you for hanging with us for the whole hour. I got two questions that have been sent to me. Well, first of all, this is something I know that you’ve had a lot of experience with surgically before there was ever an O-Shot. So talk to us about in seven minutes, your ideas about the O-Shot, where it comes into the treatment for stress and urgent continents. And then last, have you had any thoughts about the new magnet Emsella treatment?

Treating Stress Incontinence and How the O-Shot® Procedure Integrates with Mid-Urethral Slings

Dr. Ibrahim:

So let’s talk about the incontinence. First of all, you see the literature that talks about 51% of women over the age of, just making up, 40 something report incontinence. And whenever I give talks, I go, “That’s the biggest wrong number in the world.” If a woman has gone through menopause or she’s ever, let’s say 50, and she’s had one or more vaginal deliveries, they’re incontinent. But they’re all used to it. Their mother wear her pants when she caught the sneeze. Their best friend wears her pants when she’s jumping rope. And so, so many women don’t even complain about, “I have this today.” Healthy as hell, thin, fit, 50 year old woman, three vaginal deliveries. It’s on our form. I don’t care if you’re coming in for Botox. It’s one of the questions on the form. Do you leak when you cough, sneeze, laugh, job, et cetera, then in parentheses stress, urinary incontinence?

Dr. Ibrahim:

And she didn’t even think to mark it, but I looked at her history and her age and I just couldn’t conceive up. And sure enough, she says, “Oh yeah, whenever I do jump rope, which is like three to four times a week, I’m always leaking.” And I go, “Well, let’s talk about what we can do.” And so it’s far more common and I advise everybody to make sure it’s on your list of questions, because if you’re going to be part of your club and you’ve learned how to do the O-Shot, then I will address their incontinence at every single visit until they tell me either, I don’t want to hear you talk to me about my incontinence again, Dr. Ibrahim, or they go ahead and [crosstalk 00:54:34].

Dr. Ibrahim:

And [inaudible 00:54:34] is, is I have done enough slings, enough mesh, enough tax in my career. And [inaudible 00:54:42]. They were horrendous and they had brought with issues. If I had had the O-Shot when I was in residency, I would have done a third of the female vaginal incontinence procedures that I did as a resident. One-third. It would have knocked out probably at least half, if not two thirds, of the cases that I had done. Because so many women are completely dry after one or two O-Shots. Every one so far has been dramatically improved if not, parentheses, cured. And again, I thought of how long is that going to last? I don’t know. I don’t have that crystal ball. Some, they’ve never had to come back and some come back once a year and some in between. So-

Charles:

The other surgeons in our group will tell me that even if the woman chooses to go straight to a sling, they’re usually still almost always grateful that they were offered a non-surgical solution first. Because there’s this urban feeling that surgeons want to cut, but actually surgeons want to get people well. And sometimes that means surgery, but there seems to be an appreciation for a surgeon that has something other than a scalpel in their bag. And then if they choose to go straight to the swing, they’re happy that they were offered something else. And so I’m glad to hear you supporting that idea. And you’ve seen it even work with urgent continence. I’ve heard that, but it’s interesting that you’ve seen it as well.

Dr. Ibrahim:

So when somebody comes in, they might stress incontinence stress, even though we’d give them the examples. And I find out that it’s urge. You’re itching to go. You’re back of the cold section of the grocery store, and you’re looking for the bathroom and, “I got to go, I got to go.” And you wait yourself before you can get there. That’s urge incontinence. I’ve had some women say, “Look, I’ve had a friend. She had urge incontinence. You told her ahead of time. Look, I can’t promise you anything for urge.” I go, “But it’s not going to hurt it. And if anything, it might make sex better.” And if it helps her incontinence, both of us are going to be thrilled to pieces and damned if it didn’t help her incontinence. And so I can give you the anatomic reasons why stress incontinence is held by the other shot, but I have no idea how urge it is. And I’m not talking about the incontinence. I’m talking about the urgency, the neurologic feeling in the head and the bladder that have to go. It helps with that. And I have no idea how come.

Charles:

Yeah. I’ve got some, as I’m sure you do, some theories about that, but we’ll save that for the … I’m telling you guys, every time I’m in the room or on the phone with this man, I learn a lot. He’s innovative, but he knows the science as well as anybody on the planet. So if you’re looking for a hands-on class, I can’t tell you, you just need to go see him. So last thing and then we’ll close it down. What’s your ideas about the magnet that’s being used to help incontinence?

Dr. Ibrahim:

To be very quick and short about it, of course I download it and I do not own one.

Charles:

Okay. All right. So guys, I think that we better shut it down. And lots of people are busy and I’m always honored. Everybody’s busy. So I’m honored that you made the call, honored that Dr. Ibrahim made time for us, and I’ll make sure this recording is posted somewhere soon. You should get an email automatically, but if you don’t just look forward on the membership site soon for the video and the transcript. Thank you for being on the call Dr. Ibrahim. I’m always grateful to you.

Dr. Ibrahim:

Thank you so much, Charles. I do appreciate your kind words and I appreciate your comments on the workshop.

Charles:

Yes, sir. Bye-bye.

Dr. Ibrahim:

Bye.

Dr. George Ibrahim

Dr. Ibrahim’s Next Workshop<—

Dr. Ibrahim is Western North Carolina’s only physician certified by the American Academy of Anti-Aging Medicine. He has been specifically trained in the use of bio-identical hormones, having passed both written and oral exams. A former Duke University Clinical Professor of Urology, Dr. Ibrahim’s experience with hormonal balancing goes back decades.

George Ibrahim, MD is a well known, board-certified urologist who has been professor at Duke University.

Dr. Ibrahim’s Next Workshop<—

Research showing “COVID-19 lockdown dramatically impacted on psychological, relational, and sexual health of the population. In this scenario, sexual activity played a protective effect, in both genders, on the quarantine-related plague of anxiety and mood disorders.”<–(it’s ok to treat sexual disorders during the pandemic–it’s needed) (click to read)<—

Penile rehabilitation research<–

More research about the O-Shot® procedure<–

More research about the P-Shot® procedure<–

More Workshops<---

Apply for online training for the O-Shot® procedure<–

Apply for online training for the P-Shot® procedure<–

Cellular Medicine Association
1-888-920-5311

 

Marketing Medicine During COVID

Marketing Medicine During COVID


This course is offered only in-person; it is not offered virtually/online so that participants will be able to focus without distraction in a true workshop setting.

Here are some of the things you’ll learn in this full day devoted to emails…

*Not just learning but practicing in this WORKshop, and then going home with emails already written and ready to send.
*How to write informative, compelling, inspiring emails in 10 minutes or less.
*The best software to use to send your emails and a cram course on how to use it.
*How to combat the fear of saying the “wr0ng thing.”
*Write an email that displays your knowledge instead of one that turns you into a discount store.

