Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
Dr. Runels: Thank you for having me.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
Charles Runels: We’ll start with some research that I think is worth paying attention to and then we’ll answer what questions might have appeared in the past week or so and then a quick marketing tip about how to use our poster. So that’s what I have planned for today but as always, we’ll take any questions that you guys have on the call.
If you’re not a subscriber to the Journal of Sexual Medicine, oh, by the way, we also have some really crazy good press that came out this month on the current Men’s Health magazine.
The one that is on the stands now. It’s the issue that has Mark Wahlberg on the cover. So it’s in every Wal-Mart, every bookstore right now and we have an article in there. It’s titled, “New Year,” excuse my French but that’s the title of it. “New Year, New Dick,” that’s the name of the title and the guy talks about our priapus shot.
As often happens, he doesn’t get the legal part right and he spells Priapus incorrectly, but he puts shot with a lower case “s” and leaves off the registered mark (®) so there really is some pretty sloppy journalism going on (since a little research shows that Priapus Shot® is intellectual property intended to mean a particular way of using PRP injections in the penis and post op and pre op protocols).
But, Andy Warhol said, “I don’t read the reviews, I just measure them in inches.” But this is a really good time to talk about the Priapus Shot®. I’ll send out an email to the group to let people know, but the Priapus Shot® porcedure is really in the news. To put an ad in that magazine costs you quarter million dollars and we have an eight page article now about the Priapus Shot® procedure in Men’s Health, so it’s a good time to talk about that.
So back to this research, it’s pretty easy to summarize and this has been out for a few months and I’ve been wanting to bring it up. It talks about this thing that we all know that women who are put on Serotonin Reuptake Inhibitors often have a drop in their sex drive.
This is the paper that came out... Click to Read Abstract<--
But what isn’t talked about a lot is that even after you stop the medication, often times they keep the low sex drive. So I have a little formula that I use before there was an “O” shot that I’m happy to share with you and then I think combining it with the “O” shot, we should get even better results. But I wouldn’t pretend like only rejuvenating the tissue of the vagina could take care of all the problems that might be going on metabolically in the brain secondary to months on an SSRI.
What I have found works the best is this. I make sure that, I’ll just bring this up where I can kind of type it out. I’m going to put this where I can make it where you can see it. This would be my of handling this and I’ve found that just one thing often doesn’t work. The first thing I put on is I like Depo-testosterone, Depo-testosterone. This is one of those drugs unlike some, where generic is fine, I don’t or I’ll compound it, can even be better in some cases. I don’t like to start a woman with creams because she may forget them, she may sweat them off down here in the south where it gets hot. Lots of things can happen.
Maybe she’s not absorbing it well and if a month later, her libido isn’t up, I have to do blood tests to know whether or not she’s even using it or absorbing it properly. But if I start off with Depo-testosterone 50 mg IM every 21 days, which is a pretty whopping dose and so you have to obviously, you don’t just put her on that and forget her. You have to bring her back about a week to two weeks after the second dose at the latest and you redo blood tests and see how she’s doing. They’ll often say their libido pops up towards the end of that 21 days and then pops back down and then comes up after the second shot and stays there. Then I’ll adjust it and then swap her over to creams or pellets after you get her libido back. But otherwise I’ve found I fiddled too long where that I know it’s in there and I know if testosterone’s going to help, that dose will help her.
1. Depo-testosterone 50mg im every 21 days. 2. Wellbutrin 3. O-Shot® 4. Family &/or Sex Therapy
Then if she needs an antidepressant, which often times she will not after you have her on testosterone, but I like Wellbutrin. It seems to, I’m spelling that wrong Wellbutrin. Anyway, you guys know what I’m trying to write, Wellbutrin. The slow release at 150 mg somewhere in that range. That will help the depression and also help with sex drive. Then of course, the “O” shot can go in that formula now and I like to make sure of course, that someone’s thinking about whatever else might be going on at home socially, or emotionally with the woman. It’s just sexuality and orgasm is such a complicated thing. I have done some of this, talking and counseling and trying to get husbands and wives in. But, it’s time consuming and I don’t attempt it anymore. A marriage counselor or a sex therapist or both. And that combination I think, well I know, that combination has pulled without even using the “O” shot before there was an “O” shot, has pulled my people out of that.
But the reason I wanted to bring up this research, is that most people realize there’s an SSRI syndrome that causes decreased libido, but it’s not often talked about that it persists in many women for unclear causes, even after you drop the off the medicines. I’ll copy this link into the chat box so it you guys want to check that out, you’ll know where to find it.
This is the paper that came out... Click to Read Abstract<--
Okay, so that’s the research for the day and let’s get to some of the questions. If you guys have any questions, just type them in there and while I’m getting to this other research, if you want to contribute to that cause I see some gynecologists on the call, just let me know and I’ll unmute your mike because I know that many of you have experience with this and may want to add to what we just said. And I would love to hear from you. So, there should be a little thing to raise your hand if you have your mike. Some of you don’t even have a mike turned on, but if you do and you want to contribute your ideas to that, let me know because I’d love to hear from you. Let me pull up the next question.
So this is a good question I think. It says, “What’s the longest we can wait after drawing the blood and before spinning and injecting? We’re performing “O” shots intraoperatively at the end of the case, who have a longer case. We like to draw blood prior to surgery. Any thoughts?” In the thoracic suite where people are doing heart bypass surgery, this is one of the places where this has been used PRP, to help healing of the sternal wound postop. The number I’ve been quoted is up to six hours, even after you centrifuge it, it can sit there. I think it’s certainly okay to let it sit there for three to four hours as you’ve indicated here in this question and then throw it in the centrifuge and inject it. That’s the answer to that question.
Now of course, after you push it through the needle or you add calcium chloride to it, all bets are off and I like it to begin the person’s body, preferably in less than a minute or two and I’m always trying to put it once I activate it with calcium. Which I hope you’re doing if you’re doing the “O” shot, activating it either with thrombin, which some of the kits have, calcium chloride or calcium gluconate. After that activation happens, it should be in the person’s body in less than three minutes.
I see Kathleen, if you don’t mind I’m going to have you pull up this next question, talk about how you deal with the ladies in your practice who have been on SSRI’s. Are you there Kathleen?
Kathleen Posey: Yeah, can you hear me?
Charles Runels: So for those of you who don’t know, Dr. Posey has seen thousands of women in her practice, is a gynecologist down in the New Orleans area. So talk to me about how you deal with the women either who are on SSRI’s or who have been on SSRI’s while I pull up the next questions. If you don’t mind.
Kathleen Posey: Very similar to you, that’s why I didn’t say anything except I agree. I mean if they come in on an SSRI and they have diminished orgasm ability, which most of them do I don’t stop their SSRI right away, I just add Wellbutrin and usually the combo is fine. Before I do the O-shot though, I really want the O-shot to work and I really try to ween them off the SSRI on to the Wellbutrin and a lot of the times I’ll do the same thing, I’ll give a shot of testosterone in it at the same time I’m doing a pellet, or I’ll give a shot of testosterone when I’m doing the O-shot because I just want them to get started and pretty much do the same, I use the pellets more than I do the injection but that’s just my preference.
Charles Runels: Okay so when you do, let me catch up with you. So when you do, someone comes in and they’re on an SSRI, you might start Wellbutrin and give them a testosterone injection or a pellet and then either do that O-shot then or bring them back and do the O-shot later is that correct?
Kathleen Posey: Yes but I keep them on SSRI because a lot of times, you know most of them have been on the SSRI so long I find if you just stop it and then just try to get them to go to a [inaudible 00:11:18] it doesn’t work that well. Wellbutrin makes them a little bit more nervous, it’s not as sedating and if you just give it, that’s why even the therapeutic does at 150 the therapeutic dose is 300. So if you just give them 150 it seems to work with the SSRI and then I’ll let them go a month or two talking about the O-shot, talking about testosterone and I usually try to ween them, eventually [inaudible 00:11:56].
Charles Runels: Okay. Alright.
Kathleen Posey: I know a lot of the psychiatrists do it that way too, they’ll just add …
Charles Runels: Add the Wellbutrin, okay beautiful. Alright so here’s another question, it says where do you get your 30 gauge needles and your 1/16th syringes? So if you go on to the, hopefully it’s on here, if it’s not I need to fix it. If you go on to our website what I’ve tried to do is on the how to do page, so you’ll be coming from a different direction but … There should be a link to everything. Maybe there’s not. Nope. I’ll just put, I know it’s on the O-shot so let me pull it up there and I’ll add it to the vampire facelift. If you go to … by the way I just added to, let me pull this up, [inaudible 00:13:08].info … okay.
So in all the others, which I haven’t done yet on the facelift but I need to, all the others there’s a dashboard and when you go to the dashboard there’s a place where it says supplies and sources, also on the how-to-do procedure and when you click on that I just didn’t realize it didn’t have it there, maybe I overlooked it. But I know where it is on this one and right there is where I get most of my stuff from McGuff pharmacy. They have lure lock connectors, they’ve got the needles, they have the 1/16th syringes with the lure lock connection to it and I buy these by the box full for not much, there’s the part number and I’ll put this link in the little chat box and add it to the webpage where we put the answer to these questions.
O-Shot Provider Member's site P-Shot Provider Member's site Vampire Facelift Provider Member's site Vampire Facial Provider Member's site
So actually most of the questions this week were on the vampire facial website and if you guys aren’t yet doing micro needling or offering it for postpartum stretch marks it’s something to think about because I’m hearing more and more that, that’s working. Sign them up for two to three treatments and it’s really working well from what I here, I haven’t treated enough to tell you first hand but I have people in the group who have treated a lot of people with that. So, but there were quite a few questions in the vampire facial and then after these questions I’ll give you guys some marketing tips on how to use those posters. Oh by the way so here, before I get to these four good questions here I just added a new dashboard and a lot of extra content to the facial. So if you go to the vampire facial dashboard I uploaded some new videos, taken from our workshops and so this is the new facial dashboard and if you go to the how to do page you’ll see some really detailed videos where some of the stars in our group, like this one. Of course Dr. Bowen’s published some stuff about this, there’s some really nice videos, especially this one where some people who do a lot of micro needling talk about it.
So, let’s see back to our questions on this page and then we’ll talk about the posters. Four good questions here. Okay first one, where’s the quiz. I’m not sure why that’s not showing up but I’ll put that, make sure it says well there’s a little quiz there to take from some people but if you’ve already had a hands on course then it’s not going to show up. You’re not doing the hands on course you’re certified. But if you’re learning this as part of an online course then there should be a quiz that shows up. Let’s see this one, good morning I have a patient who’s [inaudible 00:16:44] hair PRP after a transplant, he’s been using Minoxidil, it’s on a low dose Finasteride. The hair is now thinning considerably, what about using the PRP after a hair transplant, any noticeable difference back on Finasteride or not?
So I’m going to approve this so it’ll show up and see if some of our hair people will help answer it but what I know is some of the people have told me that they are using PRP. Of course we know it’s being used as part of the hair transplant procedure with improved results, so most of the hair transplant surgeons are doing that now but the idea of repeating the PRP every six months or so is also becoming a thing that’s done standardly to help maintain it. So the short answer to that is yes, there’s evidence that it will help as far as putting people back on Finasteride it makes sense that it would help. There’s this talk of the occasional person who gets depressed from that and I don’t have an answer for that part of it but I know repeating the PRP every six months or so has been talked about among our group as being something that’s helping. Let’s see so how many treatments are recommended for the hair restoration?
So this again there’s not one standard, I will tell you from the things I’ve seen at the meetings, what I’ve seen that’s been published and there’s been a growing number of papers published and some of this there is not a known this is the answer but I’ll tell you what I think is the consensus for now. So how many treatments? Most people go three treatments at four to six weeks apart. How long until they’re visible? It can be up to six months, they have to be patient. But most of us are stopping if we don’t see any results a month after the second treatment, which would be two to three months in and results, as in documenting with photographs, if you see new hair growth and you keep going, most of us are stopping if you’re not seeing anything after the second month. But to be actually happy with what they’re seeing it can take six months to a year.
How long until the peek effect? Just answered that. How long do the effects last? Most people are redoing it every six months or so, just one treatment not the whole serious of three. What’s the recommended fee for each treatment? Anytime I spin blood it should be at least $600 because you have cost of good and your time. Most people are charging and that’s really almost losing money because you have to pay, not only the cost of good for these kits, which can be expensive but your time, the office time, there’s this engine running every minute in your office, you should calculate what that’s costing you by the time all the people are getting paid and the lights and the taxes and everything. Every minute that engine turn cost you money. So to really come out on this, really most people are charging a series of three for somewhere between 2500 to three grand and obviously that’s worth it if you get good results and we’re not keeping the money if we don’t get results. What type of anesthesia do you use? I put on the facelift … I need to put it on the facial side. That’s why this guys probably hasn’t seen it. But on the facelift side, I just put up a new video about hair. Actually, two new videos. So, here’s one of them. 20 minutes from one of our providers up in Canada. And then, this one. This Dr. Mario is been doing hair for a long time. I think it was 20-plus years he’s been doing hair. We filmed his technique for both doing hair, and blocking the scalp. I was somewhere down in Florida when we filmed this. So, those are two new videos that I recommend you watch to answer both the blocking part, and the technique part.
Okay. So, I think that answered all those questions. Next questions, if a patient has Botox recently, how long do you recommend waiting before scheduling a Vampire Facial? So if you think about it, the Botox binds to the nerve blocker about … it takes about four hours, so we tell our people, if you get treated with Botox, wait four hours before you lie down, stand on your head, all that stuff, so that it doesn’t migrate and cause atosis. Now, if you reversed it, and you did the Vampire Facial, you could immediately do Botox. If you did the facial first though … excuse me.
