Topics Discussed Include the Following…
*Starting the conversation about sex with your patients–in order to grow your sexual medicine practice
*How to choose between radiofrequency and lasers for vaginal therapies
*Research about using PRP to help post-menopausal women to conceive
*Research about using PRP to help with Asherman’s syndrome
*How and why your aesthetic practice can thrive and grow in times of disaster
*C.S. Lewis on Functioning During Times of Disaster
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
C.S. Lews on Thriving During Times of Disaster
In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”
In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.
This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.
— “On Living in an Atomic Age” (1948) in Present Concerns: Journalistic Essays
Live Birth in Woman With Premature Ovarian Insufficiency Receiving Ovarian Administration of Platelet-Rich Plasma (PRP) in Combination With Gonadotropin: A Case Report (click)<–
Intrauterine Infusion of Human Platelet-Rich Plasma Improves Endometrial Regeneration and Pregnancy Outcomes in a Murine Model of Asherman’s Syndrome
Cellular Medicine Association
Topics Discussed Include the Following…
*Vampire Facial® techniques reviewed in Facial Plastic Surgery Clinics of North America, August 2019
*When to activate PRP with Calcium (chloride or gluconate)
*Tear Troughs & Bags Under the Eyes
*PRP with or without Amnion in the Neck
*Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
*Selecting the Best Patients for the O-Shot® Procedure
*Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
*2 Guiding Principles That Bring More Patients and Provide Better Care
*Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
*Pelvic Floor Spasm
*A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Vampire Facial® Procedure in Facial Plastic Surgery Clinics of North America
Dr. Runels: This should be a really wonderful meeting tonight. We’ve got new research, and we have the amazing Dr. Edward Tangchitnob who is out in California, award winning for his practice, and brilliant gynecologist, and surgeon, and teacher of our procedure. This should be an interesting call. We have some new research I want to just bring up very quickly. First, let me bring Dr. Edward onto the call. Let’s see, hold on just a second. I’m going to unmute you here. There’s a couple of research things that are out that I think are really nice. Hold on just a second. Let’s see.
Edward, I’m not sure what’s going on with your mic. I don’t know if you will need to call. It looks like your audio might be turned off or something. Let me go ahead and bring up the research and as soon as I see your mic light up I’ll unmute you. Let’s see if there is something here. Anyway, so I’ll be watching for that. I can see Dr. Tangchitnob on the call but I don’t … Okay, there it is. There’s your microphone. Here we go. Beautiful. There you are. Can you hear me.
Dr. Edward T: I can.
Dr. Runels: Beautiful. Look at this. Just a review article but it came out in here it is, in Facial Plastic Surgery Clinics of North America, August 2019. I don’t think you could see a better endorsement. I mean, there’s the abstract. “Platelet rich plasma has gained popularity in facial plastic surgery because of it’s healing and growth factors.” But then this is the part I love, “One of the most popular uses facial skin rejuvenation in the form of injections and topical application during microneedling …” That would be in for a facelift and facial, “… and the promising nature makes using it for injection or conjunction with microneedling a good addition.” Beautiful. That sounds like a pretty strong endorsement in that journal, or in that periodical. This is the article I wanted you, and I put a link to that. Actually, I didn’t yet, but let me put a link to that into the chat box, you guys.
Using Scientific Research to Educate and Market To Your Patients
That’s a good one to take … If you just take this link ( https://www.sciencedirect.com/science/article/abs/pii/S1064740619300331?via%3Dihub) and you put it in an email or a Facebook post and you shoot that out to your people and say, “Hey, here’s some research that came out this month.” Here’s a little trick about … It’s just commonsense, actually, for how to talk with your patients, is make, when you have this this counts as news. We’ve all heard on CNN or whatever news channel you listen to where they talk about something, they usually report it out of the New England Journal, because the guy on the street knows that’s a reputable journal. But, often it’s the news reporting on the news. This is news, and you could call up your news channel and say, “This is what I do.” You could also just post this to your social media, or an email to your people and say, “Hey, look what came out this month, more nod of approval from the the powers that be, that this is something that’s useful, and this is what I do.”
I want to shoot over … Any comments about how you’ve been doing that, Edward? I know you’ve had some success with your marketing. Talk to us about how you’ve done things like this.
Dr. Edward T: I think that there’s a lot of information out there at the fingertips of all the patients. They’re getting bombarded constantly from their Twitter feeds, their Instagrams, their Facebook. I think everyone, and anyone, really can be the so-called expert on a particular topic. When I’m emailing my patients, and I make a habit of it every two weeks using Ontraport email client,
I think that we have a very captive audience, because the patients already know and trust us, and the open or the click rate is a lot higher, especially when it comes from us. I’ve also played around a few times with the subject line. I’ve done split testing to kind of see what kind of topics and what kind of tone of the subject, or the copy, can resonate with my patients. I’ve been actually surprised a few times in the split testing. That was something I kind of picked up along the way.
Just to kind of give you an idea, a year ago I didn’t even know what Ontraport was, or an email client was, let alone what split AB testing was. But, as I’ve come along on this journey I’m finding that my ability to communicate to my patients in sophisticated ways is being appreciated. The way I’m measuring it is that I’m able to see that the number of conversations, booked appointments, and paid procedures is going up. Just as you’ve said before, the more we seem to email and communicate the more the patients are aware of the procedures that we’re performing, and the more that they’re aware that their procedures are available from the physician, or the practice they’ve trusted all these years, the conversion rate, I think, is a lot higher.
Dr. Runels: Yeah, let me expand on a couple of important points you made that I failed to make. One is that people are bombarded, but for your patients, you being whomever is on this call, and for my patients, and Edward for his patients, they are more interested in … Because they’re bombarded it’s confusing to them. As you just said, Edward, they want us to curate that and point out to them what’s important and occasionally, I think the ratio should be mostly what’s good, but occasionally point out to them something that may be popular that you don’t think is as useful. As a general rule that’s more of a waste of our energy to talk about what’s not good, but being the curator I think we tend to think, “Why do they care about what we think since they’ve got CNN, and the Mayo Clinic Newsletter, and the Cleveland Clinic Newsletter?” I actually talked to a man today that helped the Cleveland Clinic start their newsletter. They’re doing exactly what you just said, for people who wind up going to the Cleveland Clinic they want to know what the Cleveland Clinic thinks.
My patients, and Edward’s patients, and everybody else on this call, they’re more interested in what we think than what the Cleveland Clinic thinks. So, sending that out every couple of weeks, and making it something that reports, this is your perfect … This is what you wait for, and you don’t have to wait long on their procedures because we’re in the news so much. But, you shoot this out and now you’re not spamming people, you’re reporting on the news just like CNN does.
The second thing you said is that just the general idea that when I said expand on this, the idea that email still is the powerful way. Even when you post to Facebook it doesn’t get shown to all of your friends, and they’re so bombarded, and it’s limiting the conversation. Sometimes it gets banned if it’s some picture about, or something about, sex. The old email to your patients is still, in my opinion, the most powerful way to get things done.
When to activate PRP with Calcium (chloride or gluconate)
Okay, let me pull up this other … You know, I think I’ll hold off on the other research. There’s something here about … I just wanted, since you’re an expert surgeon I wanted to talk some about how PRP’s been used in surgery. Let’s skip over that and maybe do a question. This one comes up occasionally about calcium chloride. “I used to use calcium chloride. I started with Selphyl,” so the short answer to this is if you Selphyl it comes with a kit. With the others you can either order it as, it’s the same calcium chloride that’s in your crash cart or, and here’s … I’m on the O-Shot website. The reason I’m not pointing it out to the Vampire Facelift website is I quit using calcium in the face. It makes it hurt more. If I have a Selphyl kit I just leave it out.
But, you can use the same calcium that comes in a crash cart and mix it in with … So, I took it off the Facelift site, but you can mix it with the PRP. This is a video showing you how to do it, so you can take that ampule, mix it in to just a 10 cc syringe and then use that syringe as a dispensing vial into an empty syringe and then put your PRP into that, obviously not cross-contaminating that. You can make this into a multi-dose vial.
There’s a source of it at mrcrashcart.com. It’s where you get your calcium chloride. That’s 10% calcium chloride. Also, you can get it at McGuff, which is the same place where we get our syringes, and it’s on this supply list that sits up here. There’s your supplies in the PDF file right there, and where I get some of it. There’s the phone number, there’s the email for McGuff, and that’s basically if you order everything on that you can do pretty much all of our procedures if you have a PRP kit.
What’s your … Edward, I know I really stress using calcium chloride for the O-Shot® and the P-Shot®, and if you’re trying to grow nerves. Say you lost the sensation in the breast. I’ve quit stressing it. I don’t see people talking about it much with hair anymore, or with the face. Is that still what you’re doing, or have you altered that in any way? What are you doing when it comes to calcium chloride, or calcium?
Dr. Edward T: No. I still follow the teaching that I was given originally, which is exactly what you had mentioned. I’m finding, particularly, with the Vampire Facelift®, for example, the ability to kind of spread over the cheeks and in the nasolabial folds, as well as run down very finely in the tear trough, I don’t use calcium chloride to activate. It would be a little bit to viscous, in my opinion.
Tear Troughs & Bags Under the Eyes
Dr. Runels: And there is that idea that, which you just mentioned, is that with the O-Shot® you want it to gel quickly and stay in a pretty small area, relatively speaking, where with the scalp and the face you want a more diffuse spread. This right here, I think, is a really important point. Dr. Hamilton has someone who has some bags under the eyes after injecting. I recommend, and the question is, “What do you do?” Absolutely I’ve treated a lot of people who came in with … The tear troughs, not so much in the lower lid, but in the tear trough area if it is convex I can almost guarantee you there’s filler in there. I’m seeing people say, “No, it’s not filler,” and then I put a hyaluronic base in it, just a little dot, and it goes away. When I say a dot I mean one unit on a 30-unit insulin syringe is what I do with a 31 gauge insulin syringe and just put 0.01 mL in there, or one unit on that insulin syringe, and it goes away.
But, if you don’t have a lot of experience with using fillers I just wouldn’t use. I would use PRP as a stand-alone in the tear troughs, or do a mixture of one part JUVÉDERM® and nine parts PRP, so 0.1 of JUVÉDERM® and 0.9 of PRP in a 1 cc syringe, swished around, and use that and this is less likely to happen. But, it is fixable. I know you sent me some amazing pictures, Edward. Do you have any of those handy that you could show us? And, you can talk about what you’re doing, because I know you’ve developed some pearls around the face. Do you have any of those handy that I could just hand you the screen and you could talk to us about what you’re doing?
Dr. Edward T: Sure. Give me one second here.
PRP with or without Amnion in the Neck
Dr. Runels: Yeah, that’s cool. I’ll talk about this next question while you’re pulling that up. “Any protocol for injecting PRP with or without Amnion into the neck?” I think we covered this, actually, on the last call, but just to review. I think if you’re working with the neck I’d do three things. Again, if it’s a turkey neck they need a surgeon. I send lots of people for blephs, and for neck lifts, and facelifts. If it’s just necklace lines, or if there’s some platysma looseness that I can fix with Botox® then I go for it, and people love it. I charge for the PRP part of it 600 bucks. What I’ll do is … I treat it like a scar, basically. So, in the necklace lines I’ll put 27 gauge needle into the necklace line and inject intradermally and subdermally with PRP, and then microneedle PRP on top of that.
Then, if you’re going to mix Amnion with it, I just use one of those half cc Vampire Amnion. You know we have our own brand now that’s about one-fifth the price of what most people charge and it’s good stuff. You put a 0.5 cc of that, or a half a cc of that to 5 cc of PRP and mix it up and then inject it. Then, Botox® 2 units along the line about every inch or so apart, and then put them on a good cream, put them on our Altar® Cream. If you want to go all out, put them on Retin-A 0.1% cream at night and our Altar® Cream in the morning and they get amazing results. You found some pictures for us, Edward?
Dr. Edward T: I did.
Dr. Runels: Okay.
Dr. Edward T: Let me see if they-
Dr. Runels: Yeah, I’m going to hand you the … By the way, you guys, Edward teaches a great class where … Actually, let me just give you the screen. I want you to show us your pictures and then we can talk about your class. Let’s see.
Dr. Edward T: I’ve got a great story about this first case, if I have control of the screen here.
Dr. Runels: All right. It should be offering it to you right now.
Dr. Edward T: Do you see what I see here?
Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
Dr. Runels: Yep? I got you. She’s 55-60 year old woman treated with Vampire Facelift®.
Dr. Edward T: Originally, to take us back, this patient found me. She had actually moved, her and her husband from Tennessee and found me for an O-Shot®.
Dr. Runels: Beautiful.
Dr. Edward T: We ended up doing an O-Shot® on her and there’s so much crossover with the PRP procedures that she asked about the Vampire Facelift®. Naturally, we ended up doing a facelift on her. Now, this was one of my great kind of before and afters, because she had such a great result both from kind of the textural component as well as the shape. Staying with the classic form here I ended up … I just used one syringe. I used [inaudible 00:16:07]. I did some [inaudible 00:16:08] around her PRP, and that’s the result she got. My pearl is with this particular case I remember … I think that I was able to achieve the lift I did really by pulling, doing a pulling technique. When I first started doing these injections I would go right on the periosteum, right where the zygomatic arch is.
I still do that, but now I pull up very aggressively, and I draw Dr. Hinderer’s lines, which you can see here kind of mid [inaudible 00:16:41] down to the lateral aspect of the nose, and the lateral canthus down to the mouth. See where my finger is, this pointing arrow what I do is I lift and pull up really, really high on the skin and you can actually see where that line used to be, the one I drew when you kind of pull the skin up taut. I inject where the line used to be. What I mean by that is that for patients who are over the age of 40 who have a little bit more heaviness and need more lift I’m really kind of pulling up and I’m using the filler as a tack.
Dr. Runels: Interesting.
Dr. Edward T: I think before I was, basically, just filling down to the level of the bone hoping that it would just raise the skin. But with this technique when I’m drawing Dr. Hinderer’s lines I’m pulling the skin as high as I can. I inject with my right hand, so I pull with my left hand, and then I kind of see where that line used to be and I inject there. Obviously, when you pull the skin up with your left hand here, the line you drew goes up. So, the line you can imagine that used to be there is where I inject. That’s kind of the after that I get here. There’s a lot more kind of superolateral projection doing this pull and lift technique. I started developing this because as I’m getting into the more longer-lasting fillers such as Voluma®, that’s actually how Allergan teaches it. Now, I’m combining this lift and pull technique with the Vampire Facelift®, which was my introduction to facial aesthetics when I first learned this from you, Charles.
Dr. Runels: Beautiful. So, can we go through that again? So, you draw the lines and then you pull-
Dr. Edward T: What I do is … Right. So, I draw the lines and then I pull up on the lateral aspect of the cheek just as high as I can with my non-injection hand. Where the line used to be, now that it’s been moved up, that’s where I inject.
Dr. Runels: While you’re holding it up?
Dr. Edward T: While I’m holding it up.
Dr. Runels: Okay, beautiful. You’re directing all along the lateral zygomatic arch there. Is that what you’re … Okay.
Dr. Edward T: I’m doing the 0.15 and the 0.5 is classically descried by the Vampire Facelift®. I think I’m getting more bang for my buck when I’m thinking about using it as a tack rather than as a fill, and then I put the PRP over it and it seems to work really well with that lateral superolateral projection.
Dr. Runels: That’s some beautiful photographs. What are you doing around the tear trough area? I hear lots of different techniques for the tear trough. I like that technique where you’ve taken the best of Allergan’s teachings and then one upped it with your Vampire ideas. Talk to me about … By the way, if I were defining the Vampire Facelift® it would be like this. Take a syringe of filler, do your best work with it, polish it off and think of that as reshaping the mattress, keeping in mind the ideas that you just mentioned about shaping the, restoring the youthful shape of around the eye and the mid cheek area especially, because that’s where research shows that we first get an idea about our perception of how old someone is. So, that’s where you start and then you think about the other things that are described on the website based on your understanding of the face and your understanding of your best technique.
I never expect everybody to do it exactly the same way. We all have different eyes on different days and with different people. As long as those techniques are used then they’re going to have the best result possible. It’s just what’s going to happen. So, that’s the Vampire Facelift®. Around the tear trough, and we all have a different way of seeing it, but we’re all following that basic principle, using HA, make your best useful shape, polish it off with PRP, and then if you need more HA that’s fine go for it, but let that be additional cost to the patient since it’s additional cost to us, and that way we’re all going about the same guidelines as far as our pricing, as well. The tear trough, though, is where I see the most variability, so talk to us about what you’re doing since that was one of the questions tonight.
Dr. Edward T: Absolutely. I get very, very medial all the way up almost to the nose, and then I inject and I’d watch the PRP fall backwards. I don’t activate, by the way. One of the risks that I … Actually, one of the side effects of this particular technique is I almost always get a little bit of bruising, and so they get kind of that darkened shadowing after I do a Vampire Facelift®. It goes away and I assure them of that, but I’ve been getting really great outcomes with it. I also get better outcomes I’m finding when they come back four to six weeks later, and I only inject their tear trough with PRP. I think sometimes the first PRP injection might not be enough, particularly if they are almost on that borderline of needing a lower bleph. I also finish it with Lytera®, which is a skin cream made by SkinMedica® that helps with pigment. I learned that one from an oculoplastic colleague of mine who gave me that pro tip.
Dr. Runels: Beautiful. Thanks for the pearl. That’s why we do this at night. Let me ask you for a little bit more clarification, though. You started that explanation by talking about doing something more medially. Can you talk more about what you meant by that.
Dr. Edward T: Absolutely. If I may use my … If you can still see my screen here, I’ll use this picture. My needle originates or goes in here and goes all the way to the most medial aspect of the eye near the nose here. I’m going to zoom in here slightly. To me I see this triangular shape here that I want to fill, because when I go through this crepey, or there’s almost always kind of crepeness here of the skin. The bag, or the space here, is so thin here it fills so well with that unactivated PRP that it filled all the way up to here and comes back. I don’t know if that was by design or not. I suppose to try to get rid of your tears as you kind of tear, but it’s natures way of very efficiently kind of whisking away excess fluid there. I’m just kind of leveraging that shape.
Dr. Runels: Interesting. Would you say the name of that cream again that you’re using, and you’re using it for the crepe papering in the lower eye area? Is that right?
Dr. Edward T: Correct. It’s actually Lytera® 2.0. It works great because it works well for the color. In those patients who have an ethnic predisposition to bags under their eyes this alone works fantastic. That’s where I got the idea to begin pairing this with that part of the Vampire Facelift® that involves injection of PRP under the bags of the eyes.
Dr. Runels: Just so you guys know. You may have picked up already, Edward has a strong background in mathematics as an engineer and then is a world-class and award-winning robotic surgeon and gynecologist there in Southern California, and does a really beautiful job of teaching combination therapies, teaches BioTE®, so he teaches hormones and he teaches lots of ways of thinking about how these procedures can be combined with energy sources and surgical techniques. With that introduction, can you pull us up some pictures and talk to us some about your ideas about the O-Shot®, starting with maybe, if it’s handy, maybe that picture you have of the urethra, which I think is amazing. But, talk to us more … I want to get back to marketing, because you’ve been really successful with the marketing.
Selecting the Best Patients for the O-Shot® Procedure
First, talk to us some about your ideas about patient selection. I never want to get away from the idea that the better we are about patient selection, that’s the first step to having great results. All of us want to have wonderful results and be paid appropriately for doing, basically, miracles with our patients. Can you first start with explaining this picture and then some patient selection pearls?
Dr. Edward T: Absolutely. To kind of go a step back, as an engineer I think that it’s very important to define and measure all the activities we do. As a physician I try to look for those tools in our clinical toolbox to measure these outcomes. When I had done my fellowship in robotic and urogynecologic surgery at Scripps Clinic in San Diego, one of the kind of key aspects of my training, even before I started doing pelvic surgery, was urodynamics. Urodynamics to me is the gold standard for actually assessing the different kinds of urinary incontinence. Does the patient come with a pure stress urinary incontinence? Do they come with a overactive bladder picture? Or, is it more commonly the most common kind, which is mixed, which is actually the most difficult to treat. So, when I do my assessment of the patients for their candidacy I think it’s ideal when you do the full work up, although it doesn’t happen every single time, to have some kind of urodynamic evaluation.
The area that I look at, and I’m most interested in … Actually, I’m going to scroll down here, is the intrinsic sphincter deficiency assessment, or the urethral closing pressure, because I really want to know at the urethra what the degree of damage or the degree of strength that resides. To me at one end of the spectrum you have a very healthy urethra that upon closure can actually withstand the increased pressures that are created when the patient laughs, coughs, or is a little bit heavier. That’s a young patient, maybe they’ve not had kids before. They cough real hard they’re not going to leak, because the urethral pressures and that intrinsic urethral strength is quite strong.
On the very other end of the spectrum, you have a patient who has intrinsic sphincter deficiency in which the urethra takes on more of a complete pipe shape and function. In the case of the patient with intrinsic sphincter deficiency, when you perform urodynamics on them you will see that their urethral closing pressures are way less than 50 mmHg. They’re actually quite low. In my opinion, the patient who is healthy, who can be continent when they cough really hard, versus the patient who has intrinsic sphincter deficiency, somewhere lies in between the ideal patient for doing an O-Shot® for urinary incontinence.
I’m thinking, in my mind, Charles, that the patient who doesn’t have a lot of tone to begin with … You could probably do four or five O-Shots® on them, several lasers, even putting a sling on them, and it may not work. Why? Well, I think by nature that urethra it’s too damaged or it’s not functional. Many of our procedures that are noninvasive, such as doing an O-Shot®, or doing two, or even giving them testosterone in the form of a pellet that causes hypertrophy of the muscles that surround the urethra, may not work. In fact, when you kind of do the literature search, one of the gold standards for performing a treatment on someone with intrinsic sphincter deficiency is to do a TVT, or perform a TVT, a transvaginal tape, in which it’s a lot of back support against that urethra does not work that well.
If you look at … I’m a big fan of the mini-sling, the Solyx. For those of you who are on the call right now, mini-sling is a very small sling that’s usually called the minimally-invasive sling, because it’s so small and doesn’t pierce through any of the spaces, may or may not give as much of that backstop support for someone with ISD.
What does that mean for all of us performing and looking for the ideal O-Shot® patient. Well, I would actually really use the history to try to guide us. How long has the incontinence been going on? Are there things that you can do, or things that you’ve tried? Some patients have been very good about doing Kegel’s muscles and Kegel training. They get some improvement upon doing these Kegel muscles. They just can’t get to it every day. I mean, we have such busy days. To do Kegel muscles with intent it’s just so difficult. That patient is a good O-Shot® patient, because they can demonstrate that with some exercising they could bring back that tone.
Someone who has had … I actually saw a patient today. She had had two C-sections. I’m about to do an O-Shot® on her next week. I think she’s a good candidate. We just did her urodynamics. We’ve proven that her urethral closing pressures are well above 50 mmHg. It makes sense in her history that probably with time, age, and the decrease of hormones that that tone or incontinence is changed. I think she’s going to be a fantastic candidate for an O-Shot®. These very soft findings in the history, not all of us have urodynamics ready to do in the office, I think really guide our ability to find that O-Shot® patient. Sometimes it might take another O-Shot®, for example.
Dr. Runels: Can I ask you two quick questions? First, for the person who doesn’t have the ability to make those measurements could you elaborate more on what clinical history or physical findings they might use that you’re correlating with those measurements? Second, do you have the beginnings of a data bank measurements before and after an O-Shot® that we could publish somewhere?
Dr. Edward T: I’m beginning to collect that score, because very early on, which is why I’m referencing this picture, I wanted to find a way to measure, if not visually, at least quantify the difference in the closing pressures after doing an O-Shot®. Now, this particular publication, or this article submission, was a case report of a 48-year-old gravida 5 para 2 … Actually, wow, last year. Almost by design a year ago that I had published, and this was after we did an O-Shot® in the operating room for a patient we did robotic surgery on. You can see here before the O-Shot® I put the cystoscope in. This was a 30-degree Stryker cystoscope, and you can see what the urethra looks like before the O-Shot®, and this is immediately after. I can imagine with time that the O-Shot®, the effects of the O-Shot® platelet rich plasma probably would just improve the tone of the urethra.
I actually don’t have, and I wish I did, pictures in a series of what happens at 30, 60, and 90 days, because I don’t know how I would consent a patient to do cystoscopy just to see how the O-Shot® is doing. More rather, bringing the patient in and just kind of asking what their incontinence level is.