*How to stack emails that go out automatically so that you have emails going out every day to just the right person at the right time.
*How to decrease your chances of landing in the spam folder.
*How to use the software so that it’s not much different than writing a word document for you to write a web page and an email.
*Easy templates where you can almost fill in the blanks with what’s already in your head (the things you’re tired of saying all day long in the office) and convert those things into compelling and motivating emails.
*Exactly how to convert your daily reading into ideas for writing emails.
*How to unblock your brain so that for you to write an email is as easy as doing your routine medical care.
*How to avoid being robbed and hire the right people to help you (and do most of the work yourself for almost no money or time).


Complete Money-Back Guarantee
Come to this course, bring a pencil and paper, pour yourself a cup of coffee, take notes, then write an email in 10 minutes, during the workshop, before lunchtime. If you do not think that just ONE email (distributed the way I teach you) will more than pay for this course, if you do not think that my methods will make you smarter and your patients healthier, then you can walk out and collect a complete and cheerful refund.


2021 January 30 from 9 am until 6 pm cst

Reserve 1 Seat for $1,897<–
Reserve 2 Seats $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

 


Venue for “E-Mail Secrets Workshop”

No Mask Needed On Your Breaks at the Grand Marriott–The Bay Wind Keeps You Safe. Inside, we follow guidelines.
  • The venue for the workshop will be the Grand Hotel where you will have access to a spa, golf, harbor, and resort pool. Rates are usually around $200 to $300 per night. This hotel has a shuttle from the airport to the hotel but it’s about $75 (almost as much as renting a car).
  • The closest airport to fly into is Mobile Alabama. The taxi ride from Mobile to the coastal village of Fairhope) is about 45 minutes. Here’s an article from Smithsonian Magazine about the town of Fairhope.
  • The airport at Pensacola Florida is about the same distance by time (and my favorite local airport) but will probably require renting a car since it’s further in distance than the Mobile Airport.
  • One alternative place to stay in Fairhope is The Hampton Inn (23 North Section Street, Fairhope, Alabama 36532), which is about 3 miles from the venue (Grand Hotel Marriott). The room for 2 people at the Hampton is around $140–will be discounted to $99 if you use the code “Studio Medicine when you make a reservation. If they must upgrade to a larger room due to availability, you still will get a nice discount with that code (which is only for my patients and workshop attendees).
  • In Fairhope, you can shop antiques and clothing and quaint places to eat, or stroll the Mobile Bay.

If you have difficulty making arrangements, please contact me at DrRunels@Runels.com or call 251-648-7704

I’ll be glad to see you.

Peace & health,
Charles Runels, MD

Reserve 1 for $1,897<–
Reserve 2 Seats $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

JCPM2020.12.30. Premature Ejaculation. P-Shot®. Chronic Prostatitis

Topics Discussed Include the Following…

*Premature Ejaculation
*Chronic Prostatitis
*Shock Wave
*P-Shot®

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

Premature Ejaculation Helped by HA injections<–

Apply for On-Line Training for the P-Shot® (Priapus Shot®) procedure<–

SHOCK WAVE TX FOR CHRONIC PROSTATITIS<–

Behavioral Therapy for Premature Ejaculation<–

Tool for Assessing Premature Ejaculation<–

 

Next Workshops with Live Models<---

OShotWomen.com<– (you can now buy this at wholesale if you are an O-Shot® provider. Call 1-888-920-5311 for more information)

The Priapus Shot in India<–

Cellular Medicine Association
1-888-920-5311

First Paragraph of Lady Chatterley’s Lover
Ours is essentially a tragic age, so we refuse to take it tragically. The cataclysm has happened, we are among the ruins, we start to build up new little habitats, to have new little hopes. It is rather hard work: there is now no smooth road into the future: but we go round, or scramble over the obstacles. We’ve got to live, no matter how many skies have fallen

JCPM2020.12.16.Peptology.ImmuneBoosting.

Topics Discussed Include the Following…

  • Peptides
  • Peptology®
  • Apomorphine
  • Thymosine
  • PRP

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

Peptology® Training With Dr. Heather<–

Relevant Links

Strengthen Immunity (NEJM)<–

Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis

Next Workshops with Live Models<---

Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020

More ways to possibly boost immunity<–

Apomorphine<–

O-Shot® Women<–


Cellular Medicine Association
1-888-920-5311

E Mail Secrets that Make You Smarter & Your Patients Healthier

Email Secrets…
How to Write 10-Minute Emails that Make You Smarter,
Your Patients Healthier,

& Your Practice More Profitable


This course is offered only in-person; it is not offered virtually/online so that participants will be able to focus without distraction in a true workshop setting.

Here are some of the things you’ll learn in this full day devoted to emails…

*Not just learning but practicing in this WORKshop, and then going home with emails already written and ready to send.
*How to write informative, compelling, inspiring emails in 10 minutes or less.
*The best software to use to send your emails and a cram course on how to use it.
*How to combat the fear of saying the “wr0ng thing.”
*Write an email that displays your knowledge instead of one that turns you into a discount store.

*How to stack emails that go out automatically so that you have emails going out every day to just the right person at the right time.
*How to decrease your chances of landing in the spam folder.
*How to use the software so that it’s not much different than writing a word document for you to write a web page and an email.
*Easy templates where you can almost fill in the blanks with what’s already in your head (the things you’re tired of saying all day long in the office) and convert those things into compelling and motivating emails.
*Exactly how to convert your daily reading into ideas for writing emails.
*How to unblock your brain so that for you to write an email is as easy as doing your routine medical care.
*How to avoid being robbed and hire the right people to help you (and do most of the work yourself for almost no money or time).


Complete Money-Back Guarantee
Come to this course, bring a pencil and paper, pour yourself a cup of coffee, take notes, then write an email in 10 minutes, during the workshop, before lunchtime. If you do not think that just ONE email (distributed the way I teach you) will more than pay for this course, if you do not think that my methods will make you smarter and your patients healthier, then you can walk out and collect a complete and cheerful refund.