So if you did the facial, you could immediately do the Botox same visit. No big deal. If you did Botox, you could do the facial and probably get away with it anywhere other than the more exacting spots, like the lower face or the corner of the eye, where migration would cause a problem. If you were microneedling under the eye or the forehead, it wouldn’t really matter. Ideally it’s either same visit, go facial then Botox immediately afterwards, and I do that quite a bit with the facial and the facelift. Or, if they’ve had the facial, just give it four hours, so it could be the next day, or later that day if you just forgot and did one in the wrong orders, if you did the Botox first. And I think that’s all the questions on this.
Dana Kirk just put in something that is interesting. Okay. So she says, “At the last International Society of Hair Restoration Surgery … ” You know what? I may just unmute you if that’s okay, Dana, and let you tell us what you … sounds like you were at a cool meeting recently. Let you educate us. Hold on a second. If you’d rather not, that’s okay, but I’d rather you just tell them instead of me having to rehash what you said. Are you there, Dana?
Dana Kirk: Hi. Yeah, I’m here.
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Dana Kirk: Well, it’s every other year, and it’s internationally, so they talk about the different protocols. And PRP, probably six years ago, was something that they kind of dismissed as being a standard protocol, and now it’s part of the mainstream.
Charles Runels: Beautiful.
Dana Kirk: Yeah. The recommendation is to … In the perfect scenario, you’re doing two treatments one month apart before the actual transplantation.
Charles Runels: Okay. Beautiful.
Dana Kirk: The jury’s still out as to if they do any A cell or anything during the transplant itself, but during the procedure part, they will go ahead and inject PRP at the same time.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: We do not discontinue the Finasteride. That’s continued at one milligram, and that just stays constant.
Charles Runels: Okay.
Dana Kirk: The Minoxidil is just temporarily for about two weeks, withheld.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: And then, you resume every six to nine months with the maintenance, so that they don’t lose the remaining hair. These treatments won’t affect the transplanted hair, but it’s in preservation of the existing hair.
Charles Runels: Beautiful. Very smart. Thank you for adding that. And then, you mentioned something in your note to me just a moment ago, about low-level laser. Have they started making that part of their standard protocol?
Dana Kirk: Yes.
Charles Runels: Interesting.
Dana Kirk: Yeah.
Charles Runels: Do they have a particular brand that they are mostly recommending, or is it pretty much whatever you round up?
Dana Kirk: I mean, it’s across the board. It’s more about the diodes or the [diudes 00:24:45], depending on what part of the country you’re from how you say it.
Charles Runels: Yeah.
Dana Kirk: How many basic lasers are within that. But for the most part, the device needs to have a minimum of 30, and they need to wear the device anywhere from two to three times a week.
Charles Runels: Beautiful. You got this down. Thank you for all the help. So, stay on the line and have … you and Kathleen both have your mics unmuted right now. There’s another question here from … let’s see. Who’s this? It’s from David. I’m gonna unmute you, David, so you can ask us your question. Hold on a second.
Okay. So maybe the mic’s not working. So David asked, “What’s your current protocol for the O-Shot? One? Or plan on repetitive series?” So, here’s the deal with that. When I survey our patients and when I survey our providers and I ask, “What happens first and second and third shot?” What I hear is that the first time around, across the board, the hard cases and the easy cases, this isn’t merely incontinence where we get closer to 90% or more depending on whose hand it’s in with one treatment for stress urinary incontinence. Not for that, but just averaging them all together. So, this is including hard cases. A woman who’s never had an orgasm in her life and she’s trying to learn how to have an … you know, trying to get her body to respond.
We have 65% of women are delighted after the first treatment. It jumps to 85 after the second one. And so, I had the idea of maybe just making it standard protocol that everybody gets two treatments, sort of like we do with the hair. You know, you sign up, you get two to three treatments everybody. But to me, that somehow didn’t feel fair to those women, which is more than half, who are perfectly happy after the first. Now the other thing is, a lot of people are happy after the first, but if you repeat it at eight weeks, they then love it. So, after the first treatment, her pain went away, Dyspareunia resolved. But after the second treatment, she was unchained, was the word she used. Whatever that means.
So, it does seem to be additive in some people. But again, I didn’t want to make it necessary if it isn’t necessary. So the short of it is, [inaudible 00:27:20] are happy, and they seem to be still wanting to cooperate with you as a patient, do it again about eight weeks later. I wouldn’t do it any sooner, because otherwise you don’t know the results of the first one. So, do it again. And then, if they don’t respond after the second treatment by eight weeks, now you’re into 16 weeks. Eight weeks after the first one, you can repeat it. Eight weeks after that one, you can repeat it again. Then, I would give them their money back. So, that’s kinda how I go by it. If they come back after the first one and they are better, but they still haven’t seen all the results they want, most people want to pay you again. But, if they just saw zero results, I’ll usually repeat the second one without charging them, and then give them back their money if they’re not better after the second one. So, I think that’s probably the answer to that question.
Anybody else have a question?
David: Can you hear me now?
Charles Runels: Now I can. Yes. Now I can. Beautiful.
David: All right. Sorry.
Charles Runels: Any follow-up question to that? It’s good?
David: Okay. The reason I asked that, and I think I asked it once before about three or four weeks ago, is that, you know, I did an O-Shot on Diane. She had absolutely incredible results on her bladder concerns for about 10 days.
Charles Runels: Okay.
David: She was just exquisitely pleased.
Charles Runels: Yeah.
David: And then, she saw that start wearing off, as I’ve said in past conferences. Now, I’ve teamed up with someone. You know Debra Parker, I presume?
Charles Runels: Uh-huh (affirmative).
David: She’s an RN. She said that she has found that some of the practitioners she works with … she’s an RN in Tennessee or Kentucky. I can’t remember. She has said that the protocol that they’ve used in the clinics that she’s working with now, it’s pretty much go to standard three injections and charge $2100 bucks for a combination of three, and that their success has been 95-plus.
Charles Runels: Yeah. I couldn’t argue with that. You know, you may find that some people are well after the first one or two, and are not really wanting to go further, but I couldn’t argue with that at all. It’s what we do with them. Any other PRP procedures, you know, the Vampire Facial’s a series of three. So, absolutely. I think it’s worth considering.
Charles Runels: I wouldn’t consider it bad medicine considering it’s a fairly safe thing to do. In everything we’ve seen, it seems to be cumulative. The other thing that helps if you have … ’cause some people, it doesn’t wear off until a year out, and so do you really? That’s the question I have, do you really want to have everybody go through a series of three if maybe whatever percentage of them would have been fine with just one? I don’t know the answer to that. I could argue with making it a series of three and having a higher success rate. I’m just kind of deciding on a case by case, after each shot, deciding if they need another one.
The other thing that would add to it I think is combining it with some sort of energy source. So when I talk to the people who do energy followed by PRP whether it’s laser or ThermiVa, they do energy then PRP same visit. Their success rate of the first round seems higher and it seems to hold maybe a little longer. Again, do you want to make it the standard for everybody? It’s probably not needed since many people get better with just one O-Shot®, that’s it, that’s all it takes.
But when I talk … and we don’t have the numbers, that’s part, I want to just put in another plug for this. If you go and do our patient survey, which hopefully you guys are still putting people in, we’re trying to get a feel for that because part of the questionnaire asks people, it’s sent to them by text message, all HIPPA compliant, costs you guys nothing, I can give your data back to you. But the person who puts the person in the study puts in, did you do a laser device? Did you do a radio frequency device? Then we can follow survey data about why they were treated and maybe get an idea if it’s truly what I’m hearing, which is close to 100% if you do energy followed by O-Shot® on the same visit first time around.
David: That’s interesting. Okay, well that, thanks for that. I just want to give you an upgrade and to the point …
Charles Runels: Thank you.
David: … Diana said she wants to go ahead and repeat it once or twice, because she had such good results, she wants to have a repeat …
Charles Runels: Beautiful.
David: … and she’d have no problem in doing so.
Charles Runels: Beautiful. Well, thank you for the feedback.
Hey, just hang on the line, let’s see if you have anybody … no other questions. Any other feedback that anybody has, raise your hands, otherwise, I’m just gonna do a quick like five minute, “How to Use our Poster to Get Patients,” tips.
Okay, don’t see any other hands.
While you’re on the line David, have you used our poster to recruit patients? If so, how have you used it?
David: I haven’t really, because I deal with someone who has an existing cosmetic practice, who just has some concerns about artwork and style and things like that, so I don’t want to push it.
Charles Runels: Okay.
David: I have no problem. I have not done it, I have no problem with it, she does, so I’ve kind of backed off.
Charles Runels: Yeah, interesting. She doesn’t think it matches the office, that’s okay.
David: Yeah. I’ve used the brochures and she has no problem with handing the brochures. She has no problem with my talking about it on Facebook Live, etc., etc. I don’t know, I haven’t revisited since the first time I tried, so I’ll do it again.
Charles Runels: It does bring up a good point in that some people … and I’ll meet you here in a second Kathleen, ’cause I know Kathleen’s used her poster some. But it does bring up a huge point in that some people are embarrassed to have it, because they realize you now have a sign in your office that’s talking about sex. It could be that’s she’s saying it doesn’t match with the décor, but what she’s really saying is I don’t want a sex sign in the office and that’s okay. It’s her office, she can decide whatever she wants. Then you’ll go to an office and you’ll see, they got a Cosmo on the table and the front cover is about 16 ways to give a freakin blow job.
Charles Runels: Here’s my thing about offices, my number one rule is, if you’re not taking control of the environment of your office, in my opinion, you’re losing one of the main effects of an office. I have had people occasionally come to my office and I’ll come out to bring them back to the exam room and they are sobbing because they’ll say, “I feel like this is a healing place.” What they’re feeling is that I have taken control of their environment, there is not poison in the air, there’s no TV blaring, if somebody donates magazines to my office, they go in the garbage can, because everything that you can see, read or hear in my office is good for you. I’m controlling it and if a magazine comes in, I’m gonna be advertising Botox and they’ve got an add for some stupid cream that’s supposed to work like Botox in Cosmo, so all that stuff goes out the door.
Then as far as what we put in there, everything that I’ve done, I’m trying to take the John Grisham approach. John Grisham has a rule that he never writes a book that he would be embarrassed that his mother read it. If you look at our stuff, I try to keep that in mind. These posters by the way, sit in India, they sit in Maine, one of my providers sits within a short drive of the LL Bean store, places where … I’m in Alabama in the Bible Belt, so it could be that, and I’ve heard people say, “Oh, I can’t put a poster, because it has about sex.” Again, I don’t know the situation in your office, it may not even relate to what I’m saying, but your comment triggered some stuff that probably needs to be said, which is most people find that they’re patients are so needing something to break the ice. They’re so needing anything to break the ice, because they’re afraid and they’re embarrassed to bring up the subject. Anything that you can do to break the ice, they love it.
They also have on the O-Shot® website a little five questionnaire that says something like, “Do you have pain? Are you able to have arousal?” The last question is, “Do you want to the doctor?” Adding that to the intake form gives you an icebreaker to let you know if they want talk or not.
Having said that, I’m gonna open your mic Kathleen and then I’m gonna give my steps on how to use the poster.
Okay, let’s see, you’re on mute.
Kathleen Posey: Okay.
Charles Runels: Are you using poster?
Kathleen Posey: Yes. I’ve used my poster for years, it fits in my waiting room along with the books that are in the waiting room. All my books are in all my exam rooms.
You’re talking about the patients are saying it’s easier to talk about sex. They’ll come in and say to me, “I can’t believe that you’re gonna let me talk about sex now?” What’s also interesting in what you were just talking, what I’ve also realized, I’ve gotten a lot easier to talk about sex.
Charles Runels: Interesting.
Kathleen Posey: I’ve been doing this goin on five years now and I would probably say six years ago, I either didn’t have the time, I wasn’t comfortable or I didn’t know really how to help them to say, “You know, do you have orgasms?” Now, I have no trouble asking a person about their sex life.
Charles Runels: Interesting.
Kathleen Posey: Six years ago I did and I think most gynecologists do even though we are who we are. My poster has helped, because I’m just a routine gynecologist, it’s helped my practice knowing that I’m doing something different, and if they don’t an email or whatever and having the books. A lot of times the books disappear, but I could care less, because if they disappeared in the waiting room or the exam room, they’re reading it or they’re going to give it to somebody else. I actually give out a lot of books. If they’re a hairdresser and I find out they’re a hairdresser and they an O-Shot®, I give them about 10 books, because they’re talking to everybody.
Charles Runels: Beautiful.
Kathleen Posey: The posters really help me get more comfortable about talking about sex and it’s also, I think, gotten the patients more comfortable that they can ask me.
Charles Runels: Beautiful.
Kathleen Posey: When I was doing surgery, I’d just wanted, you want to put that hand on the door when they start asking about sex, you want to run through it, I don’t feel that way anymore.
Charles Runels: Beautiful. Well, you bring up several good tips. One of them is, which before a lot of things that have happened over that last few years, not just with the O-Shot®, but other things. Why bring up the subject if you don’t have lots of options or at least some number of good options as a solution? You don’t want to bring up world hunger in part of your visit, you can’t fix it. Obviously sex isn’t world hunger, but we didn’t have as many options even five – 10 yeas ago. Now that we do, it’s more easy to bring it up. By the way, I think …
Charles Runels: Yes sir.
Charles Runels: Yes.
David: Dave again.
Charles Runels: Oh, yeah.
David: One of the things I’ve used as a … I don’t have as many stories as you do, so I use your stories.
Charles Runels: I mean good.
