JCPM2021.08.04FunctionalAnatomyOfClitoris.ReviewOfMaterialsInjectedIntoAgingVagina

Topics Discussed Include the Following…

*Materials for Injection Into the Vaginal Wall
*What are we injecting: G-Spot or O-Spot (what’s the difference)?
*The change in FSFI and FSD-R after the O-Shot® procedure
*Dr. Elizabeth Owings discusses the Functional Clitoral Anatomy

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

Transcript

Review of Materials for Injection into the Vaginal Wall

Charles Runels, MD (00:03):
Thank you guys for being here at the Journal Club with Pearls & Marketing (JCPM). And we have a very special guest tonight, Dr. Elizabeth Owings, who wrote a… She just clicked to me and said she got the wrong link. Okay. Let me send her another link or we’re not going to lose her. Hold on one second. Yeah. Okay. Just sent it to her again. Hopefully she’ll show up. Okay.

Charles Runels, MD (00:35):
So Dr. Owings, amazing, amazing physician who spent several months just studying the anatomy of the clitoris. It’s hard to believe it was actually left out of Grey’s Anatomy for a while. So Dr. Owings will be coming on in about 10 minutes. I’ve been spending a lot of time thinking about the functional anatomy, the way things that are and how we might improve our O-Shot®. Well, this paper just happened to come out, and it was actually brought to my attention by my fiance Alexandra, who’s a gynecologist out there in San Antonio. So thank you Alex, for showing me this.

Charles Runels, MD (01:11):
This came out, as you can see, it was come out in the past month and it was a nice review article that was published in Aesthetic Plastic Surgery about all the different materials that are being squirted into the vagina. Some of it you’ve seen, but having it all fit together in one paper with a very, I think, balanced view of it is helpful. I wanted to point out a couple of things, and you can download it. I’ve put it in the handout section. You just click on the little yellow flower it’ll pop up, and if you open it now, it’ll be still open when the webinar’s over. If not, it’s going to disappear.

Charles Runels, MD (01:55):
So here’s a couple of things that I noticed about this that I’d like to bring to your attention. First of all, this first little review paragraph just lists the things that have been published, and I’d like to point out that maybe multiple injections, I’m being a little picky here, but aren’t always needed. And when they talk about emboli, [inaudible 00:02:19] emboli, that happens, but it happens with HA, and that happens… Pulmonary embolism happens with fat. We haven’t had a pulmonary embolism. We’ve had one episode of blindness from PRP, and that was when it was injected near the eye. And so, except for that one episode, no one’s ever gone blind by injecting in the vagina, although pulmonary emboli have happened injecting fat and HA around the vagina.

Charles Runels, MD (02:51):
So anyway, there’s a nice little overview. I’m just going through it here, and you guys can point out, I’ll unmute the mic if you want to throw something in here. But they do point out that vaginal atrophy happens with estrogen levels being a main cause. Definitely a cause, it’s debatable how much, because there’s definitely a contribution from testosterone, as you guys know, not just estrogen. Many of you have discovered with testosterone creams also help the problem.

Charles Runels, MD (03:27):
And they’re about to quote one of the articles that are published together with some of the other people in our group. But one other thing before we get to that. On page 1232, they mentioned that… They started talking about the G-spot, and this becomes almost like a religion or a belief system more than science, I think. And although there was this study that came out in… Where this fellow, I can’t say his name. I met him. Really nice guy, at one of the [inaudible 00:04:04] courses, he did a series of dissections on cadavers and totally dissected out the G-spot. The reason I’m bringing this out is most people think that maybe it still hasn’t really been shown because there’s no specific tissue that anyone else has been able to find.

What are we injecting: G-Spot or O-Spot?

Charles Runels, MD (04:26):
The only reason I bring it out is that I think technically we’re not injecting the G-spot, and I want to make sure that we’re clear on that because… Hey, I see you, Elizabeth, thank you for jumping on. Because the G-spot, in my opinion, is a functional thing. That if you look at what Dr. Grafenberg talked about back in the fifties, and you really should do a Wikipedia read and then read all the references about Dr. Grafenberg. Amazing, amazing man, amazing story that I won’t get into now. But he thought the whole urethra was the most arousing erotic part of a woman’s body. The spot became more of a later idea. And I think it’s less established. I think most people were tending to talk more about the clitoral urethral complex, which is what Dr. Owings is about to talk about here shortly.

Charles Runels, MD (05:23):
But the G-spot is something that I think you find in the bedroom, I think it varies from woman to woman, and in the same woman, sometimes from moment to moment. But it’s in theory the place where the woman’s most aroused. And I think to point to it on an anatomy chart, it could be how you define it. You can decide that. You can decide your left ear lobe’s the G-spot if you want to, but I think the way Dr. Grafenberg talked about it, it was the most arousing place of the most arousing place. The most arousing spot along the path of the urethra, but really it’s nebulous.

Charles Runels, MD (05:58):
And that’s why with the G-Shot that was out and popular in the US a number of years ago, you had to quote map the vagina and find that place by stimulating the woman’s vagina. And in Europe, this is still done. In some of our offices it’s still done, but this is frowned upon by ACOG now, and you’re putting, I think, your license at risk if you do this in the United States with an HA in the anterior vaginal wall, because of the risk of granuloma. 1 in 40 in one study, that can cause obstruction, necessitating surgery to correct it.

Charles Runels, MD (06:34):
So the O-spot, we need a place to call our place where we put it. You can call it whatever. You can call it the Florida spot. I don’t really care, but calling it the most distal place in the peri-urethral area, between the anterior vaginal wall and the urethra most distal from the bladder, it’s a long-winded thing. So that is the description of it. I like calling it the O-spot. Nobody’s name’s involved, so there’s no ego.

Charles Runels, MD (07:09):
It’s just where we put our shot, and that you can point to on a map. So if you’re going to do the G-Shot, in my opinion, you need to spread the lady’s legs and find where she moans the most, which is… I’m saying it purposefully in a very offensive way, because some people think of it as offensive, even when you say it in a not offensive way. So I like to talk about, we don’t really map out the vagina when we do the O-Shot®, and we’re not looking for the G-spot when we do that. Okay. Now I just wanted to bring that out. Go read about Dr. Grafenberg. Couple of the things. I’m trying to keep to the schedule here. I’ve got about two minutes and I’m going to turn it over to Dr. Owings. There’s a lot more here. Let’s see.