2021 January 30 from 9 am until 6 pm cst

Reserve 1 Seat for $1,897<–
Reserve 2 Seats  $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

 


Venue for “E-Mail Secrets Workshop”

No Mask Needed On Your Breaks at the Grand Marriott–The Bay Wind Keeps You Safe. Inside, we follow guidelines.
  • The venue for the workshop will be the Grand Hotel where you will have access to a spa, golf, harbor, and resort pool. Rates are usually around $200 to $300 per night. This hotel has a shuttle from the airport to the hotel but it’s about $75 (almost as much as renting a car).
  • The closest airport to fly into is Mobile Alabama. The taxi ride from Mobile to the coastal village of Fairhope) is about 45 minutes. Here’s an article from Smithsonian Magazine about the town of Fairhope.
  • The airport at Pensacola Florida is about the same distance by time (and my favorite local airport) but will probably require renting a car since it’s further in distance than the Mobile Airport.
  • One alternative place to stay in Fairhope is The Hampton Inn (23 North Section Street, Fairhope, Alabama 36532), which is about 3 miles from the venue (Grand Hotel Marriott). The room for 2 people at the Hampton is around $140–will be discounted to $99 if you use the code “Studio Medicine when you make a reservation. If they must upgrade to a larger room due to availability, you still will get a nice discount with that code (which is only for my patients and workshop attendees).
  • In Fairhope, you can shop antiques and clothing and quaint places to eat, or stroll the Mobile Bay.

If you have difficulty making arrangements, please contact me at DrRunels@Runels.com or call 251-648-7704

I’ll be glad to see you.

Peace & health,
Charles Runels, MD

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Surviving COVID-19 from a Physician Who Did

Topics Discussed In the Following Video Include…

  • Dr. George Liakeas discusses his recovery from the ventillator during his battle with COVID-19.
  • Dr. George Liakeas gives his best tips for helping your patients fight COVID-19 and win.
  • How the Priapus Shot® procedure may help with some of the damage caused by COVID-19
  • How COVID-19 has caused an increase in erectile dysfunction.

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

Dr. Liakeas next classes<–

Transcript

Dr. Charles Runels:
Today, we have an amazing guest with us. Dr. George Liakeas. He is an amazing intellect in New York City, has an office on Billionaires’ Row. But he’s a humble, down to earth, brilliant man. He personally remodeled his office. They are in one of the high rises, so he can hammer a nail, and he can figure out your medical problem.
But the reason I asked him to be on the call, he also displayed the grit that you would expect from a Greek warrior, and both survived the ventilator with COVID-19 as well as kept his business running through COVID. So I’ll put him on the call here shortly, and before I do that, it looks like he hasn’t logged in yet. So I’ll pull him in as soon as he does, but before I pull him into the call, I wanted to bring up a couple of things that I think will help you take care of your patients.

Erectile Dysfunction After COVID

First, this came out about COVID causing erectile dysfunction. Here’s the paper it’s referring to. I’m going to put this into the chatbox. There’s a couple of reasons for noticing these papers, one scientific and one more to do with marketing/medical.

The scientific version, of course, is that people with any illness COVID or the flu, or anything that affects their peak health can affect their sexual function. But there’s also discussion here about the possible, just like you can get a mild carditis from a viral infection, possible orchitis or change in testosterone levels, just from the stress that comes with fighting off an infection.

So that’s the medical thing we should know that should heighten our sensitivity and eagerness and willingness to discuss sexual medicine, even in the middle of a pandemic.

The marketing political version of it is that as an example, I will show you this one where one of our doctors in London, Dr. Shirin, who is just an amazing doctor there who teaches for us as well, has got some press because she noticed that she’s having more people who are locked up with their lover and they’re finding out they can’t use the office as an excuse for not to be having sex. So they are having to face their sexual dysfunction and coming to the office for Priapus shot.

I’ll give you that link as well to Dr. Shirin’s article. And I’ll tell you how you can leverage this with your local press here in a second. It’s very common for us as providers to get a local press on the television or the radio leveraging the national press. It’s hard for newspeople to come up with something new every day. And they’ll often want to bring a national story into the local arena, and I’m giving you a way to give them news.

So this is from the Cleveland Clinic, but it’s made the popular press Cleveland Clinic. I’ll give you this one too. I’m about to tell you how to get on your local TV show for free if you choose. So that I’ve put in the chatbox. By the way, if you click these things in the chatbox, they will be open when I shut down the webinar. If you don’t, they disappear.

So I’ve given you the link to Dr. Shirin’s press piece to the NIH article about erectile dysfunction, and it’s open-source. So you can just see the whole article there. And as well as to the Cleveland Clinic article that references the one about erectile dysfunction. So here’s a couple of ways you could use this to help people in your community.

One is by just, of course, seeing, recognizing, and asking your patients who are coming in.

And second is by going and sending out an email that talks about this. And I’ll add one other thing to include with this in a second. Here, I’ll give you this link as well. There are actually six papers out that show Botox helps with depression. And I think everybody knows now if want to go to look the research is all over the internet about how COVID and locking people up is causing a bump up in depression and suicide and drug abuse, and divorce. And people are feeling locked up, and that makes them sad. So there’s now six papers published about Botox helping depression, even in depression that’s resistant to antidepressants.
So you have here now two reasons that you can actually, for medical purposes, talk about what people want to push into an elective thing. People are so depressed. They’re killing themselves or turning to drug abuse. That’s not cosmetic. And I would argue that cosmetic is not really an optional thing. Looking pretty makes people feel better. How many times have you seen someone who’s on chemotherapy, but they just want to look prettier.
My sweet sister, my baby sister, contracted breast cancer. And then it recurred in her liver.  After, she wanted PRP in her scalp because she wanted her hair to be there as much as possible, even when on chemotherapy. So this is where I would use the F-word if I am tempted because it makes me angry when people want to say something that has to do with just looking pretty is not important.

It is.

So how could you push this out?

You could call your local reporter and say, “Hey, the Cleveland Clinic is talking about how COVID is causing erectile dysfunction. One of the causes is a change in hormones, another cause could be a change in just fatigue or energy level. And another cause may have to do with circulation. I have ways that I’m treating all of that in my office. And so if you want, I will do a story about, and let you interview me about this and just mentioned offhandedly, but the main thing for your listeners or readers or watchers, whatever will be about the news. But of course, I’ll want to mention that I treated it in my clinic.”

And then you send them an email with links to that I just gave you. And I will be shocked if some of you don’t make it onto your local news, then you send out an email to your people about the same thing, where you say, “Hey, if you’re locked down, you’re not feeling so happy these days, and you’re suffering from sexual dysfunction or depression. I have some ways that I might be able to help you.”

So okay, beautiful. I just got a link that… Here let’s see if I got a text that George is on the call and must be signed in under someone else’s name. I don’t see his name. Hey, George, if you could raise your hand or something so I can identify you, I think it must be on someone else’s computer or something. So that I can unmute you because people want to hear your story.