David: I strongly suggest people do until they have their own. I had a woman in the office today who came to me for orthopedic issues. As you know I’m an orthopedic surgeon and I do a lot of orthopedic BLP and stem cells and peptides and whatever. In the process there of, she said, well you know she knew my associate very well, said, “I’ve known her forever, she’s done all my facial stuff and everything else. What else do you guys do?” Man that was just a perfect opening to be able to discuss. I didn’t have a poster in the room, but I turned on my verbal poster and I started telling Charles stories about your urologist friend and taking off the market by the FDA of the product for urinary incontinence, how horrible slings were except in the cases that had to have them and it when on to the girlfriend and the banker and to this that and the Sunday afternoon when you tried it on yourself. She was just like, “Oh my God, this is incredible. I had no idea that this existed.”
I encourage people to use you until they have their own stories.
Charles Runels: Beautiful and that also brings up another thing, the people that have done well with us, like super well, like Kathleen where they’ve had really really good results as far as the marketing piece, they are out there telling stories. They’ll do a YouTube video, they’ll interview a patient, patients tell their story. Stories are the best way, that’s really how a lot of people learn.
This is where the shot lives, if someone wants to pick one up and I’ll try to expand it where you can see it a little better. That didn’t expand it, just made me try to order one. But anyway, it’s written in a … Here’s the quick way to how to use it and we’ll shut down the call.
If you guys don’t mind I’m gonna mute this a little bit, I’m gonna mute some of the microphones, but I’m happy to unmute them if somebody needs that done.
Here’s my quick version of how to use the poster.
You have it sitting at a place they will be staring at it if there’s any moments waiting in your office. Not just this poster, any poster, something you want to you sell. If you notice, the bottom of the poster has a website on it. You would like for them to go to that website on their iPhone or their iPad while their waiting and find out something about it. If they ask you what the O-Shot® is and they haven’t done that, it’s a very difficult thing to explain in the office. Especially for your staff, whose phones ringing and they’re busy, they don’t want to explain it. They’ll tell them just enough to scare them off.
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When they inquire about it, the best thing to do is do what you heard Dr. Posey do, which is hand them a book or a brochure. Something that they’ll have with them physical to look and think about so that they teach themselves about it. I wouldn’t even really try to push it to a conclusion while they’re in the office, it’s too much for them to figure out what PRP is and whether they want something. You just let them know that it’s available. You don’t want to push it on someone who hasn’t thought about it and is pretty certain that’s what they want anyway. You hand them a book or brochure. I have mine in a little stack, with a little not by it that says, “Free, take two or three.” Otherwise, they feel guilty about taking one.
I have a standing challenge, so far no one’s ever called me out on it. If they do I’m happy to keep my promise, which is that if you give away 10 O-Shot® books in your office, I don’t mean throwing them out like at one of our Mardi Gras parades or stacking them up at the gym, but I mean someone taking it from your office or you handing to someone and saying, “Here, this tells you more about what’s on the poster.” Or, “Here, I think this may help you.” If you don’t get at least one patient for those 10 books, I will send you 10 more books. That’s a standing invitation, because if you don’t get one after 10 or 20 books, then I need to talk with you more about how you’re talking about it. You should be having at least one or two, often times you’ll get two or three people for those 10 books. You’re not just obviously doing a procedure, you’re changing their life. You’re changing their relationship many times.
That’s the quick version of how to use these posters. You don’t want it in the hallway where they’re passing it. One of our providers actually has it in the bathroom, so when they’re urinating, they’re staring at the poster. It could be anywhere where they have to sit for more than a couple of minutes.
I see Kathleen’s hand back up. Let me undo your mic and then I think we’re gonna call it a day.
Kathleen, you’re back live.
Kathleen Posey: Actually, that was an old. My hand was …
Charles Runels: Oh alright.
Kathleen Posey: … a while ago.
Charles Runels: Okay, so you guys have a wonderful week.
Kathleen Posey: I was actually gonna ask you a question about …
Charles Runels: Okay, go for it, I’m in no hurry. Go.
Kathleen Posey: It was back with the testosterone. Before I give testosterone or pellets or even an O-Shot®, just personally, I get their pre and total testosterone levels.
Charles Runels: Yes.
Kathleen Posey: What do you think the normal levels in a female should be? What is the limit of high that you will let it go to? I do the thing because again, it’s so conservative I want it for the boards to show that it was frankly non-existent and that’s why I gave them the testosterone. What do you do?
Charles Runels: Okay, so …
Kathleen Posey: What do you think?
Charles Runels: We’ve sat through these lectures before, as you know listening to Erwin Goldstein speak who edited the Journal of Sexual Medicine for seven years. He’s high on this website, which I’m gonna through into, post into here, which is using pre and total testosterone and sex finding globulin to calculate the pre testosterone level. If they’re having symptoms, then I like for … this is showing you all the calculations that computer’s doing for you … I like for their pre-testosterone level to be in the upper 25% of normal, that’s what I calculate for. If it’s in the lower 50th percentile, then I’ll add to it. If check it and if it’s high, and it’s above what’s normal for free, I will drop the level. I think if you don’t do that then you are sort of opening yourselves up for problems. If you’re looking at problems, not I don’t think medically, but politically it’s interesting how testosterone because of the athletes abusing it, it’s become a target for all the things with three letters, the DEA and all that.
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Even though there’s lots of evidence and I know there are physicians and women out there who feel better with the pre-testosterone that’s higher than what’s normal for a female, and I don’t think there’s anything medically wrong with it if you’re following them clinically. I’ll tell you one scenario. I had a poor little lady in her 80s who fell and broke her humerus and was teetering ongoing to a nursing home. I make no apologies, she was still bright minded and just a beautiful hearted woman who lived down the street from me. I put her on a man dose of testosterone, sent her to my favorite physical therapist and we got almost 10 more years of her living independent at home. She got a little hair on her lip, but we’d go have tea every day and she loved me and she was independent for another almost 10 years. Was that bad medicine? I don’t think so. I’m not giving her prostate cancer, she didn’t care about the facial hair so much and we had a good time. But, as far as politically goes, I think pre-testosterone that’s what you follow and there’s the calculator for it, which I’m told is more accurate than letting the lab calculate it for you using those two. You get a sex hormone bonding globulin along with the testosterone level and that’s how you get it.
Again, I start them on that 50mg IM and they get the feeling of it and they kind of blast them off and then I can drop it if I need to.
Okay, you guys have a lot of good information. A crazy good call and happy with all the participation.
Okay, I think that’s it. You guys have a great day. Good-bye.
Charles Runels, MD
Inventor of the Priapus Shot®, O-Shot®, & Vampire Procedures® (facelift, facial, breast lift, wing lift)
Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.
I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.
Let’s see what else is going on. I want to let you guys that we’ve put out some … We’ve put out a press release about some of Dr. Posey’s research about the O-Shot® (Orgasm Shot®) procedure and treating lichen sclerosus …so you may get some questions [from your patients] about that. I thought you might want to know more about what you should treat and what you shouldn’t treat if you’re doing lichens sclerosus. She’s actually on the call so I think I may undo her mic so she can tell you some of her thoughts about this research and how to know when to treat this and when not. She does a class and you might qualify to begin that class and that’s classroom … That’s a good thing. I’m going to unmute your mic, Kathleen.
Here we go. You there Kathleen? Hello?
Kathleen Posey MD, FACOG: How are you doing? Yeah, I’m here. Can you hear me?
Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.
Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …
The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.
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With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.
About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.
Charles Runels: This one?
Kathleen: No, go to the last picture. Keep going. Another one.
Charles Runels: That one?
Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?
Charles Runels: Yes.
Kathleen: You see that, Charles? That band?
Charles Runels: Yes.
Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.
I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.
Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-
Charles Runels: Yeah.
Kathleen: That to that, to that.
Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.
I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.
I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.
The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …
Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.
Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?
Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?
Charles Runels: Yes.
Charles Runels: I can. I can hear you.
Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.
Charles Runels: That don’t need the retreatment?
Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.
Charles Runels: Yeah. Okay.
Kathleen: There’s another picture, a previous picture.
Charles Runels: This one? This one?
Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.
Charles Runels: This one?
Kathleen: Yes. Yes. Can you hear me?
Charles Runels: What point do you want to make about this one?
Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.
Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.
Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.
If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.
Kathleen: Charles, I’d like to-
Charles Runels: The other thing while I was on the subject. Go ahead.
Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.
Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.
Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.
I wanted to just list out while I’m at it and talking about the O-Shot, what I would consider to be the easy things that we treat versus the more difficult. I get a lot of questions about follow up and when do you retreat or not retreat and that sort of thing, so just wanted to recover that. Here’s our easy one. Nothing is 100% but these are the ones I think where over 80% of the time either after the first shot or the second one, you’re going to have an extremely happy patient. Maybe over 90% of the time in some cases, would be [inaudible 00:16:47], decrease orgasm, and someone who’s already able to have an orgasm. This would be the lady, she can have one but it’s not like what it used to be. Decreased orgasm but can have orgasm.
Then, it would be urinary incontinence and someone where things are intact, where bladder’s not falling out into the room. Even urgent continence, we’re seeing some great results. It’s usually a mixed bag for both, but then [inaudible 00:17:43]. I know that’s a basket diagnosis, but I mean even in the ones where it’s uncertain ideology, that doesn’t mean we don’t try to work it up. The person who’s had a work up and no one’s really sure what’s causing it and they’re still hurting, that for some reason that person seems to do well with us often. The one with pelvic floor tenderness, trying [inaudible 00:18:19] injection, you inject a trigger point with PRP so pelvic floor tenderness for mesh pain. I know you’ve got some ideas about that. I’ll let you talk about that in a second.
Mesh pain and the more difficult ones, the ones where if you’re new, I wouldn’t even try these people for the first two or three months, you don’t get discouraged, I treat these people but I think in these cases our success rate is maybe closer to 50% and maybe even less, 40% depending on the person’s age and other factors. It would be never had an orgasm in their life. I think those ladies are a little more difficult to treat. A person who wants to have penis and vagina orgasm. They can have one from a vibrator, but they can’t have one with sexual intercourse. Of course, we don’t have control of the penis of that equation. Both of these two ladies, we have successes, quite a few successes, but I think that our success rate on these ladies is probably less than 80%.
Can you comment some on this mesh pain? Are you still there Kathleen?
Kathleen: Just, yeah I’m still here. Can you hear me? Hello?
Charles Runels: Yes, very well. I can hear you.
Kathleen: I’ve done it when they had perianal pain from the nerve endings around the rectum, and I’ve just injected it all around the rectum. I’ve just injected it all around the rectum and it seems to work real well. Isn’t the doctor in Europe – [crosstalk 00:20:12] yeah, isn’t she putting PRP around the pudendal nerve to ultra sound for mesh people. The lady from Spain.
Charles Runels: I heard a couple people talking about doing an old school pudendal nerve block. There was one study where the mesh was taken out and then infiltrated the field with PRP, but no one has done the study yet, showing our procedure helps it. Although, we’re seeing that even injecting the anterior vaginal wall where the mesh is. You’ve has some experience with how the mesh becomes wrapped around the pudendal nerve or something; can you talk about that? [crosstalk 00:21:00] Or something you read in –
Kathleen: One of my patients is a general surgeon at [inaudible 00:21:13] and there was an autopsy on a mesh patient, and the mesh was all entrapped with the pudendal nerve when they did the autopsy. But, even taking it out, it just has to come out in pieces. It’s so difficult. From my understanding, from that pain, injecting PRP around the … I wouldn’t do it. There are some people, that I think, do it. In Europe.
Charles Runels: [crosstalk 00:21:45] When you do it, is there some worry about injecting?
Kathleen: Yeah, just the anatomy. There’s too much you can screw up. I just don’t have the experience with ultrasound and looking around the vessels where the pudendal nerve is there.
Charles Runels: When we do pudendal nerve blocks … We did those in labor and delivery years ago. I’m hearing that just that will calm it down. Is there something about that that makes you nervous? I would have thought that was a pretty safe thing to do.
Kathleen: I think that’s safe. I’ve just done most of my deliveries with epidurals and not pudendal nerve blocks. No, I think that would be safe.
Charles Runels: Okay.
Kathleen: I would like to see what they’re doing [crosstalk 00:22:40].
Charles Runels: While I’m at it, I’ll make the list for the P-Shot® … What? I’m sorry what did you say?
Kathleen: I didn’t say anything. Nothing. I didn’t say anything.
Charles Runels: Oh, okay.
So, while I’m at it, I thought I’d do a list to the easy wins for the P-Shot®. So that would be decreased erection … And a reason for making this list, again, is all of us want to take care of people and not just take their money and make them well. When I don’t get someone well I give them their money back. I try to mostly take care of people I think I can get well. If you’re mostly taking care of the hard cases, I’m losing money. I recommend that you mostly take care of the easy wins, especially in the beginning, so that you don’t become discouraged.
I’ve seen a couple of our providers, just right out of the box, try the really hard cases. If the first two O-Shot®s you do are in women who’ve never had an orgasm in their life, and they don’t work, you lose confidence in the procedure. So stick to the ones that we know have a high percentage of success.
For the Priapus shot, we have decreased erection, but can still get an erection. In other words, on that erection scale from 5 to 25, they’re above 10, at least somewhere in that neighborhood. They’ll bump up about seven on that scale from your shot.
Peyronie’s disease. The interesting thing is, our easy win is most other physician’s hard win, so you still can be a hero and do wonderful things for people if you stick to the easy stuff.
[inaudible 00:24:35] Closed prostate surgery to help with recovery, but it’s in the person who could get an erection prior to surgery, of course. You do the whole protocol, and that’s on our Priapus shot website. Where you include both for Peyronie’s and the prostate surgery, including the pump and maybe even low dose Cialis as part of the protocol.