The second part I think you were asking is, looking at a questionnaire, which is what we did, I’d be happy to share with the group, too. There’s a great one developed by LABORIE who makes my urodynamics equipment. It’s a checklist of about ten questions that, basically, look to see, Do you feel like you have to pee as soon as you put the key in the door? We call latch-key urinary incontinence, which really speaks more towards overactive bladder. Or, Do you leak when you cough? How many pads are you using a day? You could almost get a gestalt on whether they have stress urinary incontinence or overactive bladder, for which the two treatments are different. I am seeing almost in colloquial, or kind of informally, that the patients with overactive bladder are needing to use less Detrol, something about their O-Shot® and rejuvenating some of the vaginal mucosa immediately underneath the bladder helps with overactive bladder.
Dr. Runels: Anecdotally we’ve had some people with very severe cases that have made remarkable changes, so hopefully you can get us some objective numbers that we can publish somewhere. Can you give us your pearls about actually doing the procedure, and thank you for showing those pictures and, yes, we would like to see that survey you’re using for measurements.
Dr. Edward T: I’ll get that to you and maybe you could distribute it out to-
Dr. Runels: I’ll just post it on the web … Is it copyrighted? Is it something we can post?
Dr. Edward T: It’s pretty general.
Dr. Runels: Okay, I’ll post it to the membership site for people to download. Would you talk to us about your pearls about how you think, what you’re thinking, when you actually do an O-Shot®?
Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
Dr. Edward T: Absolutely. So, when I talk about … I’ve experienced in two realms and I’m very fortunate because, I think I’ve told you this before, my hospital system has been extremely supportive with regenerative medical techniques that I’m doing in the OR. My story in terms of the OR, versus doing it in the office, which I’ll talk about in a second, really stem from a product made by Stryker. Stryker made a product called Vetigel® and Vetigel® is a combination of autologous PRP in which the scrub tech or the nurse that would have to draw the patient’s blood and then mix it human thrombin and that’s what our GYN oncologists and I were using to put on the vaginal cuff before I even took your class, Charles. This is …
Dr. Runels: Interesting.
Dr. Edward T: … before I took your class. We were finding that the rate of vaginal cuff dehiscence and post-robotic hysterectomy spotting went to nil. One of the most frequent calls that we get as a gyne robotic, or any kind of gyne surgeon, is post-hysterectomy spotting, because the cuff has little pores through it. We were just plugging the Stryker Vetigel®, which is really just PRP plus thrombin, over the cuff and the patients had less pain. They were not spotting. We had less calls. We were happy.
Then about three months later it made me so sad because Stryker pulled the product off the shelf. In my very engineer mind I said, “You know what, this is just too good of a product to not have on the shelf,” so I started looking at other companies. We use Regen. We were able to replace a pre-existing product in our hospital OR with a similar product. I think I found a very pleasant loophole, right, because I had to have something to replace it, so we found something to replace it that ended up being a lot cheaper.
Dr. Runels: You’re referring to Regen when you say there’s something to replace it? Regen Therapy?
Dr. Edward T: Yeah.
Dr. Runels: Okay. I’m going to put a link … I don’t want to stop your flow and I’m not changing the subject. I’m just going to put a link into the chat box, guys, with a few … to just a PubMed page that shows a few, four papers, about using PRP in surgical situations, one with mesh, one with rectal-vaginal fistula, along those similar lines. So, when you’re using this as part of a hysterectomy are you making a gel with your Regin kit, or how are you processing it to make it do the same thing that the previous Vetigel® was doing?
Dr. Edward T: When I do it with my hysterectomy, I do make it with a gel, and I [inaudible 00:36:47] calcium chloride, and I add about 0.1 of thrombin, that is autologous thrombin.
Dr. Runels: Yes, and Regen, just so you guys know, Regen has a kit that comes with thrombin …
Dr. Edward T: Exactly.
Dr. Runels: … or a way to make thrombin, and they also have a setting on their centrifuge to make a gel. Am I understanding properly? Is that what you’re doing? Are you using that thrombin kit?
Dr. Edward T: That’s exactly what I’m doing, but I’m doing that above the vaginal cuff. When I undock the robot and I’m done with the … Actually, I did the same exact same for a stage IV endometriosis patient today. She’s on the floor. She’s doing great, and after I undocked the robot then I used my PRP kit, and I do a classic O-Shot®, and that’s it.
Dr. Runels: Interesting. Beautiful. That’s pretty amazing combination therapy. Do the people that are getting hysterectomies from you, do they realize what a higher standard that you’re taking this procedure to? I guess they do. Tell it to me more about, do they find that out when they show up for surgery? Are you advertising this combination or way of doing hysterectomy, because it sounds like what I would want my loved one to have?
Dr. Edward T: I think that at the end of the day I’m guided by the same principle that my father, who I operate with still today, actually we just did the case together, has always taught me, which is be very patient centric. I just want to take care of my patients. The money part, and the finances, and the marketing sometimes, as you know, Charles, can get in the way of that.
Dr. Runels: Yes.
2 Guiding Principles That Bring More Patients and Provide Better Care
Dr. Edward T: It’s kind of a very means to an end, I suppose. But, when I start counseling the patients about what we do I start out by saying that we want you to recover as quickly as possible. So, when I lead with that, and I also followup with the fact that we utilize the newest and latest technology in regenerative medicine, the patients begin to understand that their body actually does have a natural mechanism to heal itself. If not using parts of their own body, why would I reach for something on the shelf if I didn’t have to, if I could use their own PRP, and their own thrombin, autologous, to help them heal? I think when it’s set up like that it’s an easy sell.
Dr. Runels: Well, and part of the reason I brought it up was that I feel like, as your father said, Part A is that the want to be patient centric and make sure that we’re always doing the best with the least amount of risk. Then, Part B is that, I think, it’s our responsibility to make sure that our patients know what we’re capable of doing. I think that’s a different way of thinking about it than the way, and I know that’s the way you think, as well, but some people think, “Oh I just want to do it but I don’t want to have to sell it,” but if you use a different way, and it has to be sincere, of course, but if your way is not trying to get people to do things, but your way is taking responsibility for educating people in what you’re able to offer them as an option, and then they decide what they want based on a fully-informed description of the possibilities.
That, I think, is really what we’re supposed to be doing anyway, whether we’re taking insurance or not. If it happens to be something that somebody could pay you for, well that’s wonderful, but it’s kind of what we’re supposed to do anyway, and that is the best way to “sell stuff.” As you know, I never script these conversations with our teachers, because I like the serendipity of discovering along with the people on the call what might be possible. Have you had any of the gynecologists reach out to you, or do they even know it’s a possibility the ones who come to your class for you showing them this way that you’re doing a hysterectomy, or is your description you just gave enough for them to take it and run with it?
Dr. Edward T: Well, I think that they understand it. I always get a very academic nod to what I’m doing but to your point, Charles, some of the GYNs that I train, they’re my colleagues, they’re a little bit slower to adopt, because we’ve been kind of put into a corner with our Board certifications, and you’re supposed to do it this way. I’ll be honest with you, if that’s how we did hormones then we wouldn’t have any progress.
Dr. Runels: Yes.
Dr. Edward T: If all we did was treat to the exact specifications of what [inaudible 00:41:25] put in brackets, none of our patients would feel better. We would still have all these issues.
Dr. Runels: Is there something you can measure, for example, that postop spotting that you were talking about? Is there something you could measure where you could do the next 40 patients, 20 with and 20 without that? It would the great to have some sort of paper where we could let people know what you’re doing. You know, I just put a link in PubMed where there is some discussion already. I couldn’t find the one … There’s one out there somewhere about using PRP as part of the hysterectomy process. I guess it came out of the people who did the research for the last product you mentioned, but I can’t find that paper right now. Anyway, I won’t dwell on it too much, just to let you know it’s something else that would help the whole group, because there’s lots of GYNs and urologists in our group.
Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
Okay, we’ve got a couple of questions, and I’m going to unmute Stephen Carp who has a question for you. Let’s see if I can unmute him here. Let’s see. I’m just going to let you ask him instead of me trying to slow down the mail. All right. Dr. Carp, you’re unmuted. Go for it.
Dr. Stephen C.: How are you? Good evening.
Dr. Edward T: Hi.
Dr. Stephen C.: I’ve got a patient that came in, been a long-time patient, who came in just looking for a potential solution. Had endometrial cancer. Had a hysterectomy with radiation and has some scarring that’s tender, and discomfort, a few cm proximal to the introitus that’s probably from about 5 to 8 o’clock or so. She came in because she’s actually a physician and wondering if PRP might be something that could help soften that, might help with that area. Have you had any experience with any PRP in post-radiation in the pelvis?
Dr. Edward T: I have not, but when I think about the three or four cases of patients who have had traumatic vaginal deliveries, they create quite a bit of scar tissue in that fourchette. The success cases I’ve had for those particular ones required more than one O-Shot®, and by O-Shot® I mean doing the classic O-Shot®, but then also doing focal 1-2 cc of activated PRP right into that area of the scar tissue to soften it up. I would also go so far as to maybe use vaginal dilators and, depending on the comfort level of the oncologist, there’s a great product that has compounded DHEA that could definitely soften that fourchette. DHEA with history of gynecologic malignancy is still kind of up in the air, but I have a lot of breast cancer survivors. We’re right next to City of Hope, my practice, and we were using a lot of these nontraditional therapies to help these patients out. I can imagine the irradiated tissue is very similar.
Dr. Stephen C.: Yeah, I would think so.
Dr. Runels: Let me add to that in that my position that I am grateful every day is now becoming described in the Earpiece for lots of brilliant people like you guys. I’ve had quite a number of people, probably a dozen different providers, call me and tell me about similar cases, several cases of dyspareunia post radiation. One case in particular comes to mind where a woman had repeated tearing and pain in an old episiotomy scar, and just like you just said, Edward, it took three treatments with injecting, basically infiltrating the areas if you’re getting ready to suture it intra and subdermally with PRP, and then waiting four to six weeks and doing it again, and doing that three times, and then the woman was without pain and without bleeding. It was something that was a nuisance for quite a number of years. Another case of radiation that had some scarring and pain around the anus, as well. Yeah, so it’s been done and it’s been helpful, and hopefully some of you guys will publish a case report.
I had a case ... While we are talking about dyspareunia, I had a case of scleroderma that got well, but just one. These are … No one person has enough to do a series, but maybe we should some case reports, or try to pool it. What else? Anything else, Dr. Carp?
Pelvic Floor Spasm
Dr. Stephen C.: I’ll just as an addition to that, have you had any experience, especially with urogynecologic, with Botox® for the spasms that they get in the pelvic floor?
Dr. Edward T: I have not done that, although many of my colleagues have. One of the risks of doing that is if you do it too much they go into retention. I have not done that particular method. I have used CO2 fractionated laser. I’m a big FemiLift physician. I use FemiLift quite a bit for overactive bladder, as well as the compounded vaginal estrogens work very well. I think there is a great deal of dysfunction at the level of the vaginal epithelium, that thin layer that separates the bladder from the vaginal canal that needs to be addressed. It gets irritated in these patients with overactive bladder.
It’s really interesting, because one of the gold standards that the insurance covers is the administration of Detrol, or an anticholinergic, which many of my patients within about 30-60 days will self-discontinue due to the side effects, the dry mouth, the dry eyes. They might have less overactive bladder but [crosstalk 00:47:28]. There’s some brain slowing, especially in the older population.
Dr. Runels: Yeah, there was actually a paper out about six months ago that was pretty compelling that there really is an increased risk of dementia long term, as well.
Dr. Edward T: I can see why. You, basically, create that parasympathetic overabundance or push the parasympathetic system to try to dry everything out, well it’s probably going to slow your brain function down, as well. The patients are getting forget. I think it’s very high risk in the older population due to polypharmacy.
Dr. Runels: Anything else, Dr. Carp?
Dr. Stephen C.: No. Thank you.
Dr. Runels: Thank you for the excellent question. There was quick question from Dr. Vora about Emsella, and the answer is, “yes,” some of us are combining Emsella with results. Some are using the intensity vibrator that has contraction component to it. Are you doing any of that, Edward?
Dr. Edward T: So, I was using the [Visa 00:48:30] Plus for a while. I don’t know if you’ve seen that as a at-home device.
Dr. Runels: Yes, talk to us about it.
Dr. Edward T: So the Visa Plus is something that the patients were using. They would take home, use as a light therapy that helps with collagen generation and urovascularization. There’s two versions of it. There’s a version that’s available in the United States, and then a stronger version which I think is only available in Canada, is one of the examples of, I think, an at-home treatment that the patients can use.
Patients always want one and done. From the very beginning I try to tell them, especially when it comes to some of the dyspareunia associated with the menopause state, once estrogen runs out and the vaginal epithelium begins to change it takes a variety of different approaches that begins in the office and really continues with the patient at home. I might do an O-Shot® on them and have them go home with something called … There’s a commercially available medication called Intrarosa®, which is compounded DHEA, or I would use vaginal estrogen. They’re going to work on that at home for the next 30 days. They may come back. I do another pelvic exam. Maybe the grade of the atrophy changes, or improves, or they could have one more sexual encounter that month. To me that’s a win. Then we will add a vaginal laser.
The in between treatments, whether it’s a device such as the Visa Plus or these creams are very, very important, whether you’re talking about vaginal health or you’re talking about aesthetics in the face. I think really beginning to set that as a proposition to the patient, “You’re going to be doing things at home, that are going to help.” Certainly having multi-modality.
I have colleagues of mine in Southern California having great success with the Emsella®, to strengthen the pelvic floor, as well as doing an O-Shot®, looking back at our … We have about 300 patients on pellet treatment right now. Many patients will cite that their urinary continence has gotten better within the first treatment of testosterone. How do I know that? It’s because they won’t show up to their urodynamics test, and so I know something is there. Having that multi-modality approach for urinary incontinence, intimacy, even aesthetics I think is going to be key.
A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Dr. Runels: Beautiful. We’re going to talk … We have about nine minutes left and Edward has some interesting ideas about when it comes to marketing with trademarking and not just our procedures but you as a provider and expanding upon that idea. So, we have about eight minutes left, Edward. Before you do that, though, I just want to tell you guys that Edward is, obviously, brilliant and excellent teacher, and excellent as a provider for our procedure, so highly recommend his classes. He’s got one coming up July 27, which is pretty close, but I don’t know if he’s got slots left, but I’ve put a link to that. If he doesn’t have slots in that one I’m sure he has another one coming up soon. With that, Edward, if you don’t mind, talk to us some about, I know you’ve thought a lot about that idea. Can you expand on that some and then we’ll close it down for the night?
Dr. Edward T: Absolutely. So, as I’m going through the mental exercise and thinking about how to combine all the different procedures and finding that a combination of different approaches that hit different aspects of what I’m doing is the best, I really did a deep dive and found that my main focus is intimacy, how to restore it, how to improve it, how to educate patients on it. I was very happy when my trademark, actually I have a copy of it here, by the U.S. Patent Attorney Office was accepted now with for the second year in a row. I’m ready to defend it, because I came up with this idea of Timeless Intimacy. You can see here, this was actually from my-
Dr. Runels: One second. I took the screen back. I’m going to give it back to you. Now you can show us. Go for it.
Dr. Edward T: I applied for a Trademark. It was actually more of an activity than anything else, and it was successfully accepted by the U.S. Patent Attorney Office. This was a recent email, actually July, by my attorney and I was able to submit it again for the second year in a row. The Timeless Intimacy trademark basically encapsulates performing a minimally invasive vaginoplasty, performing an O-Shot® and followed by a laser, in this case a CO2 FemiLift at a particular setting to help heal and to help reconfigure the vaginal vault to take on a more youthful function. I would always tell the patients, if you want a certain tightness or a certain kind of friction coefficient in terms of the sexual intimacy that you were at 21 we’re not going to go past that, right. We want you to be in a place I would say, ideally, between 20 and 30, in a place before you had children, in a place before you entered menopause, such that you could resume intimacy again comfortably and pleasurably with your partner.
As a part of that I then went on to develop Timeless Health Solutions, Inc, which is my Med-Spa or my functional wellness practice. That’s now being developed as its own entity. It has its own collateral. There’s a voice that’s being developed in which the girls in my office are trained to pick up and talk to the patients with a particular voice.
I’m finding who I am as I’m going along in this journey, that originally I started as an engineer. I think I have a very compelling story to use technology and, basically, give that technology and distribute it in such a way to help patients. I’ve become a surgeon in the last few years, a robotic surgeon in the community, helping women have surgery in a minimally invasive way and get back to life sooner, and putting it all together. I think that’s really what the Timeless Experience is. I think it’s really garnered a lot of attention in our community. I know it’s being recognized at the level of [inaudible 00:54:48] hospital systems. I’ve been recently kind of given this idea, this honor, of being a social media expert in women’s health. Now I have this wonderful platform to get all these ideas of regenerative medicine, minimally-invasive surgery, and to be able to talk about intimacy in a way that’s never been done before in my community.
I’ve been very kind of passionate. This was actually what I was going to talk to you about tonight, and I’m going to highly the second point here. I would say, Charles, right now in the last few minutes that I’m in lean startup mode, and I looked at my colleagues, my engineer friends up in Silicon Valley, and there’s this wonderful book by Eric Reese called The Lean Startup. What that means is creating these very small … Let’s see if I have a picture of it. … MVP, that is a minimum viable product, and really getting it out there to see if the population, or the market, is interested in it. What that means for us as busy physicians is before we buy that next laser, or before we buy that next cool sculpting machine, can we create these minimum viable products and test our market, and how convenient is it that our market are the patients who have been following us all this time.
Dr. Runels: Yes. Yes, we already have an audience.
Dr. Edward T: We have a captive audience. In this world of marketing you actually have to pay for these focus groups.
Dr. Runels: Yes, and let me emphasize that real quick. I don’t want to slow down your momentum, but everyone needs to remember, you are marketing to your people. If you [want to 00:56:27] market to the whole world that’s fine, but you need to start with your people. If you don’t have a group of people that you call your people, in my opinion, it’s difficult to have a steady flow. You start by building a fan base of people who love you, because you’ve done good things for you. Now you can do what you’re talking about. Okay, keep going.
Dr. Edward T: I think every once in a while when I get stuck, Charles, I put my engineering hat on and I think about what an engineer would do, because if I think about what a doctor would do, I would probably take on another [inaudible 00:56:58] contract and working harder and I’d probably be- [crosstalk 00:56:59] Just being honest with you. I’ve already seen this. I saw what happened to my father, right? I think desperate times call for desperate innovative measures, and I put my engineering hat on and I found this, and I’m just sharing this with our group, lean startup. In the last minute here I encourage …
Dr. Runels: You know what. Keep going, go a little over. That’s fine. I think this is good stuff.
Dr. Edward T: … and want all of us in the call, the physicians, to really become lean again. I think that all of us as physicians need to find a way that we retract because the environment right not conducive to us expanding aggressively. We must all come together and retract and regroup, much in the way that Sun Tzu says in The Art of War about looking at our enemy and knowing that we are not ready, and we are not powerful enough to be out there and fight. So, we have to retract, and in this very lean startup manner regroup and see what anchors us.
Dr. Runels: Yes.
Dr. Edward T: It’s very easy because all of us in quarter four … I know I’m speaking to everyone on the call right now when the tax comes all of us who are on the call most of us are in private practice, and we are lured by the laser companies, and by a big company to do that capital investment just to decrease our taxable income. Really understand what it is that our market is demanding. We can do that by creating these very small value propositions and testing it. That’s why doing a class on injectables, or learning how to do an O-Shot® is so valuable, because it may be caused that initial fee, the tuition, and that’s it. That fee is the minimal [crosstalk 00:58:47]
Dr. Runels: Then you take the money from that and do the next thing, yes.
Dr. Edward T: You got it, because what makes you think, and forgive me for saying this, that you’re going to be able to make a vaginal laser which can cost up to $100,000 work if the patients in your group don’t even want an O-Shot®? To that same degree, what makes you think buying the newest fractional CO2 facial laser is going to be appropriate when the patients don’t even want you to do a Vampire Facelift® on them?
Dr. Runels: That’s right. The guy who taught me Botox® was doing … He was the top Allergan account in the world, we talked about this before, and he always said, “Get your Botox® practice going then buy the facial laser.” So, exactly that’s the right strategy. When you get to where you’re one or two O-Shots® a week now you can take the money and take the flow, and you know that your laser’s not going to gather dust, or you’re radiofrequency. I’m loving this. Tell us about the next thing on that list.
Dr. Edward T: I guess the next thing, …. Forgive if I’m going over here but-
Dr. Runels: No go for it. We like it.
Dr. Edward T: In addition to retracting … This is what I’ve been doing. I’ve been retracting, rebuilding, regrouping, and creating my brand. The brand tells a strong story that I’m infusing technology with medicine. I actually had a doctor friend of mine, Charles, reach out to me, and she asked me how I’m seven places at once? I said, “What do you mean?” She’s like, “I’m watching your Instagram, man, and you’re like seven places at once. I’m like, “Thank you, I’m not.” I have virtual assistants. I try to automate and eliminate, and I’m doing this because I have a virtual architecture and I check in with this lovely girl in the Philippines. I give her a list of things to do and in the morning it’s all done because of the time zone difference. It could be something as simple as arranging for my dry cleaning, or figuring out a logistical issue for a seminar that I’m going to be teaching out.
But, when I’m able to do that and create that virtual architecture she learns from me. We talk about, as engineers, machine learning, and we talk about artificial intelligence. You don’t really need that when you could actually have bonafide intelligence. These virtual assistants, it’s a skill and I’ll be honest with you, coming out of fellowship I didn’t really know how to manage people that well. I’ve learned more about managing people, and learning how to lead working with these virtual assistants than I have in all the time I’ve graduated, because you learn about time management, because now I know what the value of time is in a quantifiable way. I’ll give you an example.
I found out that it’s actually a lot easier to click with my thumb Expedia and book a flight, and look for a flight than it is to go in almost two hours back and forth in different time zones to get my virtual assistant to book it. That’s a great example, right? But, for something that takes a lot of different steps, like research, I’m trying to find a cheaper way to bring in needles or syringes to my office. That’s an hour affair. I’m putting that to my virtual assistant, so now she does my supply chain and I’m like, “Oh, there’s something called supply chain. Let me learn about how to do supply chain management.” It didn’t cost me that much, and so that becomes part of my virtual architecture. It becomes part of my virtual corporation, my virtual timeless structure, and that’s the virtual architecture that’s rising me, or raising me, to make me look like I’m in seven different places at once. It’s because my virtual architecture is raising me, it’s giving me more time.
Dr. Runels: Beautiful. Both the virtual assistant and someone in the office who functions like an executive assistant, not just doing the nursing work, but they are willing, and expecting to do things like drive your car, or go buy your groceries, that sort of thing, I think when you value your time at at least $1000 an hour, which everyone on this call should be doing, then that person if they save you an hour a day, you can pay them a reasonable rate and still do well. What’s next on that list?
Dr. Edward T: I suppose the last thing … Let me give you the website that I use, and I explore …
Dr. Runels: You can just throw it in chat box and everybody will have it.
Dr. Edward T: It’s onlinejobs.ph. You actually see it.
Dr. Runels: Okay, there you go. Onlinejobs.ph. I concur with you in that the people in the Philippines they like Americans and unless they’re having a typhoon where they lose their internet they are as a rule usually reliable, and they are grateful. You can pay them what for her is not so much, and you can be helping someone have a whole different lifestyle in the Philippines. I highly recommend what you’re doing.
Dr. Edward T: The last part of my pitfall, so I will try to wrap all this up, because between becoming lean, creating a virtual architecture, becoming proficient with all of these advanced regenerative medical procedures, and learning how to do aesthetics with an artful aye, I’ve also learned along the way. A lot of the pitfalls, I think, stem from paid advertising. I think in the group whoever is still listening left, all of us, I think, have all tried to pay-
Dr. Runels: By the way, it’s everybody. Nobody’s dropped off. They’re listening.
Dr. Edward T: Anyone who’s tried to pay for advertising finds it very difficult to measure a return on investment, because in my mind as a physician if I pay for advertising it means that there will a measurable return for a booked and paid patient. However, with marketers and paid advertisers out there, their metric is leads, or …
Dr. Runels: Yes.
Dr. Edward T: … clicker rate. Things that are not as relevant clinically to us and to our bottom line. I think there’s a big discord.
Dr. Runels: They don’t pay the groceries. Clicks don’t pay the groceries do they?
Dr. Edward T: It took me a long time to learn that at the very visceral level, that we have a disconnect here. That disconnect is what’s actually preventing, in my mind, marketers and physicians from really aligning together. I think that if there was a better, more kind of physician-centric way to create paid advertising … You know it’s good that all of us on the call know the basics of marketing and advertising, but the the end of the day we are doing all this to try to get back to what we signed up for, which is to help patients and do medicine.
Dr. Runels: Yes.