Okay, let’s see if I can find him. He is supposedly on this call. Let’s see if I can find him. George survived, his businesses survived, and he survived the freaking ventilator. Give me a second. Let me figure it out. Let’s see if I can figure out where he is. I’m just going to call him. Sometimes the freaking… I’ll call his wife. He’s got a brilliant wife who runs his office there, and I’ll bet she will answer the cell phone. Here we go. And she will know where he is.
Nicole:
Dr. Charles, [inaudible 00:09:45].
Dr. Charles Runels:
Hey Nicole, I don’t see George on the call. Is he on the call?
Nicole:
Yes [inaudible 00:09:50], just hold on one second, please.
Dr. Charles Runels:
Hey, Nicole, let’s just do this, can you just hand him your… you guys, I have the phone on speaker so you can just hand the phone to him, and we can do it this way-

Dr. George Liakeas’ Tips on Surviving COVID–physically and financially

Dr. George Liakeas:

Can you hear me?
Dr. Charles Runels:
Perfectly well, so much easier than trying to do all the freaking webinar links. So guys, let me introduce you to George and his wife, Nicole. I’m going to pull up where you can see his picture. Here he is. And this is his website where he teaches. But obviously, this is a personal thing. I mean, when you have a near-death experience, that’s a personal thing. But I felt like maybe there are some lessons to be learned. And George is a natural-born teacher. He has residents come through his office there in New York City, and he teaches an amazing class for us. And many of our members have come through his classes, but I thought, how can you go through both making it as a business in New York City and making it off a ventilator from COVID and not learn something.
So I asked him if he’d be kind enough to just share whatever he thought might be helpful to the group. And here he is. So you are up, George if you want.
Dr. George Liakeas:
I’m here.
Dr. Charles Runels:
They should be able to hear every word.
Dr. George Liakeas:
Well, thank you for having me. So I still can’t, I’m still not speaking back to normal, one, this is not my voice, normal voice, and two, you’ll hear me often gasping for breath. I feel fine, but anyone who hears me, it’s a little bit scary, and it is what it is. In fact, the other day, we have a relative who was celebrating her 99th birthday while we, my wife and I were celebrating our anniversary. And this person always includes them in our anniversary celebrations. And there she includes herself because, at 99, I guess you only have a few left, but the comedy was that she couldn’t blow out her candle. I couldn’t blow out my candle. And Nicole had to blow out to all three candled, and it was really… It was like, whoa.
On the one hand, it was obviously comical. And on the other hand, my mother, who was sitting there, was saying, “I can’t believe my eyes.” So believe it, coronavirus is a little bit scary. I don’t know why. I’m only 49 years old. I don’t have high blood pressure or diabetes. I don’t know why I ended up on a ventilator. It is a different world now, that’s true. Forget about the vaccines, which whenever they are available. Thanks very simply some of the things we didn’t know where I’m just stand back in March. I got it at a time when we were telling patients to not wear masks. Not only were we telling them the masks were unhelpful, we were telling them to not wear masks because the CDC and the department of health organizations were telling us that masks you fidget, et cetera.
So that’s when I got it. I think I know a few patients that we were testing and might’ve given it to me. One of them I spoke to not too long ago, and I said, “Paul, did you ever… How sick did you get? Because I think you gave me coronavirus.” He says, “I don’t think so. You probably got it from somebody else.” Maybe, also, maybe not anyway, whatever. I don’t know why I was even bringing it up, but it’s become sort of a comical part of my life. And I can only say this, of course, because I survived.
At the end of the day, people said, “Well, what did you learn?” By the time I got sick, I had tested about 30 people positive. I had tested probably 80 people in total. I mean, I was testing them on the street, and because we didn’t want them to contaminate the office, Paul snuck upstairs and felt he was fine, didn’t want to leave. So he was a good example of how easy it is to contaminate your environment.
But even when we were testing, even when I was testing people on the street and I would say to them, “I’m going to put this in your nose, or even you put it in your nose, don’t cough, they might make you sneeze or cough. Don’t cough in my direction. Don’t cough in that puddle. Don’t cough on that guy’s car.” The city was empty. But I would tell them these things and test them right there on the street. And as they put it in their nose, and of course you see stars a little bit. They would turn to me as if to say, “I’m about to sneeze, get away.” And then they would sneeze in my direction even though I was [inaudible 00:14:27] as if I told them when you sneeze, sneeze on me.
I already know a few people that tested positive that did not follow my directions. I wasn’t wearing a mask. That’s probably how I got it. But what was very strange was that they had all… when I would call them two and a half days, three days later to tell them, “Yep, you’re positive. Now stay home and quarantine, et cetera, et cetera.” They all said, “Well, I’m shocked because I am better already.” So when I proceeded to get fevers, fevers that were shocking because I mean, I don’t remember having a fever of 104, and it’s not going down with Tylenol, but otherwise, I felt fine. No shortness of breath, no cough, no nothing. And I, too, was telling my wife, “I’ll be fine. Give me a few more hours. Give me a few more days. Let me sit here in the corner of our bedroom, I’ll be fine.” And she was very adamant that I should go to the emergency room.
And, of course, she’s not a doctor. Why would she be telling me what to do? But to appease her, I went to the stupid emergency room. And as I get there, of course, I have some patients who are patients in the emergency room. And I’m waving at them through the glass, et cetera. And after being there for an hour, wondering what I’m doing here, because who’s smarter than me, right? I don’t need to be here. All of a sudden, I couldn’t breathe.
And then I told you the comedy about it once before I’ll spare everybody the trouble. But basically, then I had to call the telephone number that I was given by my nurse. And she must’ve gone on break. So now I’m calling the front desk of Cornell University, New York-Presbyterian hospital’s emergency room, trying to tell them that I can’t breathe. And they’re telling me, “Sir, speak up. I can’t hear you.”
Dr. Charles Runels:
And this is where I just want you to pause for a moment because if you did a sitcom and George when he wants to be, or even when he’s not trying, he could be very comical. But I just want to make sure people get the picture. You’re in the ER, but there’s no one near-
Dr. George Liakeas:
People say even come to examine me. You got to get suited up. So they put me in an isolation room, and I’m by myself feeling fine, minding my own business, waving to my friends or patients/nurses, et cetera. And then all of a sudden I can’t breathe, and there’s no one to tell-
Dr. Charles Runels:
Yes.
Dr. George Liakeas:
So then I have to call the front desk. Apparently, instead of what was supposed to be the charge nurse’s phone, it went to the front desk. And I had to explain to them that I’m calling from the emergency room, and she’s telling me, “Sir, I can’t hear you. Where are you calling from, bad connection?” So I called the second time. And just to give you an idea of the seriousness, I really couldn’t breathe, but I wasn’t even thinking about it. I just wanted them to know I couldn’t breathe. And I woke up two weeks later.
But I don’t know if they found me in the corner of that room blue. I don’t know if I was… perhaps obviously, I had passed out and was cyanotic or at least my oxygenation. When I went to the hospital, my oxygenation was 88, but I felt fine. So to give people an idea, when I was telling my wife, I’m fine, this is ridiculous. I don’t have to go to the emergency room. I mean, I felt it, I wasn’t trying to be cavalier, but it turned on me very quickly. And if I had not already been in the emergency room, they would have been bagging me in my apartment. So I just survived-
Dr. Charles Runels:
That’s a very sobering thought, isn’t it? So sobering. That it can sneak up on a physician who obviously knows the signs to look for, but this idea of being hypoxic without experiencing dyspnea is unusual. Isn’t it?
Dr. George Liakeas:
But it just seems to be a common thread in COVID for some reason. For some reason, people can be hypoxic and not short of breath is what many people are saying, and that’s deceiving. So when now patients of mine tell me they tested positive, I tell them, “Do me a favor by a pulse oximeter. And if it gets below 92, I’m curious if it gets below 90, that’s not normal. And if it’s below 88, make your way over to the hospital as soon as possible.”