The change in FSFI and FSD-R after the O-Shot® procedure

Charles Runels, MD (07:55):
If you go down to this little graph where they talk about the research we did, and just a couple of things to point out. It’s not apparent from this is that we published this little study. And what I did was I had a patient who used to work in getting universities ready for inspection by the FDA. After she retired from the FDA, where she was an inspector of research projects done by universities, after she retired, then she worked as a consultant on the other side to help people get ready for what she would have done when she worked for the FDA. I loved her, love her still. I saved her life with some stuff I was doing, and so she felt obligated. So I said, okay, let’s go through my charts. I don’t want to even touch the charts. And find women for whom we have a female sexual function index and a female sexual distress scale revised that was filled out plus or minus a few weeks around the 12 week mark. As you can see, 12 to 16 weeks. And we have one before and we have one at that time, because I think that’s when it probably maxes out. And just add it all up and let me see what it shows. My hands are going to be off.

Charles Runels, MD (09:10):
And she did it as meticulously as only an FDA person might do. And thankfully, it showed benefit. You realize I wasn’t even seeking people who were distressed. And ironically, of the two that showed increased distress on the distress scale, I called one of them because her distress scale had gone up, I think from a one to a two. It just bumped from zero distress, basically, to a little bit more distress. And when I asked her why her distress went up, she said, well, I’m having great sex, and now my boyfriend can’t keep up with her. So that was, that was her distress.

Charles Runels, MD (09:51):
The other woman had a divorce right after the shot, and her whole life was distressed. But the bottom line is that we showed some benefit. Obviously there was no placebo, and rightly so, he points that out. But I want you to know how those numbers were generated.

Charles Runels, MD (10:08):
This one, I think very well done. I think it’s complicating it. If you notice the people who were doing the procedures, like the recent one that made the cover of the journal Sexual Medicine, the people who were doing the sex procedures, who have never done this in the face, in my opinion, are complicating it. If you ever squirt PRP in the face, you’ll see, it’s like filling up a sponge. You wouldn’t feel obligated to stick the sponge, if it were small, in three or four different places. You would just put the needle in the sponge and it would fill without lots of sticks, which is what you see when you see PRP spread through the face.

Charles Runels, MD (10:47):
But not having witnessed that, I think some people complicate it, just my opinion. I may be proven to be wrong, but I don’t think you have to put multiple sticks. And I think most of what happens does go along, especially when you’re treating for stress urinary incontinence, but even when you’re treating for sex, because of the sensitivity of the urethra, I think anything away from 12:00 for sure, by the time you get to 2:00 and 10:00, perhaps benefits are rapidly declining. I’ve seen lectures about hyaluronic acid when I lectured in Europe, and many of you on the call now or listening later will know about this, because you live in Europe. We don’t have as yet an HA that’s approved for the vaginal space. The guy who invented [inaudible 00:11:42] came out with one that is, but the recommendation is that it only be used in the posterior vaginal wall for the same reason, I just mentioned. The G-Shot is not recommended, it’s condemned by ACOG, because when you put the HA in the anterior vaginal wall, some not happy things can happen. Where it’s safer in the posterior vaginal wall.

Charles Runels, MD (12:06):
The end point is often pH, which is interesting to us in the States. And you can see people are mixing it with PRP as we are doing in our wing lift. This, again, I think is something that hopefully will eventually be something we’re able to do here. There’s a region kit that comes with an HA as an activator that’s not cross-linked, that is supposed to be available here eventually.

Charles Runels, MD (12:34):
And then the collagen botulinum toxin, I’ll get back to fat as it does lead to embolism. When you get to stem cells, I don’t even like saying that on a microphone now because the FDA is so rambunctious about making sure we don’t talk about stem cells too much. So that’s it. Let’s see if there’s any other notes and we’ll turn this over to Elizabeth. Anyway, hopefully you guys will think about that, and… Oh, I know what else was going to show you. This last little part in the summary, and then I’ll shut this down. The references here are crazy good. So you might want to go through those when you have a Sunday afternoon. This part.

Charles Runels, MD (13:24):
Well, the bottom line is that instead of having one tool, the idea of combining tools is important. We definitely need to standardize it. The double-blind placebo needs to happen, but I think it might need to be a positive control, because saline is not a placebo. If you think about what happens when you power wash your driveway, I’m afraid there may be some disruption of tissue that makes it not a placebo. So in fact, our procedure is part biological by activating pluripotent stem cells with PRP-derived growth factors and cytokines. It’s partly a physical procedure when you’re hydrodissecting tissue. So it’s a little tricky doing a placebo-controlled trial, unless maybe you just stick the needle there. Anyway, I’m playing around with that. I actually stopped one study when I saw another study where the saline placebo worked almost as good as PRP and much better than you would have expected a placebo to work in a histological study.

Charles Runels, MD (14:30):
So I think now let’s unmute Dr. Owings and I have her beautiful pictures that she’s accumulated to help explain some of the function of the anatomy and how it relates to what we just talked about. Let’s see, I see two microphones, Elizabeth. I’m going to unmute them both. There you go. Should be live now.

Elizabeth Owings, MD (14:57):
Okay.

Dr. Elizabeth Owings discusses the Functional Clitoral Anatomy

Charles Runels, MD (14:59):
You’re there. There’s something that’s causing an echo. So while she’s flipping that off, just to let you guys know, Dr. Owings is really a… I meet lots of smart people, but she’s one of those Renaissance ladies who has a music degree and plays the piano like Liberace or something, and she’s got so many fricking specialty trainings I can’t track them, and still looking for the new thing to think about. So thankfully some of those new things that she wanted to think about included our procedure. So let me see if I can make this… Yep. There it is. And I’ll just run through this whenever you tell me to, Elizabeth, and we can hear you now beautifully.

Elizabeth Owings, MD (15:47):
Okay. Terrific. Glad you can hear me. Just had two mics, because I didn’t know which one was going to link up right.

Charles Runels, MD (15:53):
[inaudible 00:15:53]. We got it now.

Elizabeth Owings, MD (15:55):
Perfect. So I guess I have been thinking about this. I’ve been thinking about this a lot. Any of you heard me give this talk, my third patient after I was trained in the O-Shot®… And I’ve got general surgery training and we do gynecology rotations and you learn about it in medical school. The third patient had lichen sclerosis. I had never seen it before to recognize it. Yes. Thank you, Charles. But this is a condition where the, the tissues just sort of adhesed together over the clitoris. You can actually feel it underneath there, but you can’t see it. And when you think about how to do an O-Shot®, it’s a bit perplexing and not something that you want to walk into.