Dr. Edward T: As a pitfall I think what I’ve been guilty of is going down too far and kind of veering off course, and there’s so many tools, and so many virtual assistants, and so many Ontraports, and mail … I mean, there’s so many digital pools out there that I think every once in a while I have to pull myself back, not as an engineer now, because that’s all we do is create tools, right, for better solutions, but pull myself back to the medium, which is the physician in me and go back to doing medicine. I would say that’s a pitfall that I’ve realized that it’s very easy to go down that rabbit hole and find that next digital tool, that next widget, that next app, and forget what we kind of signed up for.
Dr. Runels: Just let me expand on that just a little bit and then let’s call it an night. All wonderful stuff, Edward, by the way. There are so many tools, and I’m literally at a class now in Cleveland that cost me 30 grand. I’m in a class today, earlier today, with a guy that made $900,000 in two weeks online. These are high-end people, high-end in that they know how to make money online. It’s interesting, what I’ve noticed is the people who are making 10 million or more on the internet, they’re still doing the basics, and it’s not just online. The other thing that these guys with real businesses with tell you is that you bring it offline as soon as you can. It’s handing out the brochures to your patients, or your just physical card and saying, “Hey, if you know somebody else I can help, would you give this to someone.”
Using the tools, just the basic tools of a video so you don’t have to keep explaining it, emails that you send to your patients every couple weeks so they know that you’re there, that are not fancy, that are messages that give them the things you would say to them if they were in your office anyway about what you want them to do to be healthy, and what you’re able to do for them with explanations and clicks to show them the research. So, a video, a web page that’s helping you let them know what you’re able to do, and then instead of doing all your time marketing you’re doing something, it’s a practice, and so you’re practicing it. But, here’s the fun part, you’re practice of marketing is actually making you a better physician, because you’re teaching your people how to be well leveraging digital tools.
I know if people are on the call that have done it on Instagram and Facebook and all the other tools, and I’m not saying you don’t do those things, but for these procedures what you just said is the formula that works, an email, a video, a web page. Deliver good messages and then while that’s doing you have more time and more money to go take care of your people, sometimes for free because the money’s flowing.
Edward, always a pleasure. I know people, I’m telling you the stick rate was amazing tonight. Everybody was listening, so I know they loved it. One last thing, guys. Edward does a mean class and you can tell he’s on top of all dimensions of this. So, have a great night, and I’m honored always to have your attention. Bye-bye.
Dr. Edward T: Thank you, everyone. Goodnight.
Topics Discussed Include the Following…
[note, these weekly meetings are usually only held with our CMA members, we occasionally post the meetings for any provider who may wish to enjoy with the hopes that they may both find benefit to their patients and that they may consider joining us]
*Beauty analysis math & science of face & labia.
*The Beauty & the Beast
*New review paper of the aesthetics of the labia
*Tune Up your PRP protocol from a basic science paper
*FDA & PRP
*Strong warning about profiting from PRP kits and teaching PRP procedures [don’t]
*The Story of Altar™
*Up-coming hands-on classes with live models
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Beauty Analysis. Face & Labia…the Math of Beauty
If math applies to the face, does it apply to the labia?
Charles Runels: So first, let me say congratulations to Dr. Alinsod, who just published another paper. We definitely want to get to that. I think let’s start by teeing that [research up] with some ideas that I think are widely accepted about the face. This is a website that is put out by Dr. Marquardt, who did some studies about what [mathematically] makes the perfect face, which you kind of have to think, “Well obviously, we were all made to be beautiful, and so, is it okay to decide what’s perfect?”
We’ll get to the labia. But I think most people are accepting that there are certain ideas that we recognize to be beautiful, although of course our affection for each other changes the beast into the beauty in the fairy tale. And of course that happens … It’s a metaphor for what happens when we fall in love with each other.
We know genetically we’re usually attracted to someone whose eyes are of similar color to our mother or something else about the face [that may be genetically determined by our brains]. There are certain mathematical things that go on, as Dr. Marquardt has shown with much of his research.
For example, the upper lip is usually about half the width of the lower lip [in the face of those we consider most beautiful]. I’ve put a link to this, or I will put a link right now into the chat box. Most of you guys are aware of this, because if you’re doing our Vampire Facelift, because I talk a lot about Dr. Marquardt’s work. He was an engineer before he was a physician, and did a lot of really accurate measurements with calipers before we all had computers on our desk and then translated that over. If you look at what he actually talks about here, how if you go all the way back even to, you can see, in former times …
It’s worth browsing this website because even if you look at artwork from ancient days, on every race, every race every continent, you’ll see the artwork very carefully closely matches what we talk about is beauty. I bring that up not just because many of us are doing the faces, but because it’s a major idea that is coming about in the cosmetic world, as most of you guys know. Dr. Alinsod just published something, and I’ll let you take a look at it, and I’ll provide a link to it. Let’s see. Let me pull this up for you. There you go.
So this just came out. Dr. Alinsod and Dr. Güneş … I suppose I probably said that incorrectly … published this paper where they talk about the ideas of aesthetics for the genitalia.
It’s interesting that in the days of Fifty Shades of Grey and such, in my opinion that, we can readily … The reason I started with talking about the face is…
it’s very unlikely anyone had any problems thinking about the idea that certain measurements [of the face] might be genetically embedded to our perception of why it [an individual face] might be beautiful.
And yet, when you swap that same idea [which also applies to the] figure and the breasts, when you swap it to the labia, people start to balk.
There’s a very strong political movement, both pro and con, and some of the thought leaders like Dr. Alinsod are trying to play a scientific role and leadership role and taking lots of heat for it, and teaching the world that maybe if it’s okay to think in that way with a face, it’s okay to think about it [in regards to] the labia. And so, in this review article, he talks about surgical and non-surgical ideas relating to aesthetics.
The references are very helpful, and I will put a link to this in the chat box right … Actually, it will be on the page for the recording for this once the transcript is posted (click to read).
But the couple of ideas that I would point out, and then I’ll open the mic for discussion. The things that caught my attention were, first of all, how strongly some of the ideas are opposed
and then just in general how [in following] the idea of making things more beautiful, we have stumbled upon how it [creating beauty] also is making things more functional.
Dr. Goodman was on one of our previous journal clubs, where he talked about his research showing that women actually have better orgasms and better sex when you do some of the things we’re talking about now, when it comes to just [improving] the appearance [of the labia in the eyes of the woman]. Let me swap something over. I want to show you an example from my practice. Let’s see here. So this is from the Vampire Wing Lift™ website, which if you’re doing the O-Shot®, you should have also a listing here. If you don’t, let us know about it. But if you go on the before-and-after photos, there are several here that were supplied by our providers.
Here’s from Carolyn [Delucia, MD, FACOG], and you can see there are others over here. But the one I want to bring up is this one, because I know the woman. She’s actually one of our providers. If you look at this, you’d think, “Wow. This is a lot of volume loss,” and you might think the rest of her body may look not so young by looking at her labia majora.
The truth is this woman was so fit that if she … If you saw her at the gym, you would think, “Okay, that’s a 60-ish-year-old woman, and that’s the way I want to look when I’m 60-ish,” because of course when women lose the fat in their body and stay lean, they also lose it in the cheeks [which is one of the reasons we do HA fillers and the Vampire Facelift®].
But what hasn’t been talked about is they [lean women over 35 years old] also lose it [faty] in the labia majora. And so, simply by adding volume back, with the combination of PRP and an HA filler, we’re able to easily restore this more youthful look in a very quick procedure. Now of course, Dr. Alinsod talks about surgical ideas as well in that paper I just showed you. I highly recommend this book, which also has a … And this will be the bottom when I post the transcript in the video for this webinar. I’ve already put the links here. But this book has a section on both the surgery as well as PRP and radiofrequency and laser and all the rest.
So, it’s not just for surgeons. I’ve never seen this price. It’s usually $230. I’m not sure why it’s dropped in price like that, but it’s a good time to buy it. I think I’ve talked enough.
Let me see. If anybody else wants to comment before we move to the next topic, please let me know. But I want you guys to know about this because it’s one … I would show it to your patients. Give them permission to do whatever feels natural to them. We’re not taking people and making them feel self-conscious about their body, as some might imply.
We are taking people who want to make all parts of their body well and functional, not just their bicep or their spine or their brain. Or why should we think about optimal brain function, optimal flexibility, cardiac, VO2 max, anaerobic threshold and not think about sexual function? It’s a pretty obvious, rhetorical question that some people have trouble with. So, empowering your patients by giving them links to our references, and I will post the one I just showed you at … If you go to just any of our websites, like you go to OShot.info or Vampire Facelift® or any of them, you’ll see a research tab at the top.
Even on Vampire Wing Lift®, we have actually a paper showing benefit from that procedure, Juvederm with PRP, combined in the labia majora. So there it is right there. Okay, so, I don’t see any hands up. I see Dr. Harrison on the call. I’m going to unmute you because Dr. Harrison told me about a really fascinating paper about the basic science of PRP. So, let me pull it up so you could talk about it. I’ll put a link to this one, as well. Let’s see. Why don’t I just go ahead and put that. I’ll put this one in the chat box as well.
All right. So there’s a link to get it.
So here we go. I’m going to unmute you, Dr. Harrison. Are you there, Dr. Harrison?
Dr. T. Harrison [Theodore Harrison, MD MBA ABAARM]: Yes, I’m here.
Charles Runels: There you go. Talk to us about this paper.
Dr. T. Harrison: Well we thought this was a really interesting paper. One of my Canadian colleagues sent it to me about a week and a half or two weeks ago. We have a little research group here in Victoria, British Columbia, where we have our little lab. We do a few experiments from time to time on different PRPs to try to find out what makes the best and how to make PRP and stuff like that. So when this came across our computers, we thought it would be interesting to see what these guys said and see if there was any way to make it practical, because this is a lab paper from Argentina.
It’s not very practical the way it’s presented here. What these guys did essentially was they took PRP, and they use a double-spin method for making PRP, which is unfortunately not described in the paper. But it’s referenced to a previous paper that they did, so you can find out how they did it. But anyway, they took PRP, and they did a couple of things to it to see if they could make it better. The first thing they did was they took it down to four degrees. They put it in a refrigerator and they got it down to four degrees for half an hour.
Then they tested it to see, with the various growth factors, and there are some pictures there about they tested migration and embryonic cell growth and how it affected it and the like. Yeah, you can see right there. Those pictures there are the first ones from the cold. The top graph is cell growth, the middle one is migration, and the bottom one is new blood vessel formation. They found that if you took just the … Well the control there on the left-hand side, that’s just fetal bovine serum. So there’s nothing in it.
Then the middle one is PRP releasate, which is to say, they took PRP and they activated it with calcium. I think maybe they tried thrombin too. Then the third bar from the left is washed PRP releasate. That is, they took PRP, and they did a second spin so that all the platelets formed a pellet now at the bottom. Then they removed the plasma from it, and they washed it with some kind of lab solution stuff, not really necessary in my opinion. But then they reconstituted it and activated it after exposing it to cold.
Then you can see what the results were. They got more migration, they got more angiogenesis, and they got more human embryonic cell growth from it. Also in the references, they have a good reference to the paper that gives good overview of what cold does to platelets. And essentially, what happens is, when platelets get cold, they get a lot more sensitive to activation, and they’re pretty sensitive to begin with. I mean, almost anything can cause a platelet to activate. I mean, I made a list once and it had like 20 or 30 things documented that cause platelet activation.
The only thing that keeps this from turning into a clot in five minutes is the fact that there are anti-activation proteins circulating in the whole blood. So that if a platelet accidentally tripped off, it just doesn’t set off the cascade and clot your whole vascular system. But, the fact is that they got a lot more results when they took away the plasma, and they got a lot better results when they made it cold. The second thing they did was take away the plasma.
Now, I’d heard a lot before that plasma helped PRP or helped the platelets in PRP. But these guys have some pretty interesting results here that show that if you take the plasma part away, the PRP actually does better. This is the washed platelet releasate part that they have there.
Dr. T. Harrison: Have there. So that was kind of interesting too. It doesn’t look … I can’t really tell from their data whether they cause lysis or not by doing these things. We know that lysate performs better than PRP by itself, and I guess I should define a couple of things here. Everybody on the call I’m sure knows what platelet rich plasma is and platelet poor plasma is. But there’s also a couple of nuances. There’s platelet releasate and platelet lysate. Platelet releasate is what happens when you make PRP, and then you spin it down and you add calcium to it. And then you spin it down again, and take off the remains of the platelet. So all you have left is the plasma, and what got dumped into the plasma from the alpha granules and delta granules after it’s activated with calcium, or something like that. That demonstrably performs better than just PRP by itself.
Now, platelet lysate is what you get when you take PRP and you spin it down, and you take all the plasma off, and you lyse the remaining platelets. So in that case what you get is a hodgepodge of everything that was in the platelets. I mean, it lyses the platelet cell membrane, but it also lyses the alpha granules, the delta granules, the lysosomes, the mitochondria. I mean everything that was in there just gets dumped into the mix. But what happens, this results in much higher concentrations of the growth factors and cytokines. And the research so far tends to go toward lysate being even more powerful than PRP, or PRP releasate as far as growing human embryonic stem cells. I mean human embryonic cells, our concern.
So these guys did the cold, and they found that that made the releasate more powerful, and they took away the plasma, and they hypothesized … and that made things better too. Again more immigration, more angiogenesis, more human embryonic cell growth. And they hypothesized that there were inhibitors in the plasma that were keeping the PRP releasate, the regular PRP releasate, from it’s full potential, you might say. And then when you got rid of the plasma, and then activated the cells and or lyse the cells, then you didn’t have these inhibitors anymore, and that’s why the plasma-free PRP I guess releasate you’d call it worked better.
And then they did one more thing. They also tried adding cryoprecipitate to the PRP to see what that would do. And they made the cryoprecipitate by basically freezing their PRP, or spinning down the PRP, taking off the plasma, and then freezing that plasma. It’s basically fresh frozen plasma. But they froze it for 24 hours. And then they warmed it and centrifuged it again to get the precipitate, which is mainly fiber and fibrinogen, von Willebrand’s factor, and a few more proteins like that. And so they took that precipitate, and they added that to their PRP as well. And they didn’t quite document so well what happened there, but it does seem like these proteins form a matrix which allows better migration. And it also has a little more effect on proliferation, though I think it didn’t have much of an effect on angiogenesis at all.
So basically they got three different ways they could make PRP better. You know, make it cold, take away the plasma, and add cryoprecipitate. So, I dunno, for office purposes, making the cryoprecipitate’s probably not very practical. But the other two are probably pretty easily doable, so we ran a little experiment ourselves here. Basically we took some PRP and we took a 3 cc syringe of PRP and we wrapped it in an ice brick. You know, one of these bags full of something that freezes really easily that you put in the freezer and then you put in a cooler or something. We just wrapped that around the 3 cc syringe, froze it, and then we took out the or empty 3 cc syringe, and we put in a 3 cc syringe full of PRP, and we took the temperature to see how long it took us to get down to four degrees. And it took about four and a half minutes to get the temperature of the PRP down to four degrees, same temperature as they used here.
And then we ran it through the hematology analyzer to see what happened there. And we found there was probably a little lysis. But not much else happened. It didn’t look like they were activated yet at that time. So for practical purposes, it looks like you can make PRP cold in about four and a half or five minutes. So that might work in the office pretty well.
And the other thing of course is just taking the plasma off, so it doesn’t inhibit the growth factors and cytokines that are released when you make releasate, or when you make lysate for that matter. And that’s just easy to do. You just after your second concentrating spin, or maybe during your second concentrated spin, you just spin it hard enough so the platelets form a pellet down at the bottom. And then you just take off all the plasma. And then you can reconstitute it with water if you wanna get a lysate. Or with D50 if you want to get a combination lysate releasate. Or maybe with normal saline if you wanna just get a releasate out of it.
So that’s pretty easy to do too. So from a practical point of view in the office, you could do about two thirds of the things that these people did to make their PRP more effective. And you can see from the graphs, that they got anywhere from 30% to 50% improvement in their PRP results when they did these things. So it looks like it might be pretty effective stuff.
This is only one study, and I hope other people will do other studies that’ll confirm this. But it is pretty exciting that you can increase your PRP effectiveness this much with some pretty simple things that you could do in the office.
Charles Runels: That’s very fascinating, and I was not even aware of this paper, so I’m sure everyone’s cheering you for, and just the fact that you told me that you went and counted by reading the research 30 different ways to activate platelets, I’m impressed and very grateful. My impression is that if anyone studied this paper in detail, they would have to come away understanding platelet rich plasma in a deeper way whether or not they adopted the techniques or not. You know, just the reading of the introduction to me was encouraging. Just as a reminder, as they go through as their intro for the study, the safetiness of it, and they go just these three words: recruitment, proliferation, and differentiation of stem cells. We all know that, but just to be reminded, all those things are happening, especially to those on the call who are new to platelet rich plasma. That’s what you’re doing. That’s a powerful statement.
And then on this next page, as you were mentioning, they say surprisingly, I think that’s an understatement to say that in something called platelet rich plasma, the plasma’s actually decreasing the effectiveness of angiogenesis. And they talk briefly here about why that could happen and give a reference. Anyway, you’ve done such a wonderful job of talking about it, I’m not going to muddy the waters anymore. But could you expand more on, having read this now, has it changed your practice as far as your daily … and you know Victoria Canada, like when you take the boat from Seattle up to that beautiful, amazing place right there. Is that where you are?
Dr. T. Harrison: Yep, that’s where we are.
Charles Runels: Wow, I was there once. I don’t see how you get any work done living in such an amazing place. It’s so beautiful there. I would just be outside, gawking all the time. So how has this [research under discussion] changed what you do? Or has it?
Dr. T. Harrison: Well, we haven’t really tried this on patients yet, but we’re definitely going to, because it’s really easy to just put your PRP in a freezer brick for four or five minutes. And it only adds a little bit of time to the preparation, and it’s pretty easy to take off the plasma after a second spin, and then reconstitute it with something. Now the question that we have is what do we reconstitute it with? Because we did a study earlier this year, which we presented at the AALM Conference, where we took PRP and we diluted it 50/50 with different concentrations of dextrose. Because we’re really interested in prolotherapy and using this in joint. And dextrose has been the main deal for prolotherapy for many, many years, ’til people started using PRP. We thought the two might be synergistic, so we decided what would happen if we added them together?
So we did different dilutions, from basically to sterile, distilled water, all the way up to D50. And we mixed them half and half with PRP, regular PRP, to see what would happen. And of course when we mixed it with water, we got about 80% lysis of the platelets. So it was almost a perfect lysate. Not quite, I don’t know why those last 20% of platelets didn’t lyse, but they didn’t. And at D5, D12.5, and D25, we got about maybe 15%-20% lysis. There seems to be something in dextrose that platelets are sensitive to. At least some platelets are sensitive to.
But when we got to D50, and we added one cc of D50 to our one cc of PRP, we still got 20% lysis, just like we had with all the other dextrose concentrations. But the other 80% of the platelets activated. The lower concentrations of dextrose did not activate the platelets, but at D50, all the platelets activate. The rest of the platelets activate. So you get a combination of lysate and releasate at that concentration. So that’s what we’ve been using for prolotherapy.
Charles Runels: Interesting.
Dr. T. Harrison: Now, for other uses, I’m not sure whether that would work or not. It certainly gets you activation, and dextrose is good for platelets, because platelets use dextrose. They eat it. They feed off it. And when you give PRP normally, the platelets don’t just dump all their alpha granules and die. They continue to live for about five to seven days, and they release further alpha granules in waves. So it’s not all the alpha granules that get dumped. And when you activate with calcium or with thrombin, it’s only the first wave. Because the alpha granules contain both pro-angiogenesis factors, and anti-angiogenesis factors. They are pro-inflammatory and anti-inflammatory. And they have both pro coagulation and anti-coagulation factors in them.
So it wouldn’t make any sense to dump all the pro’s and anti’s at the same time. And so they don’t. You get a first wave that’s probably mostly the pro-inflammatory, pro-coagulation alpha granules, and then you get a second wave, maybe within the next day or two, that has the anti-inflammatory, and maybe the pro-angiogenesis ones, and then so forth. They go through five to seven days of releasing new waves of alpha granules as they do their job. And it ends up the last wave is gonna be the anti-angiogenesis as they knock off all the little blood vessels that they made that they didn’t need anymore once the healing is all finished.
But when you make regular PRP and inject it, that’s what you get. The platelets stick around, they release their alpha granules in waves, it’s sorta like the normal healing process. When you make a lysate, all those guys just get dumped together. The pro’s and the anti’s and everything else, from the lysosomes and mitochondrian. It just all gets dumped together. But it seems that the much higher concentrations of growth factors that you get from that outweighs the presence of the anti-coagulants and the anti-angiogenesis. You know, the other factors that would normally work against the new migration growth, cell growth, and all that sorta stuff.
So, so far at least, it looks like lysate’s the most powerful PRP preparation. And so we’re thinking maybe we outta cool it, or maybe we oughta wash it, and then cool it, and then reconstitute with water, and see how much of a lysate we can get from doing that to get the maximum potential out of the PRP.
Charles Runels: Wow, what a wealth of knowledge. You should be teaching. It sounds like you probably are, but if you ever want to teach our procedures, I would certainly show up as a student to see how you’re thinking about it. One other question. If you look at this just as a reminder, and you’re doing this, when they talk about how PRP is used in regenerative medicine, it mentions of course muscle damage which you guys are doing as doing prolotherapy, I’m sure you’re treating that already. So if you were, as we’ve developed our O-Shot® techniques around the pelvic floor and the vagina and the urethral space, if you were treating a woman who had dyspareunia and had pelvic floor tenderness, or if you were just treating incontinence and using PRP in combination with an Emsella machine, where in theory, you’re causing strengthening of the pelvic floor, in those two cases, if you would … Because the thought is, of course, that perhaps you could inject the pelvic floor if you’re trying to strengthen it and then do your m-cellular treatment with the electromagnetic stimulation of the muscle, and maybe get a better result than if you did just one of those alone.
Note…we offer an icon on our directory to identify O-Shot® providers who also offer Emsella, radio-frequency, or laser in conjunction with the O-Shot® procedure. If you are offering these combination therapies, please let our office know so we can add the icon to your name on the directory (email@example.com).
Where would you inject, and how would you treat your PRP before doing something in the pelvis or vagina, where the idea was treating either dyspareunia or pelvic floor laxity, to help incontinence?
Dr. T. Harrison: Well, if it was for stress incontinence, I’d be fairly cautious because, you guys have run into cases where basically, you caused urinary obstruction from people injecting too much PRP around the urethral area. And since this is more powerful PRP, I’d want to sort of proceed cautiously there, using this sort of enhanced PRP stuff.
Now, for pelvic muscle floor, I don’t think that would be so much of a problem. And if you inject along the top of the vagina, out to the sides, along the course of the urethra using these more powerful solutions, you might actually be able to strengthen the whole pelvic floor that way.
Charles Runels: Or, if you were, say, treating pelvic floor tenderness, a trigger point injection for dyspareunia with pelvic floor trigger point reproduction of the pain, you would do … When you say that way, would you do your lysate with water and cold technique? Would you expect that to work better?
Dr. T. Harrison: I think I would expect it to work better than just plain PRP. Yeah.
Charles Runels: Yes.
Thank you. That’s helpful. To think about the overflow incontinence just to … Thank you for bringing that up, just for the rest of the people on the call, if you haven’t heard of that, we’ve had so far, I know of three cases. In every case though, the reassurance is that the volumes injected were 7 CCs or more, and so it’s yet to happen with our recommended 4 CCs. If you look, inject 4 CCs, it may not sound like much, but if you injected say … Imagine injecting, if when we do the face, we just inject one, it’s a pretty large volume. So, our thinking is, it’s probably more from a volumetric fact, but I appreciate your caution, would maybe if you had more platelet-rich fiber matrix formed, because of changing the consistency, perhaps that might cause it as well.
The other reassurance is that, in all three cases that I know of, that it within a week of an overflow obstruction basically from having created artificial hematomas, is really what you’re doing, it resolved, and the people did very well with the eventual resolution of their stress incontinence.
It’s pretty scary, though, when your person comes for stress incontinence and then they have to wear a diaper for weeks, because they’re dribbling all the time.
So, people don’t usually like that.
Dr. T. Harrison: Yeah, and the other thing you want to remember with using at least the plasma-free technique here is, you’re not going to get a fibrin clot, because you’ve taken all the fibrin, fibrinogen, and stuff away, so if you’re using it for maybe things where you want the PRP to all stay in one place like the O-Shot and scalp type things, where you don’t want it just wandering off, and diffusing really rapidly, you might not want to do this.
Charles Runels: Interesting. Yeah. Very good.