Again, lichen, we’re going to get lichen too. Lichen sclerosus, not planus … Although, I think you treated some lichen planus didn’t you? Kathleen?
Kathleen: Yes. Yes.
Charles Runels: [crosstalk 00:25:26] We had that anecdotal initially; I should put this up here. I treated a woman with extremely severe scleroderma, and they can have horrible problems with intercourse. It was a life changing thing for her with one procedure. Lichen sclerosis in men is an easy win.
The hard wins for men, I think, if their main reason for getting the shot is for penis growth … Although, sometimes that can be very rewarding. It can be frustrating, often times, in the men who has the most urgency about growing. So the men who has the three inch erection responds, in my experience, less dramatically than the guy with the six or seven inch erection or a five inch erection.
It’s a percentage of growth than the absolute. So if there is 10% growth on the smaller penis, it’s less noticeable results. Then the person who has long standing diabetes or whatever cause of erectile dysfunction, basically he has no response at all. [inaudible 00:26:55] There’s no response at all to Viagra or TriMix, and that person who probably has some vascular disease proximal to the penis is not likely to get well.
Those are my easy wins and hard wins for the Priapus shot and want to stick to these easy wins in the beginning.
Anything you’d add to that, Kathleen?
Kathleen: Nope. I think you got it.
Charles Runels: Okay.
I always like to cover something with marketing too. Let’s see if I have any new questions from the [inaudible 00:27:32]. There weren’t that many on the websites on this time around. Let’s see. I don’t see any coming through.
I think there is something meant to be noticed about, as far as the marketing goes, what I’m doing right now. This is a wonderful way to create interest before I was part of this amazing group of physicians. I would do webinars, just like this, for patients.
Back in the day, before I started doing the internet, it wasn’t webinars. It was a conference call. I would record the call and put that on the website. So, if you, as a marketing idea, the best marketing is to teach people how to be well. If you put out an email to your patient, whatever it is you want to talk about … Maybe it is dyspareunia or erectile dysfunction, or urinary incontinence, or something that we’re not even talking about here; maybe it’s something to do with the way you do Botox. If you want to do a webinar like this, the software is very simple to do both setting this up, as well as recording it. Then you have something that can go on your website and play, and play, and play.
I thought I would show you guys where I do this. I know you have to log in to go webinar.com to get here. This is the software … GoToMeeting.com or GoToWebinar.com and they have plans that are not that expensive. Then, you send out an email to your people, you schedule it … and what you’ll find is, that even if just one person shows up, that the content you deliver is on a different level than if you sat down and just said “okay, I’m just going to record an audio or a video about urinary incontinence.”
Then when you’re done, you have the video and you can tell your webmaster to put that on your webpage somewhere. It looks like this. Most of you guys have seen this, but when I do these webinars, I put the recording either on the membership site or I put on our Cellular Medicine Association website. It just sits there to play.
This is probably the best advice I can give you about marketing to your patients. If you teach people about the disease and how to get well, then they will trust you to take care of their disease. If you go through the trouble to teach them how to be well, then they’re much more likely to trust you to take care of them.
So, the short version: teach people about the disease and they will trust you to take care of their disease.
It’s really an amazing time that we live in that we can just, almost no money, wherever you are on the planet, you can just sit down and have a conversation like this with your patients. Then when you’re done, you have a video that you can play for them perpetually on your website.
I think that’s all I have for today, unless you guys have other questions. I’ll put the transcript for this up within the next 24-hours and a link to the book that I recommended, and I’m always honored that you’re here.
Thank you for the help, Kathleen.
Kathleen: Thank you too.
Charles Runels: Alright, you guys have a good day. Bye.
Cellular Medicine Association<–
Charles Runels: I thought it may be helpful to start offering suggestions about what I’m reading, and what others in the group are reading and writing, so that our weekly meetings become not just sharing our procedures but approach being something like a journal club or a reading club, book club. That’s why you see what’s here on the screen now. I just got this in the mail. I bought it before it was published. It just came today, so I’m extremely pleased with this. The reason I’m so interested in centrofacial rejuvenation is something if you know, if you’ve attended my class. That is the most important part to improving … It’s the number one place to improve the appearance of going back in time in appearing younger. It’s the eye to the mid-cheek.
Some of the procedures in here are surgical. Chapter eight has some beautiful diagrams offering midface volumization with fillers. It talks about the anatomy, and highly recommend this book. I’m putting a link to it in the chat box, and I’ll put a link to it on the page where I put the recording, but very well done. Other chapters are helpful in [inaudible 00:01:53] videos. Part of what brought this up is I had a question today. I had some cosmetic questions. Let me pull those up. Then I’ll field questions from you guys. I copied this out of a email that came to me. Number one, “Why use none activated platelet-rich plasma on the face? Can we use activated prp and when?” Again I’m going to put it here and recommend that you guys check it out. This question, I’ll cover it again because it’s helpful.
If you go to Cellular Medicine, actually I want to just show you where a lot of these questions live. I’m happy to go over it, but if you have a way to search and find it very quickly without waiting for me to answer, then that would be a better thing. Some of you guys don’t know how easy it is. If you go to CellularMedicineAssociation.org, and you just put in the search box right here, so you can say activation. Hopefully, I’ve got that in there somewhere. There you go, so it’s like an index. I don’t have something that says index but it will pull up … Because I’m having all these transcribed, it will pull up any transcription that has that word in there, and so that’s a good way to search for things.
You could also go to the membership sites, so if you went to VampireFacelift.com into the member section, and this is the backside so you wouldn’t see this. You would land on, I’ll show you. You would land on the dashboard, so it would look like this right here. Then see where it says, “Post,” you could just click and you post. There should be a search box. I guess there’s not. I need to put one on this one. Most of the membership sites have the search box, so my bad. I’ll put one there. You could also go through here and look at just there’s the titles, recent comments, and there’s key words. This one needs a search box. Anyway, that’s the two places to look on our main website, the Cellular Medicine Association.
Looking at recent posts, and you’ll get the most recent stuff, but on the membership sites, the other place to look, it’s just look under the directory. I mean go to the dashboard, and then look under webinars. There’s the dashboard. No, not taking you back. Anyway, that first dashboard where we were at, it’s a directory, workshops, forums, and then there’s a page for webinars. Then at the bottom of every page there’s a question and answer session. You can see there’s a place to post it, so go in there. The good thing about doing that is you get answers from other people, not just from me if you do that. There’s one about calcium chloride. “Does it help? When do I use it?” Then you can see well, here’s the answer and it takes you to a recording from one of our webinars.
I like doing it that way because it makes sure, it give everybody a chance to contribute, so it quits being about Charles. I’ve been fortunate enough to play around with plasma for eight or nine years, but newer people in our group are also doing that and have different expertise so it’s helpful. Here’s the answer to the question of why use nonactivated platelet-rich plasma. The reason for not activating it is the calcium makes it hurt more. Calcium chloride just hurts. The other reason to not use it as in activate the plasma is that you do get around 65% activation without activating it because when you put the plasma, inject it into the tissue, the exposure of the platelets to the collagen of the tissue itself activates it as it would in a normal [inaudible 00:06:47] if you had an injury and the platelets come outside the body, it activates the [Thorman 00:06:51] cascade, exactly the same thing.
You get 65% activation if you just take the inactive platelets in the syringe and inject it subdermally or intramally, and it doesn’t hurt as much. It seems to work well enough for the hair and the face. Most people are not activating. The reason we changed that and activate with the [Priapus 00:07:16] Shot, and with the O-Shot, and with when we’re trying to regrow nerve as with decreased sensation in the areola of the nipple, is because we’re thinking that because it’s more therapeutic type effect, and because we’re trying to maintain the material in a smaller space. Geographically we want it to stay close to the urethro so in a very small area the calcium makes it activate more quickly and more thoroughly. That’s the reason. No one can fault you for activating it with the face as well. It’s just a cop out to make it not hurt as much.
Number two, “Can you use prp in the vaginal lining?” I have used it everywhere, and I see one of our gynecologists is on the call, so I may get Kathleen Posey to comment on this too. Can you use prp in the vaginal lining? You can pretty much use it everywhere as best I can tell. I can’t find any ill effects except in one case where it was injected into the eyeball trying to do something with the retina, so don’t give anybody a shot in the eyeball. Otherwise, I have injected circumferentially. I’ve injected in the labia minora, the labia majora, posteriorly. Anecdotally, we’ve had two people in our group see help with rectal incontinence in a severe postpartum tear. That was years out and still saw some improvement in rectal incontinence. We’re using it all over.
The only reason I quit putting it completely around the vagina circumferentially is that in the beginning it was so costly I was trying to avoid injecting more places than needed because it cost us so much to make the plasma. I found, so 80/20 rule, I could get actually all the results I needed by just injecting around the clitoris and along the anterior vaginal wall thinking that’s where a lot of the sensation is as in Grafenberg, not just the spot but the whole urethra being sensitive, the Skene’s glands, that’s where a lot of the sensation takes place. It’s also up there near the inner part of the clitoris and all the nerves [inaudible 00:09:45], just a lot of magic happens there.
Not so much the anterior vaginal wall, there’s not that much lining there. I mean, excuse me, there’s not that much sensation there. Having said that, I’m going to see what Dr. Posey has to add to that. Then we’ll get back to the face, the best way to treat nasolabial …
Charles R.: … that and then we’ll get back to the face, the best way to treat nasolabial folds. So if you don’t mind, I’m going to unmute you, Kathleen, and see because I know you’ve done a lot of these. Are you able to talk, Kathleen? Are you there? You may not have a-
Kathleen P.: Yes. Hi. Hi.
Charles R.: Good to hear from you.
Kathleen P.: Hi. You too. I have injected it there not a lot [inaudible 00:10:26] end up with some left over, I’ll inject it in the labia minora, the labia majora. And it just depends, if they’re having pain in that area, I’ve definitely used it a fair amount and it does help decrease the pain.
Charles R.: In the lateral vaginal wall, you mean?
Kathleen P.: I have a little-
Charles R.: He didn’t really say vaginal. He just says vaginal lining, doesn’t he? I’m sorry. Go ahead.
Kathleen P.: Yes some … Yeah. I’m more doing it in the posterior vagina. I don’t know if it hurts sticking it in lateral because the vessels and stuff. I worry about hematoma. I wouldn’t go too deep if I were to inject it there.
Charles R.: Okay. You know what? While it’s on my mind, if you will do this, Kathleen. And I’m going to put it here so others may want to. If you go … so far I’ve only done this with three, excuse me, two of our providers, but I’ve never made it public. I’m trying to make it … I’ll show you what I’m doing. If you go to the O-Shot® website and you on the … over here on the recent posts, you can see I’ve talked to Dr. Goodman about some of his surgical techniques and how he thinks about orgasm and how the different procedures he’s using and I’ve just recorded it and put it there for patients and doctors to learn from. There’s nothing … becomes a very good explanation of the surgeries for potential patients as well.
So back to … oh, you can’t see it. [inaudible 00:12:04] where you can see what I’m talking about. There. So this is a post on the O-Shot® website and it just comes in recent posts and I’ve done that … I’ve set it up to do with [inaudible 00:12:21] and we had some … we weren’t able to record it well and I’ve done it with another one of our providers, but I’m going to put here … it’s so hard. Everybody’s schedule is so busy, but any physician who has … who wants to be interviewed, I see it as a great way to … cellular … let’s see … it’s a great way to get the word out about what we’re able to do and, just as importantly, what we cannot do and how we’re thinking about the science. And here’s where to set that up…
So I’ll show you what happens when you set that up and where to go. So if you take that and put it into … and I’m hoping you’ll set this up, Kathleen, so I can interview you because you got so … I’ll pick your brain a little bit at a time when we do these webinars, but you got so much information about lichen and the other stuff.
Okay so if I put that in there, it takes you here and then if you go to 30 minute phone meeting, book that, and we may actually be on the phone longer than that but just … and you can see you can just click that and pick a day and that fits your schedule and then I’ll record it. You don’t have to have PowerPoint slides. You can if you want, but any doctor in our group who feels like they have a message they want to deliver that would be helpful to doctors and/or patients. I like the interview format because it gives me a way to showcase our physicians and, because I’m seeing a lot of the questions that come by email and such, it gives me a way to get a more balanced answer to these questions rather than me doing all the talking, which is just not the way it should be. Okay, let me get back to these questions. So if … I’m going to put that in the chat box too and, hopefully, you’ll set that up, Kathleen. So anybody else can call because you got so much … how many years have you been doing this now? Three? Four?
Kathleen P.: About four.
Charles R.: I know no one … I don’t know anyone who’s inject … who’s treated more people with lichen sclerosus [using the O-Shot®] and you’ve got a strong surgical background too, as strong as it comes so let’s set that up. I’m overdue to do that. Okay, so back on topic. I’m just going to leave your mic unmuted there, Kathleen, and get back to finishing these questions. Let’s see. Go back to here.
Okay. So now for a face question. What’s the best way to treat nasolabial folds? With therapy or threading or with filler? I think this one is … let me pull up a picture. Let’s see if I … I think a picture would answer it better. Let me find a picture I have permission to use. Because this is definitely a case a picture’s worth way more than me babbling on and on.