Elizabeth Owings, MD (16:36):
My assistant had applied the lidocaine and I just came in to do the procedure. Very straightforward procedure, only it wasn’t. But it prompted me, I realized, I didn’t know nearly what I needed to know about the clitoris. I spent the next month, basically, downloading articles. I didn’t go back to the anatomy textbooks, because I’d already looked at them and they really weren’t helpful to me to really understand what was going on behind the scenes underneath the small, external portion of the clitoris, which is what anatomists tell us that the clitoris is, is just this tiny, external portion. And they’re thinking about… Do I have a pointer?

Charles Runels, MD (17:22):
I can give you the pointer. Hold on a second. Let me see if I can do that.

Elizabeth Owings, MD (17:26):
But just when they, in your anatomy books, they think of the clitoris is… Oh, there you are. Just this, the glans in the shaft. That’s all they think of as the clitoris. You may just want to point, Charles.

Charles Runels, MD (17:51):
Okay, I’ll point for you. All right. Let’s do that.

Elizabeth Owings, MD (17:54):
Okay.

Charles Runels, MD (17:54):
Take it back. Hold on one second. Got it. Okay. I’ll be your pointer.

Elizabeth Owings, MD (17:55):
Okay. Be my pointer. So the glans in the shaft is all it would be pointing at. That’s just that top, just the very, very, part of the glans and the shaft, but not the deep part is what they thought. So the deep part would be the legs of the clitoris that Charles is pointing to now. And you can’t see that from the outside. And so modern anatomists and ancient anatomists don’t really think of that as part of the clitoris. So it’s the easiest for me to understand it is starting with the sameness, the things that are the same about the female anatomy and the male anatomy.

Elizabeth Owings, MD (18:32):
And so the male anatomy, almost everybody has seen an erect penis, an erect phallus. You’re familiar with the fact that it’s firm. It’s supposed to be firm when it’s erect, and what makes it from are these two tubes that fill with blood. When it happens normally, that’s wonderful. And then sometimes people have to take medications to make that blood flow happen. And then sometimes of course, people actually have to take an injection. It’s injected into the tube to make the blood flow in there to make the penis hard. If a man has a penile prosthesis, it’s basically implanted where these tubes are to make it erect.

Elizabeth Owings, MD (19:15):
Well, females have those same tubes. They’re just mostly on the inside. So this is the male, that Charles has pulled up for us. There we go. The big circles on the top, when I was in a microanatomy histology class, they told us to think of the cross section of the penis as looking like a monkey. Two big eyes, and those are those tubes that get hard. And then the part down at the bottom is the part that surrounds the urethra.

Elizabeth Owings, MD (19:43):
And so in the female… And there it is, there we go. That’s a nice picture of how these tubes are very wide open, ready to fill with blood, ready to become engorged. And they actually are joined and are one space towards the end of the penis, towards where the glans of the penis is. And they separate down at the base and in the deep parts of the penis. There’s another picture of it. You got that up at the top, there’s this combined space, there’s a septum, but it’s got a lot of space in there where fluid can flow back and forth. That’s why when you do a Trimix injection for the penis to become erect, you only have to inject in one spot. And that fluid in the medication is active throughout that whole space. When we do our PRP injections, very shortly after it’s injected, it becomes a platelet-rich fiber matrix. It turns into a clot, basically, on the inside, but not the bad kind, not the kind that causes problems. This is the kind that’s basically generating those healing factors so that the function is going to improve.

Elizabeth Owings, MD (20:54):
I just always like to include this slide, because you can see that even in the glans penis, you don’t think of it as a tube. And you’re looking at the microscopic section. There are these big spaces in it. And when you did your Priapus shot, when you did that injection in the tip of the penis, which is a completely separate space from those two tubes that become erect. But when you do that injection in the tip, it doesn’t raise a bleb, it doesn’t raise a wheel. This is a great picture so you can understand that there’s the spongy part that surrounds the urethra, that leads up to the glans, and it’s spongy, even in a very erect penis, the glans will have some give to it. Where the shaft of the penis will not. That’s that those tubes that I was talking about that become erect.

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Elizabeth Owings, MD (21:41):
The same thing happens in the clitoris. Those same tissues are all present. I love this picture, because this shows perfectly well where to put that shot. As soon as you see those side to side rugae in the vagina, just inside the hymen, even if you’re not sure if you’re looking at the hymen or not, if you see those lines going side to side, that’s the place where you put your O-Shot®. That is the O-spot.

Elizabeth Owings, MD (22:10):
The same thing on that right picture. You have a really good view now of where that O-Shot® goes, and then all of the deep tissues of the female that are all part of that clitoris. It’s all part of that clitoris complex. So it’s not just the tip, not just [inaudible 00:22:28]. So I just included this picture of me and my son out in front of a [Glendonhall 00:22:32] glacier, and there’s an iceberg down there. So just like they taught us about iceberg, most of it is under the surface. The same is true for the clitoris. Most of it is deep. The part that we see is a very, very small part of it. So go ahead into the next one.

Elizabeth Owings, MD (22:46):
And you can see this pretty well on the slide here. And if you think of this, what you’re looking at is maybe just a longitudinal section of the penis with a foreskin or prepuce surrounding the glans. Then that’s exactly what you’re looking at with the clitoris. And there are those two tubes that are going to make the clitoris hard just like the penis. It doesn’t stand up because of the way it’s constructed. A penis will stand up. The clitoris does not. It will become full and engorged, but it doesn’t stand up, just because of the way it’s constructed. We don’t need to look at that one. I like that next one though.

Elizabeth Owings, MD (23:25):
To just point out, this is a two year old child. This is fully developed. Just exactly like you would see in an adult. Go ahead to that next one. Again, great anatomical picture. The tip of the clitoris with the glans is what you would expect to see on the outside, with little shaft that’s going up. You might see that. But the vast majority of it is deep. So when you put an injection, not in the glans, but just behind the glans, you’re going into that tube, and the fluid will go all the way down. We’ve proven this on ultrasound. The fluid will go all the way down to the deep parts of the clitoris.