What a wealth of knowledge you are, I would want to spend the next two hours talking with you.
One of our physicians, Pamela Kulback, who’s one of the interventional radiologists in our group, typed in the question, about using, perhaps, the centrifuge. That is itself cool.
Do you know of such a device? Or do you have something in your-
Dr. T. Harrison: Oh yeah. We don’t have one, but refrigerated centrifuges, well they’re a bit expensive of course, but they’re easy to come by. All the labs have them, and you could do it that way.
The thing is, if you put the PRP in a refrigerated centrifuge, you would refrigerate it before you removed the plasma, because the plasma is still in there when you do that, and you might pre-activate some of the platelets when you did that.
So we prefer the technique of getting rid of the plasma first and then making it cold, so that we don’t have the plasma interfering with stuff while it’s in the centrifuge.
Charles Runels: Beautiful!
Well, stay on the call because we may want to pick your brain again. I think that covered the research we were going to talk about today.
FDA Approval of PRP
There was one question on the membership site that brought up the FDA question again, so I just want to remind everyone where I put that, of course thankfully, the FDA doesn’t drift all the way up to Victoria, but some of us have to think about that, so I’m going to open this where you guys can see where it lives.
And again, this will be posted to all the membership sites. But I’ve kept this page as up-to-date as I can (if someone finds another paper, let me know) but I’ve put here actual articles by the FDA where they have talked about, in very specific terms, they do not regulate platelet-rich plasma.
In the United States, they do regulate the devices and I think you’re safest in the US by using a device that is approved by the FDA to prepare plasma to go back into the body.
Now, in other countries, maybe that’s not such a big deal, assuming you have the depth of knowledge you just heard displayed.
There actually are people in the US who have a different level of laboratory that they’ve had approved by the FDA, essentially, the FDA has come in and said, “Yeah, you’re able to do this.”
But unless you have that in the States, I’d recommend you use one of the kits.
So the short of all this, and again, I have multiple references here, where the FDA is talked about … this isn’t second-hand knowledge, they’ve done articles for the New England Journal and their own website, and I have a video that explains at least my idea about it, and a transcript.
So anything that has to do with the FDA and PRP, we are in good standings.
The one thing that I would be careful about that I see going on and it’s nothing unethical about the intentions, but as far as the FDA goes, you could get slapped around some, is, if you are a physician and you are doing these procedures, and you are also selling therapy kits to physicians, as in, you are teaching usually, and you are either directly or indirectly profiting from selling PRP kits, in my opinion and in the opinion of the FDA (so I’m giving you a very gentle warning), the FDA has shut down sales people who teach what to do with the plasma because you’re teaching what the FDA has not said the device is able to do, they’re [FDA] only saying the device can make the plasma. The FDA doesn’t approve specific use for it.
WARNING! So if you’re profiting from the device, and you’re teaching something that no one’s proven the device is capable of doing, whether you’re the salesman who’s selling and teaching, or you’re the teacher who’s teaching and selling, you should be looking over your shoulder, because the FDA could come slap you around in a pretty dramatic way.
But other than that, as far as using it, if someone else is selling it to you, they’re profiting from the kit and now as the physician, you’re deciding what to do with the blood or the blood products, the FDA is very plain. They’re not at all bashful about telling you, they have no interest in telling a doctor what to do with blood, as long as you’re not manipulating the tissue to the point that it becomes a drug, and part of the point of a lot of these articles is that, when it comes to stem cells in the US, once you do a certain amount of manipulation, it gets reclassified, and now they are very interested in what you’re doing with it and again, unless you’re in a study, you should look over your shoulder in the US.
So that’s the quick version of that.
We’re coming up on the end of the hour.
If anyone else has some questions they want to throw in, I’m getting close to our topic list here.
This, we just posted, I’m not going to waste your time getting there again, but with [inaudible 00:40:24], I posted a video, actually had a interview with the guy who patented the ingredient … a cancer researcher at Harvard, then a cancer cell biologist at Berkeley, it was shocking to me when he told the whole story about how this product came about. I knew there was a lot of thought in it, but I didn’t know that it had directly six years of research on that level and a $2 million NIH study behind it, initially for the study of wound healing, which of course is related to cancer, as it involves cell growth.
I feel blessed that we [member of the CMA provider groups like the Vampire Facelift® and Vampire Facial® and O-Shot®] have the exclusive on this.
So it’s an idea to use post-treatment for the face, for the labia, (even for the penis) and I just wanted to remind you that it’s there and we also have classes coming up,
so if you want to check that out, and I think after that, that’s all I have to say today.
I can’t tell you how grateful we are, Dr. Harrison, for that amazing discussion about platelet-rich plasma. That’s just maybe the most detailed, informed explanation maybe that I’ve heard of the research on these calls so thank you for being on the call.
Okay so I don’t see any other questions, so I’m going to shut this down. You guys have a wonderful week.
Cellular Medicine Association
Topics Discussed Include the Following…
*Can you pump too much? Do you really need a pressure gauge?
*Where to buy a penis pumps wholesale & how to adjust price
*Do you have to use the pump after the Priapus Shot® procedure?
*Other side effects of the pump.
*Dr. Delucia & The number one reason doctors do not get free press?
*Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration
*Briars, Woods Walking & Medical Innovation
*How to measure web traffic. One of my secret tools.
*A way to get a free appearance on your local TV station
*Dr. Michael Goodman talks about innovation in medicine & funding research
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Penis Pump Research
Charles Runels: Let’s start by talking about penis pumps. I received two pretty interesting questions in the past week about penis pumps. One of them had to do with … Oh, by the way, we’re also wanting to speak a little bit about amnion research, and an article that came out today giving us some free press about the O-Shot, and about how to use that press, to leverage it for your own practice.
First about the penis pump. This is a sampling of some of the research that’s out there about penis pumps (click), and some of this research answers questions that were posed to me. One sent me a photograph of a penis where they did a Priapus Shot, this story, guy has an erectile dysfunction score of about 15 or so. So he has some function, but it’s not like what it used to be.
So he comes in for a Priapus Shot® [procedure]. After the shot, the pump was applied. Then, when they took the pump off, the patient had some looked like vesicles on the glands’ penis, filled with clear fluid, three of them, and some increased bruising, more than what would be expected from just the injection. The question was, what might’ve gone wrong?
My first question was, what pressure was put on the pump? This provider had … By the way, there was no permanent damage, so I’ll just go ahead and tell you the ending of the story is good. But the provider, rather than follow our protocol, which is that you apply a negative pressure of 7-10, provider had found somewhere on the internet the recommendation of a pressure of minus 15. The cause of that, that’s what created those vesicles and the increased bruising.
Can you pump too much? Do you really need a pressure gauge?
Along those lines, I wanted to show you one article that shows that over inflation, as you might expect, there’s one of many. There’s case reports out there of people doing stupid things like hooking their penis up to the home vac system, and it just gets ripped off. Obviously, we’re not going to do anything like that in our office. But this is just a simple case where a 66 year old gentleman used a vacuum erection device, but he bought one without a pressure gauge.
I think that’s really dangerous to have people using something that you cannot measure. They get overzealous, maybe there’s loss of sensation already from diabetes or injury. They can’t tell what they’re doing. If you do a Priapus Shot®, by definition, you’ve probably put some topical anesthetic or maybe did a block, and so they don’t have the pain as a feedback.
I think it’s really dangerous, in my opinion, to either use or recommend that someone use a pump without knowing what they’re doing. Now, if you go back and you look at the research, which this is representative, but there’s others I’ll mention shortly. You’ll find that it is, if it’s done the proper way, this has been a therapy that’s been around since 1974 or so, and it’s known to be a safe and effective treatment. Provided that you use it intelligently, just like almost everything we do in medicine, there’s a sweet spot in less is less effective, and more is damaging.
Same with this, and if you’ll go back to the old protocols that people were using, they were going sometimes up to a pressure of 15. It starts to sound like people comparing notes with lifting weights or something. Where is it better to do high intensity heavy weights for short repetitions or small weights with high repetitions? It sounds a little bit like people comparing notes at the gym.
I think there’s still room for thinking about this, but there’s couple of papers in the Journal of Sexual Medicine that you can go look at. The patent, which I think was very tightly edited by Irwin Goldstein, where it showed that using a vacuum pump increases the effectiveness of Viagra and Cialis. Men taking those therapeutic medications get a better result if they use a pump, intelligently, which makes sense. You’re just basically stretching out a water balloon to make it easier to blow up, but if you look at the old protocols involved, sometimes going to pressure 15, but most people think now, if you’ll look at the protocols being used in penial rehabilitation therapy where you also find a lot of this pump research.
Rehabilitating the penis post prostate surgery. The usual protocol’s a negative 7-10, and some guys, they seem to be really sensitive, and that’ll complain of pain at three or four, that’s okay. Just something that increases the erection equivalent or maybe slightly more than what would be experienced with a normal erection using the vacuum pump. That seems to be the place to where people see some improvement.
There was also this article, and another, looking at … Yes, this one. This is the journal of sex … Wrong one, I’m sorry, excuse me. This one.
Yes, so this was The British Journal of Urology, nice paper where they took people who had Peyronie’s disease scheduled for research, 31 people, and over a course of 12 weeks they had them use a pump twice a day. Half of them canceled their surgery, because just the mechanical makes sense. You have the scar tissue, stretch it out every day, a couple times a day, it might straighten it out, and it worked. When I talked to Ronald Virag who published the most recent, I think, landmark study about using PRP for Peyronie’s, which you can find if you go here, you go to our website, priapusshot.com/peyronies
By the way, I think this relates very nicely with the work that Andrew Goldstein did for us, with lichen sclerosus, because it all relates to the PRP down regulating the autoimmune response. If you go to, let’s see. If you just go /peyronies, which I recommend you give this website to your patients, because I put on here everything that I could find in the literature that had been shown in a really nice study to help with Peyronie’s. One of which was the Priapus Shot, which we can now say now.
If you go to just click on the references, so give them that, PriapusShot.com/peyronies so they will include all of those things in their protocol. For example, there’s a higher incidence with smoking. They’re sort of undoing the things we do if they don’t quit smoking, or at least try to do that. Not this one, this one.
Dr. Virag, who I think is amazing, he’s a legend, because he was the first guy to think of doing the TriMix injections, vascular surgeon turned ED expert, because of that idea. Here in this study, he showed that using PRP works better with fewer side effects than Xiapex, really nice research including some objective data using imaging. I’m kind of going in a circle here, but if you talk with him, which I have, shared the podium with him a couple times. If you talk with him, he’ll say in practice he combines PRP with the pump.
Circling back to what the original topic was, we have a pump study showing that mechanical traction helps Peyronie’s disease. Then we have this really nice study showing that PRP helps Peyronie’s disease, and when you talk with Dr. Virag, he’ll tell you that in practice he combines the two. Of course, when you’re doing a study, you just want one variable, but in practice, that combination is really nice, which is what we’re promoting when people come to us. Back to the pumps, you need to know what you’re doing, in my opinion.
Where to buy a penis pumps wholesale & how to adjust price
I think you use a pump that has a pressure of somewhere between … that you could measure, and then you have them put that pressure somewhere between 7 and 10. Now, I’ll show you where some people have trouble finding this, for some reason, so I’ll show you where I have a link. Where you can buy it wholesale, penis pumps, and I’ll tell you how some of our people are using this to create, not only a better outcome, but more profit, which is really nice when you can help people tremendously, and also the combination of doing more creates more profit. Let me get to this and show you.
If you go, sort of coming in the back way, so let me have one more click before I show you what you’ll see. When you login to the Priapus Shot membership sight, and then when you land, you’ll be on the dashboard, which is the next page I’ll show you. Here. Then when you click on the how to do the procedure part and scroll down, unless it’s somehow fallen off the page, which somehow computers do that sometimes, I’m not sure why, but if you scroll down, there should be a clicking link here somewhere where you can buy that. That’s it.
That is a wholesale, place to buy wholesale pumps. There’s a hand pump, an electric pump. This pump, not saying that you should have to use this, but I like this pump, because it’s a heavy duty metal device, and it has a pressure gauge on it. But, what some people are doing to increase both profit and outcome, is ordering this electric pump, which has a retail value of around $500, give or take.
If you go, this is the wholesale sight of this website, if you go to the retail sight, this has a perceived value of around $500. So some are buying this at wholesale, giving it to the patient, and charging, instead of our usual 18 or $1,900 for the Priapus Shot, charging them $2,200, but you’re giving them a device that’s worth $500. The overall perception of value, and the real delivery of value is actually more. This works well, because you can just set this.
One guy who came to me who had some nice results, he said he just set this and read the Wall Street Journal for an hour a day. I know that’s more than most people wanna devote to a pump, but the point is that if you set it at a nice low … and he used the pressure of seven and had really great results before he ever got his Priapus Shot. I feel like I need to talk more about this, because this is something that sort of freaks people out, and they’re not familiar with it. The other thing that I would tell you is that most people, if you get somewhere around 2-2.2, this is the diameter of the cylinder.
It’s going to fit most people, and seldom will people need the other tube, so maybe you buy one of those to have it on hand, one of each of these, but if you keep the tube to the 2.2 on hand, most people will fit one of those. You kind of see what you’re dealing with, and if it’s the average sized penis, you give them one of those, and give them this. Most of us are giving them a pump as part of the procedure, and just figuring it into the price. Anyway, that’s all there for you.
I kind of cut that deal for you guys, and if you wanna see the retail side of that, this guy Dr. Kaplan, Joel Kaplan out in San Diego. I went and checked him out, I like to meet people personally and see them. It’s interesting, if you go to his “office” it’s a huge warehouse literally stacked up 30 feet high with penis pumps, and about five people manning the computers. He’s making so much money with these pumps, because he delivers a nice product at a good price, but this is the patient side of it, which I like them being able to get to, so I don’t become the pump service repairman.
Whatever pump you give them, I like it to be something they can get … if something breaks on it, they can just order another cylinder without calling your nurse and turning her into the pump mechanic. If they want to get a different size something, because they grew, which happens sometimes, or whatever, it’s all on here for them to measure and do all that. This is the company from which you’re getting the wholesale version of this, it also gives them a way to see that you’re actually giving them something. I said $500, it’s 495 for this system that you’re giving them, or depending on what you’re attaching to it.
Somewhere between 4, 500 bucks, roughly, that you’re giving them, along with your procedure. All right, so that’s one problem, and you have research that shows the pump is helpful mechanically for Peyronie’s. If you go back to PubMed and you look at this, because the other question I get is, “Do we have to do the pump?” I actually had three questions this week about pumps.
Do you have to use the pump after the Priapus Shot® procedure?
One was, “Do we have to do the pump?” No, you don’t really even have to do the shot, right? They could just watch game shows and not have sex, but if you want to get the best effect of this thing, if it’s Peyronie’s, we have good science showing that it could be helpful as a standalone. If you have erectile dysfunction, we have studies showing that it could be helpful.
If it’s done intelligently. If you have prostate surgery, we have good studies showing it’s helpful, and if you want to read that, you just go to PubMed, and put in penile … That’s not PubMed, let me get back to PubMed. You put in “penile rehabilitation,” and a lot of science about how to recover post prostate surgery, and you’ll see that almost all of these protocols involve some combination of Cialis, low dose daily with a pump used daily.
Now, let’s just stop and quit thinking science for just a minute and just think commonsense. I’m a big fan of Richard Feynman, because he had two Nobel Prizes in physics, but he wasn’t into the limelight. He would actually use a fake name when he was going to lecture at universities, because he only wanted the mathematicians in the room. He didn’t want anybody showing up just because he had a Nobel Prize in physics, but he was a big fan of commonsense.
You do the math, but then you stop looking at the math, and you think what I’m looking at, is it commonsense? If you think about what we’re doing, as far as just mechanically allowing a balloon to be easier to blow up, then it makes commonsense that it would be helpful. Now, the other thing, can we take the commonsense thing one more step? There was a time, not so long ago, that I can actually remember, being 58, I can remember as early teens, 12, 13 year old, trying to figure out how to make muscles grow.
There were still people, at that time, who thought that lifting weights was somehow not good for you. If you go all the way back to the ’50s, it was actually … athletes were discouraged from lifting weights. But you had physical therapy post stroke. Physical therapy post stroke, after an injury, trying to recover strength.
It wasn’t until the 1980s, when I was in medical school, that the first article came out that actually said, “Yes, anabolic steroids actually make you stronger.” If you go back before that, they were saying that, “Well, maybe it’s just water weight, they’re not really that much stronger.” But the athletes all knew that was wrong, and I was working as a trainer in the gym, and we’re looking at people lifting the whole side of the gym, so I knew that was not right. Commonsense said it was not right.
Now, back to penises. If we have something that seems to be working for rehabilitating the penis, so if you use that analogy with weight training, why wait until the injury? Is what I’m saying. You don’t wait ’til you have stroke to go get rehabbed with your muscles, you lift weights to try to maintain strength so you don’t fall and break your hip, or you go walking, or some sort of weight resistance, so you don’t wind up like astronauts, where your bones break for standing up, which happens to the elderly.
Back to this. I think that the old will become new. Penis pumps were a thing before we had Viagra, I think they’re becoming a thing again, as we start to rethink how physical therapies might help penial help. Okay, that’s me just kind of trying to think like one of my heroes, Richard Feynman, with commonsense, without looking at the literature. But go read the literature, think about it.
The questions I got were, this week, three of them, “Do you need the pump?” The answer is, you don’t really need it, but you’ll probably get a better results if you use it intelligently. The one exception of that is probably if you have loss of sensation, just anecdotally, what I’ve noticed is those guys, if their only complain is loss of sensation, you’re maybe better off without using the pump. I figured this out, or noticed it in multiple patients.
That also makes sense if you’re trying to grow fragile nerve endings, perhaps the mechanical stretching may not be so helpful. That’s the exception to that things we’re using the pump for. The other question was about … Should you use it? My answer is probably yes.
Can you over use it? Do you need to get something with an actual gauge on it? Yes, I think you do, and this guy claims he’s got something that’s FDA, a device that’s been evaluated by the FDA, to where you actually have an accurate pump on it. You don’t want to get blamed for somebody else’s impotence, which is what happens if they over pump, consistently.
Other side effects of the pump
The other side effects are that their skin can become darker, so you just tell them that, and it will reverse if they stop pumping, and they can get some edema if pump for a long time, even if they don’t over pump on the pressure. Should you use it? Yes, for everything, maybe except for loss of sensation. Get something with a gauge on it, and I’ve shown you where to get it wholesale from our website.
Now you have a protocol that you can follow. There’s also a nice little video here that kind of talks you through it. Normally what I do is, I’ll do the shot, I’ll get the pump going, most people are afraid of them. I de-stigmatize that thing by calling it yoga for your penis, and that seems to, I don’t know.
Maybe one of you guys should do that penis yoga, but I think that seems to kind of calm them down a little bit, and I recommend that they not try to hide it. Just take the thing out and pump it up when you’re watching TV with your sweetheart and try not to make it into some big giant secret. The worst thing about porn is people keep it secret from their lover, and then it takes on this mystical thing that turns women into porn widows, where their husband’s off jacking off to porn. Where it loses power and usefulness, I think, when it becomes more shared.
Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration (click)<–
Okay, so I went off and made lots of circles there, but that’s my ideas about the pump. Now, let’s see, what else did I promise you guys? Maybe I should open up … Anybody want to comment about that? That’s on the call, I know there’s some people on here that have done really nice work and had lots of success.
If you just click the button, I’ll unmute you where you can talk to the group, I have a really nice group tonight, and you probably want to comment more about the pump thing. Okay. The other thing I promise we talk about is just to show you guys where some of the amnion research lives. Oh, you know what?
Free marketing for the O-Shot® [Orgasm Shot®] procedure
Let’s take a break from the research for a second and show you some free research thanks to one of our many amazing people, Carolyn Delucia, who is on the call. I’m gonna unmute you Carolyn, ’cause we have two crazy good articles. Before I unmute her, let me just show you, this is a gift from Carolyn, who’s created a really nice relationship with this lady who’s been writing about our stuff, I think, very intelligently. Here’s one that came out March the 11th, about the O-Shot, and here’s one that came out, check this out, April the 2nd about vaginal rejuvenation.
Wait, let me click on this thing. I went down too far. It talks about many of the things that we do, so this is a … I think an intelligent way and a balanced way that doesn’t over promise things. So, this is another nice thing to show your people, and so, how do you show people?
But before I get to going here, maybe Carolyn can talk a little bit about not just the procedures … I just un-muted you, Carolyn, but maybe just kind of some words of wisdom because she’s been teaching for us. She’s managed to get some amazing press. Part of it is because she’s in a nice town, but part of it is that she hustles and she knows how to talk with the press. Okay, are you there, Carolyn?
Carolyn Delucia: Hi everybody. Kind of shocking to be unmuted here but that’s okay. We love you, Charles. When it comes to getting press, I’ve been very fortunate to have gotten by accident noticed by one of the … Daily Elite, I think, was the first one, and once that happened, I was invited to give opinions on many articles. I think that the point there is if they ask you, say yes, and answer their questions quickly, and they are kind enough to alert you when they actually publish something that you have said, and it gives you, without any merit, truly an expert status, which is kind of comical, but we do these procedures day in and day out, helping our patients, and never really expecting anyone to notice, but if they do, it’s a way of letting everybody else know that this is available, and it’s been my soapbox for quite a number of years now.
Charles Runels: So, can I bring up something because … I won’t interrupt you for too long, but I want you to address a couple of times as you talk.
Carolyn Delucia: I’m done.
What’s the number one reason doctors do not get free press?
Charles Runels: So, one of them is this. There is an unspoken rule among physicians that is a really scary rule, and I’m going to speak it out loud. Here’s the unspoken rule: You don’t really have a right to be in the spotlight until you’ve published for many, many years, and maybe you have a professorship or something somewhere, and if you jump around, and you get a lot of attention before that happens, maybe you might be breaking a rule. Now, there’s no one who comes in and arrests you for that, but there’s uncomfortableness about that, and do you think I’m making that up, or what’s your experience, and how do you deal with that?
Carolyn Delucia: I think that the only reason why, without tons of publications, that I’m able to speak on this topic is that everybody else is afraid to, and I feel that women have got to know that these treatments are available even if it’s before all the literature comes to fruition, and I think that keeping it secret and not speaking of it and not being … I think for OBGYNs, mainly, our issue is that it’s not yet approved or officially condoned by the American College of OBGYN. So, with that, it’s making everybody a little bit uncomfortable to try it, and to speak of it, but we’re seeing such amazing results, and internationally, the literature is there. Whether I’m publishing it or not, I can certainly refer to plenty of literature defending these procedures. Whether they’re completed in the US already or not, they exist, and the results are in the great promise that we see in our patients.
Charles Runels: So, let me-
Carolyn Delucia: So, I don’t care.
Briars, Woods Walking & Medical Innovation
Charles Runels: So, I want to point out something, and let you elaborate this, and I want to pull in Dr. Goodman because he’s on the call, and as you know, he did some of this research, and was in it before we were in it, and I think the ways …
I always imagined myself when I was six. I used to go bird hunting with my dad, and we would go … Down in Alabama, the forest is so thick, and there’s a lot of … I don’t know what you call them up north, but we just call them briars down here, and those briars will just literally rip your skin, and I remember my dad walking ahead of me, and stepping on things, and knocking the briars out of the way so I would still be cut enough to where I’d feel like I went to the forest, but he sort of blazes the path for me, and so I feel like we, the people in this call, are blazing that path, but I think Dr. Goodman was kind of the daddy up there that took a lot of the heat before we got involved.
But before I pull him onto the call, I want to say that there was something key to you’re saying more in tone than in words, but you hinted at it in words. You believe in this, and you feel like women need to hear it, and I think that part of what makes what we’re doing important, maybe, to somebody is that you know this is at least working for some people, and there is some research and a growing body of research. Some of the anchor stuff actually done by Dr. Goodman, who I’m going to hopefully speak up in a second. I’ve got him muted for now, but they need to know, and because we’ve seen families and lives change because of it, we’re sort of willing to take some hits, and we do take hits, right?
Carolyn Delucia: Yes.
Charles Runels: We do all take hits, and we bleed. Metaphorically, we bleed, and the people on this call, I think, have a right to say, “At this point, we’re still in the early innovator stage, trying to get the research.” By the way, I was on the call today with Johnny Peet, and I think we’re going to very soon blast off with placebo study with incontinence. Andrew Goldstein is proceeding. I just kind of revived our recruitment for our double blind placebo shot for the O-Shot for orgasm, and our group is contributing literally hundreds of thousands of dollars to helping make some of this happen. I haven’t paid Dr. Peet anything yet, and he thinks he can do that one fairly economically, but the point is we’ve got some funds. Our group is financing a lot of this because there’s no pharmacy to kick in, and we’re risking taking the heat.