Okay, here. So if this is the problem that you’re trying to make go away, the question was: is it better to use fillers or plasma or some sort of thread lift or surgery? There’s lots of different things. What can you do for that? So the main principal I follow is that this cheek area is more important than whether there’s a line present here or not. You’ll see nasolabial folds in children, but this is not necessarily an age line. It become a sign of age, when relative to the rest of the face, when you see that this … let’s see if I can draw on this. Let’s see what I can draw. Good. Okay. So when there’s a stripe, there’s a heavy strip, you can see it kind of goes like that there, with this being flat over here. And when you see that, it’s not the line that’s making people look older and you can kind of see the appreciation of a line right there, but not so much visible there sort of like a dash line. There’s definitely a line there under the eyes and then there’s this line and then this looks relatively flat. When you see that, that’s a person for whom either fillers or platelet-rich plasma is going to help.
If I’m trying to decide which will be appropriate, then I go by how much volume loss is there. If there’s quite a bit of volume loss here, the chances that I will maintain … the shape will look beautiful if I just fill it up with plasma, but the chances that I can maintain that shape become less good than if there’s a lot of volume loss here. If it’s someone who’s never had anything done and they’re … if you’re looking for numbers, if they’ve never had anything done and they’re 40 and up, then they’re probably going to need some fillers there, especially if they have a thin face. If they’ve got a full face and they’re younger or even if they’re over 40 or 50 and they have a full face, sometimes you can get by with the plasma alone. But the bottom line is that adding volume here is going to pull this up and round it out so there’s not a heavy stripe here. And then even if you have a line here, it’s going to be less distracting and not really age causing.
And so that’s kind of how I judge it. So I either use plasma plus prp if they can afford it and they have a fair amount of volume loss or if they’re … if I use prp alone, it’s usually in someone where the volume’s pretty close to where it needs to be and they kind of just want to be fluffed up and usually that’s … they’re 35 or under or they’ve had some work done already or their face is already full just because of their body weight. So most of the time, I’m using both. As far as the threads go, if you do the threads, I would still consider doing this because now you’re doing something similar to a surgical “facelift” but relative to the bone, even though you’re pulling this fold out, you’re pulling the tissue close.
Charles Runels: Even though you’re pulling this fold out, you’re pulling the tissue closer to the bone. You’re really collapsing the face relative to the bone and though the line looks better, you have some risk of causing skeletization and not that round, full feeling look that’s in a younger face.
In the end, all three, the answer to that question is, they all three work. That’s the way I decide. I would seldom use a thread without using fillers or most of the facial plastic surgeons now, almost all of them, even if they do a surgery and pull the skin back, they’ll do it in culmination with fillers to maintain the shape so you’re not just chasing a line. You’re creating a younger shape. I think that answers that question.
I think there’s another one here. Anybody want to add to that, just click the button and I’ll unmute your mic for you. Let’s see. Let’s get back to that question. I think I answered it, just to be sure I did all that. Yeah. That answers that question.
There’s one in here that some of our callers. That’s a good question. Why do you not have a dashboard similar to the others with supplies and videos with a facelift like the other procedures? It’s just simply because I’m the one that’s doing it. I apologize. I just haven’t done it yet.
What they’re referring to is if you’re on the facelift, the dashboard is not as organized with O-shot and P-shot. It’s all still there, but you just have to look around for it more. I’m actually trying to recruit someone who can help me with the websites. I’m still doing them all myself. I started doing websites in 1998 and I can’t find …
So far, I haven’t found anyone that suits me. They’re either over-qualified because they’re actually writing code, which is what I need or they’re under-qualified and they can’t write it. If anybody knows a good web design person that wants to move to Fairhope, then send them this way.
Let’s see. Any other questions? There was one that popped up on the Vampire website from Dana. Let me pull that one up because I answered it. Here it is. I went ahead and answered it, but let’s cover it here because it was a good question.
Dana says she had a beautiful 56-year-old patient who had general aesthetic questions. This is really important because I’ve never covered this in a webinar, by the way, so I’m so grateful for this question. She said, “She’s not new to injectables, but has not received any kind of treatment for the last six months because she has left-sided Bell’s Palsy.”
“Previous management for her palsy’s included prednisone, anti-virals, acupuncture. Her friends think she’s showing improvement. Although this wasn’t the reason for seeing me, I’m wondering if PRP might help with the Bell’s Palsy. When you search on ClubMed, it appears not only to be safe, but possibly helpful.”
Yes, is the answer to that. I haven’t counted, but I know at least two people, maybe three, that have told me that dramatic improvements. As you know, Bell’s Palsy can come-and-go, so maybe it was just luck of the draw treating a lot of diseases that wax-and-wane, who knows?
I think the logic is there when we have something that’s an anti-inflammatory and is an immune enhancing-type therapy. It makes sense that it might help Bell’s Palsy. Also, it’s a nerve re-generator. The last time I looked, it was about 60 or 70 papers about that. This is an important thing that I’ve never talked about so thank you for that question.
I would get a really good consent form because obviously if you’re not treating Bell’s Palsy, if you just gave her a Tootsie roll, it could get better or worse and has nothing to do with your Tootsie roll. In the same way, there’s always a chance it may worsen even though the science indicates it should get better.
I’d get a good consent form, which we have on the websites now that we’ve even enhanced our consent forms. If you haven’t downloaded them lately, download one. We’ve also made an Amnion version. There’s a Vampire facelift and there’s a facelift with Amnion. There’s an O-shot and O-shot with Amnion for those of you who are considering adding that to your procedure.
If I were giving her the Rolls Royce treatment, I would consider an injection. Do the Vampire facelift and add some Amnion to it. She’d have the best we know how to do.
Let’s see if there’s any other. Here’s another question. Any reason to stop anti [inaudible 00:25:46] prior to P-Shot® or O-Shot®? Here, I’d treat this like an injection, not like a surgery. Most people who are on anti-coagulants are on them for serious reasons.
I had an internist mentor who always said, “The most dangerous medicine an internist ever prescribes is Coumadin.” You can make the case with just a baby aspirin itself. The last time I looked, something like 35,000 people per year bleed to death from gastric hemorrhages from aspirin.
They’re dangerous drugs. People are not going to be on them for frivolous reasons. Therefore, I usually just don’t even get into it. I just hold pressure longer. Tell them they have more bruising. The bruising is also PRP. It could enhance the effects. We’re just going to hold pressure and I do all procedures as I normally would.
The only thing with aspirin, if it’s possible for you to stop. I know that’s not the question, it’s anti-coagulants, but if it’s possible to stop aspirin or non-steroidal a week or two before, that’s better because it’s going to interfere with your platelet function.
Platelets have a longer half life than a week, so I wonder sometimes about that time frame, but that seems to be the standard recommendation is to stop for a week before and to stop steroids, if you can. I do the procedures and I hold pressure.
I was going to, if there’s not any other questions. Let’s see.
Kathleen Posey: Actually, Charles, I have a question.
Charles Runels: Go for it.
Kathleen Posey: I wanted to say, I did do one Bell’s Palsy patient. She had tremendous improvement, even after a year. But, my question has to do with …
Charles Runels: Wait a sec. You got beeped out for some reason on the sound. You said she had tremendous improvement and then what came after that?
Kathleen Posey: Even after a year. She had the Bell's Palsy for a year and still had some residual left. It was able to take away the residual palsy, which to me, was amazing.
Charles Runels: Beautiful. I’m glad that Dana asked that question. Thanks for throwing that in. Go ahead. You had a question too?
Kathleen Posey: I have a question about interstitial cystitis. What’s been the group’s treatment plan on that and how successful do you think that is? I mean, I’ve done a few, but I’m running about 50/50. I was just wondering. I mean, just do a regular O-shot? I mean, that’s what I’ve been doing.
Then, also, the same patient had an urethral caruncle. I put PRP in there. I actually think it grew, but anyway. I told her to go ahead and have it surgically removed, which the urologist was refusing to do but the pain was so related to that caruncle. I just think it needs to come out. Just wanted to know if you knew anybody else that had experience on the line with UC?
Charles Runels: I think what I’ll do. I’ll tell you what I’ve heard, but I think what I will do after this call, is I, as usual, I will send out an email to let people know the recording is there. I’ll ask for more comments from our urologists and gynecologists who are treating UC.
To tell you what I’m hearing is, I’ve had now three separate … Well, two urologists and one uro-gynecologist call me excitedly to tell me about multiple patients in all three practices, not just one, but multiple patients, who became completely well after many years of suffering with pain.
That doesn’t mean, of course, that everyone they’re treating is getting well. I don’t think the placebo effect on someone who’s tried everything under the sun and can’t get better and finally they get well with your one thing. My guess about it is that it’s multi-factorial and what’s working with us, is those that have …
Charles Runels: … the factorial and what’s working with us is those who have some sort of chronic inflammatory/infectious process going on with the Skene’s glands but I’m completely guessing with that. The others may have something that has to do with the bladder itself that we’re not reaching with our procedure. How we dissect out the subset that responds versus that don’t I don’t know but I keep offering to finance a study and if you want to do that and try to … Let’s try to work up a protocol and get it approved, someone in our group needs to do that study. I’d like it to come from a gynecologist or urogynecologist, which I’m not, so that it’s paid more attention to. To help you with it, I’ll post it and try to drum up more interest and let’s talk to each other about it so I appreciate you bringing that up.
Let’s see what else we got. I think that’s all the questions.
I always like to do a little marketing tip or two. We’ve had a few people lately … Let’s see, I’m not sure what you guys were looking at, let me get you back looking at the web page. Just one minute. We’ve had people on the news, quite a few lately actually, and along with that one was on a radio show. It’s not always TV news, one was on a radio show yesterday and so two really nice luncheons lately. I thought I would pull them out and tell you guys both how to make this happen in your own town and the advice I give people when they call me and say, “Okay, give me tips about what to say on the news.” Then if you just know it’s here the next time I’m still always happy to talk with you. If you know it’s here the next time you get that call you can go refer to this.
I’ll fix it where you can see what I’m looking at. Here’s one of our doctors, she’s a gynecologist, Dr. Singer, and she’s doing the O-Shot and you can see she’s come out of sometimes with the laser treatment. Now, first I’ll start with how you get on the news itself and maybe I’ll just tie it kind of step-by-step what to do. First I would get the name of the person, just your local news channel. You want to call the news and say, “I’m a local physician and I just want to be available for comments or help any time you’re doing a health story that involves whatever you do.” For Kathleen it would be women’s health. If you’re an anti-aging doctor you could say anything that has to do with aging in men and women, whatever you want to be known for.
Then you say, “May I speak with your health reporter?” Here’s the thing. You would think, well they would laugh at you and say we’re too busy. The truth is it’s very, very hard to come up with news and I can prove it to you. Just watch the news and see how many times one news reporter is interviewing another news reporter, it’s very often. How does that make news if they’re interviewing each other? They are really hard up. How many times do you see one … They call it breaking the story. One news channels breaks a story and then all of them talk about it for the next week. It’s hard to come up with something new and interesting every day. Then when they do a lot of times they need an expert to comment. If they have someone on speed dial, and this is what you tell them.
First you ask to speak to this person and you say you want to make yourself available if she ever has a story and needs a comment on or off the record. You tell her or him that you always answer the phone and then you give them your cell phone number and you tell your staff, “If you ever get a call from this news you want to be told immediately.” They are not to take a message, they are to get you to the phone immediately because if you don’t take the call they’re usually on a really tight schedule and they will call someone else and you’ll miss the chance for … I literally have millions of dollars of free publicity just because. They’ll tell me, “You know, I was going to call so and so.” I just ask them and they’ll say, “Yeah, I was going … My deadline, I’ve got an hour to get this done and if I hadn’t answered I would have just been out of the story.”
You tell your staff … Make sure they have your short list, you probably have that already. “These are the people you’re to never take a message.” My short list is my children, my parents, my sisters, my attorney, and anything with three letters; the IRS, the FBI, the DEA, anything that has three letters get me to the phone. That includes CBS, ABC, NBC, and any news reporter of any kind, doesn’t matter how big or small, bring me to the phone. Then after you get the news reporter on the phone you just tell them that, make yourself available. Now, if you want to make news, if you want to be on the news for free you try to tie it to the national press and I put … If you go here, I think I’ve got it on here, let’s see.
If you go to the marketing part of this … Anyway, it’s somewhere on here. There’s a webinar about how to take advantage of the national press and marketing … Let’s see, what is it? Insurance practices, avatar, anyway somewhere on here. You’re right, it’s easier to find the O-Shot but the thing is if they have … Let’s say that the press does a story on some new treatment for incontinence, it could be any treatment. Well, you call them up and you offer to comment on it, on your local station about that treatment. Of course, you’re going to talk about your O-Shot too. I actually changed the Health Department policy in my county after someone had an injury in Atlanta, the swimming pool. They had no Health Department inspection here back in the 90s and I said, “Let’s do a story,” and we did a story about how there was no Health Department inspection. It would not have been a story had there not been a recent death in Atlanta from their dirty swimming pool.
You watch the national news and when something happens nationwide that relates to what you’re doing you call your local channel and you offer to do a story about it. That can include national press about our stuff. When this hit the news recently, this one. This is a local station but we have clearer … When we hit the national press I will send out an email. When the email comes out and says … Let’s see. Back in October we made a Real Magazine Website and plugged in others about the Vampire breast lift. When that happened you could have called your local TV station and say, “Hey, the Vampire breast lift was just on [inaudible 00:37:53] website or Allure,” whichever one you want to mention or both, “And if you want to do a story about that I do that procedure here in our city.” Then they will interview you often because you have a local comment about a national matter so that’s how you get in.
Now when it’s time to talk how do you get ready to actually be on the news? Here’s some quick tips and you’ll know where this is. It also applies if you’re just going to be, say, giving us a talking somewhere, and it helps you plan the talk. Here’s the tips on that and I think I’ll type them out for you. Let me pull this up because it’s simple but it’s really helpful. I’ve been on the news more than I like to think about in different countries, in Serbia and London and New York. Anyway, the bottom line is this is the process I go through before I’m going to be interviewed.