Elizabeth Owings, MD (24:04):
This is an MRI. This is a picture closest to the outside, and that’s why we call it the introitus and not the vagina on the line drawing right to the right. So these are 18 year old women who’ve never had a baby. And you can see where the vagina is. I love this MRI picture. Very clearly, you can see where the legs of the clitoris are deep, the glans and the urethral meatus right there with the introitus. That’s good. Just like that. Go ahead. There it goes.

Elizabeth Owings, MD (24:38):
A little bit deeper, the body of the clitoris they’ve got mapped out right there for you. And then the crura coming down side by side, and there’s the bulb of the clitoris. That is analogous to the corpus spongiosum in the male penis. And it’s there. I don’t think I’ve got the photomicrographs, but it exists all the way up to the glans of the penis, just like it does surrounding the urethra to the male. The urethra in the female just comes directly to the outside. It doesn’t have to track up to the glans like it does in the man.

Elizabeth Owings, MD (25:17):
There we go. And then deeper still, at the very top, you’ve got the mons. Right under that is the pubic symphysis, and right under that is the crus of the clitoris, and then the urethra. Under that, sort of with the transverse shape here, is the vagina itself. Go ahead to that next one.

Elizabeth Owings, MD (25:43):
This is one of my favorite views, because you really get an idea… They tilted it, it’s not exactly anterior to posterior. It’s tilted just a little bit so that you can see the entire body of the clitoris. You just get an idea of the glans at the tip, and then these deeper structures, all part of the clitoris that are surrounding the urethra and the vagina. And when you look at this picture, I think that’s when I realized anything that we do that makes those tissues more healthy and lens support to them… You expect your face to sag a little bit after 50 or 60 years, and probably every other tissue in your body is as well. So if you’re lending any support at all to these tissues, it’s going to support the urinary continence mechanism. It doesn’t make the muscle any tighter. It’s just lending support to these structures. They’re going to become not necessarily more engorged, but there’s just going to be more just basic tissue tone. Go ahead.

Charles Runels, MD (26:47):
Let me just throw one thing in there, Elizabeth.

Elizabeth Owings, MD (26:50):
Yes.

Dr. Owings’ book to explain the clitoris. A great educational/marketing tool for physicians.

Charles Runels, MD (26:51):
We have an MRI study that’s listed on the reference page of the O-Shot® that showed where a female radiologist, she did MRIs just like this of women who have trouble with orgasm and women who easily orgasm, and there was a correlation with the size of the clitoris and the distance of the clitoris to the vagina. So the bigger the clitoris, and the closer to the vagina, the more it correlated directly with ability to orgasm. So just stressing I like this picture as well, because the idea of anatomy just being for surgeons maybe isn’t right, because we all have to think about how the parts work together. I think that this picture explains why just talking about a spot maybe as the main thing isn’t exactly so accurate.

Charles Runels, MD (27:47):
It shows where this clitoral urethral complex, it also points out why the answer to, if you’re going to treat urinary incontinence, do you still treat the clitoris? I think there’s two reasons why you do. One is, as you’ll see in these upcoming micrographs, but especially the one that Elizabeth just pointed out, there was some contribution to the clitoris to the continence mechanism. And then of course if you’re going to treat sex, do you still treat around the urethra, because of what we just talked about with Dr. Grafenberg. Of course you do that as well. So I always treat both, whether the complaint’s sex or incontinence. And I think, as you just pointed out, Dr. Owings, that picture tells a lot.

Elizabeth Owings, MD (28:36):
The other thing that I’ve noticed is even if people don’t complain, if something improves, when they see you again, they will let you know. So maybe urinary incontinence wasn’t the chief complaint, but when they come back in six weeks or six months or a year, maybe it’s time for another one, or maybe I had more than one patient that said, “Well, I thought I knew how good sex could be, but it was never as good as this. And I don’t know how good it can be. Let’s do it again. Let’s have another O-Shot®.” More than one, and not all young, healthy people. One of my earliest clients was a 65 year old woman, and she was just really excited with how positive her sex life could be. Thanks for moving me on here.

Charles Runels, MD (29:28):
That was an accident, actually. Finish your story. That was an accident.

Elizabeth Owings, MD (29:33):
That was the end of it. She did not have a lot of complaints. She just wanted some improvements in the sexual function characteristic, but urinary continence got better, and sex got a lot better. And when she came back, I actually treated her nipples, because at that point, I didn’t know if it would be beneficial or not. She did not have any problems with her nipples. She had normal sensation, had never had surgery on her nipples, but she had better sexual arousal from nipple stimulation. It was not just a part of her sexual response. In her words, it was off the chart. The party line for PRP is going to be two or three weeks for the start, and then three months for full effect. She hunted me down in the gym at six weeks, because we went to the same gym, and said, “That nipple thing is amazing. I had no idea that was possible.”

Charles Runels, MD (30:28):
Wonderful. It’s good [inaudible 00:30:29] that. And you and I can go all night, I love it, with stories, but I’ve had some men want their nipples done. And second point is that if someone comes in and talks about, I just want it for urinary incontinence, we all know it, but I think it’s worth bringing it out in the light that can we all agree that sometimes people lie about sex, or they’re embarrassed to talk about sex, and they might use it incontinence as a ticket to be there as we often have our patients do, but they’re just embarrassed to say about the sex part. So it’s another reason why I always treat the clitoris, even if they’re there for incontinence.

Elizabeth Owings, MD (31:08):
Well, exactly. And this is my slide of the title Why Girls Don’t Compare Parts. It’s just that the clitoris, which is the part that’s external is so small and so deeply hidden between the labia minora and the labia majora, there’s a prepuce there. It’s just hard to see. But the truth is, if you look at it, if this is what you do for a living and actually you are paying attention, it looks exactly like a little penis. How do you make it bigger? You give the woman testosterone. And that’s the sex change. Surgeons taught us that. I think it’s probably a slide later on.

Elizabeth Owings, MD (31:48):
I went ahead and looked at the gross anatomy. What do the surgeons who were doing the dissections, what are they seeing? What does it really look like underneath the skin? And so you can see there’s the glans of the clitoris and the clitoral body, which we’re used to seeing on the outside. And then those deeper structures that crus, the bulb, and the way they wrap around. Wrap around the urethra with the vaginal vestibule right underneath it. They’re just right there together. Go ahead. Same thing here, a little bit kind of from the side, the crus is sort of coming down. This long, long leg that comes down straight.

Charles Runels, MD (32:24):
I really like this picture. It really I think shows how everything’s laid on top of each other.