Dr. Charles Runels:
Yeah. Smart advice. So-
Dr. George Liakeas:
It’s has been an interesting time. We are in a different place. There’s no question about that. And since then I woke up two weeks later comedy ensued, even though I was a doctor, of course, you’re by yourself in these rooms. And I had to sort of learn how to walk again. I was completely not cachectic, but I had lost a lot of weight, my muscles had atrophied, and it was a mess. And to this day, I still am quite fatigued or easily fatigued. And this speech problem is probably from the tubing rather than coronavirus. It’s probably from a ventilator, and they tell me it could last a month for every day that you’re on a ventilator, and I was on for two weeks, but I otherwise feel fine, and I’m happy to be here. And I still go to the office to pat everybody on the back and do the things that only I can do.
I haven’t been seeing the general patients. We have half the office does the cosmetic side that my wife runs, and as estheticians and half the office does the medical, strictly medical, and for the medical, I just can’t. This is a good day, but normally I just can’t keep the level of speech going without losing my voice, et cetera.
We also have a friend who’s a plastic surgeon that came on board to help me out with some of the cosmetic things so that I’m not overly doing it because I can’t handle it. And we’ve been managing.
Dr. Charles Runels:
Good. So a couple of questions that I frequently get from our providers and from patients that I’m sure you’ve thought about in-depth. I want to come back to a near-death experience because I think there may be other things to say about that. Probably a day’s worth of things to say about that, but talk to me about what can people do? I think there should be more discussion about… I know there’s some randomness to it, but yet there’s also some science to it.
What can people do if they are just under the assumption I’m going to be exposed to COVID? What in your mind can people do to make it such that they can survive it? And here I’m thinking along the lines of, let’s say that yours as an analogy, if you’re the mother of a child with cystic fibrosis, every pathogen is a potential life-threatening thing, and you know your child’s eventually going to be on the ventilator in an ICU. And 20 years ago, I think the lifespan was 25. And now I don’t know. Maybe it’s 45 or 50, and you know it’s coming.
So my discussions, I don’t know about you, but when I talk with mothers of children with cystic fibrosis, they’re basically living with a child that’s in equivalent of a COVID pandemic all the time. But they do things to make their children extremely hardy so that when they’re on a ventilator or when they get attacked by some pathogen immune system, VO2 max, everything is optimized so that they can survive it.
So now, having come through it, by your understanding of the literature, what would you advise your patients and for us to pass on to our patients best way if you just know you’re going to rub up against COVID? What’s the best way to come out on the other side?
Dr. George Liakeas:
That’s a good question. I’m sure that there is no shortage of anecdotal information, et cetera. But most of what is said is that we would tell people that get diagnosed, and now is the time to perhaps tank yourself up, and it mostly revolves around your immunity. So I would say to other doctors, and even to patients, especially elderly patients, of course, now’s the time to sleep well, diet, exercise, try to be as healthy as you can, try not to be so stressed out if that’s possible or whatever that means, but for sure, tanking yourself up on vitamin C, vitamin D, maybe even vitamin B, those are all things that are good for your immunity.
The other things specifically for COVID is zinc and Pepcid, and Pepcid does appear to have some sort of prophylaxis or-
Dr. Charles Runels:
I haven’t heard that.
Dr. George Liakeas:
Yes, know that. So it doesn’t hurt to take a Pepcid. So why not? And then if you do get exposed or if you want to start sooner at definitely, and perhaps the most important thing is baby aspirin. So if you get exposed, when I first came out of the ICU, I was given blood thinners, Rivarox, or ultimately Eliquist, but after three to six months, it starts becoming perhaps more of a risk. So switch to baby aspirin. If there’s no contra-indication, perhaps taking baby aspirin for that person who might be positive and not know it for a week or from botic events, microemboli things like that.
Dr. Charles Runels:
So, let me make sure I catch up with you. So vitamin C, vitamin B, vitamin D, all the things grandmother said about sleeping, a baby aspirin if you’re exposed, and one Pepcid per day. Interesting. I didn’t know that Pepcid works.
Dr. George Liakeas:
And zinc.
Dr. Charles Runels:
And zinc, yes. Zinc. So we’ve got quite a lot of people on the call that are interested in what you have to say. And many of them have put in things about zinc. What sort of dosages are you telling your patients to take of the various things you just mentioned?
Dr. George Liakeas:
The vitamins C in water-soluble, and the B. So that’ll go through you, but 1000 or 2000 to start taking four or mega doses it might be excessive if you have not been exposed. So I usually tell people 1000 or 2000, they don’t have to go crazy. And if they’re exposed, then they could do as much as they want. And it may not matter the scientist Watson believed in taking 4,000 a day, but anything with vitamin B, I almost tell my patients take a multi… Sorry, take a B complex and do what a bottle says.
To zinc that I’ve been given is 400 milligrams. 200 is fine as well. Again, baby aspirin, but vitamin D because it’s winter, there’s very little chance you will overdose. You’re probably already vitamin D deficient. So instead of one or 2000, I would easily take 5,000 a day, or there’s a 50,000 once a week dosage.
Dr. Charles Runels:
All right, very helpful. And like you said-
Dr. George Liakeas:
If you do have COVID and it affects your lungs, obviously, N-acetyl cysteine seems to be very lung helpful.
Dr. Charles Runels:
Okay, beautiful.
Dr. George Liakeas:
And I believe that’s 50 a day, but NAC, which you can find at any GNC or life extensions, is a very popular vitamin link website.
Dr. Charles Runels:
Beautiful. So while you’ve been speaking, Dr. Byman has been sending me links. So thank you, Eric, that backup much of what you’re talking about. And so that’s nice. So if you guys are listening or if you go to the chatbox, you’ll see some research backing of what you hear George speaking about. Anything, I want to get to what you’ve done. I know Nicole is a critical player there and keeping your clinic running. And so if she wants to jump in, feel free, but I’m interested in how with the combination of illness. And I mean, it’s just to me, you and your bride demonstrate the epitome of grip. When you can go through a life-threatening illness in the city that’s locked down probably more than any other city and still be financially solid throughout it all and continue.
To me, this is what doctors do, right? I mean, how many physicians have died taking in the middle of the COVID pandemic, physicians and nurses and EMTs, and if nothing else out of this, it seems to be maybe the meter of respect for physicians might have come back a little bit more high on the gauge than it was a year ago because people are realizing, “Oh, wait a second. People are actually risking their lives.”
As we do with the flu epidemic every year and HIV and hepatitis C, all those things are potential pathogens to healthcare workers, but it seems like people are noticing more. And now I’m speaking to a man who almost died from what he was doing as a healthcare provider. So anyway, let’s swap from… Go ahead.
Dr. George Liakeas:
Let me say ironically. So, first of all, when I was sick, there’s no question that my wife not only saved my life by telling this fool to go to, in fact, the hospital. But had I gone two days earlier, they would have sent me home. So you have to be very cognizant of things can change, but maybe most of all, you need an advocate.
Nicole was essential to probably saving my life because she served as an advocate reminding them that not only I’m a doctor, he’s a VIP. Take care of him at a time when I can tell you from colleagues that admitted, look, we didn’t even know what to do. And maybe people died because we didn’t know what to do with them. So whether it’s somebody to advocate for you, to advocate for somebody else that is extremely important. During my time, they weren’t allowing visitors. I was in the medically induced coma.