I first think about … I imagine not everybody in TV land, not everyone. I imagine one person that I love and I pretend that person is watching and I forget everybody else. If it has to do with men’s health I imagine my son’s watching. If it has to do with women’s health I imagine my mother or a woman that I love and I pretend like that’s the only person and that person is on the other side of the television. That couch is my language so that I don’t sound salesy, I don’t sound anything except sincere and engaged and eager to communicate what the message is. That gets the frame … That is so important and I’m not just saying this. This isn’t something I’m just talking about, I literally do that every time I’m in front of a camera or a microphone if you’re being interviewed by the radio. I was interviewed on Shade 45, which is, it’s a rapper station.
That’s the only time I’ve ever been interviewed where I was the most conservative person in the room. They were talking to me about orgasm and it was a call in station and so it was pretty interesting. It didn’t matter, I was still imagining not talking to everybody out there, being interviewed by radio stations in South America where they have a translator or in Columbia, Mexico. Every time I just think of one person that I love and it’s the only person that matters. Then how do you, what about the content, what do you have in front of you? I think about the problem that my thing is going to solve and I imagine that person with the problem.
Let’s say I do a talk about the O-Shot, then I’m thinking about incontinence or orgasm or whatever it is that is to be the expected topic. Then, and quit speaking about me trying to be pretty or smart or say all the right things, it just becomes about me trying to communicate to that one person I love on the other side of the camera. I know this is all a mind game but it works and it’s the reason you’re there or you just go home. We’re here to solve problems for people and so, not to try to be pretty, they got movie stars that do a lot better job of that than I do, be funny or entertaining. I’m a physician, I’m there to teach people how to solve health problems so that’s the mind frame you get and I forget about the rest of it.
Then I think, and this one’s key I think. I think of key words and phrases that I think would be helpful. Let’s say that … And I write this down and then look at them before I go on camera. Let’s say if it were O-Shot I might think, I would think of the words O-Shot, I might think of the words relationship, relationships healed. I might say psychological pain, you get the point? I would make a list of all the friend … I would day provider group, that’s protected, be careful about seeing someone outside the group. Two and three word phrases that I would want to try and weave into my conversation and realize, no matter what they ask. Ask me about the weather. You say, “Well, is it hot outside?” I would say, “You know, it’s unusually cool down in Florida today, which is exactly what happens to relationships when sex doesn’t work.”
Ask me what color my car is. It’s black. “You know, that’s exactly the mentality people have. They have a black, depressed mood when they don’t get sexual relationship fulfillments in their marriage.” My point is, no matter what they ask you you can weave these phrases into the conversation if you have them in your head before you go on. Then I always thank the person, usually I’ll thank them up front for … It’s not a long thank you, it’s a … Because people get bored by, “Thank you so much for having me.” Nobody wants to hear that crap. What I would say is, “Thank you for being brave enough to talk about sexuality on your show because many people are afraid of that and we know how important this is for relationships.”
You throw little kudos to the host for being brave enough to talk about uncomfortable things and they always like it obviously because they can’t brag on themselves. Then it sets the tone and they know their viewers are looking up to them with a little more respect because of something you said. That’s kind of my, that’s my … Then oh, last thing is you want to invite them to do something; contact you, you want to make sure you have the website because here’s the other thing, here’s the bad, I’ll show you the bad news. Here’s the bad news. If you don’t do … This will go away in about 24-48 hours unless you post the recording. Anyone [inaudible 00:44:51] her TV show. It was good for a boost, it lasted less than a week.
The doctor show will last less than two days. A good news report, and I’m watching the traffic on a website. A good news channel … Actually, sometimes the doctor show you can’t even see the blip because a lot of people aren’t watching daytime TV but a good, very populated website will last two, three days and then it’s gone away so why be on the news if it only gives you traffic for 2-3 days? Once you have it then you take these videos like this and you post them on your website. You see where it says … Oh, I had a link copy. Anyway, there’s a way to actually embed this onto your website and hopefully Dr. Singer has that.
Now, every time a patient on the website that says, “Oh, this lady is [inaudible 00:45:47] enough to be on the news,” and then they hear her explain it in an engaging way with her news interview and it just sits there and educates patients day after day, year after year. Then, that’s when you get some traction and that’s really when you go on the news. It’s not you get a little grip. If that was all you got, honestly, I don’t know if I’d waste my time. That footprint that stays out there and gets showed by all of us on the website, that goes … Oh, are you all seeing what I’m seeing? This can be shared and embedded so that that sits on her website and that is what keeps owning on educating people.
I think that’s it unless somebody has more questions. I think we’re going to stop it there, see if there’s any other questions. The take home do for this one, for today’s thing is that we’re going to try to drum up some more talk about the chronic interstitial cystitis because we’re at least three years overdue for doing that study. If you want to get on the news, at least let yourself be known, make introductions to the health reporter in your town. Then when something happens nationwide you can call, they already know who you are, he or she does, and they know to call you if they have a need for a comment. Then there’s the book that I recommended if you’re doing faces for, that’s newly published about the mid-face because I really like the way he talks about that.
Let’s see if there’s any other questions. Thank you guys, it’s always an honor to have when you spark people interested in what we’re talking about. I’ll post a recording if that’s helpful. Goodbye.
Cellular Medicine Association
Here’s a summary of the FDA regulations concerning PRP…
Here’s a nice summary article with wonderful references…
Here’s an abstract summary of the above article…
Here’s where the FDA plainly says that PRP is not under consideration for regulation..
New England Journal Article about Stem Cells…
I’m just back from an ISSWSH meeting, which I highly recommend that you guys do if you haven’t been yet. Here’s their website for the Fall course. Maybe once every year or two I recommend. You can see the content is pretty amazing. These are the handouts that they had. I thought I would just run through some of the highlights of the lecture that Andrew Goldstein gave on dyspareunia.
Dyspareunia, as you guys know, to a gynecologist, it’s like saying back pain to a orthopedic surgeon or an internist—the etiologies are so numerous that it’s almost the name of a symptom not a diagnosis. Although there was an article, an editorial, in the Green Journal Obstetrics and Gynecology about three years ago now where the editor said, “We’re not treating it as well as we can, and often times it really does go undiagnosed.” But even with that being the case, it’s worth looking at in more detail, the different diagnoses/etiologies
I’m going to unmute your mic, Kathleen, because I know you’ve been to this meeting (ISSWSH). You are going to have things to say about it. It would be very helpful to talk about it, I think. I don’t know if you’re able to talk. Can you hear me, Kathleen?
Kathleen Posey: Yeah, I can hear you. Can you hear me?
Charles Runels: Yep. We’re recording this because even though not so many compared to speaking, not a huge percentage of our people make it to the call, usually it’s in the neighborhood of 20 or 30 people out of over 1,000 people, I think it’s really worth thinking about pain/dyspareunia.
The good news is that often times when we have pain and it’s not easily diagnosed, our O-Shot® procedure seems to be working. Whether it’s healing damaged tissue or if it’s causing a decrease in inflammation like it does with lichen, I don’t know. But I thought we’d run through these known causes. I don’t pretend to be giving this presentation the way Andrew Goldstein gives it, but I’ll hit the headlights, the highlights. Hopefully, you guys can hear the lecture for yourself sometime in the next year or so.
This is the textbook that he helped edit about dyspareunia, which I highly recommend that you go through this. Eventually, I think there will be a chapter about an O-Shot. You can find this on Amazon.
This is the one, the version that he wrote for patients.
These are the known causes [see video]. Talk about this for a second, Kathleen. What on here do you see us helping with? Obviously, we wouldn’t try to treat fibroids with an O-Shot, but talk about this list for a second, and just the diagnosis of dyspareunia in general. Can you see it?
Kathleen Posey: Yeah, I can see it. I basically put PRP wherever the pain is. I map it out. I rule out the things like yeast infections, chlamydia, endometriosis, PID. I treat them just like we would treat those, but usually when there’s no reason, I just get out that Q-tip or just my index finger and say, “Where’s the pain? Does it hurt here?” Then I put the PRP.
Actually, a case I talked about a couple weeks ago was a anal cancer in a 40 year old that had radiation and complained of menopause and decreased lubrication. She went to a plastic surgeon who did Thermi-va on her, which only made her small vagina smaller. But mainly the pain was a posterior fourchette. I did put the PRP and did an O-Shot® because I do both. About two to three weeks later, her pain got better. That’s my method.
You can look at all these diagnoses. We know how to treat most of these things, but it’s the unknown ideology of the pain that I think the PRP helps. It doesn’t always. I had a classic vulvodynia around Hart’s line that was real painful, and she really didn’t respond that well, but that’s just one out of the many that I’ve treated. I’ll still try it on another patient like that, too. I wouldn’t limit it to that.
Charles Runels: Beautiful. Let me add to what you just said.
First of all, I agree. Most of the people, by the time they get to us for an O-Shot®, the patient’s already, before they are willing to pay cash, they’ve already been to other physicians and had lots of tests done. The good is that most of these things, if they were there, have already been treated.
The other thing I would add, which I know you do this, Kathleen. I know you treat some people for free, as do I, and that we’re both careful not to keep money if people don’t get well. I highly, highly recommend that everyone do that. If you’re treating pain and someone doesn’t get well and you keep their money, they feel like we stole from them. Even though we’re not used to giving back copays or whatever, insurance doesn’t refund money if we don’t … Obviously, we know we can’t get everyone well, highly recommend that if you treat someone for pain, and they don’t get well, either repeat it or refund their money.
By the way, the reason I’m talking to Dr. Posey for those of you that don’t know, you’ve been involved with the group right now for quite a few years. She’s been teaching it to other gynecologists. She’s a gynecologist, board certified, out of the New Orleans area, who has recently presented some research where she treated lichen sclerosis with a combination of surgical procedures and PRP, and teaches that method. A lot of experience seeing many thousands of women over the years as gynecologist and very well-trained, busy surgeon in the day. Back in the day, I know you were a high … Anyway, lots of experience.
Back to this list. Back to the list. The endometriosis, obviously, you wouldn’t treat it. The psychological, that hopefully is going to be teased out with your conversation. I wouldn’t try to treat psychological, obviously, with PRP. But let’s get to some of these pictures, though, because I think a lot of our providers don’t really know what to look for. I know that you’ve seen quite a few people who are being followed by a gynecologist-
Charles Runels: Some of these women, saw gynecologists who never diagnosed the pathology the gyn just went for the pap smear and never stopped to look at what was going on.
You just mentioned … This, by the way, is his algorithm for pain. I don’t show this, obviously, expecting anybody to memorize this whole thing from my overview here, but I just want people to realize there’s some thought that goes into figuring out pain. They’re not just willy-nilly treating someone without making sure that someone, if they’re not a gynecologist or a dermatologist, that someone hasn’t thought through a differential diagnosis … If there’s a rash for example, it should be biopsied. Someone should be thinking about that.
This first one is a big one. There is a pain disorder that’s associated with low testosterone. This is stressed over and over when I talk to people who treat a lot of vaginal and vulvar pain. The vagina and the vulva needs testosterone to stay healthy, and there’s a actual syndrome associated with pain and birth control pills, which almost always drops testosterone levels. Some women are susceptible to that, and some are not, but that’s something to think about.
This vestibulodynia of different ideologies is a whole subject in itself, but interestingly, I did meet a woman at this last ISSWSH meeting who had a woman with long standing vestibulodynia that was of this [neuroproliperative 00:09:01] type that responded to our PRP. Somehow it decreased that inflammatory whatever makes things go on here. This is a whole area for research that we need to take up, talk about. But obviously this is not a healthy looking vestibule. When you have this erythema around Hart’s line, then it’s worth thinking about testosterone creams. I think it’s worth trying our PRP as a way to modulate that.
Again, I’m just skimming through this just so you can see this should be thought about. This is that Hart’s line that you just heard Dr. Posey talk about that one. That’s inflamed, and this responded to using testosterone and estrogen creams.
Our O-Shot® is not the cure all, end all, be all, but I think it’s an extra tool that can be used in the thoughtful treatment of these problems, so I just-
I just wanted people to get a look at what some of this neuroproliferative. Vestibulodynia is a horrible problem. Basically, someone stays inflamed to the point that then if the inflammatory agent is removed they still stay inflamed.
A lot of times, they’re treated with creams that have some sort of propylene glycol or paraben in it that causes the inflammation. You’ve got inflammation, you treat it with a cream that actually causes a chronic inflammation to the point that when it stops, sometimes they’re left with a continued process that turns into this.
I think that was the main thing. The other thing to think about is here’s the pelvic floor muscles. Normally, these have been treated historically by palpating, as you heard Dr. Posey talk about, palpating and finding the place where a person’s tender, just like you would look for trigger points in a tender back and in the same way that physiatrists are now injecting PRP to treat this.
When you find that tenderness, you can now inject PRP. That will usually hurt worse for about a week and then it goes away. You have anything to add to these pelvic floor injections?
Kathleen: Not really. I’ve never really done them. I refer to pelvic floor PT, but I will say that even of the lichen sclerosus patients I’ve seen, a lot of them have pelvic floor dysfunction. You just touch them and their levator ani muscle just almost goes into spasm. It’s interesting, a lot of women when they’re touched, they wanna squeeze that butt together and I’m telling them, “Look, put your butt down into the table.” There’s a lot of comorbidity there with vulvar pain and then these muscles getting involved is what I see.