Elizabeth Owings, MD (32:28):
And the bulb actually comes a little bit forward, and the vaginal introitus is sort of all the way on the right side of the screen there with the bulb in the middle, and then the clitoral crus on the side there. That bulb is wrapped right around the vagina with the crus just outside of it.

Charles Runels, MD (32:49):
Beautiful.

Elizabeth Owings, MD (32:51):
It’s the same picture. They’ve just turned it a little bit further.

Charles Runels, MD (32:58):
So I just want to rant shortly. How many of our colleagues think about the vagina as just a simple tube that leads to the cervix where you can deposit some semen? And how many people are taught all the way through college that that’s kind of what it is. And yet, when you see the elegance of the functional anatomy and what’s happening when there’s a penis here or what’s happening when various sexual or non-sexual activities go on. Obviously we all know it’s much more complicated than that, but I think showing and talking about this with our patients is very helpful. And with our colleagues.

Elizabeth Owings, MD (33:41):
Right. So again, it’s just a little bit of a different view, but the same concept. These pictures, I like, because you really get an idea. If you take the urethra and you look at the tissues around it, what are you looking at? And the answer is, so the urethra is kind of that hole in the middle. It’s got a U in it, and around it, you may see this. It’s erectile tissues around it. That’s where the deep areas of the clitoris are directly overlying the urethra. And then on top of that is the layer of muscle. And when that muscle is what’s responsible for our urinary… Well, that, and all the other structures. There’s no muscle that wraps all the way around the urethra like there is in the man. I’ve got a slide about that later. In the woman it’s just this band of muscle that’s listed up at the top and this… Go ahead to the next one. There we go.

Elizabeth Owings, MD (34:38):
SM is muscle. That’s it. And I counted it, because I’m that person. It’s about 30 cell layers thick. It’s not very thick. If you buy broccoli, that’s got that big thick, rubber band around it, it’s about that width, and about that thickness. It’s very thin, it’s not nearly as strong as that rubber band is, but it’s just not a very big muscle. And that is responsible for sort of pinching off the urethra against the anterior vaginal wall. So anything that you’re doing that’s going to lend some support to those structures on the on the inside, whether it’s the anterior vaginal wall, placing a platelet-rich fiber matrix right in between those tissues, that’s what you did with that deeper injection and the O-Shot®, when you can even actually feel it. It feels like a Walnut in there. That is going to support those structures for urinary continence. And I believe that that’s why the effects for continence are almost immediate.

Charles Runels, MD (35:44):
Elizabeth, something that I haven’t talked about that I’ve been trying to find more reasoning and a clearer picture about is that if you go to the sports medicine literature, PRP has been talked about quite a bit. It’s still debated about how effective it is, but when you injure muscle, as you know from your many surgery residencies, that it can turn to atrophy, it can be infiltrated with adipocytes or scar tissue. And instead of growing new muscle back, you’re left with this weaker structure. But you have a lot of research now showing that PRP can activate these stem cells that live within the muscle, mostly in the periphery of the muscle, that are just waiting to be activated to regenerate when there’s injury or stress.

Charles Runels, MD (36:42):
I’ve started to wonder if perhaps some of what we’re seeing with our great results with incontinence in my person is both the bulk that you just talked about and perhaps that we’re actually making these intricate muscles that we’ve just lumped together as the pelvic floor, but actually there’s all these different intricacies that are almost like the mast of a ship or something, with ropes going lots of different directions and lots of different opinions about which is pulling what. But the fun thing is when you just flood the whole area with PRP, and then you do your kegels or not, or you do your [inaudible 00:37:23] or not, we could be doing sports medicine in this muscle inadvertently, and without maybe thinking about it except when you show us these pictures and we say, “Oh yeah. Well, the erectile tissue’s important, the muscles are important. The blood flow is important. The nerves are important in both stress and urge incontinence.” And thankfully we have a material that makes all those things better.

Elizabeth Owings, MD (37:50):
It’s true. I’ve been blown away from the very beginning about what’s possible with platelet-rich plasma, and you can go back and forth about platelet-rich, platelet-poor, activated, not activated, leukocyte-rich and leukocyte-poor. It doesn’t matter. Ultimately, I find myself asking, can a human being, various functions, various portions be made better than they were with this as an adjunct? And I think the answer is very often yes. It’s not necessarily predictable who or where, but very often, yes. And I’ve had this more than once. “It’s never been like this before.” And that’s a happy thing for me.

Elizabeth Owings, MD (38:30):
This picture, this line drawing is my line drawing of the… The cross section is through the urethra that you just looked at the slides of just a minute ago, so that you can see there’s a spot right in between where the urethra is. The one big blob on your left is sort of the bladder. Ureter is behind that, and the vagina sort of underneath that. And then there’s this tract in between, and Charles talked about hydrodissection and we know that when we put our PRP in there, there is going to be some hydrodissection just based on where that is. I don’t think that alone would explain any urinary continence improvement, but I don’t know. I definitely don’t have the data on that.

Elizabeth Owings, MD (39:12):
But what this picture is just shows the darker area of the urethra is where all that erectile tissue is that I tried to show you in the cross section. And then a little bit further than that, a little bit closer to the end of the urethra is where that muscle is. Now, a lot of people have proven this. Going further back in there with your platelet-rich plasma does not make a better continence procedure. You still want your O-Shot® to go in the O-spot. That’s where you want your PRP to go, is just inside the most distal portion of the urethra, underneath the urethra just inside the vagina, just at that most distal point. Climbing in deeper does not do you any good. It does not help the patient.

Elizabeth Owings, MD (40:09):
It’s a beautiful artistic rendition that my friend Kent Rush did for the book. There’s some good pictures, but you just get the idea again. The clitoral legs are on the outside, and the bulbs are right there around the vagina itself. Go ahead to the next one. Same song. Second verse. Keep going.

Elizabeth Owings, MD (40:31):
This is the male sphincter. There’s really a sphincter. That’s that deep magenta thing marked SS around the urethra that’s marked U. It is truly a sphincter. It’s a band of muscle that goes all the way around the urethra. Women don’t have that. And the good news for men though, the P-Shot®, it can actually help that work better as well. I’ve helped a lot of people with, they’re just not functioning well, especially after prostate surgery. I’m not sure these men are getting what I would consider informed consent, but I don’t know. Anyway, the problems I think are much more common than people are led to believe. You may say that the incidence of this or that side effect is only 20%, but if it happens to you, it’s a hundred percent. So anyway, next slide.