So somebody needed to be communicating to remind people that he’s a person, do what you can, and otherwise, again, colleagues will admit that at least in the crazy times in March and April, people fell through the cracks. So having an advocate was very important, but I will say it’s the reverse, or the opposite perhaps of what you’re saying is that even now, maybe it’s me, it does feel a little bit like, “Well, that’s not a vote of confidence that the good doctor gets sick, obviously not washing his hands, touching his mouth.”
So, although people will acknowledge that it’s very contagious, the ones that don’t get it pat themselves on the back and how good a job they’re doing protecting themselves, perhaps, and the ones that do get it are a little bit in the scrutiny of, “Well, you must not have been safe,” which is not unfair, but its sort of like the doctor that smokes is a good advocate to other smokers that look, I know how difficult it is, but it’s a very bad advocate for people who don’t have smoking as advice and don’t see why it’s such a big deal.
So I think definitely again, in my case, we didn’t have masks. It is what it is, but I think definitely if you do get it, you want to reinforce that you are a clean person who is conscious and aware of the risks, and you still got it. Because similarly, I think patients need to hear that you’re taking this pandemic very seriously and that you are doing things to protect them.
Dr. Charles Runels:
Let me just, I want to go a little bit rogue on-
Dr. George Liakeas:
And I feel confidence that I got it.
Dr. Charles Runels:
Yeah. I’m going to go a little bit rogue here and just out of bounds for just one minute. There’s this in general when it comes to sickness. There’s this general idea of not just COVID among some sets of people that anytime someone is suffering. They must have done something wrong. And no matter what the suffering, if you go back to C.S Lewis writes about pain, and if there’s God, then why is there pain? And I think he puts it best when he says, “You’re going to have pain or use disease in this case, because you can do something wrong because you did something wrong would say cirrhosis, because you drank a fifth of Jack Daniels every night, you can also have pain because you did something, right like stand on the fucking sidewalk of New York and let your patients sneeze on you all day long.”
And you can also suffer. Let me put, so you can suffer for doing wrong. You can suffer for doing right. And you can also suffer because we don’t know the fuck why? Like, why does a young Jewish man get Lesch-Nyhan syndrome? And she was tongued, why does the baby get born with cystic fibrosis or sickle-cell? I don’t know. Maybe there’s something that I can’t see about that, but it seems to me they didn’t do anything wrong.
And so it’s shocking to me, although it shouldn’t be that that attitude might appear. And it’s cool that you brought it up because I know a number. I know one of our providers, and Tron was hospitalized. She would make it on the vent, but others in our group have had COVID, and I should have expected that reaction from some people, but I hadn’t.
So anyway, just in general, that’s the way I like to think about pain, and here, I think it’s the reverse. You have a man who’s suffering because he put himself in harm’s way to take care of his patients. Talk to us more about what you and Nicole did to make and what you’re still doing to help patient flow at a time when people are afraid to go outside.
Dr. George Liakeas:
Right So in the office and patients want to hear this, and many groups have done it from churches to schools, et cetera. We’ve been communicating with our patients from the beginning that we have established COVID protocols from things like social distancing stickers to handless pumps of soap in the bathroom, to remind the patients what we are doing in between patients to sanitize the room, keeping windows open, including guns that spray alcohol, even into the air.
We have an ozone machine. Some of the things I don’t even know exactly how good they are, but I know patients like to hear it. The problem is, how do you stay viable and profitable when, in the past, part of the ability to do that was to have a full waiting room and keep the patients turning. Now, I’ve never seen an empty waiting room in 17 years, and now, even if I’m not at the office, if I look in the cameras, it’s shocking to see an empty waiting room.
Now we’re not at quarter capacity, half capacity, but we’re moving them into the rooms much more quickly. And the waiting room is empty. Maybe that’s a good thing in general, but you have to tell them that you’re going to be doing that. And the one time that two people come off the elevator at the same time, somebody might even inform us, “Hey this person’s here at the same time I am.” All right, “Well, you’re 10 minutes early that person’s 10 minutes late, but what do you want me to tell you?” But they consider it bad planning on your part. So you communicate that you are doing everything you can and remind them. And if nothing else, it’s a way to stay in their minds.
Dr. Charles Runels:
Interesting. So how are you communicating? By emails, social media, how?
Dr. George Liakeas:
By email.
Dr. Charles Runels:
Email.
Dr. George Liakeas:
Yes. When we see patients, we are following up with them a little bit more afterwards and always sort of reminding them stay safe. Don’t forget to wash your hands, social distance, things that remind them we are the doctors, the healthcare professionals, and make them feel like we care and that we are on top of things. And that we are not only calling to see how did their procedure goes. You might have some swelling, et cetera, but also, we are the go-to people for all of questions.
Nicole:
Hi guys, can I chime in?
Dr. Charles Runels:
Yes.
Nicole:
Hi, everybody. So you can see our website right there. My website, I think it’s very important to have protocols on the website. People are looking for it. Even show cleaning while the clients or my clients are here. I have my spot coordinators with Clorox in hand and spraying down everything very carefully using the right words. Like we want to keep you safe. We want to keep ourselves safe, showing on social media that we’re cleaning the rooms, that we’re wearing our masks, and that we’re cocooning them here. That we’re very safe, and we’re very mindful of that. And I think sending emails constantly to remind the clients of that is very important so that they feel safe.
Dr. Charles Runels:
What’s constantly for you, Nicole? How often are you sending emails?
Nicole:
I send emails about twice a week. Or if I’m not, I send-
Dr. Charles Runels:
Yes, I do believe it. So I want to pause there and make sure everybody gets that because most doctors are afraid to send an email every two weeks or have some horror of being put in somebody’s spam folder. But what I think you’re saying is-
Nicole:
I thought that in the past, but I have come to realize more and more. I am sending them the past year. Now I’ve been sending them twice a week.
Dr. Charles Runels:
Yes, and a thing I want you to correct me if I’m wrong, what happens if you’re their person, if you’re their doctor or healthcare provider, if you’re the person they look up to, they might not read everything you send out, but if you’re sending them the kind of information you’re talking about, they won’t put you in the spam, and they’ll actually be grateful that you’re taking enough time to communicate with them, what’s new in your brain, about current events, and what’s new at your office.
Nicole:
Correct.
Dr. George Liakeas:
So we’ve spoken about this in our masterminds. Whether or not you think two emails a week is a lot or whatever. One thing that’s always important is to not just make the emails a selling as you want to sell your practice by giving them something, and what we can do very easily is educated. So the type of email is, “Hey, just a reminder, aspirin is good for the microemboli that can happen after coronavirus, keep doing that. If you feed them something and then throw in your selling pitch, they are less likely to think you’re bombarding them with spam.
Dr. Charles Runels:
Now, talk to us some about… because I’m still old school email, we talked about this a few weeks ago, the Wall Street Journal did an article about how industry is rediscovering that email. You don’t have big brother unless you’re using Mailchimp, kill Mailchimp. They’ve started censoring email of all things, but so far, except for Mailchimp, no carriers censoring emails and websites. So we’re able to talk about sexual matters and not get banned like what can happen on Facebook and other venues.
And to me, it feels like a more in-depth discussion, but I don’t know, expand upon that. Tell me your thinking about why it’s email versus social media and how are you doing it, what mechanism you’re using to send it out.
Nicole:
We’re using MyEmma. I don’t know if you guys have heard of MyEmma. I’ve been using that since I’ve been around since 2002. So that’s just something I work with, and I continue to use it. We use it for medical Sets in Smooth Synergy. It seems to be pretty good. And I just find that if you train your clients to read your emails, I send them out on Tuesdays and Thursdays. I send out educational things on Tuesday, and I also have my product line. So I sent out my products on Thursday. And that’s kind of how I’ve divided the week from Sets Smooth Synergy.