Charles Runels: Just to add to that, we do have people in our group who work with the pelvic floor therapists. I know you have them in New Orleans. Our little town doesn’t have one. But that’s a good referral source. One of our people actually had a pelvic floor therapist put a satellite office in their office actually they had a good working relationship [inaudible 00:12:30]. His O-Shot helps her therapy work better. That’s worth looking into.
The way that he established that relationship is he just had her bring one of her patients over and he treated the patient with the therapist in the room so she could see what was involved. Then she went back and did this therapy as she normally would and had a nice result. It’s a way both to help their therapies work better and to help everybody’s business. Let’s see.
Kathleen: At the conference in Boston, they talked about putting Valium in the vagina.
Charles Runels: They did.
Kathleen: Did they talk about that at all?
Charles Runels: They did. It didn’t seem to be as helpful, at least the feeling I got from the lectures, as using Botox. That was something that was talked about.
We don’t have the research showing that our PRP works with pelvic floor trigger points, but it should apply, since that research has been done in the physiatry literature with back pain.
They did talk at ISSWAH about trigger point injections of Botox and they mention diazepam and suppositories, but Botox seemed to be the first choice on the menu (before diazepam).
100 units is what they talked about using, which would be one bottle of cosmetic Botox. Some are doing it under anesthesia. I know Andrew Goldstein was saying he likes to use it without general anesthesia so he can tell better about where to put it.
Let’s see. I think that was the main thing I wanted people to see was just that. Oh, yeah. He does a vulvar vestibulectomy but he says he does a whole lot less of these than he did in the beginning of his career when people were not using testosterone creams.
It was really talked about a lot, especially in someone who’s on birth control and how common it is that that gets dropped in people who develop these pain syndromes, not just this vestibulitis pain syndrome. But this is a last resort, obviously, but it’s something that’s done just to know what’s out there. It can be done if somebody develops this pain that just won’t go away.
I think that we’ll find that there’ll at least be a subset of these people that get better with our O-Shot. We’ll see. I think that was the main thing I wanted to show. I don’t feel like it’s my place to just put all this stuff out since it’s their intellectual property, but I just wanted people to see that there’s a lot of stuff out there and it’s worth, I think, attending one of their meetings. It’s called ISSWSH, International Society for the Study of Women’s Sexual Health. Maybe go there once every couple of years and get a good update.
Okay. We didn’t have as many questions this week as we normally do. We had one question that showed up on the Priapus shot website about has anyone used PRP combined with amnion with the Priapus shot. Some of us have, but I don’t think I have enough experience yet to tell you that it’s working better. I think it would be worth trying if someone didn’t respond and you were treated Peyronie’s disease especially if you’re trying to heal scar tissue, or someone just wanted to get the best that you knew to do.
Again, amnion is not stem cells, it’s where you’re harvesting the proteins from the amniotic membrane and then they gamma-radiate it. There’s nothing living in there. You just have the cellular proteins, the amino acid peptide chains that code for wound healing. That research has been done. I think just as a general help, I always like to add in a couple things that have to do with marketing and something to do with business.
We got a really big hit that’s worth talking about when it comes to the Priapus Shot® procedure. If any of you guys are doing this, it’s worth talking about. Dr. Gaines is in our group and he popularized the Gains Wave™, which is combining the Priapus Shot® with shockwave therapy.
You can see the guy in the Men’s Health article talks about the Priapus Shot® itself, or the P-Shot®, and it’s a very complimentary article, somewhat sensational, but he’s an entertainer. This is “Men’s Health,” this is not “The New England Journal.”
Obviously, we don’t make claims we can’t fulfill and you want to have a consent form and make sure that your explanation is not the same as “Men’s Health” magazine, but Lord knows we get huge amounts of negative press that’s absolutely uninformed and factually wrong. Someone wants to make this a little bit entertaining by talking about his penis he claims was 10 inches when he put it in the pump, I don’t know, maybe it was 10 inches. Who knows? But I’m not one to dispute him.
It’s a nice article that at least can start the conversation and maybe lead to you helping some people who need your help for their erectile dysfunction. That article’s there if you just Google “Priapus shot in Men’s Health.” Some of us are combining the shockwave therapy when people want it. Just so you know, if you look on our director, PriapusShot.com/members/directory, I added a logo so that if you’re using shockwave therapy people can find you.
Also, I know Dr. Posey uses the- That right there, that’s our shockwave logo.
If you are doing shockwave therapy and want the logo by your name, let me know and I’ll add it.
If you go to the O-Shot® directory, we have a logo now if you’re doing radio frequency. I think what’s gonna happen is as the research becomes more available, as we do more research, then people are going to want different flavors of our procedure based on their problem. I know there are some things that one of these machines, like Dr. Posey just mentioned, someone who had dyspareunia had a small, constricted introitus, that’s not the place to use your radio frequency device.
But you can see I added this. This is what I added, Kathleen, to indicate you’re doing radio frequency. If you want one of those by your name, just send it to support. I’m gonna put it in here…
I just put it in the chat box. You just send that and let us know and we’ll put the little thing. This means you’re treating lichen, this means you’ve put five people in our research project or a survey, this means that you’re using radio frequency device, and we have one for laser’s too. I need to update.
This is the legend so that whomever’s using this directory knows what these little symbols mean. I just added this last week, so I need to add that to the legend so that people know that means you have Thermi-O or radio frequency device.
So, let’s see Dr. Desmond Ebanks just put something in the chat box. So, the automatic pump he uses, I don’t, the guy talks about this pump like it’s the bomb. Who knows if that’s part of his journalistic license, but he talks about this pump as being a pretty intelligent thing, so I’ll ask Dr. Gains what brand of pump they’re using.
Let’s see whats the other question…
which shockwave device do you recommend? As far as the shockwave device, what I have right now is the E-Vive. There are others out there, I think they’re all made by, or most of the main brands are made by the same company. They’re kinda re-branded, depending on who’s selling it. So I think a lot of it comes down to who you want to work with. And who’s having a good deal, and good support. But right now, I have the E-Vive, which is the one Eclipse sells, in my office.
Let’s see, Dana Kirk just said here, okay, so here’s the question from Dana. She says, “Often the Vampire Facial®’s being administered for acne scarring often have some leftovers. Anyone injecting into the larger pock marks? If so, is it worth activating?”
Ok, so this is a good question about acne. When I treat acne, I use micro-needling. But two tips on that….
First of all, if it’s in their budget to do Juvederm. If you think about what happens to the divet, or say the divets in say a basketball, if you put more air in it? The divets become more shallow, just from expanding the ball. So even before you treat the pocks marks, or treat the acne scars, if you’ll use some Juvederm, if they can tolerate it, as in, do they have any room for some improvement in the cheeks, and if it’s a female, almost always they do, unless they’re obese, they’ll have some. You can add to their cheeks and things look better. And the acne scars are already smaller (before you actually treat them). At least the ones in the cheek area.
Then, micro-needle with PRP (Vampire Facial®), but also go intra-dermal and sub-dermal with your PRP, subsize/undermine the scar, just like you would if you were treating acne scars before we had the Vampire Facial®, so taking the bevel of your needle and sub-sizing the scar releases it some. I
Inject a little PRP sub-dermally, inject some intra-dermally, and then micro-needle on top of it. Intra-dermally as in blanching the skin.
And all those combined will get a really nice result. Usually I treat them every six weeks for three treatments, and they love it.
As far as activating it for the face, I usually don’t (I used to do so). Because I don’t think it adds to it enough to warrant the extra pain. In the face. But I do activate the PRP in the O-Shot®, the P-Shot®, and for loss of sensation in the breast.
So Sherry, I don’t see your question, it just says … maybe you can type it again. Okay, wait, here it is… “Does it matter which order you do the p shot, the shockwave therapy, and did the p shot … okay….”
So, the way I think about the energy, whether it’s shockwave, laser, or radio frequency, the way I’m thinking about it is, if you’ve ever used, say, insulin or growth hormone, if you just take, if you buy Omnitrope or a growth hormone, or Genitropin, whatever brand. These are small amino acid or peptide chains. It will tell you not to shake, to gently stir when you put the water in. Just shaking the vial, it mechanically shears the amino acid protein chains, so it’s like taking the words of the sentence and just chopping them up and turning them into letters. And now that amino acid chain no longer acts as a small peptide signal. Right? So these amino acid chains act as signals that plug in to receptors on the cell, and that’s how growth hormone, that’s how insulin, it’s how all those amino acid chains work.
Over 200 made by the pituitary gland that we know about. Peptide chain signals. So, imagine if you did that, I have no research to back this up, but imagine if you injected a peptide chain, and then now you hit it with shockwaves. In the same way, imagine what happens to an egg when you put it in a skillet and fry it. Obviously those peptides or those proteins are being changed.
So the bottom line is, I like to use the energy, whether it’s shockwaves, lasers, radio frequency, whatever it is. Use that on the tissue first. And then immediately afterwards, same visit, then apply your PRP. Now if you want to, if you did the shockwave yesterday, or last week, or three weeks ago, or a month ago, and you wanted to do PRP after that, that’s fine, you’re not hurting anything. And if you want to, if you did the PRP three weeks ago and now you want to add the energy, you can. But in my opinion, as soon as you add the energy, you are probably shutting down whatever growth was taking place, from the PRP that you put. So it’s like you’re stopping, it’d be like you just watered a seed, the stem cells are [inaudible 00:25:26] stem cells that you just put there. And now if you’re trying to generate more growth by damaging tissue, now you’re crushing the little sprout or whatever tissue is growing. You’re crushing it or injuring it, in my opinion, if you didn’t do the shockwave therapy before it has a chance to mature.
So I would try to do them back-to-back on the same visit. And not do anything else mechanical to disturb the growth of the pluripotent stem cells until at least six weeks out, maybe even eight. To give what you did a chance to work.
So if you did the P-Shot® three weeks ago, yeah, you could do the shockwave now, but you’d probably be stopping whatever further benefit might have occurred from that original P-Shot®. It might be better to give it at least another three weeks before you did the shockwave therapy.
Okay. Let me give you guys, I don’t see any other questions that are up. I want to give you guys one quick marketing tip, and then unless somebody has another question, we’ll shut it down.
This one has to do with when people get to your website. It is something you can ask your web designer for. This is my old internal medicine website. And this is just a form and here’s the scenario that will happen. And this is why this form is so important. You don’t have to make it, I just want you to know it exists, and this is a ten minute job for your marketing person. And if you don’t have one of these, you’re losing about at least 30 to 40% of the traffic that you could be getting to call your office.
So let’s say that you’re in, let’s say that you’re, you do an o shot, or you do a vampire, or you just do a pap smear on someone. And they go back home, and they go to Thanksgiving dinner. And they tell their mother, sister, friend, cousin, whatever, how wonderful you are. And they say, oh, what’s their name. And they say, oh, it’s Dr. Posey.
So now they take out their cell phone, or they remember the name and tomorrow, day after Thanksgiving, they google you. And they wind up on your website. If all you have is stuff for them to read, they read it and they go away. And there’s very good chance that a week from now, they’re not thinking about you. It’s all done. They will never become your patient.
If you put something on here that they can have for free, that costs you nothing, not a free consult, it’s gotta be something that costs you nothing. If you put something on here that they can have for free, and we’ve all done this before, that’s worth something to them, but costs you nothing, somewhere between ten and 30 percent of the people who land there will do that.
And then, now you have their email address. They start getting your newsletter, and a certain percentage of those will eventually become your patients. So it gives you a chance- this is not the main way you get your patients. Most of your patients are gonna be word of mouth, or someone googling you. But this plugs the hole, and it will increase the number of people you have by about 20 to 30 percent, that come in through your website, by capturing those people who would have never called you, had you not created this form.
And the way you ask for it, is you decide something you’re going to give away, first of all. It could be, and I, it should be a podcast or an email, or downloadable book. It doesn’t even have to be your podcast. What I’m giving away here is a podcast where I’ve just recorded for an hour the benefits of walking. So it says, number one weight loss melt secret, free immediate download. So that takes them, you ask them for the first name and email address, and when they give you that, now they’re on your email list, every time you send out an email, they get it. And as soon as they do that, and you can sign up for this so you can see how it works, as soon as they enter that data, they’re taken to the place to download that.
So, it could be an email, excuse me, it could be a podcast or a video that you made. I know Dr. Posey made one on incontinence. So it could be free video on the treatment of incontinence. In exchange for first name and email. And so you tell your, here’s what you say to your web person, if you want to do this, you should write this down. And this works for Constant Contact, A-webber, Ontraport (what I use most), Mail Chimp, all those different places.
All those different places, it all works the same. And you can go online and figure how to do this yourself, but it’s a 30-minute job at most for whoever does your websites for you. You say you want a form and you want it to be in the right upper-hand corner of your website. On the homepage at least, maybe on all your pages, but at least on your homepage. And it should offer the thing that you’re giving away. And it should only ask for their first name and their email address, that’s it. If you ask for last name, you’ll lose about half of them. So first name and email address.
And then you let them know that you’re putting out a new health lessons every two weeks. Don’t call your newsletter a newsletter. Nobody really cares about your news. Give them a name that implies some sort of benefit. So I call this Health Lessons. You can call yours whatever. And then tell your person to put that on the form.
If you supply them the link to the thing you want to give away … You realize also on Amazon, there’s a lot of books for free. You could literally find a book that you can read on Kindle for free and give that away. But I recommend you find something either audible of a podcast or a video. Preferably something that you did. And that’s it. That one thing is gonna increase the production of new patients by your website by 20 to 30 percent. Now we talk more about this sort of thing in my workshop where I teach marketing, but there’s your freebie right there that is just some of the best stuff.