Charles Runels, MD (41:21):
[crosstalk 00:41:21] placebo controlled study that I pushed out in another email with rats. And of course, with rats, you don’t have to worry about a placebo effect, and you can harvest the penis. But this is the third one I’ve seen where they looked at that, or they tried to model prostate surgery with nerve injury and injected the penis with PRP, and the other group got saline and then harvested the penis, and they saw repair. So anyway, I’m hoping one day, at least by the time my grandkids are grown, that PRP will be routinely part of the rehabilitation protocol [inaudible 00:42:03] prostate surgery.

Elizabeth Owings, MD (42:04):
I agree. So this female corpus spongiosum, let me just tell you why I included this slide. There is still a pervasive myth. It’s been in the medical literature for decades, for well over 50 years, that there’s no corpus spongiosum, but the glans of the clitoris comes off the corpus cavernosum because there is no corpus spongiosum. Once you know what the deeper structures are, and you’ve seen some of these photomicrographs, that’s obviously not true.

Elizabeth Owings, MD (42:40):
Somehow, Charles, this is… It’s slid off sideways.

Charles Runels, MD (42:48):
Oh, I did something wrong. I don’t know what I did.

Elizabeth Owings, MD (42:52):
So what they’ve done is given this woman testosterone and all portions of the clitoris have hypertrophied, including the corpus spongiosum. So the glans is pulled up by a suture at the very, very top. Point it up at the top. That’s it, right there. And the long strand right there would be what in a male would be surrounding the urethra. That would be the corpus spongiosum. This is a photo micrograph. It’s hard, I wish I had the pointer, but the bottom line is the corpus cavernosum are these two big round things, but the corpus spongiosum is there through the entire length of the clitoris all the way up. It’s submucosal, meaning if you’re looking at the outside of the vulva, you won’t know it’s there. You would have to do a dissection, but it’s there. The whole way.

Elizabeth Owings, MD (43:51):
Go ahead with the next one. This is [Ashazinsky 00:43:55], the guy with the hardest name to say, who said he dissected these out. I think you can probably only do this in Poland. Eight consecutive cadavers. And he dissected out this thing he called the G-spot. There’s an ongoing debate. If you go to PubMed.org, and just put in G-spot and anatomy probably it’ll come up. Helena O’Connell, the lady who did, I think, some of the gross anatomy dissections, and maybe the MRIs too, I can’t remember. I think she was also a partner on that study. Has gone through and done all these dissections and said there’s no such thing as the G-spot. But the debate rages on.

Elizabeth Owings, MD (44:39):
So if you look at this nice picture he gave us, because this thing that he found, which looks sort of like a thrombosed hemorrhoid, it is deep inside the vagina and right near the bladder. And so that might make you think, well, this is going to work better for sex if I go really, really deep with my O-Shot®. And again, it doesn’t. It doesn’t work for sex, and it doesn’t work better for incontinence. I don’t know why.

Elizabeth Owings, MD (45:06):
There you go. Those were those pictures for the lichen sclerosis. You won’t harm anyone by putting PRP in that. That is actually the treatment. I thought I could learn this, and I really think they belong in a center of excellence. I refer everybody to Kathleen Posey in Mandeville, Louisiana on the north shore above New Orleans. Someone once listened to my lecture, what you’ve heard so far, and said, “Well, we know why women have urinary incontinence. It’s because when they have a baby that this is torn and that is torn.” Which it set my teeth on edge because it’s obvious to me that there are plenty of women who’ve never had a baby that have urinary incontinence. And if I go to PubMed and just type in urinary incontinence, and nulliparous, I get a whole couple of… I don’t even remember how many. You should go look at it. Articles about where people have looked at this.

Elizabeth Owings, MD (46:07):
So anyway, we’re biased. We think that if you’ve haven’t had a baby, then you shouldn’t have as much incontinence as if you have had a baby. If you’re in shape, then you should not have incontinence. And if you’re out of shape, then that’s more likely. And if you’re old, then you should have more than young. And that’s not quite what we found at all, if you look at all these reviews from 1% to 42%, depending on various factors. Heavy women seem to have it worse. Childhood bed wetters and people who engage in high-impact exercise are more likely to. Even women without babies who’ve had… Go ahead to the next one. So even we find that women 18 to 40 who’ve never had a baby, are active and have a low BMI may have up to 23% urinary incontinence. Go ahead.

Elizabeth Owings, MD (47:01):
30% in athletes versus 13% in controls. These are young women, roughly median age, 19. 372 athletes and 372 age match controls. Their risk factors were high-level sport, a history of urinary tract infections, had family history of urinary incontinence, and constipation. And I think the family history of urinary incontinence goes along with maybe some anatomic features. History of constipation, I think probably as well as high impact exercise goes along with increased abdominal pressure. You’ve got all this pressure. Just think about jumping on a trampoline, just like jogging. A woman with urinary incontinence may never jog again. She may just walk. So that’s something that you can use to reach people and reach their pain. If they’re changing their lifestyle because of urinary incontinence, that’s a big deal. Go ahead.

Charles Runels, MD (47:56):
I think you just made a big point. How much leaking do you have to have before it counts as incontinence? Sort of like the question, how big does a boat need to be before it’s a ship? It has to be so big you cannot carry it across land. Now it’s a ship, not a boat. And the answer to how much leaking before you have incontinence… For you guys on the call, I haven’t tried to define that… Is if it interferes with your hygiene or your lifestyle. So you have to start wearing a pad or change your clothes, obviously, hygiene. If you stop something that you normally like to do, like your gymnastics or cheerleading as a teenager, which is 1 in 20 teenagers, in college people, or you can’t sit through your meeting at work, you’re changing your lifestyle. That’s incontinence.

Elizabeth Owings, MD (48:44):
Yeah. So many of these are similar. Go ahead and see if you can find a sister study. It’s not too much further ahead. Yeah, sisters. I love this. So they took post-menopausal women, and one sister had never had a baby and one sister had had a baby, and they found that the incidence was exactly the same. 47 versus 49%. That is not statistically significantly different.

Charles Runels, MD (49:08):
Totally unsurprising, huh?

Elizabeth Owings, MD (49:11):
Yeah. And then sisters had a high concordance. They were very likely to have the same situation. If one had normal continence, then the other one probably did. And the same thing for incontinence. Go ahead. And then the elite trampolinists. So this was fun. So 80% of the… These were 12 to 22 year olds. Mean age was 15. 80% during training, they would leak about an ounce. Started after two and a half years of training.