Dr. Charles Runels:
Beautiful.
Nicole:
Yeah. And for social media, we try to use social media. I really would love to have more following on social media, but I find that it’s hard to get someone who really can engage with my clients. I mean, with my client-based in my spa, I have locked down. My ideal client doesn’t really go on social media all that much. So for me, I find that the emails are working the best.
Dr. Charles Runels:
Yeah. So maybe just one more comment about that. Let’s say you were going to deliver a message about the best way. What you just mentioned about how you don’t forget to use aspirin if you are exposed to COVID, and you’re going to send that to someone you love, your family member, you wouldn’t tweet it to them. You’d write an email, or you may be pick up the phone, but if you’re not going to call them, you would send it in an email or a text message. You wouldn’t tweet it or Facebook it.
And so along those same lines, I think what you’re saying is that because you have relationship with your patients, email is more like a communication between two people who have something to say who were in a relationship, which for me, the best way to get lots of followers on social media is do outlandish things like, I don’t know, take a picture in your phone by the swimming pool, or you balance a champagne glass on your booty like Kardashian did. I’m not saying that people in our group haven’t been successful marketing with social media, but I think most of them are not paying enough attention to the depth and the quality that can happen with an email.
And if you just listen to what you’re saying, we’re hearing two concerned people who’ve experienced near death, and you’re actually delivering your heartfelt message about how to stay well to the people who love you that you care about. And you’re choosing email to do it. I should talk less and listen more. So tell me more about what’s in your brain that you’d want the group to know. And then I think we’ll shut it down. We’re coming to the end of the hour. Thank you so much, both of you, for taking time to do this.
Dr. George Liakeas:
Oh, I would probably say one thing that I think is important in terms of what can I do to generate revenue? Is, this is an opportunity to do things COVID-related. When I had coronavirus, and if you read about it, you’ll see a lot of people lose their hair. And I can attest to that. I mean, it was like, “Whoa,” it was amazing. The hair would fall behind me as I would walk, and then it stopped, and they say it’s a stressor that a number of viruses can do. And it’s, telogen effluvium, but it was impressive.
So this has been an opportunity to push, for example, the Vampire Hair Therapy for before you get coronavirus or after you get coronavirus. This is something that might be able to mitigate the strength of your hair loss. And that has been good. There’s been a good response to that.
Dr. Charles Runels:
Beautiful.
Nicole:
So I ran a little special on Smooth Synergy through the Email Blast that for the Vampire Hair Therapy, and that seemed to work. And people agreed. They said, “Oh yes I’m losing my hair,” whether it’s from them being sick from COVID or the stress from COVID. We had a real big up in the Vampire hair treatments.
Dr. Charles Runels:
Interesting.
Dr. George Liakeas:
Also, because it’s holiday season, you can start preparing for a new world and vaccine is here 2021 and start throwing out the specials for them for people that want to pre-purchase or purchase and give as a gift or whatever. It’s also that time of year. People are probably looking for a way to get rid of the negative and see some positives.
So it’s a good time for businesses to advertise. I know in Nicole’s case, she also has been very good at with some of the local businesses that have complained when they needed to shut down or when people don’t want to come. For example, collaborating with some of the hair places nearby that deal with beauty come to us.
Nicole:
Drybar. Just did a collaboration this week with Drybar. So if they come this week to Smooth Synergy, then they get a complimentary dry style at Drybar, which is right around the corner from here.
Dr. Charles Runels:
That is brilliant. And I haven’t heard people talk about that much. I forgot that I actually used to be something I would do. If you have local businesses that share clients, high-end clothing stores, high-end beauty salons, and personal trainers across promotions like that, it works wonderfully well. What about, I’ve never had that much success selling gift cards and always felt like I was doing something wrong. Are you selling gift cards? And if so, tell me how you’re doing it because I see it on your website.
Nicole:
We don’t sell that many gift cards. However, we did. We were very successful every year. I’m not a big promotion person because, in the way past, I’ve learned a lot. I mean, I’ve been in business for now since 2002. In the beginning, I used to do a lot of promotions. Right now, my brand, I’ve kind of changed my tune a little bit in the past since I’ve moved to the new location. So it’s a very high location you can see from the pictures. We put a lot of money, a lot of work into this space. We’re very proud of that.
Dr. Charles Runels:
It’s amazing, by the way, guys, if you go there, you’ll want to move in and live there it’s beautiful.
Nicole:
Thank you. So I really have moved away from promotions, and I really have moved more towards being in touch with our clients. Really giving more for their value, really going back to the gift cards. So now it’s just, I do 25% off on gift cards for Black Friday. That’s really the only time I do like a super promo and that 25 Black Friday that weekend, and then Cyber Monday, I do a 15% off. So I will give 15% off, 20% max here and there very strategically.
I don’t believe in giving away everything like I used to. No, it’s really not good for my brand. And people start understanding that there’s a lot of costs to this. There’s my expertise. There’s my knowledge. And really, it’s about the fact that I built a brand, and it’s not about giving everything for free.
Dr. Charles Runels:
Yeah. And just to add to that, everyone on this call, your brand, your most important brand, of course, is your name. And if you treat the people who come to you like they’re members of an exclusive club, because they’re able to see you and you make that a real thing by taking outstanding care of them, then that translates into what you hear Nicole talking about, which is now you don’t have to attract people by doing Groupons. They become grateful that you’re letting them walk through the door.
Nicole:
So the only thing is sometimes I am embarrassed to say, “Oh gosh, I’m done. People will Google me. And there is a Groupons that pops up.” So for people who might hang up and Google me, Smooth Synergy, I do it very strategically. I only used Groupon for facial, so way back when Groupon started and I would see all my colleagues or my competitors giving away everything for free. I was like, “What are they doing? They’re going to commoditize this industry. This is horrible. They’re going to go out of business.” And as right now, those people have closed. They made a quick buck, and they closed.
So what I did recently about a few years ago, when I decided Groupon was kind of hounding me, and I said, “Fine, I’ll do it very strategically. I’m only going to give away facials or I will stage one of microdermabrasion.” So again, I get them through the door, and believe me, I could not even believe this, but I was so surprised a lot of the Groupon, I have converted into old fellas to really very loyal clients.
Dr. Charles Runels:
I like it.
Nicole:
And I have not believed it.
Dr. Charles Runels:
I like it. So you’re pulling in, well, of course, you guys you have billionaires in your neighborhood, even billionaires, like good deals, but the idea of-
Nicole:
And they also don’t know where to go. They also don’t know where to go sometimes?
Dr. Charles Runels:
So pulling them in through your lowest price or one of your lower-priced services to help you find each other is different than just generally, that’s your main strategy for getting people in the office and keeping them there.
Guys is at the end of the hour. I’m really am grateful on notes. Crazy busy there, and lots of things going on. But quite a number of people on the call, and I’ll make this available to our group to listen to and the replay. And I know there’ll be grateful for you having the courage and making time to come talk to them. You guys have a great day. Thank you. Thank you, George. Thank you, Nicole.
Dr. George Liakeas:
Thank you, everybody. Happy holidays.
Nicole:
Thank you. Happy-
Dr. George Liakeas:
We’ll get through this; this too shall pass.
Dr. Charles Runels:
That’s right. Bye-bye, thank you.
Nicole:
Bye-bye.
Dr. George Liakeas:
Bye-bye.