So, I think the thing that was in there that you, being humble, didn’t emphasize much, but the biggest thing to be talked about in the press is, one, getting a little attention, but then having the courage to actually do it. So, my hat’s off to you. I think part of the reason Italians ruled the world twice is Italian women so I mean, you’ve got the courage [inaudible 00:30:38] to do the thing, right? So, I’m doing to pull in Dr. Goodman and see what he has to say because I’m …
Now, one other thing about these words. I know Dr. Goodman, for every reason, has a right to the rejuvenation. I think that Dr. Matlock actually may have a trade mark on this rejuvenation word, and we just launched a website called Vaginal Reconstruction. It’s going to be just for our surgeons in the group that do the O-Shot, and it’s going to be … It’s in the preliminary stages, but I have plans to drive a lot of traffic so people aren’t confused about what’s surgery and what’s rejuvenation.
One of my big favorite authors is Thomas Moore, who wrote Care of the Soul, and he has a book about writing where he says [In Thomas Moore on Writing], “Everybody sort of has their own personal dictionary.” So, my grandmother always called a car “fliver.” I don’t know where that word came from. We all have different meanings for word, but the thing here is that when people have a lot of time and energy and money invested into a word, it’s an important thing, and for example, when I started using the word “facelift” associated with an injection procedure, I caught a lot of criticism from the surgeons who wanted facelift to mean just a facial surgery, and I understand that. I mean, I have a crazy respect for facial plastic surgeons. That is not an easy thing to put a face back together after you go through a windshield, and I would never pretend to do that, but I sort of took that word and made it mean something else, and then I thought anything lifting the skin away from the skull should mean facelift, and so there is some emotion tied around this word, I think, for a good reason.
So, I’m going to unmute Dr. Goodman, and just recognize him as someone who took the heat before I even knew this was a ring to get into, and he was getting punched up and doing some research. So, I’m going to unmute Dr. Goodman, and he will have-
Charles Runels: Hey, Dr. Goodman. Are you there? Michael? Hello? Dr. Goodman?
Okay, so are you there? Okay, so we’ll see. Maybe he’s not able … Maybe his microphone’s not working right now, but anyway, so anything else you want to say, Carolyn?
Carolyn Delucia: I think you’ve said it all, Charles. I really do. I think that the most important thing is that women are aware that these procedures are available, and that is not a cure nor a promise, but it may be a help, and I think that the main point is getting the word out, and that’s been my journey.
Charles Runels: Yeah. So, thank you for speaking up, and thanks for being courageous. Now let me see if I … If you don’t mind, Carolyn, can I just leave you unmuted, but let me see if I can give you guys a couple of tips on what to do with this because now this is here. It’s talking about lasers. It’s talking about surgery, and it’s talking about, of course, the O-Shot so it’s all here, and even though I take heat, the good thing I’ve learned to do, although not as well as I would like, is to realize that even bad press can at least bring attention to it, and if you’re okay with bleeding a little bit, and it brings attention even if you catch criticism, it’s okay to let that go.
So, what do you do, I guess, when you have this? How do you take this, and turn it into patients coming into your individual office? There’s a system I have. First of all, you want to look at Alexa, and see if it’s worth noticing. So, can you see that pop-out screen, Carolyn, that shows-
How to measure web traffic (one of my secret tools)
Carolyn Delucia: No.
Charles Runels: Okay, all right. So, you guys can’t see it. Okay, so I’ll just show you. If you go to alexa.com … I guess the first thing that I like to do is to make sure someone’s listening. If I look at a website, whether it’s good or bad, and it turns out it’s someone’s little blog that nobody’s reading, it doesn’t really matter if I post something to it. I’m not sure this allows … I don’t think it does, but most of the webpages where something like this happens, it allows you to comment. This one allows you to make a question, answer a question, but usually, there’s a place to comment, and why take the time to comment if it’s a blog that no one’s reading?
So, I use alexa.com. You go to A-L-E-X-A.com, and then you can just copy the address from where you were just at, and put it in here, and it will give you the traffic. So, here’s the traffic on this website, and it’s ranked 27000th in the US. That’s really very high. That’s very, very high so that’s worth noticing. So, that tells me that if there was a place to make a blog post here, that people are going to read it, and then that gives me a free ad perpetually after that. Is there … I’m going to show you an example if you Google “vampire breast lift” because I’ll give you an example of another article that Carolyn did where a lot of us got some press out of it. So, breast lift Cosmo is the one that really allowed us to make a lot of comments. Power to Cosmo for Cosmo …
So, if I told you, you could get an ad on the Cosmo website for free, that would be worth huge amounts of money because to have a display ad on Cosmo would cost you many thousands of dollars, but when Carolyn got this article about the breast lift, at the time, I don’t know if it’s still here, but at the time … Let’s see if they’re letting you do it. Well, it went away, but usually, they let you … There was a place to make a post.
The point I’m getting at, if there’s a place to post a comment, you do it, and you do it in such a way that it’s not an ad. You just make an intelligent comment on the article, and then you will have basically a display ad on that website, but before you do that, the first test is to go to Alexa, and see if people actually visit that blog. So, Cosmo, if you do an Alexa thing, it’s not showing you, but it comes out at 1000, and 27000 is this one. If you do say, for example, Botox Cosmetic, it’s about 130000 to 150000 in the US. Our O-Shot is usually about 50000 so we’re not this much traffic, but we’re much better … Anyway, there’s a lot of traffic so it’s a respectable site, and you would make a comment if that’s possible.
*Next step is that you then take that link for it, and you just write an email that goes very simply something like this, and this is what you send to your patients, “Hello, I thought you might be interested in this procedure that helps urinary incontinence. Here’s a nice article about it. If you or someone you love,” always put you or someone love, “has this problem, and is interested, please give us a call or shoot us an email,” …
*and then you put a link to the page. It’s that simple. You don’t have to become Thoreau. You just write a very simple article like that, and post it, and then you can take that same thing, and I’ll show you how you can put it on Facebook very easily.
You just copy the address, and then if you want, you can just click the Facebook link and it puts it there, but if you want to very quickly make something more individualized, you just go to your page, and watch what Facebook has the … See, I’ve already done this, but I wanted to make a more intelligent comment about it, if you put the link in there, it pulls up the page, and then you can just make a comment about it into that box, and you’re not seeing the pop-up box, but it pulls up a pop-up box, and I’ll just show you an example, and then when you post it, now you can see. I just typed in an example right there, but I could’ve put something like, “Come see us about this procedure,” or whatever suits your personality, but all I did was in this, right here, I posted the HTML address into that space, and then it pulls up the picture, but it allows me to type something else there so that’s how you do it. I better take this away. That’s how you do it to Facebook or Instagram or wherever.
So, for me, it’s an email that’s two or three lines as if I were writing it to my mother or my girlfriend or sister or something, and then with a link to the thing with a plea for them to either call me, or let someone they love know about it, and they will think about that. It gives them the chance to help their sister or their best friend or whatever, and they will forward it to them. Okay, and now you’re using the national press to promote your practice.
A way to get a free appearance on your local TV station
*One last thing, and this one’s a big one if you have the courage to do it. Then what you do is you should have in your pocket, in your cell phone, the phone number of the health reporter for the news channel in your town, and then you call them, and say, for example, when this hit Cosmo, if you would’ve called your local channel and said, “Hey, there’s a thing in Cosmo about the vampire breast lift,” and you’ll notice they said this was the most looked at thing on Cosmo that month, but think about it. What could possibly pull more traffic than the word “vampire” and “breast” and Kim Kardashian during the Halloween season? I don’t know what other perfect lining up of things you would have to do to be able to generate traffic.
So, all of those happen. You got crazy amounts of traffic, and so, at that same day, and this is your step-by-step thing so I’m about to give you the next step. First, it’s a two line email to your people linked to the thing, asking them to call you or to forward it to someone they love that may have the problem. Second, you post to Facebook or whatever social media you’re doing. Third, you call the local news reporter and you say, “Hey, that thing that just happened or that’s on Cosmo, I’m doing that,” because, if you notice, the news reports on the news …
It’s really funny. You watch CNN, they’re talking about what the Fox News people are saying. Fox News is talking about what CNN and NBC is saying, and you’re watching the people on CNN, one reporter interviewing another. When did that get to be news when two reporters interview each other? But you see it all the time, but the point of that is that the news is hard up for news. It’s hard to think of something new every day, especially in your local town where there’s just not as many people to make things happen. So, when you give them something that is timed to the national press, that’s the point of all this, they will usually gobble it up, and they will call you for more things if you have the courage to do it.
All right, so, anything else you could say about that, Carolyn, and then I want to get back to the science a little bit.
Carolyn Delucia: No, not at all. I think that’s fantastic. Great advice.
Dr. Michael Goodman talks about innovation in medicine
Charles Runels: So, still have you unmuted, Michael, if you could hear me. I’m not sure if you’re there or not, but I’d love for you to jump in here about some of this research that we’ve talked about. Anyway-
Michael Goodman: Charles?
Charles Runels: Yes? Hello?
Michael Goodman: Can you hear me?
Charles Runels: Yeah! There you are! Beautiful!
So, back to this article because I don’t know if you heard me because I couldn’t hear you, but I’ve been bragging on you because I know that you must’ve taken a lot of heat back in the day. Talk to us some because I know I’ve heard Andrew Goldstein talk about that first paper you put out about how some of the cosmetic procedures made physical sex better. Talk to me some about the … And you’re too humble to talk about to talk about your courage, but at least some of the conflict you had to deal with, and give us a little sage advice because you’re the guy who was taking the briars and who created the path.
Michael Goodman: I heard you earlier, actually. I was in the garden sitting, my spring lettuce-
Charles Runels: You’re making me hungry.
Michael Goodman: Yeah, I had my headset on. For some reason, I didn’t connect so I came inside, and I’m on the-
Charles Runels: Thank you.
Michael Goodman: So, I can hear you now, and thanks for all the comments earlier. As far as early on, the journals and organized medicine really don’t like to things that happen outside of the university, and happen outside of officialdom. So, way, way back when [Camden John 00:44:58] and Harry Rich and several others and myself started doing advanced operative laparoscopy, and we’re dealing with ectopics in the late 70s, and doing hysterectomies and ovarian cystectomies and so forth in the early 1980s, and we tried to publish our first series back in ’84, I think, it was near ’84, none of the journals would have anything of it. In fact, the Green Journal called us cowboys, and basically wouldn’t hear of what we were doing.
We had the audacity of operating at a conference through a scope, and removing ovaries through the scope, and Harry Rich and I doing hysterectomies through the scope, all of which is just sort of standard practice today, and it was the same thing when plastic surgeons started to do breast augmentations for cosmetic reasons, and it’s exactly the same thing today, and it’s interesting. There is a decent amount of evidence based research in the Aesthetic Surgery Journal and in Journal of Plastic and Reconstructive Surgery and in the great journal, the American Journal of Obstetrics and Gynecology, and then certainly in the Journal of Sexual Medicine, there’s tier one evidence about changes in sexuality and in body image in women undergoing vaginal aesthetics.
It’s evidence-based that yes, there’s improvements in body image, and yes, there’s improvement in sexual satisfaction, and it’s all there in the literature, but ACOG really won’t hear of it, and when they quote the literature, they don’t quote any of these articles, so it’s pretty selective. That’s, you know, Charles, you run into that, and a lot of us who have done things, who have been in community medicine rather than in academic medicine. I have an academic appointment, but I’m a community physician.
Those of us that are community physicians, our voices aren’t heard as much. The interesting thing, when you look at results from procedures or results from treatments, everything has to be evidence-based. I’m definitely someone who believes in evidence-based medicine, but I’ve come to realize that anecdotal information is not chopped liver. The reality is that certain things will never, unfortunately, get the stamp of approval of evidence-based because there’s no money for funding.
That’s where the Cellular Medical Association comes in, and where it’s been, where you’ve been so helpful in that, is providing some funding money. When you take a look at things like treatment of PMS, you know, the official treatment of PMS is either risperidone, which is an anti-anxiety medication, or SSRI antidepressants. Those are the only things evidence-based that work for PMS. Why? Because there’s no studies that talk about caffeine avoidance, and talk about exercise, and talk about progesterone therapy.
There’s no studies that talk about progesterone therapy because nobody’s going to pay for them. They’re not patentable, and that’s what it sort of ends up being. If you have something that’s patentable, you can get money for research and you can prove whatever you want to prove. So much of the stuff in the literature is not comparing one treatment with another, but it’s just evaluating that singular treatment.
I mean, I’ll quit now while I’m ahead rather than use up all the air time, but I think what you’re doing as far … What we’re all contributing in as far as doing studies about the effect of the O-Shot®, and these treatments that no one will put money into because things aren’t patentable. You can’t patent the use of platelet rich plasma in Gräfenberg’s area and in the clitoris, and so there are not going to be studies unless someone like you or someone else takes the plan and says, “No, we’ve got to, let’s put some science into this.”
There’s always battles to be fought, and unfortunately, medicine is going into such a place where it’s sort of run by insurance companies and doctors have very little say and end up being employees, and it’s really hard to spend time with women and understand what their goals are, understand what’s bothering them, understand what their goals are, and try to meet those goals. One other thing, Charles, you still there?
Charles Runels: Yeah, and don’t feel restrained with time. You may not realize it, but you know, your thoughts are very encouraging to us as we just got through speaking. Carolyn’s been … I hope you guys know each other. I think you do. You know Carolyn Delucia, right? You guys know each other?
Michael: I don’t know if we do. Carolyn, do we know each other? I don’t know.
Carolyn Delucia: I don’t think we’ve ever met face to face. I don’t think so, actually. We’ve been at a lot of conferences together but never actually met.
Charles Runels: I’m glad you guys are meeting at least this way, because it does take … It’s scary sometimes, to be doing what we do, but yet we do it because we know that some of our women will be helped profoundly by it, and we try to do it intelligently so that we … We’re doing it in such a way there’s minimal harm always, of course, first do no harm. But it’s scary, and Carolyn has been hauled in and taken some blows, and out there. So, it’s good for us to hear, back in 1984 when I was still in college, that you were out blazing trails and yet you survived it, and you’re smarter and tougher because of it, so it’s good to see, and it’s very encouraging to me and I think probably to the others.
Carolyn Delucia: Absolutely.
Charles Runels: Of course, it’s not me doing it. There’s nothing I could be doing. I’ve become mostly a facilitator of conversation and a note taker and basically a pipe for the money to flow through to the research and the marketing and the lawyering. Anyway, I don’t really take credit for any of it, but just being maybe an admirer of people like you and [Bill Say 00:51:56] and all those guys who were out there taking the hits when I was still wiping my snotty nose.
Michael: [inaudible 00:52:04] a major role [inaudible 00:52:06] that we’ve taken with Andrew Goldstein, and Andrew and I have been friends for a long time. There’s no way he would have been interested in this and taking his ability to write up a good [inaudible 00:52:23] and get things published. That wouldn’t have happened without your facilitation. What I was trying to search for before was operative gymnasts, that’s what we called them in an editorial in The Green Journal, operative gymnasts, because-
Charles Runels: Operative gymnasts, like people who do flips on the balance beam?
Michael: Operative gymnasts; back in those days, laparoscopy was used for diagnosis only and tubal ligation, period. The fact other things were being done through the scope was heresy, but a lot of things start that way. You know, we were talking about the term vaginal rejuvenation.
Charles Runels: Yes, talk about that.
Michael: Yeah, I go way back with that term. The term initially, as you noted, the term initially was put forth by David Matlock, and I don’t know how many on this call know David. I’ve known him personally for about 15 years, and Davis is the penultimate marketer. I mean, no, maybe not the penultimate. You may be at this point, but maybe back in the day, you know, David has an M.D. and an MBA, a masters of business administration, and this was back when docs were not supposed to market at all. It was just sort of bad form to speak about your own practice and to market.
David had the audacity to try to patent the term laser vaginal rejuvenation. He was unable to patent it. I think he was unable to trademark it also for various reasons, but that term, vaginal rejuvenation, was, when David was talking about it, had nothing to do with machines, had nothing to do with radiofrequency, had nothing to do with laser. It was doing a surgical vaginal tightening operation. It was a modified, it was pretty much what we’re doing today with some modifications. It was a modification of a posterior colporrhaphy by adding in a levatorplasty, adding in the bulking of the scar tissue underneath the vulvar vestibule and perineum and distal vagina.
Where the laser came in, and that was his kick, where the laser came in was he was using a touch laser fiber as a surgical tool. Now, laser vaginal rejuvenation has nothing to do with the fractional CO2 lasers or erbium lasers that are used today. That’s not what laser vaginal rejuvenation is. It’s use of a touch laser fiber as a cutting tool. You can use a scalpel, you can use a scissors. I use a radiofrequency needle, same difference, it was use of a laser as a cutting tool for a surgical procedure.
That was there, and I remember John Miklos and I had an open discussion at one of the vaginal aesthetics meetings many years ago, where he was beginning to use the word vaginal rejuvenation. At that time, I spoke up against that saying, “That’s a can of worms.” For example, I’ve talked about this before, if you have a 65-year-old woman and she’s maybe 12, 13 years post-menopause and she hasn’t been on hormone therapy. She’s a widow, and her poor vagina has become very atrophied, she barely can put her little finger in there, and she’s met someone and she wants to have sex, and you work with her with vaginal estrogens, and you work with her with dilators, and over time, you get her vagina back so she can have sex, you’ve done a vaginal rejuvenation.
[inaudible 00:56:31] with the word vaginal rejuvenation is that it’s become a marketing term, and no one knows what the hell it means. If you ask 10 people what vaginal rejuvenation is, you’ll get 10 answers and unfortunately, patients feel that vaginal rejuvenation is going to cure their ills, whatever they are, whether they’re sexual ills, whether they need tightening, whatever it is. Vaginal rejuvenation is such a nonspecific term, and I still … Because it’s so nonspecific. I mean, what does it mean to you, Carolyn? What does it mean to you, Charles? What does it mean to everybody?
It’s not specific. Does it mean surgery? Does it mean levatorplasty and a full perineoplasty with elevation of the perineal body? That’s very different than using DHEA suppositories or estrogen in the vagina for your rejuvenation, and that’s very different from using, from resurfacing tissue. You resurface the face, you can see those changes. You’ve gotten rid of acne pits, and you’ve gotten rid of blemishes and so forth.
What does resurfacing of the vagina with laser mean? What does it do? What is resurfacing of the vaginal mucosa with radiofrequency? What does that mean? How often? We do it [inaudible 00:57:54] times, a month apart. Where did that come from? Why shouldn’t it be more? Why do we just do it two? How often do we do it? What kind of results do you get? Unfortunately, I’m seeing patient after patient after patient, well, just two patients after patient, I’ve seen several patients that have put out several thousand bucks and say, “You know, I felt a little different for a few months. Maybe there was something there, and it really didn’t do much.”
They put out a couple thousand dollars for vaginal resurfacing that really didn’t suit their needs. That said, I’m talking to doctors who say, “You know, my patients love it. I’m doing diVa,or I’m doing ThermiVa or I’m doing one of the other Vas, and the patients seem to be happy, and the greatest thing is they keep coming back and the money keeps flowing in.” But, are we really helping patients? I think sometimes we probably are, but the term is so nonspecific that we really have no idea what we’re doing, and it’s very hard to get any even anecdotal, even a compilation of anecdotal results, because one person’s rejuvenation is not another’s.
Charles Runels: I have a suggestion about what might, what I think might be evolving, and I have a lot of respect of course for you and the other guys like Dr. Matlock and Dr. Bill Seay and those guys that blazed the trail. But I think what I’m seeing is that you’re exactly right, rejuvenation has become more like, instead of the specific thing that it was intended to be, it’s become more of a, as you said, almost meaningless umbrella that can mean whatever is being done.
The reason I have this pulled up, I have a suggestion based on data. I like to look, and this, I’m giving away one of my secret weapons here. I’m a big believer in, how do people think about words? That word Vampire Facelift was not haphazard. I had the procedure, but I thought about the name for it for about a week of studying numbers to learn about words. I’m giving you one of my secret weapons, it’s called Wordtracker. You go, you log in to Wordtracker. It costs you a little bit, but you log in and you can put in a word, and you can see how many times people are using it.
I have a suggestion based on this. If you look at vaginal rejuvenation, it’s been used about 33,000 times in the past month, in the United States, of people looking for something. Now, these numbers talk about competition, so for example this is the number of Websites where it’s in the title and it’s in the text, and there’s a back link coming back to it, so just the word vaginal rejuvenation.
Now, notice this number, 33,000 in the past month, and then here’s some related ones. Here’s, and I’m telling you, this is worth gold what I’m showing you guys, now if you put in vaginal reconstruction, I don’t think there’s anybody that can make this into something other than a surgery. I don’t think anybody’s going to imagine I’m going to reconstruct, although maybe on a cellular level, I think … Not maybe, I think we are on a cellular level reconstructing things when we use platelet rich plasma and when we do energy therapies. But, I don’t think anyone’s going to ever evolve into thinking reconstruction is anything other than changing the mechanics and the surgical procedure, and it’s a pretty amazing vein of gold.
Now what I mean by vein of gold is this. In the early days, when Bill Clinton was elected president, there were only 33,000 Websites on the planet. If you made a Website that had to do with anything that a lot of people were looking for, you were the sole source of a lot of people looking for that thing, and they would be dropping dimes in your pocket or coming to your door, whatever it was you wanted them to do.
Now, there’s a Website for almost everything, and there’s very few veins of gold left out there where not many people are talking about something that a lot of people are looking for. This is one of the tools I use to look for those veins of gold. If you look at vaginal reconstruction, it’s not 33,000, but it’s still over 5,000 people, and there’s only two Websites with that in the key word, and one of them is ours, VaginalReconstruction.com. Then, these numbers are crazy good, because the higher the number the more competition, and this number is only 3.12.
If you look at this last one we were looking at, at vaginal … If you remember, if you go back to vaginal rejuvenation, I’m giving you marketing advice here, but maybe not just marketing, but ways to educate our patients. Rejuvenation, and so if you look at this one, that same KEI number is almost 100. The other one is only three, and that means that there’s a whole lot more people trying to capture this amount of volume.
Even if the volume is less but still significant, if there’s not many people catching it, you’re going to get a lot of traffic. I have given as a gift VaginalReconstruction.com, which costs me I won’t say how much, but it had a noticeable number of zeros behind it, and I bought that domain using our funds from the O-Shot® to create a Website just for the surgeons. Now, there’s always a selfish reason in everything, so if you go to VaginalReconstruction.com, this now belongs to us.
I’ve just put something as a placeholder until we develop it, so I got a little something from Red, and something from Michael, and a textbook, and another textbook, and a little bit from Carolyn up there in New York. But, my rule is going to be only surgeons who do the O-Shot® can be on this Website, so it also feeds the O-Shot® side of people who don’t do surgery. But, it’s a way to capture that really low KEI number so there’s the significant numbers of people who are looking for vaginal reconstruction get funneled to the excellent surgeons in our group.
So, that’s what we have going, and what I’m suggesting is that you can decide yourself what vaginal rejuvenation means, but I don’t think anyone’s going to ever get confused about what vaginal reconstruction means, and that if you start using that in your posts, if you’re a surgeon, I’m going to make that, if I’m able, into a word that starts to dwarf the 33,000 that’s used for vaginal rejuvenation, or at least approach that same number. That is my intention to make that happen, so I’m kind of showing my cards to this group because this is a group that’s all friends and in the same thing. We’ve gone over an hour, so I think I’ll probably shut it down here. Hopefully that was useful to you guys.
The last thing on my list that I promised was to show you where it lives, the research that has to do with the Amnion. I’m not going to talk about it much, because I’ve already gone over the hour, which I don’t like to do. But there’s a link, you know what? I’ll just put it in the link under the recording from this thing. But we have, on the cellular medicine site, a really nice list of the research that has to do with Amnion. I’m interested what happens with you guys as you start to maybe use that as a combination with your PRP and your hard to treat cases.
I better shut this down since we’re over an hour. Thank you very much, Carolyn, and thank you very much, Michael. I don’t know if you realize it, but it’s a huge encouragement to us to hear about how you blazed a trail and continue to do so. You guys have a good week, thank you.
Carolyn Delucia: Thank you, thank you.
Charles Runels: Goodbye.
Both Dr. Delucia & Dr. Goodman offer hands-on workshops and can be found on the following directory…
Cellular Medicine Association
Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
Dr. Runels: Thank you for having me.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
The following is a video and transcript of the weekly “Round Table Journal Club” of the Cellular Medicine Association.
Charles Runels: We’ll start with some research that I think is worth paying attention to and then we’ll answer what questions might have appeared in the past week or so and then a quick marketing tip about how to use our poster. So that’s what I have planned for today but as always, we’ll take any questions that you guys have on the call.