Elizabeth Owings, MD (49:41):
And if they put a pad in and tested, they found that it was a hundred percent over the age of 15 were leaking during their training event. So it’s not a sphincter, that urinary incontinence mechanism. There are a lot of parts to it. It’s much more sort of like a siphon, like a valve and not a sphincter. Because it can be overcome, just like the valves and the veins in your leg can be overcome if there’s enough pressure. So that’s what I wanted to say there.

Elizabeth Owings, MD (50:12):
Thinking about this in the future and how to teach this and how to think about this, I’ve been thinking about models. I think that’s where I’m going to be going. The direction I’m going to be taking is making a form of model where some of these parts can be snapped together and then unsnapped so that you’ve got not just a visual, but you can actually hold things in your hand and go, “Oh, this is how this goes together.” With perhaps various stages in, because it’s the same, maybe at eight weeks gestation, it’s exactly the same. You can’t tell the difference, whether it’s a male or a female. They are the same at that point, from the standpoint of what the tissues look like. And these changes come over time. Lots and lots of influences, and over the weeks, between 7, 10 weeks or so, things are changing so that eventually you can tell the difference, which is a boy and which is a girl. Usually. Those ultrasound people get it wrong sometimes.

Charles Runels, MD (51:20):
I’ve never seen such a low dropout rate. You’ve held everybody’s attention. I think this is the best clitoral anatomy… and I’ve heard others… lecture I’ve ever heard. And could I just have an email that people could contact, because I know that you teach classes. Dr. Owings will do a one-off class if someone wants to go follow her around and see how she thinks about her business. She’s in several different cities with her practice, so there’s some menu there to choose from. Could I just type an email address into the chat box so they can reach out to you?

Elizabeth Owings, MD (51:55):
Sure. That’d be great. E as in Elizabeth, P as in Patricia, Owings, O-W-I-N-G-S @gmail.com.

Charles Runels, MD (52:03):
Okay.

Elizabeth Owings, MD (52:03):
Am I supposed to do that or are you going to do that?

Charles Runels, MD (52:06):
I just typed it in. It’s all there. Thank you so much for being on the call. Anything else you want to throw out there before I shut it down?

Elizabeth Owings, MD (52:12):
No. No. Just looking forward to hearing from everybody. Thank you so much for your attention.

Charles Runels, MD (52:16):
Thank you, Elizabeth. You have a wonderful night.

Elizabeth Owings, MD (52:22):
You too.


Relevant Links

Zheng Z, Yin J, Cheng B, Huang W. Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy. Aesthetic Plast Surg. 2021;45(3):1231-1241. doi:10.1007/s00266-020-02054-w<-click-to-read<–
Runels CE, Melnick H, DeBourbon E., A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction. J Women’s Health Care 2014, 3:4
—>>>Click here to read. The introduction explains the science of the O-Shot®<–click<—
Altar™–A Vampire Skin Therapy™

 

 

 

Cellular Medicine Association
1-888-920-5311

Double-Blind, Placebo-Controlled Study Demonstrates that the P-Shot® Works for Erectile Dysfunction

It’s True! The P-Shot® Helps Men with Erectile Dysfunction

News provided by
Cellular Medicine Association
June 14, 2021
FAIRHOPE, AL, June 14, 2021 /PRNewswire/ — Sixty men volunteered to have their penis injected with their own blood by eight urologists from Aristotle University in Greece; the results—a double-blind, randomized, placebo-controlled clinical trial published in the May 2021 issue of the Journal of Sexual Medicine—showed that “Platelet-Rich Plasma (PRP) Improves Erectile Function.” More than two-thirds of the men who had their penis injected were pleased with the improvement in their erection and there were zero complications from the procedure. During the study, the sixty men who participated were not allowed to use any other treatments to improve erections.

Dr. Charles Runels (the inventor of the procedure, which is called the Priapus Shot® or P-Shot®) said, “It’s been a long decade with much resistance, but I’m hoping this new study helps more physicians recognize the potential benefits of the P-Shot® procedure.” 

On September 12, 2010, Dr. Charles Runels registered his Priapus Shot® (P-Shot®) with the US Patent and Trademark office—announcing that he had found a way to inject platelet rich plasma into the penis to improve the health and function. Since then, multiple studies have been conducted and have shown benefit; but, adoption by urologists has been slow. 

“We needed this study.

We needed this study. I’m a community physician with a small office who just happened to be blessed with the discovery of this therapy more than a decade ago. We have amazing and brilliant providers in multiple universities; but, even they have trouble securing financing for research since the procedure involves the patient’s own blood—there’s no drug, and so there’s no pharmaceutical company to finance the research. If this were a drug, you would see commercials about it on every televised football game—it’s that effective. Until now, surgery and prescription medicines have been the first choice of most urologists and family practitioners; with this procedure, there is not a drug to buy or sell and there’s no surgery. I’m grateful these brilliant physicians from Greece have strengthened the evidence that the P-Shot® should be considered along with the current therapies. Nothing goes away, but this important option should no longer be ignored” said Dr. Runels.

Dr. Runels also invented the Vampire Facelift® in 2010 and used his observations from that procedure to design the P-Shot® procedure and the O-Shot® procedure—all of which use PRP: which is known to improve the circulation, nerve conduction, and collagen production and so to improve the health of tissue in over thirteen thousand research papers in multiple tissue types.

“Though these brilliant researchers helped prove the concept of the P-Shot®, their research protocol had to be kept simple to improve the clarity of the conclusions; their published protocol does not include all of the components of the P-Shot® procedure,” said Dr. Runels

All of those physicians and nurse practitioners who are licensed to perform the P-Shot® procedure (in 55 countries) will be found at PriapusShot.com. Providers not listed there may be performing an inferior procedure or doing the procedure illegally. Dr. Runels and his colleagues of the Cellular Medicine Association, conduct and consult regarding research in the areas of esthetics, erectile dysfunction, urinary incontinence, orgasmic dysfunction, lichen sclerosus, & the treatment of scaring using blood-derived growth factors. 

“Please beware, serious problems have happened when patients have undergone what was advertised as one of our procedures (Vampire Facelift®, Vampire Facial®, O-Shot®, or P-Shot®) from unlicensed providers who did not follow the protocols of the CMA,” said Dr. Runels.