Next Workshops with Live Models<---
Relevant Links

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Cleveland Clinic: Research Shows How COVID-19 can damage the endothelium of the penis<–

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Cellular Medicine Association
1-888-920-5311

 

New Ideas in ED Therapy and Staying Well

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Sexual Wellness (free on Kindle):Optimize Your Relationship, Pleasure & Sexual Health

This book provides the wisdom and practical advice of seven separate physicians who not only understand the most up-to-date science of sex but also bring to that science more than 200 years of collective experience in taking care of people seeking to make sex better.

Each of the following seven contributing authors actively practices medicine (not just talk about it) and have collectively cared for thousands of people both well and not well to help them find better sex and a better life…

1. Dr. Jean Luc Le Provost describes powerful but simple daily routines that can be used to improve overall health in such a way to specifically improve sexual wellness and pleasure.

2. Dr. Prabhat Soni uses his vast experience as a pulmonologist and sleep specialist to show you ways to optimize sleep and why poor sleep can kill your sex life. You need a functioning brain to have sex. But, just as importantly, the pituitary gland is literally attached to that brain, controls all the other glands, and is profoundly affected by sleep.

3. Dr. Cristyn Watkins discusses her personal battles and how out of those battles she became an expert in cellular therapies that improve sexual wellness from the level of tissue and histology. Healthy tissue makes for healthy, fully functioning genitalia.

4. Dr. Bill Song discusses a number of options to help increase the size of the penis—for improved confidence in men and enhanced pleasure for their lovers. Multiple modalities can be used. He helps you sort the options.

5. Dr. Dan Botha discusses extremely helpful new technology that helps with a more exact treatment of erectile dysfunction and of Peyronie’s disease. No more guessing where the problem is or if and how things might be improving after treatment.

6. Dr. Kimberly Evans describes how in her practice of gynecology she improves sexual wellness and pleasure by expertly micromanaging the hormones of women and their partners. Hormones affect the growth and function of everybody tissue; so there’s no finding your best sexual wellness without this step.

7. Dr. Ramesh Kumar draws from his decades of experience as a radiation oncologist to describe ways to recover sexual desire, health, and pleasure after cancer—especially after prostate cancer.

Dr. Charles Runels, as the producer of the book, and inventor of the Vampire Facelift®, O-Shot®, and P-Shot® procedures, uses his 30 plus years as a physician to build a utilitarian framework on which to organize the wisdom of the above seven authors with his description of systems analysis and how such analysis can be used to better understand orgasm—the Orgasm System.

Good sexual health, like good health in general, is not an event where you do one or two things occasionally and all is good for the rest of your life.

Wellness, sexual or otherwise, arises with the daily practice of certain behaviors combined with specific modern therapies when things are broken.

Labia, Beauty, Love, & the Vampire Wing Lift®

Dr. Carolyn Delucia, MD, FACOG

In Celebration of Women (and Halloween)…

A free webinar discussing the wonders of considering the beauty of all parts of the body–including the labia. Featuring Dr. Carolyn Delucia (board-certified gynecologist, teacher, and author) discussing strategies that bring sexual health and empowerment to women (including the Vampire Wing Lift®).

October 28, 2020, at 9 pm New York time.
Register for free here (click)<–