If you’re not a subscriber to the Journal of Sexual Medicine, oh, by the way, we also have some really crazy good press that came out this month on the current Men’s Health magazine.
The one that is on the stands now. It’s the issue that has Mark Wahlberg on the cover. So it’s in every Wal-Mart, every bookstore right now and we have an article in there. It’s titled, “New Year,” excuse my French but that’s the title of it. “New Year, New Dick,” that’s the name of the title and the guy talks about our priapus shot.
As often happens, he doesn’t get the legal part right and he spells Priapus incorrectly, but he puts shot with a lower case “s” and leaves off the registered mark (®) so there really is some pretty sloppy journalism going on (since a little research shows that Priapus Shot® is intellectual property intended to mean a particular way of using PRP injections in the penis and post op and pre op protocols).
But, Andy Warhol said, “I don’t read the reviews, I just measure them in inches.” But this is a really good time to talk about the Priapus Shot®. I’ll send out an email to the group to let people know, but the Priapus Shot® porcedure is really in the news. To put an ad in that magazine costs you quarter million dollars and we have an eight page article now about the Priapus Shot® procedure in Men’s Health, so it’s a good time to talk about that.
So back to this research, it’s pretty easy to summarize and this has been out for a few months and I’ve been wanting to bring it up. It talks about this thing that we all know that women who are put on Serotonin Reuptake Inhibitors often have a drop in their sex drive.
This is the paper that came out... Click to Read Abstract<--
But what isn’t talked about a lot is that even after you stop the medication, often times they keep the low sex drive. So I have a little formula that I use before there was an “O” shot that I’m happy to share with you and then I think combining it with the “O” shot, we should get even better results. But I wouldn’t pretend like only rejuvenating the tissue of the vagina could take care of all the problems that might be going on metabolically in the brain secondary to months on an SSRI.
What I have found works the best is this. I make sure that, I’ll just bring this up where I can kind of type it out. I’m going to put this where I can make it where you can see it. This would be my of handling this and I’ve found that just one thing often doesn’t work. The first thing I put on is I like Depo-testosterone, Depo-testosterone. This is one of those drugs unlike some, where generic is fine, I don’t or I’ll compound it, can even be better in some cases. I don’t like to start a woman with creams because she may forget them, she may sweat them off down here in the south where it gets hot. Lots of things can happen.
Maybe she’s not absorbing it well and if a month later, her libido isn’t up, I have to do blood tests to know whether or not she’s even using it or absorbing it properly. But if I start off with Depo-testosterone 50 mg IM every 21 days, which is a pretty whopping dose and so you have to obviously, you don’t just put her on that and forget her. You have to bring her back about a week to two weeks after the second dose at the latest and you redo blood tests and see how she’s doing. They’ll often say their libido pops up towards the end of that 21 days and then pops back down and then comes up after the second shot and stays there. Then I’ll adjust it and then swap her over to creams or pellets after you get her libido back. But otherwise I’ve found I fiddled too long where that I know it’s in there and I know if testosterone’s going to help, that dose will help her.
1. Depo-testosterone 50mg im every 21 days. 2. Wellbutrin 3. O-Shot® 4. Family &/or Sex Therapy
Then if she needs an antidepressant, which often times she will not after you have her on testosterone, but I like Wellbutrin. It seems to, I’m spelling that wrong Wellbutrin. Anyway, you guys know what I’m trying to write, Wellbutrin. The slow release at 150 mg somewhere in that range. That will help the depression and also help with sex drive. Then of course, the “O” shot can go in that formula now and I like to make sure of course, that someone’s thinking about whatever else might be going on at home socially, or emotionally with the woman. It’s just sexuality and orgasm is such a complicated thing. I have done some of this, talking and counseling and trying to get husbands and wives in. But, it’s time consuming and I don’t attempt it anymore. A marriage counselor or a sex therapist or both. And that combination I think, well I know, that combination has pulled without even using the “O” shot before there was an “O” shot, has pulled my people out of that.
But the reason I wanted to bring up this research, is that most people realize there’s an SSRI syndrome that causes decreased libido, but it’s not often talked about that it persists in many women for unclear causes, even after you drop the off the medicines. I’ll copy this link into the chat box so it you guys want to check that out, you’ll know where to find it.
This is the paper that came out... Click to Read Abstract<--
Okay, so that’s the research for the day and let’s get to some of the questions. If you guys have any questions, just type them in there and while I’m getting to this other research, if you want to contribute to that cause I see some gynecologists on the call, just let me know and I’ll unmute your mike because I know that many of you have experience with this and may want to add to what we just said. And I would love to hear from you. So, there should be a little thing to raise your hand if you have your mike. Some of you don’t even have a mike turned on, but if you do and you want to contribute your ideas to that, let me know because I’d love to hear from you. Let me pull up the next question.
How long can you wait after phlebotomy before doing preparation of the PRP?
So this is a good question I think. It says, “What’s the longest we can wait after drawing the blood and before spinning and injecting? We’re performing “O” shots intraoperatively at the end of the case, who have a longer case. We like to draw blood prior to surgery. Any thoughts?” In the thoracic suite where people are doing heart bypass surgery, this is one of the places where this has been used PRP, to help healing of the sternal wound postop. The number I’ve been quoted is up to six hours, even after you centrifuge it, it can sit there. I think it’s certainly okay to let it sit there for three to four hours as you’ve indicated here in this question and then throw it in the centrifuge and inject it. That’s the answer to that question.
Now of course, after you push it through the needle or you add calcium chloride to it, all bets are off and I like it to begin the person’s body, preferably in less than a minute or two and I’m always trying to put it once I activate it with calcium. Which I hope you’re doing if you’re doing the “O” shot, activating it either with thrombin, which some of the kits have, calcium chloride or calcium gluconate. After that activation happens, it should be in the person’s body in less than three minutes.
I see Kathleen, if you don’t mind I’m going to have you pull up this next question, talk about how you deal with the ladies in your practice who have been on SSRI’s. Are you there Kathleen?
Kathleen Posey: Yeah, can you hear me?
Charles Runels: So for those of you who don’t know, Dr. Posey has seen thousands of women in her practice, is a gynecologist down in the New Orleans area. So talk to me about how you deal with the women either who are on SSRI’s or who have been on SSRI’s while I pull up the next questions. If you don’t mind.
Kathleen Posey: Very similar to you, that’s why I didn’t say anything except I agree. I mean if they come in on an SSRI and they have diminished orgasm ability, which most of them do I don’t stop their SSRI right away, I just add Wellbutrin and usually the combo is fine. Before I do the O-shot though, I really want the O-shot to work and I really try to ween them off the SSRI on to the Wellbutrin and a lot of the times I’ll do the same thing, I’ll give a shot of testosterone in it at the same time I’m doing a pellet, or I’ll give a shot of testosterone when I’m doing the O-shot because I just want them to get started and pretty much do the same, I use the pellets more than I do the injection but that’s just my preference.
Charles Runels: Okay so when you do, let me catch up with you. So when you do, someone comes in and they’re on an SSRI, you might start Wellbutrin and give them a testosterone injection or a pellet and then either do that O-shot then or bring them back and do the O-shot later is that correct?
Kathleen Posey: Yes but I keep them on SSRI because a lot of times, you know most of them have been on the SSRI so long I find if you just stop it and then just try to get them to go to a [inaudible 00:11:18] it doesn’t work that well. Wellbutrin makes them a little bit more nervous, it’s not as sedating and if you just give it, that’s why even the therapeutic does at 150 the therapeutic dose is 300. So if you just give them 150 it seems to work with the SSRI and then I’ll let them go a month or two talking about the O-shot, talking about testosterone and I usually try to ween them, eventually [inaudible 00:11:56].
Charles Runels: Okay. Alright.
Kathleen Posey: I know a lot of the psychiatrists do it that way too, they’ll just add …
Where do you get your supplies?
Charles Runels: Add the Wellbutrin, okay beautiful. Alright so here’s another question, it says where do you get your 30 gauge needles and your 1/16th syringes? So if you go on to the, hopefully it’s on here, if it’s not I need to fix it. If you go on to our website what I’ve tried to do is on the how to do page, so you’ll be coming from a different direction but … There should be a link to everything. Maybe there’s not. Nope. I’ll just put, I know it’s on the O-shot so let me pull it up there and I’ll add it to the vampire facelift. If you go to … by the way I just added to, let me pull this up, [inaudible 00:13:08].info … okay.
So in all the others, which I haven’t done yet on the facelift but I need to, all the others there’s a dashboard and when you go to the dashboard there’s a place where it says supplies and sources, also on the how-to-do procedure and when you click on that I just didn’t realize it didn’t have it there, maybe I overlooked it. But I know where it is on this one and right there is where I get most of my stuff from McGuff pharmacy. They have lure lock connectors, they’ve got the needles, they have the 1/16th syringes with the lure lock connection to it and I buy these by the box full for not much, there’s the part number and I’ll put this link in the little chat box and add it to the webpage where we put the answer to these questions.
O-Shot Provider Member's site P-Shot Provider Member's site Vampire Facelift Provider Member's site Vampire Facial Provider Member's site
So actually most of the questions this week were on the vampire facial website and if you guys aren’t yet doing micro needling or offering it for postpartum stretch marks it’s something to think about because I’m hearing more and more that, that’s working. Sign them up for two to three treatments and it’s really working well from what I here, I haven’t treated enough to tell you first hand but I have people in the group who have treated a lot of people with that. So, but there were quite a few questions in the vampire facial and then after these questions I’ll give you guys some marketing tips on how to use those posters. Oh by the way so here, before I get to these four good questions here I just added a new dashboard and a lot of extra content to the facial. So if you go to the vampire facial dashboard I uploaded some new videos, taken from our workshops and so this is the new facial dashboard and if you go to the how to do page you’ll see some really detailed videos where some of the stars in our group, like this one. Of course Dr. Bowen’s published some stuff about this, there’s some really nice videos, especially this one where some people who do a lot of micro needling talk about it.
Vampire Hair Growth™
So, let’s see back to our questions on this page and then we’ll talk about the posters. Four good questions here. Okay first one, where’s the quiz. I’m not sure why that’s not showing up but I’ll put that, make sure it says well there’s a little quiz there to take from some people but if you’ve already had a hands on course then it’s not going to show up. You’re not doing the hands on course you’re certified. But if you’re learning this as part of an online course then there should be a quiz that shows up. Let’s see this one, good morning I have a patient who’s [inaudible 00:16:44] hair PRP after a transplant, he’s been using Minoxidil, it’s on a low dose Finasteride. The hair is now thinning considerably, what about using the PRP after a hair transplant, any noticeable difference back on Finasteride or not?
So I’m going to approve this so it’ll show up and see if some of our hair people will help answer it but what I know is some of the people have told me that they are using PRP. Of course we know it’s being used as part of the hair transplant procedure with improved results, so most of the hair transplant surgeons are doing that now but the idea of repeating the PRP every six months or so is also becoming a thing that’s done standardly to help maintain it. So the short answer to that is yes, there’s evidence that it will help as far as putting people back on Finasteride it makes sense that it would help. There’s this talk of the occasional person who gets depressed from that and I don’t have an answer for that part of it but I know repeating the PRP every six months or so has been talked about among our group as being something that’s helping. Let’s see so how many treatments are recommended for the hair restoration?
So this again there’s not one standard, I will tell you from the things I’ve seen at the meetings, what I’ve seen that’s been published and there’s been a growing number of papers published and some of this there is not a known this is the answer but I’ll tell you what I think is the consensus for now. So how many treatments? Most people go three treatments at four to six weeks apart. How long until they’re visible? It can be up to six months, they have to be patient. But most of us are stopping if we don’t see any results a month after the second treatment, which would be two to three months in and results, as in documenting with photographs, if you see new hair growth and you keep going, most of us are stopping if you’re not seeing anything after the second month. But to be actually happy with what they’re seeing it can take six months to a year.
How long until the peek effect? Just answered that. How long do the effects last? Most people are redoing it every six months or so, just one treatment not the whole serious of three. What’s the recommended fee for each treatment? Anytime I spin blood it should be at least $600 because you have cost of good and your time. Most people are charging and that’s really almost losing money because you have to pay, not only the cost of good for these kits, which can be expensive but your time, the office time, there’s this engine running every minute in your office, you should calculate what that’s costing you by the time all the people are getting paid and the lights and the taxes and everything. Every minute that engine turn cost you money. So to really come out on this, really most people are charging a series of three for somewhere between 2500 to three grand and obviously that’s worth it if you get good results and we’re not keeping the money if we don’t get results. What type of anesthesia do you use? I put on the facelift … I need to put it on the facial side. That’s why this guys probably hasn’t seen it. But on the facelift side, I just put up a new video about hair. Actually, two new videos. So, here’s one of them. 20 minutes from one of our providers up in Canada. And then, this one. This Dr. Mario is been doing hair for a long time. I think it was 20-plus years he’s been doing hair. We filmed his technique for both doing hair, and blocking the scalp. I was somewhere down in Florida when we filmed this. So, those are two new videos that I recommend you watch to answer both the blocking part, and the technique part.
When do you add in the Botox when using PRP?
Okay. So, I think that answered all those questions. Next questions, if a patient has Botox recently, how long do you recommend waiting before scheduling a Vampire Facial? So if you think about it, the Botox binds to the nerve blocker about … it takes about four hours, so we tell our people, if you get treated with Botox, wait four hours before you lie down, stand on your head, all that stuff, so that it doesn’t migrate and cause atosis. Now, if you reversed it, and you did the Vampire Facial, you could immediately do Botox. If you did the facial first though … excuse me.
So if you did the facial, you could immediately do the Botox same visit. No big deal. If you did Botox, you could do the facial and probably get away with it anywhere other than the more exacting spots, like the lower face or the corner of the eye, where migration would cause a problem. If you were microneedling under the eye or the forehead, it wouldn’t really matter. Ideally it’s either same visit, go facial then Botox immediately afterwards, and I do that quite a bit with the facial and the facelift. Or, if they’ve had the facial, just give it four hours, so it could be the next day, or later that day if you just forgot and did one in the wrong orders, if you did the Botox first. And I think that’s all the questions on this.
Dana Kirk just put in something that is interesting. Okay. So she says, “At the last International Society of Hair Restoration Surgery … ” You know what? I may just unmute you if that’s okay, Dana, and let you tell us what you … sounds like you were at a cool meeting recently. Let you educate us. Hold on a second. If you’d rather not, that’s okay, but I’d rather you just tell them instead of me having to rehash what you said. Are you there, Dana?
Dana Kirk: Hi. Yeah, I’m here.
Next Workshops with Live Models<-- Find O-Shot® provider Find Priapus Shot® provider Find Vampire Facelift® provider Find Vampire Facial® provider Find Vampire Wing Lift™ provider The Cellular Medicine Association (who we are)<-- Charles Runels: Beautiful. Talk to us. So, you were just at a big meeting. Tell us about the meeting.
Dana Kirk: Well, it’s every other year, and it’s internationally, so they talk about the different protocols. And PRP, probably six years ago, was something that they kind of dismissed as being a standard protocol, and now it’s part of the mainstream.
Charles Runels: Beautiful.
Dana Kirk: Yeah. The recommendation is to … In the perfect scenario, you’re doing two treatments one month apart before the actual transplantation.
Charles Runels: Okay. Beautiful.
Dana Kirk: The jury’s still out as to if they do any A cell or anything during the transplant itself, but during the procedure part, they will go ahead and inject PRP at the same time.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: We do not discontinue the Finasteride. That’s continued at one milligram, and that just stays constant.
Charles Runels: Okay.
Dana Kirk: The Minoxidil is just temporarily for about two weeks, withheld.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: And then, you resume every six to nine months with the maintenance, so that they don’t lose the remaining hair. These treatments won’t affect the transplanted hair, but it’s in preservation of the existing hair.
Charles Runels: Beautiful. Very smart. Thank you for adding that. And then, you mentioned something in your note to me just a moment ago, about low-level laser. Have they started making that part of their standard protocol?
Dana Kirk: Yes.
Charles Runels: Interesting.
Dana Kirk: Yeah.
Charles Runels: Do they have a particular brand that they are mostly recommending, or is it pretty much whatever you round up?
Dana Kirk: I mean, it’s across the board. It’s more about the diodes or the [diudes 00:24:45], depending on what part of the country you’re from how you say it.
Charles Runels: Yeah.
Dana Kirk: How many basic lasers are within that. But for the most part, the device needs to have a minimum of 30, and they need to wear the device anywhere from two to three times a week.
Charles Runels: Beautiful. You got this down. Thank you for all the help. So, stay on the line and have … you and Kathleen both have your mics unmuted right now. There’s another question here from … let’s see. Who’s this? It’s from David. I’m gonna unmute you, David, so you can ask us your question. Hold on a second.
When do you repeat the O-Shot® (Orgasm Shot®) procedure?
Okay. So maybe the mic’s not working. So David asked, “What’s your current protocol for the O-Shot? One? Or plan on repetitive series?” So, here’s the deal with that. When I survey our patients and when I survey our providers and I ask, “What happens first and second and third shot?” What I hear is that the first time around, across the board, the hard cases and the easy cases, this isn’t merely incontinence where we get closer to 90% or more depending on whose hand it’s in with one treatment for stress urinary incontinence. Not for that, but just averaging them all together. So, this is including hard cases. A woman who’s never had an orgasm in her life and she’s trying to learn how to have an … you know, trying to get her body to respond.
We have 65% of women are delighted after the first treatment. It jumps to 85 after the second one. And so, I had the idea of maybe just making it standard protocol that everybody gets two treatments, sort of like we do with the hair. You know, you sign up, you get two to three treatments everybody. But to me, that somehow didn’t feel fair to those women, which is more than half, who are perfectly happy after the first. Now the other thing is, a lot of people are happy after the first, but if you repeat it at eight weeks, they then love it. So, after the first treatment, her pain went away, Dyspareunia resolved. But after the second treatment, she was unchained, was the word she used. Whatever that means.
So, it does seem to be additive in some people. But again, I didn’t want to make it necessary if it isn’t necessary. So the short of it is, [inaudible 00:27:20] are happy, and they seem to be still wanting to cooperate with you as a patient, do it again about eight weeks later. I wouldn’t do it any sooner, because otherwise you don’t know the results of the first one. So, do it again. And then, if they don’t respond after the second treatment by eight weeks, now you’re into 16 weeks. Eight weeks after the first one, you can repeat it. Eight weeks after that one, you can repeat it again. Then, I would give them their money back. So, that’s kinda how I go by it. If they come back after the first one and they are better, but they still haven’t seen all the results they want, most people want to pay you again. But, if they just saw zero results, I’ll usually repeat the second one without charging them, and then give them back their money if they’re not better after the second one. So, I think that’s probably the answer to that question.
Anybody else have a question?
David: Can you hear me now?
Charles Runels: Now I can. Yes. Now I can. Beautiful.
David: All right. Sorry.
Charles Runels: Any follow-up question to that? It’s good?
David: Okay. The reason I asked that, and I think I asked it once before about three or four weeks ago, is that, you know, I did an O-Shot on Diane. She had absolutely incredible results on her bladder concerns for about 10 days.
Charles Runels: Okay.
David: She was just exquisitely pleased.
Charles Runels: Yeah.
David: And then, she saw that start wearing off, as I’ve said in past conferences. Now, I’ve teamed up with someone. You know Debra Parker, I presume?
Charles Runels: Uh-huh (affirmative).
David: She’s an RN. She said that she has found that some of the practitioners she works with … she’s an RN in Tennessee or Kentucky. I can’t remember. She has said that the protocol that they’ve used in the clinics that she’s working with now, it’s pretty much go to standard three injections and charge $2100 bucks for a combination of three, and that their success has been 95-plus.
Charles Runels: Yeah. I couldn’t argue with that. You know, you may find that some people are well after the first one or two, and are not really wanting to go further, but I couldn’t argue with that at all. It’s what we do with them. Any other PRP procedures, you know, the Vampire Facial’s a series of three. So, absolutely. I think it’s worth considering.
Charles Runels: I wouldn’t consider it bad medicine considering it’s a fairly safe thing to do. In everything we’ve seen, it seems to be cumulative. The other thing that helps if you have … ’cause some people, it doesn’t wear off until a year out, and so do you really? That’s the question I have, do you really want to have everybody go through a series of three if maybe whatever percentage of them would have been fine with just one? I don’t know the answer to that. I could argue with making it a series of three and having a higher success rate. I’m just kind of deciding on a case by case, after each shot, deciding if they need another one.
The other thing that would add to it I think is combining it with some sort of energy source. So when I talk to the people who do energy followed by PRP whether it’s laser or ThermiVa, they do energy then PRP same visit. Their success rate of the first round seems higher and it seems to hold maybe a little longer. Again, do you want to make it the standard for everybody? It’s probably not needed since many people get better with just one O-Shot®, that’s it, that’s all it takes.
But when I talk … and we don’t have the numbers, that’s part, I want to just put in another plug for this. If you go and do our patient survey, which hopefully you guys are still putting people in, we’re trying to get a feel for that because part of the questionnaire asks people, it’s sent to them by text message, all HIPPA compliant, costs you guys nothing, I can give your data back to you. But the person who puts the person in the study puts in, did you do a laser device? Did you do a radio frequency device? Then we can follow survey data about why they were treated and maybe get an idea if it’s truly what I’m hearing, which is close to 100% if you do energy followed by O-Shot® on the same visit first time around.
David: That’s interesting. Okay, well that, thanks for that. I just want to give you an upgrade and to the point …
Charles Runels: Thank you.
David: … Diana said she wants to go ahead and repeat it once or twice, because she had such good results, she wants to have a repeat …
Charles Runels: Beautiful.
David: … and she’d have no problem in doing so.
Charles Runels: Beautiful. Well, thank you for the feedback.
Hey, just hang on the line, let’s see if you have anybody … no other questions. Any other feedback that anybody has, raise your hands, otherwise, I’m just gonna do a quick like five minute, “How to Use our Poster to Get Patients,” tips.
How to use an office O-Shot® or P-Shot® poster to help patients who need you to find you…
Okay, don’t see any other hands.
While you’re on the line David, have you used our poster to recruit patients? If so, how have you used it?
David: I haven’t really, because I deal with someone who has an existing cosmetic practice, who just has some concerns about artwork and style and things like that, so I don’t want to push it.
Charles Runels: Okay.
David: I have no problem. I have not done it, I have no problem with it, she does, so I’ve kind of backed off.
Charles Runels: Yeah, interesting. She doesn’t think it matches the office, that’s okay.
David: Yeah. I’ve used the brochures and she has no problem with handing the brochures. She has no problem with my talking about it on Facebook Live, etc., etc. I don’t know, I haven’t revisited since the first time I tried, so I’ll do it again.
Charles Runels: It does bring up a good point in that some people … and I’ll meet you here in a second Kathleen, ’cause I know Kathleen’s used her poster some. But it does bring up a huge point in that some people are embarrassed to have it, because they realize you now have a sign in your office that’s talking about sex. It could be that’s she’s saying it doesn’t match with the décor, but what she’s really saying is I don’t want a sex sign in the office and that’s okay. It’s her office, she can decide whatever she wants. Then you’ll go to an office and you’ll see, they got a Cosmo on the table and the front cover is about 16 ways to give a freakin blow job.
Charles Runels: Here’s my thing about offices, my number one rule is, if you’re not taking control of the environment of your office, in my opinion, you’re losing one of the main effects of an office. I have had people occasionally come to my office and I’ll come out to bring them back to the exam room and they are sobbing because they’ll say, “I feel like this is a healing place.” What they’re feeling is that I have taken control of their environment, there is not poison in the air, there’s no TV blaring, if somebody donates magazines to my office, they go in the garbage can, because everything that you can see, read or hear in my office is good for you. I’m controlling it and if a magazine comes in, I’m gonna be advertising Botox and they’ve got an add for some stupid cream that’s supposed to work like Botox in Cosmo, so all that stuff goes out the door.
Then as far as what we put in there, everything that I’ve done, I’m trying to take the John Grisham approach. John Grisham has a rule that he never writes a book that he would be embarrassed that his mother read it. If you look at our stuff, I try to keep that in mind. These posters by the way, sit in India, they sit in Maine, one of my providers sits within a short drive of the LL Bean store, places where … I’m in Alabama in the Bible Belt, so it could be that, and I’ve heard people say, “Oh, I can’t put a poster, because it has about sex.” Again, I don’t know the situation in your office, it may not even relate to what I’m saying, but your comment triggered some stuff that probably needs to be said, which is most people find that they’re patients are so needing something to break the ice. They’re so needing anything to break the ice, because they’re afraid and they’re embarrassed to bring up the subject. Anything that you can do to break the ice, they love it.