Contact:
Charles Runels, MD
Medical Director
Cellular Medicine Association
888-920-5311 phone
251-650-1251 fax
DrRunels@Runels.com
https://PraipusShot.com
https://CellularMedicineAssociation.org
SOURCE Cellular Medicine Association 

A Double-Blind, Placebo-Controlled study shows that the P-Shot® (Priapus Shot®) works for ED.
More research about the Priapus Shot® procedure<—
Find the P-Shot® provider nearest you (50 plus countries)<–
Apply for training to become a licensed P-Shot® provider<–

Legal Notice

After trying to resolve quietly, the Cellular Medicine Association was forced send the following letter:

–>Read Warning Letter (Click)<—–

More about current FDA guidelines and PRP<—

Charles Runels, MD

Cellular Medicine Association
1-888-920-5311

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

Topics Discussed Include the Following…

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

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

Transcript

Charles:

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

Charles:

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

Dr. Ibrahim:

Dr. George Ibrahim

Fine. Hello Charles.

Charles:

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

Charles:

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

Dyspareunia

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Charles:

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

Dr. Ibrahim:

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

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Charles:

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

Combination Therapies for Peyronie’s Disease

Charles:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Penis Pump Tips

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Who NOT to Treat with the Priapus Shot® Procedure

Charles:

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

Charles:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

The P-Shot® after Prostate Surgery

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Sarah:

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

Charles:

Yeah. Go for it.

Sarah:

Great. So, one is, how much time-

Charles:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

[inaudible 00:32:11].

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Sarah:

I have too.

Dr. Ibrahim:

Yeah. Which-

Sarah:

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

Dr. Ibrahim:

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

Sarah:

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

Dr. Ibrahim:

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

Charles:

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

Sarah:

Nope. Thank you so much.

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Charles:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

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

Dr. Ibrahim:

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

Charles:

Yes, sir. Bye-bye.

Dr. Ibrahim:

Bye.

Dr. George Ibrahim

Dr. Ibrahim’s Next Workshop<—

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

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

Dr. Ibrahim’s Next Workshop<—

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

Penile rehabilitation research<–

More research about the O-Shot® procedure<–

More research about the P-Shot® procedure<–

More Workshops<---

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

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

Cellular Medicine Association
1-888-920-5311

 

From Vampire to Orgasm & Priapus–How and why I invented the Vampire Facelift®, O-Shot®, & Priapus Shot® procedures

Southern Research Institute
Center for Wound Care and Hyperbaric Medicine
Springhill Medical Center
Vampire Facelift® research<–
Priapus Shot® (P-Shot®) research<–
Orgasm Shot® research (O-Shot®)<–
Treatment of erectile dysfunction in the obese type 2 diabetic ZDF rat with adipose tissue-derived stem cells

Apply for physician training<–

JCPM2020.03.11.SexConversationsMadeEasy.AshermansSyndrome.ThrivingDuringDisaster

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

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

Apply for online training for the P-Shot® procedure<–
Next workshops for O-Shot® hands-on with live models<–

Transcript (coming)

Dr. Peter Castillo, MD

 

 


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


 

Next Workshops with Live Models<---
Relevant Links
Dr. Peter Castillo<–
Dr. Runels during hurricane Katrina<–
More numbers about mortality and Coranavirus<–
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
Altar™–A Vampire Skin Therapy™

 

 

Vampire Amnion<–

 

Cellular Medicine Association
1-888-920-5311

 

JCPM2019.7.10VampireFacialResearch.TearTroughs.BagsUnderEyes.OShotPearls.DyspareuniaPostRadiation

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

Transcript

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. Edward Tangchitnob, MD, ACOG

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.

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

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 Tangchitnob's Next Classes<--

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.

Gyn Surgery with PRP as Adjunct<--(click)

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.

Relevant Links

More about the Cellular Medicine Association<–

Dr. Tangchitnob’s next hands-on workshops with live models<–

Next hands-on trainings world-wide<–

Altar™–A Vampire Skin Therapy™

 

 

 

 

 

 

 

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

Topics Discussed Include the Following…

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

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

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

Transcript

Beauty Analysis. Face & Labia…the Math of Beauty

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another reference concerning the math of beauty

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

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

 

Click to see the after photo<–

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

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

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

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

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

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

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

PRP Tune-Up

click to see PRP basic science research<–

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Charles Runels: Interesting.

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

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

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

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

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

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

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

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

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

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

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

Charles Runels: Yes.

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

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

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

So, people don’t usually like that.

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

Charles Runels: Interesting. Yeah. Very good.

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

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

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

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

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

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

Charles Runels: Beautiful!

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

FDA Approval of PRP

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

FDA & PRP click to read<–

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

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

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

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

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

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

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

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

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

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

So that’s the quick version of that.

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

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

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

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

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

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

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

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

Next classes world wide with faculty of multiple specialties<—

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

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

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

Good-bye

Next Workshops with Live Models<---
Relevant Links

Beauty Analysis Facial Topographical Map<–

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

FDA & PRP<–

 

 

 

 

 

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

Topics Discussed Include the Following…

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

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

Transcript

Penis Pump Research

Next Workshops with Live Models<---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Penis Pump Research (click)<--

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

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

Other side effects of the pump

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

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

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

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

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

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

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

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

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

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

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

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

Carolyn Delucia: I’m done.

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

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

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

Charles Runels: So, let me-

Carolyn Delucia: So, I don’t care.

Briars, Woods Walking & Medical Innovation

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

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

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

Carolyn Delucia: Yes.

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

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

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

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

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

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

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

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

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

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

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

Carolyn Delucia: No.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Michael Goodman talks about innovation in medicine

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

Michael Goodman: Charles?

Charles Runels: Yes? Hello?

Michael Goodman: Can you hear me?

Charles Runels: Yeah! There you are! Beautiful!

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

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

Charles Runels: You’re making me hungry.

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

Charles Runels: Thank you.

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

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

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

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

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

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

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

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

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

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

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

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

Carolyn Delucia: Absolutely.

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

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

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

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

Charles Runels: Yes, talk about that.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carolyn Delucia: Thank you, thank you.

Charles Runels: Goodbye.

Both Dr. Delucia & Dr. Goodman offer hands-on workshops and can be found on the following directory…
click<–

Cellular Medicine Association
1-888-920-5311

 

Cell Doctor News. February 2018

 

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PRP and Sex

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Owning Tylenol® and Saying ‘Acetamenophen’

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Sylvia Sylvestri’s Best Marketing Pearl

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