They also have on the O-Shot® website a little five questionnaire that says something like, “Do you have pain? Are you able to have arousal?” The last question is, “Do you want to the doctor?” Adding that to the intake form gives you an icebreaker to let you know if they want talk or not.
Having said that, I’m gonna open your mic Kathleen and then I’m gonna give my steps on how to use the poster.
Okay, let’s see, you’re on mute.
Kathleen Posey: Okay.
Charles Runels: Are you using poster?
Kathleen Posey: Yes. I’ve used my poster for years, it fits in my waiting room along with the books that are in the waiting room. All my books are in all my exam rooms.
You’re talking about the patients are saying it’s easier to talk about sex. They’ll come in and say to me, “I can’t believe that you’re gonna let me talk about sex now?” What’s also interesting in what you were just talking, what I’ve also realized, I’ve gotten a lot easier to talk about sex.
Charles Runels: Interesting.
Kathleen Posey: I’ve been doing this goin on five years now and I would probably say six years ago, I either didn’t have the time, I wasn’t comfortable or I didn’t know really how to help them to say, “You know, do you have orgasms?” Now, I have no trouble asking a person about their sex life.
Charles Runels: Interesting.
Kathleen Posey: Six years ago I did and I think most gynecologists do even though we are who we are. My poster has helped, because I’m just a routine gynecologist, it’s helped my practice knowing that I’m doing something different, and if they don’t an email or whatever and having the books. A lot of times the books disappear, but I could care less, because if they disappeared in the waiting room or the exam room, they’re reading it or they’re going to give it to somebody else. I actually give out a lot of books. If they’re a hairdresser and I find out they’re a hairdresser and they an O-Shot®, I give them about 10 books, because they’re talking to everybody.
Charles Runels: Beautiful.
Kathleen Posey: The posters really help me get more comfortable about talking about sex and it’s also, I think, gotten the patients more comfortable that they can ask me.
Charles Runels: Beautiful.
Kathleen Posey: When I was doing surgery, I’d just wanted, you want to put that hand on the door when they start asking about sex, you want to run through it, I don’t feel that way anymore.
Charles Runels: Beautiful. Well, you bring up several good tips. One of them is, which before a lot of things that have happened over that last few years, not just with the O-Shot®, but other things. Why bring up the subject if you don’t have lots of options or at least some number of good options as a solution? You don’t want to bring up world hunger in part of your visit, you can’t fix it. Obviously sex isn’t world hunger, but we didn’t have as many options even five – 10 yeas ago. Now that we do, it’s more easy to bring it up. By the way, I think …
Charles Runels: Yes sir.
Charles Runels: Yes.
David: Dave again.
Charles Runels: Oh, yeah.
David: One of the things I’ve used as a … I don’t have as many stories as you do, so I use your stories.
Charles Runels: I mean good.
David: I strongly suggest people do until they have their own. I had a woman in the office today who came to me for orthopedic issues. As you know I’m an orthopedic surgeon and I do a lot of orthopedic BLP and stem cells and peptides and whatever. In the process there of, she said, well you know she knew my associate very well, said, “I’ve known her forever, she’s done all my facial stuff and everything else. What else do you guys do?” Man that was just a perfect opening to be able to discuss. I didn’t have a poster in the room, but I turned on my verbal poster and I started telling Charles stories about your urologist friend and taking off the market by the FDA of the product for urinary incontinence, how horrible slings were except in the cases that had to have them and it when on to the girlfriend and the banker and to this that and the Sunday afternoon when you tried it on yourself. She was just like, “Oh my God, this is incredible. I had no idea that this existed.”
I encourage people to use you until they have their own stories.
Charles Runels: Beautiful and that also brings up another thing, the people that have done well with us, like super well, like Kathleen where they’ve had really really good results as far as the marketing piece, they are out there telling stories. They’ll do a YouTube video, they’ll interview a patient, patients tell their story. Stories are the best way, that’s really how a lot of people learn.
This is where the shot lives, if someone wants to pick one up and I’ll try to expand it where you can see it a little better. That didn’t expand it, just made me try to order one. But anyway, it’s written in a … Here’s the quick way to how to use it and we’ll shut down the call.
If you guys don’t mind I’m gonna mute this a little bit, I’m gonna mute some of the microphones, but I’m happy to unmute them if somebody needs that done.
Here’s my quick version of how to use the poster.
You have it sitting at a place they will be staring at it if there’s any moments waiting in your office. Not just this poster, any poster, something you want to you sell. If you notice, the bottom of the poster has a website on it. You would like for them to go to that website on their iPhone or their iPad while their waiting and find out something about it. If they ask you what the O-Shot® is and they haven’t done that, it’s a very difficult thing to explain in the office. Especially for your staff, whose phones ringing and they’re busy, they don’t want to explain it. They’ll tell them just enough to scare them off.
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When they inquire about it, the best thing to do is do what you heard Dr. Posey do, which is hand them a book or a brochure. Something that they’ll have with them physical to look and think about so that they teach themselves about it. I wouldn’t even really try to push it to a conclusion while they’re in the office, it’s too much for them to figure out what PRP is and whether they want something. You just let them know that it’s available. You don’t want to push it on someone who hasn’t thought about it and is pretty certain that’s what they want anyway. You hand them a book or brochure. I have mine in a little stack, with a little not by it that says, “Free, take two or three.” Otherwise, they feel guilty about taking one.
I have a standing challenge, so far no one’s ever called me out on it. If they do I’m happy to keep my promise, which is that if you give away 10 O-Shot® books in your office, I don’t mean throwing them out like at one of our Mardi Gras parades or stacking them up at the gym, but I mean someone taking it from your office or you handing to someone and saying, “Here, this tells you more about what’s on the poster.” Or, “Here, I think this may help you.” If you don’t get at least one patient for those 10 books, I will send you 10 more books. That’s a standing invitation, because if you don’t get one after 10 or 20 books, then I need to talk with you more about how you’re talking about it. You should be having at least one or two, often times you’ll get two or three people for those 10 books. You’re not just obviously doing a procedure, you’re changing their life. You’re changing their relationship many times.
That’s the quick version of how to use these posters. You don’t want it in the hallway where they’re passing it. One of our providers actually has it in the bathroom, so when they’re urinating, they’re staring at the poster. It could be anywhere where they have to sit for more than a couple of minutes.
I see Kathleen’s hand back up. Let me undo your mic and then I think we’re gonna call it a day.
Kathleen, you’re back live.
Kathleen Posey: Actually, that was an old. My hand was …
Charles Runels: Oh alright.
Kathleen Posey: … a while ago.
Charles Runels: Okay, so you guys have a wonderful week.
Kathleen Posey: I was actually gonna ask you a question about …
Charles Runels: Okay, go for it, I’m in no hurry. Go.
What’s the best way to measure and adjust testosterone levels in women?
Kathleen Posey: It was back with the testosterone. Before I give testosterone or pellets or even an O-Shot®, just personally, I get their pre and total testosterone levels.
Charles Runels: Yes.
Kathleen Posey: What do you think the normal levels in a female should be? What is the limit of high that you will let it go to? I do the thing because again, it’s so conservative I want it for the boards to show that it was frankly non-existent and that’s why I gave them the testosterone. What do you do?
Charles Runels: Okay, so …
Kathleen Posey: What do you think?
Charles Runels: We’ve sat through these lectures before, as you know listening to Erwin Goldstein speak who edited the Journal of Sexual Medicine for seven years. He’s high on this website, which I’m gonna through into, post into here, which is using pre and total testosterone and sex finding globulin to calculate the pre testosterone level. If they’re having symptoms, then I like for … this is showing you all the calculations that computer’s doing for you … I like for their pre-testosterone level to be in the upper 25% of normal, that’s what I calculate for. If it’s in the lower 50th percentile, then I’ll add to it. If check it and if it’s high, and it’s above what’s normal for free, I will drop the level. I think if you don’t do that then you are sort of opening yourselves up for problems. If you’re looking at problems, not I don’t think medically, but politically it’s interesting how testosterone because of the athletes abusing it, it’s become a target for all the things with three letters, the DEA and all that.
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Even though there’s lots of evidence and I know there are physicians and women out there who feel better with the pre-testosterone that’s higher than what’s normal for a female, and I don’t think there’s anything medically wrong with it if you’re following them clinically. I’ll tell you one scenario. I had a poor little lady in her 80s who fell and broke her humerus and was teetering ongoing to a nursing home. I make no apologies, she was still bright minded and just a beautiful hearted woman who lived down the street from me. I put her on a man dose of testosterone, sent her to my favorite physical therapist and we got almost 10 more years of her living independent at home. She got a little hair on her lip, but we’d go have tea every day and she loved me and she was independent for another almost 10 years. Was that bad medicine? I don’t think so. I’m not giving her prostate cancer, she didn’t care about the facial hair so much and we had a good time. But, as far as politically goes, I think pre-testosterone that’s what you follow and there’s the calculator for it, which I’m told is more accurate than letting the lab calculate it for you using those two. You get a sex hormone bonding globulin along with the testosterone level and that’s how you get it.
Again, I start them on that 50mg IM and they get the feeling of it and they kind of blast them off and then I can drop it if I need to.
Okay, you guys have a lot of good information. A crazy good call and happy with all the participation.
Okay, I think that’s it. You guys have a great day. Good-bye.
Charles Runels, MD
Inventor of the Priapus Shot®, O-Shot®, & Vampire Procedures® (facelift, facial, breast lift, wing lift)
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Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.
I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.
Let’s see what else is going on. I want to let you guys that we’ve put out some … We’ve put out a press release about some of Dr. Posey’s research about the O-Shot® (Orgasm Shot®) procedure and treating lichen sclerosus …so you may get some questions [from your patients] about that. I thought you might want to know more about what you should treat and what you shouldn’t treat if you’re doing lichens sclerosus. She’s actually on the call so I think I may undo her mic so she can tell you some of her thoughts about this research and how to know when to treat this and when not. She does a class and you might qualify to begin that class and that’s classroom … That’s a good thing. I’m going to unmute your mic, Kathleen.
Here we go. You there Kathleen? Hello?
Treating Lichen Sclerosus with the O-Shot® Procedure
Kathleen Posey MD, FACOG: How are you doing? Yeah, I’m here. Can you hear me?
Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.
Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …
The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.
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With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.
About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.
Charles Runels: This one?
Kathleen: No, go to the last picture. Keep going. Another one.
Charles Runels: That one?
Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?
Charles Runels: Yes.
Kathleen: You see that, Charles? That band?
Charles Runels: Yes.
Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.
I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.
Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-
Charles Runels: Yeah.
Kathleen: That to that, to that.
Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.
I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.
I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.
The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …
Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.
Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?
Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?
Charles Runels: Yes.
Charles Runels: I can. I can hear you.
Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.
Charles Runels: That don’t need the retreatment?
Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.
Charles Runels: Yeah. Okay.
Kathleen: There’s another picture, a previous picture.
Charles Runels: This one? This one?
Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.
Charles Runels: This one?
Kathleen: Yes. Yes. Can you hear me?
Charles Runels: What point do you want to make about this one?
Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.
Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.
Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.
If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.
Kathleen: Charles, I’d like to-
Charles Runels: The other thing while I was on the subject. Go ahead.
Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.
Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.
Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.
Easy Vs. Difficult Cases to Treat with the O-Shot® Procedure
I wanted to just list out while I’m at it and talking about the O-Shot, what I would consider to be the easy things that we treat versus the more difficult. I get a lot of questions about follow up and when do you retreat or not retreat and that sort of thing, so just wanted to recover that. Here’s our easy one. Nothing is 100% but these are the ones I think where over 80% of the time either after the first shot or the second one, you’re going to have an extremely happy patient. Maybe over 90% of the time in some cases, would be [inaudible 00:16:47], decrease orgasm, and someone who’s already able to have an orgasm. This would be the lady, she can have one but it’s not like what it used to be. Decreased orgasm but can have orgasm.
Then, it would be urinary incontinence and someone where things are intact, where bladder’s not falling out into the room. Even urgent continence, we’re seeing some great results. It’s usually a mixed bag for both, but then [inaudible 00:17:43]. I know that’s a basket diagnosis, but I mean even in the ones where it’s uncertain ideology, that doesn’t mean we don’t try to work it up. The person who’s had a work up and no one’s really sure what’s causing it and they’re still hurting, that for some reason that person seems to do well with us often. The one with pelvic floor tenderness, trying [inaudible 00:18:19] injection, you inject a trigger point with PRP so pelvic floor tenderness for mesh pain. I know you’ve got some ideas about that. I’ll let you talk about that in a second.
Mesh pain and the more difficult ones, the ones where if you’re new, I wouldn’t even try these people for the first two or three months, you don’t get discouraged, I treat these people but I think in these cases our success rate is maybe closer to 50% and maybe even less, 40% depending on the person’s age and other factors. It would be never had an orgasm in their life. I think those ladies are a little more difficult to treat. A person who wants to have penis and vagina orgasm. They can have one from a vibrator, but they can’t have one with sexual intercourse. Of course, we don’t have control of the penis of that equation. Both of these two ladies, we have successes, quite a few successes, but I think that our success rate on these ladies is probably less than 80%.
Can you comment some on this mesh pain? Are you still there Kathleen?
Kathleen: Just, yeah I’m still here. Can you hear me? Hello?
Charles Runels: Yes, very well. I can hear you.
Kathleen: I’ve done it when they had perianal pain from the nerve endings around the rectum, and I’ve just injected it all around the rectum. I’ve just injected it all around the rectum and it seems to work real well. Isn’t the doctor in Europe – [crosstalk 00:20:12] yeah, isn’t she putting PRP around the pudendal nerve to ultra sound for mesh people. The lady from Spain.
Charles Runels: I heard a couple people talking about doing an old school pudendal nerve block. There was one study where the mesh was taken out and then infiltrated the field with PRP, but no one has done the study yet, showing our procedure helps it. Although, we’re seeing that even injecting the anterior vaginal wall where the mesh is. You’ve has some experience with how the mesh becomes wrapped around the pudendal nerve or something; can you talk about that? [crosstalk 00:21:00] Or something you read in –
Kathleen: One of my patients is a general surgeon at [inaudible 00:21:13] and there was an autopsy on a mesh patient, and the mesh was all entrapped with the pudendal nerve when they did the autopsy. But, even taking it out, it just has to come out in pieces. It’s so difficult. From my understanding, from that pain, injecting PRP around the … I wouldn’t do it. There are some people, that I think, do it. In Europe.
Charles Runels: [crosstalk 00:21:45] When you do it, is there some worry about injecting?
Kathleen: Yeah, just the anatomy. There’s too much you can screw up. I just don’t have the experience with ultrasound and looking around the vessels where the pudendal nerve is there.
Charles Runels: When we do pudendal nerve blocks … We did those in labor and delivery years ago. I’m hearing that just that will calm it down. Is there something about that that makes you nervous? I would have thought that was a pretty safe thing to do.
Kathleen: I think that’s safe. I’ve just done most of my deliveries with epidurals and not pudendal nerve blocks. No, I think that would be safe.
Charles Runels: Okay.
Kathleen: I would like to see what they’re doing [crosstalk 00:22:40].
Charles Runels: While I’m at it, I’ll make the list for the P-Shot® … What? I’m sorry what did you say?
Kathleen: I didn’t say anything. Nothing. I didn’t say anything.
Charles Runels: Oh, okay.
Easy vs. Difficult Problems to Treat with the P-Shot® Procedure
So, while I’m at it, I thought I’d do a list to the easy wins for the P-Shot®. So that would be decreased erection … And a reason for making this list, again, is all of us want to take care of people and not just take their money and make them well. When I don’t get someone well I give them their money back. I try to mostly take care of people I think I can get well. If you’re mostly taking care of the hard cases, I’m losing money. I recommend that you mostly take care of the easy wins, especially in the beginning, so that you don’t become discouraged.
I’ve seen a couple of our providers, just right out of the box, try the really hard cases. If the first two O-Shot®s you do are in women who’ve never had an orgasm in their life, and they don’t work, you lose confidence in the procedure. So stick to the ones that we know have a high percentage of success.
For the Priapus shot, we have decreased erection, but can still get an erection. In other words, on that erection scale from 5 to 25, they’re above 10, at least somewhere in that neighborhood. They’ll bump up about seven on that scale from your shot.
Peyronie’s disease. The interesting thing is, our easy win is most other physician’s hard win, so you still can be a hero and do wonderful things for people if you stick to the easy stuff.
[inaudible 00:24:35] Closed prostate surgery to help with recovery, but it’s in the person who could get an erection prior to surgery, of course. You do the whole protocol, and that’s on our Priapus shot website. Where you include both for Peyronie’s and the prostate surgery, including the pump and maybe even low dose Cialis as part of the protocol.
Again, lichen, we’re going to get lichen too. Lichen sclerosus, not planus … Although, I think you treated some lichen planus didn’t you? Kathleen?
Kathleen: Yes. Yes.
Charles Runels: [crosstalk 00:25:26] We had that anecdotal initially; I should put this up here. I treated a woman with extremely severe scleroderma, and they can have horrible problems with intercourse. It was a life changing thing for her with one procedure. Lichen sclerosis in men is an easy win.
The hard wins for men, I think, if their main reason for getting the shot is for penis growth … Although, sometimes that can be very rewarding. It can be frustrating, often times, in the men who has the most urgency about growing. So the men who has the three inch erection responds, in my experience, less dramatically than the guy with the six or seven inch erection or a five inch erection.
It’s a percentage of growth than the absolute. So if there is 10% growth on the smaller penis, it’s less noticeable results. Then the person who has long standing diabetes or whatever cause of erectile dysfunction, basically he has no response at all. [inaudible 00:26:55] There’s no response at all to Viagra or TriMix, and that person who probably has some vascular disease proximal to the penis is not likely to get well.
Those are my easy wins and hard wins for the Priapus shot and want to stick to these easy wins in the beginning.
Anything you’d add to that, Kathleen?
Kathleen: Nope. I think you got it.
Charles Runels: Okay.
How to do your own webinars to educate your patients…
I always like to cover something with marketing too. Let’s see if I have any new questions from the [inaudible 00:27:32]. There weren’t that many on the websites on this time around. Let’s see. I don’t see any coming through.
I think there is something meant to be noticed about, as far as the marketing goes, what I’m doing right now. This is a wonderful way to create interest before I was part of this amazing group of physicians. I would do webinars, just like this, for patients.
Back in the day, before I started doing the internet, it wasn’t webinars. It was a conference call. I would record the call and put that on the website. So, if you, as a marketing idea, the best marketing is to teach people how to be well. If you put out an email to your patient, whatever it is you want to talk about … Maybe it is dyspareunia or erectile dysfunction, or urinary incontinence, or something that we’re not even talking about here; maybe it’s something to do with the way you do Botox. If you want to do a webinar like this, the software is very simple to do both setting this up, as well as recording it. Then you have something that can go on your website and play, and play, and play.
I thought I would show you guys where I do this. I know you have to log in to go webinar.com to get here. This is the software … GoToMeeting.com or GoToWebinar.com and they have plans that are not that expensive. Then, you send out an email to your people, you schedule it … and what you’ll find is, that even if just one person shows up, that the content you deliver is on a different level than if you sat down and just said “okay, I’m just going to record an audio or a video about urinary incontinence.”
Then when you’re done, you have the video and you can tell your webmaster to put that on your webpage somewhere. It looks like this. Most of you guys have seen this, but when I do these webinars, I put the recording either on the membership site or I put on our Cellular Medicine Association website. It just sits there to play.
This is probably the best advice I can give you about marketing to your patients. If you teach people about the disease and how to get well, then they will trust you to take care of their disease. If you go through the trouble to teach them how to be well, then they’re much more likely to trust you to take care of them.
So, the short version: teach people about the disease and they will trust you to take care of their disease.
It’s really an amazing time that we live in that we can just, almost no money, wherever you are on the planet, you can just sit down and have a conversation like this with your patients. Then when you’re done, you have a video that you can play for them perpetually on your website.
I think that’s all I have for today, unless you guys have other questions. I’ll put the transcript for this up within the next 24-hours and a link to the book that I recommended, and I’m always honored that you’re here.
Thank you for the help, Kathleen.
Kathleen: Thank you too.
Charles Runels: Alright, you guys have a good day. Bye.
Cellular Medicine Association<–
Charles Runels: I thought it may be helpful to start offering suggestions about what I’m reading, and what others in the group are reading and writing, so that our weekly meetings become not just sharing our procedures but approach being something like a journal club or a reading club, book club. That’s why you see what’s here on the screen now. I just got this in the mail. I bought it before it was published. It just came today, so I’m extremely pleased with this. The reason I’m so interested in centrofacial rejuvenation is something if you know, if you’ve attended my class. That is the most important part to improving … It’s the number one place to improve the appearance of going back in time in appearing younger. It’s the eye to the mid-cheek.
Some of the procedures in here are surgical. Chapter eight has some beautiful diagrams offering midface volumization with fillers. It talks about the anatomy, and highly recommend this book. I’m putting a link to it in the chat box, and I’ll put a link to it on the page where I put the recording, but very well done. Other chapters are helpful in [inaudible 00:01:53] videos. Part of what brought this up is I had a question today. I had some cosmetic questions. Let me pull those up. Then I’ll field questions from you guys. I copied this out of a email that came to me. Number one, “Why use none activated platelet-rich plasma on the face? Can we use activated prp and when?” Again I’m going to put it here and recommend that you guys check it out. This question, I’ll cover it again because it’s helpful.
Finding the Answer to Questions
If you go to Cellular Medicine, actually I want to just show you where a lot of these questions live. I’m happy to go over it, but if you have a way to search and find it very quickly without waiting for me to answer, then that would be a better thing. Some of you guys don’t know how easy it is. If you go to CellularMedicineAssociation.org, and you just put in the search box right here, so you can say activation. Hopefully, I’ve got that in there somewhere. There you go, so it’s like an index. I don’t have something that says index but it will pull up … Because I’m having all these transcribed, it will pull up any transcription that has that word in there, and so that’s a good way to search for things.
You could also go to the membership sites, so if you went to VampireFacelift.com into the member section, and this is the backside so you wouldn’t see this. You would land on, I’ll show you. You would land on the dashboard, so it would look like this right here. Then see where it says, “Post,” you could just click and you post. There should be a search box. I guess there’s not. I need to put one on this one. Most of the membership sites have the search box, so my bad. I’ll put one there. You could also go through here and look at just there’s the titles, recent comments, and there’s key words. This one needs a search box. Anyway, that’s the two places to look on our main website, the Cellular Medicine Association.
Looking at recent posts, and you’ll get the most recent stuff, but on the membership sites, the other place to look, it’s just look under the directory. I mean go to the dashboard, and then look under webinars. There’s the dashboard. No, not taking you back. Anyway, that first dashboard where we were at, it’s a directory, workshops, forums, and then there’s a page for webinars. Then at the bottom of every page there’s a question and answer session. You can see there’s a place to post it, so go in there. The good thing about doing that is you get answers from other people, not just from me if you do that. There’s one about calcium chloride. “Does it help? When do I use it?” Then you can see well, here’s the answer and it takes you to a recording from one of our webinars.
Activation or Not Activation of PRP?
I like doing it that way because it makes sure, it give everybody a chance to contribute, so it quits being about Charles. I’ve been fortunate enough to play around with plasma for eight or nine years, but newer people in our group are also doing that and have different expertise so it’s helpful. Here’s the answer to the question of why use nonactivated platelet-rich plasma. The reason for not activating it is the calcium makes it hurt more. Calcium chloride just hurts. The other reason to not use it as in activate the plasma is that you do get around 65% activation without activating it because when you put the plasma, inject it into the tissue, the exposure of the platelets to the collagen of the tissue itself activates it as it would in a normal [inaudible 00:06:47] if you had an injury and the platelets come outside the body, it activates the [Thorman 00:06:51] cascade, exactly the same thing.
You get 65% activation if you just take the inactive platelets in the syringe and inject it subdermally or intramally, and it doesn’t hurt as much. It seems to work well enough for the hair and the face. Most people are not activating. The reason we changed that and activate with the [Priapus 00:07:16] Shot, and with the O-Shot, and with when we’re trying to regrow nerve as with decreased sensation in the areola of the nipple, is because we’re thinking that because it’s more therapeutic type effect, and because we’re trying to maintain the material in a smaller space. Geographically we want it to stay close to the urethro so in a very small area the calcium makes it activate more quickly and more thoroughly. That’s the reason. No one can fault you for activating it with the face as well. It’s just a cop out to make it not hurt as much.
Can you “use prp in the vaginal lining?”
Number two, “Can you use prp in the vaginal lining?” I have used it everywhere, and I see one of our gynecologists is on the call, so I may get Kathleen Posey to comment on this too. Can you use prp in the vaginal lining? You can pretty much use it everywhere as best I can tell. I can’t find any ill effects except in one case where it was injected into the eyeball trying to do something with the retina, so don’t give anybody a shot in the eyeball. Otherwise, I have injected circumferentially. I’ve injected in the labia minora, the labia majora, posteriorly. Anecdotally, we’ve had two people in our group see help with rectal incontinence in a severe postpartum tear. That was years out and still saw some improvement in rectal incontinence. We’re using it all over.
The only reason I quit putting it completely around the vagina circumferentially is that in the beginning it was so costly I was trying to avoid injecting more places than needed because it cost us so much to make the plasma. I found, so 80/20 rule, I could get actually all the results I needed by just injecting around the clitoris and along the anterior vaginal wall thinking that’s where a lot of the sensation is as in Grafenberg, not just the spot but the whole urethra being sensitive, the Skene’s glands, that’s where a lot of the sensation takes place. It’s also up there near the inner part of the clitoris and all the nerves [inaudible 00:09:45], just a lot of magic happens there.
Not so much the anterior vaginal wall, there’s not that much lining there. I mean, excuse me, there’s not that much sensation there. Having said that, I’m going to see what Dr. Posey has to add to that. Then we’ll get back to the face, the best way to treat nasolabial …
Charles R.: … that and then we’ll get back to the face, the best way to treat nasolabial folds. So if you don’t mind, I’m going to unmute you, Kathleen, and see because I know you’ve done a lot of these. Are you able to talk, Kathleen? Are you there? You may not have a-
Kathleen P.: Yes. Hi. Hi.
Charles R.: Good to hear from you.
Kathleen P.: Hi. You too. I have injected it there not a lot [inaudible 00:10:26] end up with some left over, I’ll inject it in the labia minora, the labia majora. And it just depends, if they’re having pain in that area, I’ve definitely used it a fair amount and it does help decrease the pain.
Charles R.: In the lateral vaginal wall, you mean?
Kathleen P.: I have a little-
Charles R.: He didn’t really say vaginal. He just says vaginal lining, doesn’t he? I’m sorry. Go ahead.
Kathleen P.: Yes some … Yeah. I’m more doing it in the posterior vagina. I don’t know if it hurts sticking it in lateral because the vessels and stuff. I worry about hematoma. I wouldn’t go too deep if I were to inject it there.
Where to go to create an “interview video” for your website
Charles R.: Okay. You know what? While it’s on my mind, if you will do this, Kathleen. And I’m going to put it here so others may want to. If you go … so far I’ve only done this with three, excuse me, two of our providers, but I’ve never made it public. I’m trying to make it … I’ll show you what I’m doing. If you go to the O-Shot® website and you on the … over here on the recent posts, you can see I’ve talked to Dr. Goodman about some of his surgical techniques and how he thinks about orgasm and how the different procedures he’s using and I’ve just recorded it and put it there for patients and doctors to learn from. There’s nothing … becomes a very good explanation of the surgeries for potential patients as well.
So back to … oh, you can’t see it. [inaudible 00:12:04] where you can see what I’m talking about. There. So this is a post on the O-Shot® website and it just comes in recent posts and I’ve done that … I’ve set it up to do with [inaudible 00:12:21] and we had some … we weren’t able to record it well and I’ve done it with another one of our providers, but I’m going to put here … it’s so hard. Everybody’s schedule is so busy, but any physician who has … who wants to be interviewed, I see it as a great way to … cellular … let’s see … it’s a great way to get the word out about what we’re able to do and, just as importantly, what we cannot do and how we’re thinking about the science. And here’s where to set that up…
So I’ll show you what happens when you set that up and where to go. So if you take that and put it into … and I’m hoping you’ll set this up, Kathleen, so I can interview you because you got so … I’ll pick your brain a little bit at a time when we do these webinars, but you got so much information about lichen and the other stuff.
Okay so if I put that in there, it takes you here and then if you go to 30 minute phone meeting, book that, and we may actually be on the phone longer than that but just … and you can see you can just click that and pick a day and that fits your schedule and then I’ll record it. You don’t have to have PowerPoint slides. You can if you want, but any doctor in our group who feels like they have a message they want to deliver that would be helpful to doctors and/or patients. I like the interview format because it gives me a way to showcase our physicians and, because I’m seeing a lot of the questions that come by email and such, it gives me a way to get a more balanced answer to these questions rather than me doing all the talking, which is just not the way it should be. Okay, let me get back to these questions. So if … I’m going to put that in the chat box too and, hopefully, you’ll set that up, Kathleen. So anybody else can call because you got so much … how many years have you been doing this now? Three? Four?
Kathleen P.: About four.
Charles R.: I know no one … I don’t know anyone who’s inject … who’s treated more people with lichen sclerosus [using the O-Shot®] and you’ve got a strong surgical background too, as strong as it comes so let’s set that up. I’m overdue to do that. Okay, so back on topic. I’m just going to leave your mic unmuted there, Kathleen, and get back to finishing these questions. Let’s see. Go back to here.
What’s the best way to treat nasolabial folds–PRP, fillers, or threads?
Okay. So now for a face question. What’s the best way to treat nasolabial folds? With therapy or threading or with filler? I think this one is … let me pull up a picture. Let’s see if I … I think a picture would answer it better. Let me find a picture I have permission to use. Because this is definitely a case a picture’s worth way more than me babbling on and on.
Okay, here. So if this is the problem that you’re trying to make go away, the question was: is it better to use fillers or plasma or some sort of thread lift or surgery? There’s lots of different things. What can you do for that? So the main principal I follow is that this cheek area is more important than whether there’s a line present here or not. You’ll see nasolabial folds in children, but this is not necessarily an age line. It become a sign of age, when relative to the rest of the face, when you see that this … let’s see if I can draw on this. Let’s see what I can draw. Good. Okay. So when there’s a stripe, there’s a heavy strip, you can see it kind of goes like that there, with this being flat over here. And when you see that, it’s not the line that’s making people look older and you can kind of see the appreciation of a line right there, but not so much visible there sort of like a dash line. There’s definitely a line there under the eyes and then there’s this line and then this looks relatively flat. When you see that, that’s a person for whom either fillers or platelet-rich plasma is going to help.
If I’m trying to decide which will be appropriate, then I go by how much volume loss is there. If there’s quite a bit of volume loss here, the chances that I will maintain … the shape will look beautiful if I just fill it up with plasma, but the chances that I can maintain that shape become less good than if there’s a lot of volume loss here. If it’s someone who’s never had anything done and they’re … if you’re looking for numbers, if they’ve never had anything done and they’re 40 and up, then they’re probably going to need some fillers there, especially if they have a thin face. If they’ve got a full face and they’re younger or even if they’re over 40 or 50 and they have a full face, sometimes you can get by with the plasma alone. But the bottom line is that adding volume here is going to pull this up and round it out so there’s not a heavy stripe here. And then even if you have a line here, it’s going to be less distracting and not really age causing.
And so that’s kind of how I judge it. So I either use plasma plus prp if they can afford it and they have a fair amount of volume loss or if they’re … if I use prp alone, it’s usually in someone where the volume’s pretty close to where it needs to be and they kind of just want to be fluffed up and usually that’s … they’re 35 or under or they’ve had some work done already or their face is already full just because of their body weight. So most of the time, I’m using both. As far as the threads go, if you do the threads, I would still consider doing this because now you’re doing something similar to a surgical “facelift” but relative to the bone, even though you’re pulling this fold out, you’re pulling the tissue close.
Charles Runels: Even though you’re pulling this fold out, you’re pulling the tissue closer to the bone. You’re really collapsing the face relative to the bone and though the line looks better, you have some risk of causing skeletization and not that round, full feeling look that’s in a younger face.
In the end, all three, the answer to that question is, they all three work. That’s the way I decide. I would seldom use a thread without using fillers or most of the facial plastic surgeons now, almost all of them, even if they do a surgery and pull the skin back, they’ll do it in culmination with fillers to maintain the shape so you’re not just chasing a line. You’re creating a younger shape. I think that answers that question.
I think there’s another one here. Anybody want to add to that, just click the button and I’ll unmute your mic for you. Let’s see. Let’s get back to that question. I think I answered it, just to be sure I did all that. Yeah. That answers that question.
There’s one in here that some of our callers. That’s a good question. Why do you not have a dashboard similar to the others with supplies and videos with a facelift like the other procedures? It’s just simply because I’m the one that’s doing it. I apologize. I just haven’t done it yet.
What they’re referring to is if you’re on the facelift, the dashboard is not as organized with O-shot and P-shot. It’s all still there, but you just have to look around for it more. I’m actually trying to recruit someone who can help me with the websites. I’m still doing them all myself. I started doing websites in 1998 and I can’t find …
So far, I haven’t found anyone that suits me. They’re either over-qualified because they’re actually writing code, which is what I need or they’re under-qualified and they can’t write it. If anybody knows a good web design person that wants to move to Fairhope, then send them this way.
Treating Bell’s Palsy with the Vampire Facelift®
Let’s see. Any other questions? There was one that popped up on the Vampire website from Dana. Let me pull that one up because I answered it. Here it is. I went ahead and answered it, but let’s cover it here because it was a good question.
Dana says she had a beautiful 56-year-old patient who had general aesthetic questions. This is really important because I’ve never covered this in a webinar, by the way, so I’m so grateful for this question. She said, “She’s not new to injectables, but has not received any kind of treatment for the last six months because she has left-sided Bell’s Palsy.”
“Previous management for her palsy’s included prednisone, anti-virals, acupuncture. Her friends think she’s showing improvement. Although this wasn’t the reason for seeing me, I’m wondering if PRP might help with the Bell’s Palsy. When you search on ClubMed, it appears not only to be safe, but possibly helpful.”
Yes, is the answer to that. I haven’t counted, but I know at least two people, maybe three, that have told me that dramatic improvements. As you know, Bell’s Palsy can come-and-go, so maybe it was just luck of the draw treating a lot of diseases that wax-and-wane, who knows?
I think the logic is there when we have something that’s an anti-inflammatory and is an immune enhancing-type therapy. It makes sense that it might help Bell’s Palsy. Also, it’s a nerve re-generator. The last time I looked, it was about 60 or 70 papers about that. This is an important thing that I’ve never talked about so thank you for that question.
I would get a really good consent form because obviously if you’re not treating Bell’s Palsy, if you just gave her a Tootsie roll, it could get better or worse and has nothing to do with your Tootsie roll. In the same way, there’s always a chance it may worsen even though the science indicates it should get better.
I’d get a good consent form, which we have on the websites now that we’ve even enhanced our consent forms. If you haven’t downloaded them lately, download one. We’ve also made an Amnion version. There’s a Vampire facelift and there’s a facelift with Amnion. There’s an O-shot and O-shot with Amnion for those of you who are considering adding that to your procedure.
If I were giving her the Rolls Royce treatment, I would consider an injection. Do the Vampire facelift and add some Amnion to it. She’d have the best we know how to do.
Should you stop anti-coagulants before doing the P-Shot® or the O-Shot®?
Let’s see if there’s any other. Here’s another question. Any reason to stop anti [inaudible 00:25:46] prior to P-Shot® or O-Shot®? Here, I’d treat this like an injection, not like a surgery. Most people who are on anti-coagulants are on them for serious reasons.
I had an internist mentor who always said, “The most dangerous medicine an internist ever prescribes is Coumadin.” You can make the case with just a baby aspirin itself. The last time I looked, something like 35,000 people per year bleed to death from gastric hemorrhages from aspirin.
They’re dangerous drugs. People are not going to be on them for frivolous reasons. Therefore, I usually just don’t even get into it. I just hold pressure longer. Tell them they have more bruising. The bruising is also PRP. It could enhance the effects. We’re just going to hold pressure and I do all procedures as I normally would.
The only thing with aspirin, if it’s possible for you to stop. I know that’s not the question, it’s anti-coagulants, but if it’s possible to stop aspirin or non-steroidal a week or two before, that’s better because it’s going to interfere with your platelet function.
Platelets have a longer half life than a week, so I wonder sometimes about that time frame, but that seems to be the standard recommendation is to stop for a week before and to stop steroids, if you can. I do the procedures and I hold pressure.
I was going to, if there’s not any other questions. Let’s see.
Kathleen Posey: Actually, Charles, I have a question.
Charles Runels: Go for it.
Kathleen Posey: I wanted to say, I did do one Bell’s Palsy patient. She had tremendous improvement, even after a year. But, my question has to do with …
Charles Runels: Wait a sec. You got beeped out for some reason on the sound. You said she had tremendous improvement and then what came after that?
Kathleen Posey: Even after a year. She had the Bell's Palsy for a year and still had some residual left. It was able to take away the residual palsy, which to me, was amazing.
Charles Runels: Beautiful. I’m glad that Dana asked that question. Thanks for throwing that in. Go ahead. You had a question too?
Treating Interstitial Cystitis with the O-Shot® Procedure
Kathleen Posey: I have a question about interstitial cystitis. What’s been the group’s treatment plan on that and how successful do you think that is? I mean, I’ve done a few, but I’m running about 50/50. I was just wondering. I mean, just do a regular O-shot? I mean, that’s what I’ve been doing.
Then, also, the same patient had an urethral caruncle. I put PRP in there. I actually think it grew, but anyway. I told her to go ahead and have it surgically removed, which the urologist was refusing to do but the pain was so related to that caruncle. I just think it needs to come out. Just wanted to know if you knew anybody else that had experience on the line with UC?
Charles Runels: I think what I’ll do. I’ll tell you what I’ve heard, but I think what I will do after this call, is I, as usual, I will send out an email to let people know the recording is there. I’ll ask for more comments from our urologists and gynecologists who are treating UC.
To tell you what I’m hearing is, I’ve had now three separate … Well, two urologists and one uro-gynecologist call me excitedly to tell me about multiple patients in all three practices, not just one, but multiple patients, who became completely well after many years of suffering with pain.
That doesn’t mean, of course, that everyone they’re treating is getting well. I don’t think the placebo effect on someone who’s tried everything under the sun and can’t get better and finally they get well with your one thing. My guess about it is that it’s multi-factorial and what’s working with us, is those that have …
Charles Runels: … the factorial and what’s working with us is those who have some sort of chronic inflammatory/infectious process going on with the Skene’s glands but I’m completely guessing with that. The others may have something that has to do with the bladder itself that we’re not reaching with our procedure. How we dissect out the subset that responds versus that don’t I don’t know but I keep offering to finance a study and if you want to do that and try to … Let’s try to work up a protocol and get it approved, someone in our group needs to do that study. I’d like it to come from a gynecologist or urogynecologist, which I’m not, so that it’s paid more attention to. To help you with it, I’ll post it and try to drum up more interest and let’s talk to each other about it so I appreciate you bringing that up.
Let’s see what else we got. I think that’s all the questions.
How to Get on Your Local TV News
I always like to do a little marketing tip or two. We’ve had a few people lately … Let’s see, I’m not sure what you guys were looking at, let me get you back looking at the web page. Just one minute. We’ve had people on the news, quite a few lately actually, and along with that one was on a radio show. It’s not always TV news, one was on a radio show yesterday and so two really nice luncheons lately. I thought I would pull them out and tell you guys both how to make this happen in your own town and the advice I give people when they call me and say, “Okay, give me tips about what to say on the news.” Then if you just know it’s here the next time I’m still always happy to talk with you. If you know it’s here the next time you get that call you can go refer to this.
I’ll fix it where you can see what I’m looking at. Here’s one of our doctors, she’s a gynecologist, Dr. Singer, and she’s doing the O-Shot and you can see she’s come out of sometimes with the laser treatment. Now, first I’ll start with how you get on the news itself and maybe I’ll just tie it kind of step-by-step what to do. First I would get the name of the person, just your local news channel. You want to call the news and say, “I’m a local physician and I just want to be available for comments or help any time you’re doing a health story that involves whatever you do.” For Kathleen it would be women’s health. If you’re an anti-aging doctor you could say anything that has to do with aging in men and women, whatever you want to be known for.
Then you say, “May I speak with your health reporter?” Here’s the thing. You would think, well they would laugh at you and say we’re too busy. The truth is it’s very, very hard to come up with news and I can prove it to you. Just watch the news and see how many times one news reporter is interviewing another news reporter, it’s very often. How does that make news if they’re interviewing each other? They are really hard up. How many times do you see one … They call it breaking the story. One news channels breaks a story and then all of them talk about it for the next week. It’s hard to come up with something new and interesting every day. Then when they do a lot of times they need an expert to comment. If they have someone on speed dial, and this is what you tell them.
Get to Know your Local Health Reporter
First you ask to speak to this person and you say you want to make yourself available if she ever has a story and needs a comment on or off the record. You tell her or him that you always answer the phone and then you give them your cell phone number and you tell your staff, “If you ever get a call from this news you want to be told immediately.” They are not to take a message, they are to get you to the phone immediately because if you don’t take the call they’re usually on a really tight schedule and they will call someone else and you’ll miss the chance for … I literally have millions of dollars of free publicity just because. They’ll tell me, “You know, I was going to call so and so.” I just ask them and they’ll say, “Yeah, I was going … My deadline, I’ve got an hour to get this done and if I hadn’t answered I would have just been out of the story.”
Tell Your Staff to be ready
You tell your staff … Make sure they have your short list, you probably have that already. “These are the people you’re to never take a message.” My short list is my children, my parents, my sisters, my attorney, and anything with three letters; the IRS, the FBI, the DEA, anything that has three letters get me to the phone. That includes CBS, ABC, NBC, and any news reporter of any kind, doesn’t matter how big or small, bring me to the phone. Then after you get the news reporter on the phone you just tell them that, make yourself available. Now, if you want to make news, if you want to be on the news for free you try to tie it to the national press and I put … If you go here, I think I’ve got it on here, let’s see.
Tie to National News
If you go to the marketing part of this … Anyway, it’s somewhere on here. There’s a webinar about how to take advantage of the national press and marketing … Let’s see, what is it? Insurance practices, avatar, anyway somewhere on here. You’re right, it’s easier to find the O-Shot but the thing is if they have … Let’s say that the press does a story on some new treatment for incontinence, it could be any treatment. Well, you call them up and you offer to comment on it, on your local station about that treatment. Of course, you’re going to talk about your O-Shot too. I actually changed the Health Department policy in my county after someone had an injury in Atlanta, the swimming pool. They had no Health Department inspection here back in the 90s and I said, “Let’s do a story,” and we did a story about how there was no Health Department inspection. It would not have been a story had there not been a recent death in Atlanta from their dirty swimming pool.
You watch the national news and when something happens nationwide that relates to what you’re doing you call your local channel and you offer to do a story about it. That can include national press about our stuff. When this hit the news recently, this one. This is a local station but we have clearer … When we hit the national press I will send out an email. When the email comes out and says … Let’s see. Back in October we made a Real Magazine Website and plugged in others about the Vampire breast lift. When that happened you could have called your local TV station and say, “Hey, the Vampire breast lift was just on [inaudible 00:37:53] website or Allure,” whichever one you want to mention or both, “And if you want to do a story about that I do that procedure here in our city.” Then they will interview you often because you have a local comment about a national matter so that’s how you get in.
Getting Ready to be on the News
Now when it’s time to talk how do you get ready to actually be on the news? Here’s some quick tips and you’ll know where this is. It also applies if you’re just going to be, say, giving us a talking somewhere, and it helps you plan the talk. Here’s the tips on that and I think I’ll type them out for you. Let me pull this up because it’s simple but it’s really helpful. I’ve been on the news more than I like to think about in different countries, in Serbia and London and New York. Anyway, the bottom line is this is the process I go through before I’m going to be interviewed.
I first think about … I imagine not everybody in TV land, not everyone. I imagine one person that I love and I pretend that person is watching and I forget everybody else. If it has to do with men’s health I imagine my son’s watching. If it has to do with women’s health I imagine my mother or a woman that I love and I pretend like that’s the only person and that person is on the other side of the television. That couch is my language so that I don’t sound salesy, I don’t sound anything except sincere and engaged and eager to communicate what the message is. That gets the frame … That is so important and I’m not just saying this. This isn’t something I’m just talking about, I literally do that every time I’m in front of a camera or a microphone if you’re being interviewed by the radio. I was interviewed on Shade 45, which is, it’s a rapper station.
That’s the only time I’ve ever been interviewed where I was the most conservative person in the room. They were talking to me about orgasm and it was a call in station and so it was pretty interesting. It didn’t matter, I was still imagining not talking to everybody out there, being interviewed by radio stations in South America where they have a translator or in Columbia, Mexico. Every time I just think of one person that I love and it’s the only person that matters. Then how do you, what about the content, what do you have in front of you? I think about the problem that my thing is going to solve and I imagine that person with the problem.
Let’s say I do a talk about the O-Shot, then I’m thinking about incontinence or orgasm or whatever it is that is to be the expected topic. Then, and quit speaking about me trying to be pretty or smart or say all the right things, it just becomes about me trying to communicate to that one person I love on the other side of the camera. I know this is all a mind game but it works and it’s the reason you’re there or you just go home. We’re here to solve problems for people and so, not to try to be pretty, they got movie stars that do a lot better job of that than I do, be funny or entertaining. I’m a physician, I’m there to teach people how to solve health problems so that’s the mind frame you get and I forget about the rest of it.
Then I think, and this one’s key I think. I think of key words and phrases that I think would be helpful. Let’s say that … And I write this down and then look at them before I go on camera. Let’s say if it were O-Shot I might think, I would think of the words O-Shot, I might think of the words relationship, relationships healed. I might say psychological pain, you get the point? I would make a list of all the friend … I would day provider group, that’s protected, be careful about seeing someone outside the group. Two and three word phrases that I would want to try and weave into my conversation and realize, no matter what they ask. Ask me about the weather. You say, “Well, is it hot outside?” I would say, “You know, it’s unusually cool down in Florida today, which is exactly what happens to relationships when sex doesn’t work.”
Ask me what color my car is. It’s black. “You know, that’s exactly the mentality people have. They have a black, depressed mood when they don’t get sexual relationship fulfillments in their marriage.” My point is, no matter what they ask you you can weave these phrases into the conversation if you have them in your head before you go on. Then I always thank the person, usually I’ll thank them up front for … It’s not a long thank you, it’s a … Because people get bored by, “Thank you so much for having me.” Nobody wants to hear that crap. What I would say is, “Thank you for being brave enough to talk about sexuality on your show because many people are afraid of that and we know how important this is for relationships.”
You throw little kudos to the host for being brave enough to talk about uncomfortable things and they always like it obviously because they can’t brag on themselves. Then it sets the tone and they know their viewers are looking up to them with a little more respect because of something you said. That’s kind of my, that’s my … Then oh, last thing is you want to invite them to do something; contact you, you want to make sure you have the website because here’s the other thing, here’s the bad, I’ll show you the bad news. Here’s the bad news. If you don’t do … This will go away in about 24-48 hours unless you post the recording. Anyone [inaudible 00:44:51] her TV show. It was good for a boost, it lasted less than a week.
The doctor show will last less than two days. A good news report, and I’m watching the traffic on a website. A good news channel … Actually, sometimes the doctor show you can’t even see the blip because a lot of people aren’t watching daytime TV but a good, very populated website will last two, three days and then it’s gone away so why be on the news if it only gives you traffic for 2-3 days? Once you have it then you take these videos like this and you post them on your website. You see where it says … Oh, I had a link copy. Anyway, there’s a way to actually embed this onto your website and hopefully Dr. Singer has that.
Now, every time a patient on the website that says, “Oh, this lady is [inaudible 00:45:47] enough to be on the news,” and then they hear her explain it in an engaging way with her news interview and it just sits there and educates patients day after day, year after year. Then, that’s when you get some traction and that’s really when you go on the news. It’s not you get a little grip. If that was all you got, honestly, I don’t know if I’d waste my time. That footprint that stays out there and gets showed by all of us on the website, that goes … Oh, are you all seeing what I’m seeing? This can be shared and embedded so that that sits on her website and that is what keeps owning on educating people.
I think that’s it unless somebody has more questions. I think we’re going to stop it there, see if there’s any other questions. The take home do for this one, for today’s thing is that we’re going to try to drum up some more talk about the chronic interstitial cystitis because we’re at least three years overdue for doing that study. If you want to get on the news, at least let yourself be known, make introductions to the health reporter in your town. Then when something happens nationwide you can call, they already know who you are, he or she does, and they know to call you if they have a need for a comment. Then there’s the book that I recommended if you’re doing faces for, that’s newly published about the mid-face because I really like the way he talks about that.
Let’s see if there’s any other questions. Thank you guys, it’s always an honor to have when you spark people interested in what we’re talking about. I’ll post a recording if that’s helpful. Goodbye.
Cellular Medicine Association