Okay. Let’s see if there’s any other questions and then we’ll shut this down. We didn’t have a lot of questions on the websites. Okay. I think that’s it. You want to add anything? And thank you for helping us, Dr. Posey. I know you’ve had a lot of … I think more experience with treating lichen with PRP than anybody.
By the way, the way I think about this, it’s all the freaking O-Shot, it’s just we’re varying the way we do it. Just like you do a hysterectomy and you vary the method based on who you’re taking care of. It’s all the same thing. But Dr. Posey made a good point and this is worth remembering, because some people asked me if they’re there for incontinence, do you still treat the clitoris? Or if they’re there for sex, do you still treat the anterior vaginal wall? Or if they’re there for lichen, do you still do the rest of the O-Shot? Or for pain, do you still do the rest of the O-Shot?
There’s two reasons why you treat all of it. One is people lie about sex. Everybody does. And so if someone says they’re there for incontinence, maybe they’re not. Maybe they’re just too embarrassed to tell you. Or maybe they’re living alone, single and they don’t want to tell you they have a lover. Whatever reason. Maybe they just decided it’s not your business. And of course, you would want to treat the clitoris if you’re treating for sex, but you would also want to treat it for incontinence because if you look at the anatomy, the clitoral tissue actually comes around and forms some of the structure for urinary incontinence.
Also, it could be that those nerves of micturition that come down through that area are helped and our clitoris is acting like the wick to help rejuvenate those nerves of micturition. We do know that we have people with urgent incontinence that are getting better as well. And we’re not sure exactly why.
So I always treat the clitoris even if it’s for incontinence. And of course, if you read Grafenberg, the urethra is very erotic in women and you would definitely want to treat (even if there for sex). Also, you have the female prostate gland or the Skene’s glands, so you would definitely want to treat the anterior vaginal wall, not just the clitoris if you were treating for sex because the urethra is such a sexual organ as well.
And if you’re treating lichen and you’re hopeful that it’s going to get better, and you’re down there anyway, why wouldn’t you go ahead and treat the structures that have to do with sex so that that can be recovering at the same time you’re treating the lichen itself?
One big plug though, if they have sclerosis or phimosis, where you cannot pull that clitoral hood back, which many of them do, then you can go ahead and treat them, but make sure that you don’t stop there and you refer them to Dr. Posey or someone else in our group who knows how … If you don’t know how, someone else who knows how to free up that clitoral phimosis. So if you can’t retract the clitoral hood all the way back to see the shaft, if all you can see is the tip of the glans or if you can’t even see the glans, then they need a surgical consult from one of the people in our group so that that can be exposed and be more responsive. It’s hard to have good sex if you can’t get to the clitoris.
Okay. I think that’s enough rambling. Anybody else have any questions? If not, I’m gonna shut it down. Thank you for your help, Dr. Posey. Thank you guys for being here. I’ll put a recording up by the end of the day.
Kathleen: I just wanna say something that I hear … I mean it’s going off on a little bit of a tangent. But to me, a lot of times, they want the O-Shot because they want that penis and vagina orgasm. And yes, it does help that somewhat, but I’m really … I look at a lot of vaginas, and I’m really paying attention to that distance between the clit and the vagina and/or urethra. And it really … You oughta start looking at it, Charles, because it varies with women. Some of them, it is like five to seven inches.
Charles: Yeah, it’s huge.
Kathleen: When I talk to those people, they have never had a penis and vagina orgasm. It might be something to really examine the person before. And if you really talk to them about why they really want the O-Shot, I’m seeing 70 percent of them really want that penis and vagina. And it’s being advertised or said it’s gonna make them have that. Just be careful because if that distance is a long way, yeah, the orgasm will get better. But to bring you to surgery, in my opinion.
Charles: Let me add to that. First of all, what you said is backed up by research. And that research I think is actually on our O-Shot website. But there was MRI studies showing that the further the clitoris is from the vagina, the harder … It was a correlation between … It was done about two years ago. You know this research, so you’re seeing it actually in your patients.
But there was a study where radiologists looked at women who can easily have orgasm and those who have trouble. And the distance from the clitoris to the vagina correlated with ability to have orgasm. And the size of the clitoris correlated.
Now, her conclusion was that she showed it, but there was nothing to do about it. Actually, we do know some things to do about it, putting someone on testosterone is going to make the clitoris larger. And it could be that doing our O-Shot® procedure actually helps, even though it’s not going to make that distance shorter or smaller, it could perhaps make it more responsive. But there’s also always a place for surgery, and there are ways to do that that you specialize in and others in our group to bring things closer together.
Now, and I’ll also say that of the things that we treat, trying to help a woman achieve penis and vagina orgasm, who is able to have it with a vibrator, is one of our more difficult problems. I think our success is probably in the 30 to 40 percent range in that group. Where if you’re treating incontinence in a younger woman, stress incontinence is probably closer to 80 to 90 percent.
So I agree that something ... And it brings up another point in that I recommend, especially in the beginning, that people stick to the problems that we have the high success rate, so the provider doesn't become discouraged. I know you were very motivated and trusting it. But way back, years ago, when we didn't have so many people doing this and we had less research to back it up. But anybody, even with our current researcher who is just starting out, they should probably avoid treating, I think, until they have some success under their belt, the people who never had an orgasm because those are the people who are more difficult and probably they're always gonna need testosterone on top of what we're doing, I think. And the people who we just mentioned trying to have an orgasm with penis and vagina sex, they're more difficult. Stick to the stress incontinence, the dyspareunia, the lichen sclerosis, the women who can have an orgasm and wants to be stronger, those are our more easier cases. And in all cases, always, always, always, in my opinion, if they don't get well by the end of 12 weeks, then either offer them another treatment or give them their money back because we can make a profit and take good care of people without having to have people feel like we ripped them off.
Anything else, Kathleen?
Kathleen: I didn’t mean to say it wouldn’t help because I do think it helps and I do think you can even … I think the O-Shot, by putting it in the vagina, does shorten the distance a little bit. And maybe millimeters like what the P-Shot is doing. And it can get better, it just can’t … When you really see a big long distance, I would ask them and then I would just say, “Your orgasm is probably gonna get stronger, easier to obtain, but it may not help that.” I don’t know, it’s hard to give them a negative … I wouldn’t give them a negative embedded command. Just watch it if they’re there for penis and vagina orgasm.
Charles: I’ll tell you what I tell everybody. It’s good advice. And what I tell everyone when I’m leaving the room is I’ll say, “You just spent whatever amount of money it is. And for that much money, you have to love it. And if you don’t love it, I want to know about it.” Because of course, I’m gonna be following up with them. But what I found when I follow up with some of the people … So when people contact me and they tell me they’re not happy, I refer them to the doctor who took care of them because I’m not their doctor. So I don’t need to be involved. But it’s helpful for me to know who took care of them. Then I call the doctor and talk to them and see if I can offer help.
But back to this thing about satisfaction and setting expectations. I think that what I’ve seen happen sometimes when people are not happy is they never let their doctor know. Because maybe they’re afraid they’re gonna hurt their feelings or there’s gonna be some sort of conflict or something. I think it’s helpful to actually tell your patient, “I want to know. I want to know if you don’t love it because I want to take care of you, and I don’t want you to feel like that our energy and time and your money has been wasted.” And that really helps a lot, both with you getting them well and helps prevent them sliding away disgruntled without you ever knowing about it.
And in the process, you can say what you just mentioned, Kathleen, that if it’s a more difficult case, it’s worth telling them, “This is something that a percentage of,” if you’re dealing with someone who’s trying to have an orgasm with penis and vagina sex, “This is something that doesn’t work as well. We have a much higher percentage with treating stress incontinence, but we do have successes that by our surveys, are in the 30 to 40 percent range. If you want to try it, we’ll do it. But I want you to love it. And if you don’t, let me know. And we’ll either repeat it or we’ll figure out something else, including, I won’t keep your money.”
And in the end, although you give back money occasionally, you wind up making many more people happy and making more money and you sleep better at night.
Okay, I think that’s it. Thank you guys for your attention ’cause this thing … What we’re doing here, I think, is really changing medicine and I’m the facilitator between all you guys thinking about it and all the feedback and all the good research. So keep it coming and I’ll try to keep pouring our money back into it.
We have two double-blind placebo studies going on now. We’re having a little trouble filling the orgasm study (click to help), so I’m gonna put out a link to that again. So if you guys know people who live in the Washington D.C. area … Bottom line though is we’re investing into the research. We’re investing into supporting our group. And I think you’re gonna see medicine change a lot in the next five years from what we’re doing. Okay, you guys have a good day. Thank you, Dr. Posey.
Charles Runels: … Don’t want me to do it, then I won’t post it. I’ve turned on the recording, so now lets hear the story of what you’ve done and what questions you still have.
Speaker 2: Sure, and it’s not necessary … I just want to make sure as things evolve, I’m sure some things change and might not get documented quite as soon as it gets sent out to us. I just want to make sure … I’m not really having challenges per se. I just want a little clarification.
Charles Runels: Good.
Speaker 2: When I’m seeing the patients, I’m telling them the correct verbiage, I guess, so they’re aren’t getting any conflicting information. One of them is … Does the AJ actually activate? That’s how I understand it on the videos. It activates and creates a scaffolding of sorts or fibrin scaffolding for the PRP.
Charles Runels: I’m glad you asked that, because I get that question at least twice a week. Maybe I need to make a video that just, the title of it is Activation and maybe this will be it. Because it confuses people and apparently I’ve yet to explain it to where people are not confused by it. When it comes to activation, all we’re referring to is the fact that platelets, when they’re in your blood stream, obviously they’re not releasing any of these growth factors … Or they would just clot up in your blood, right? You have platelets that are floating around and when you take them our of your blood and you put them in a centrifuge, they’re still biochemically unactivated. Unless something happens to them, and then the activation-
Speaker 2: Right, so [00:01:54] injured.
Charles Runels: Right, so the activation opening the platelets, which basically act as suitcases that are carrying those chemotactic growth factors and such around. All right? If you just take platelets, and you put them, for example, in a syringe and you block off the syringe and then you put negative pressure and vacuum, that will activate them. There’s a patented method for doing that. Cell Fuels kit comes with a few drops of calcium chloride and you can … For that they use the terminology platelet rich fibrin matrix because surely theirs is the only kit that comes with that calcium chloride to activate those platelets. Whenever you activate platelets in any other way, you’re also forming that fiber rich fibrin matrix. The platelet rich plasma is just plasma that has lots of platelets in it. Then the platelet fibrin matrix is when that plasma gets … Something is done to it to make those platelets release the growth factors and that causes the plasma to cause form this gelatinous material. That can happen in a vacuum, it can happen with Cell Fuel that comes with the calcium chloride, or you can buy your own calcium chloride or calcium gluconate.
Region has a kit where you make your own thrombin. You can add thrombin to it. You can technically, in theory you could pull it through a needle, a tiny needle, when you have a negative … When you have a difficult phlebotomy, and you have to pull hard on the syringe, and you say it clots in the syringe. Well that’s what you did. You activated the platelets with the negative pressure.
You can also just take those platelets and inject it in the tissue. That activates the platelets. When the platelets are activated, as in they leave your syringe, in which they’ve not been activated, unless you put something in the syringe. Let’s say you take the platelets put them in the centrifuge, don’t do anything else to them. Now you inject them to the tissue. When they hit the collagen in your body, that activates them. The basic science literature says that probably only about 65% of them are activated when you just inject into the tissue. Now, when you read the basic science literature it gets confusing, but the best I can tell you only get about 65% activation. If you add your own calcium, or you add your own thrombin, either calcium chloride or calcium gluconate or thrombin kit … If you do any of that … Because you don’t have to use the Cell Fuel kit, which comes with the calcium, you can buy the calcium chloride or the calcium gluconate. Then when you add that, then you’ve activated it and you get 100% activation, but now some of those chemotactic factors and the growth factors only have a half life of a few minutes and so you have to-
Speaker 3: It’s 3 o’ clock.
Charles Runels: You have to inject them into the tissue quickly. If you don’t then 3 minutes forms this matrix, and you can’t get it out of the syringe. “When do you activate or when do you know?” I get that question a lot. If you’re … If I’m treating something … Again, I don’t know what the final answer is going to need to be. We have to do that research to figure it out, but at the present moment I’ve had … I highly recommend that everybody does an O-shot, the activate. If you do a [00:05:20] shot they should activate, as in do something to those platelets before you inject them to make them release the growth factors, so you get 100% activation.
Now the problem with that, is that you got to have something to activate it with. You got to add something to it and you have to use it quickly. Frankly, I don’t know that, that’s necessary, but I think it probably is because anecdotally I’ve had some people that were not getting good results. When I told them activate, and they did, they started getting good results. The other thing I’m thinking about is if you don’t activate it and you get a more slow activation. Not only is it more incomplete, which maybe not matter if it’s in the scalp, your face, you’re just going for cosmetic versus therapeutic benefit … If you get maybe 50% activation in your face, you’ll look a little younger, okay. Everybody wins. But if you only got a 50% activation, and your goal is to make [00:06:08], or your erection hard, or your lichen sclerosus to be gone, well then maybe you didn’t get full effect.
You also … The way I’m thinking about it is that when you activate it’s going to stay in a smaller area. When you’re treating, say incontinence, that’s a therapeutic effect, and I want it to stay in an area that’s only a few millimeters wide. Where with … If possible at least as close to that as I can … Where with the scalp I want it to spread all over the place. I recommend that we activate every time, with every person, with the O-shot and the P-shot, and when we treat the breast for loss of sensation around the areola. Those are activation places for the P-shot, the O-shot … Excuse me. For the face, and the scalp, and the breast in general, or for micro-needling, no activation. I don’t think it’s needed. For P-shot, O-shot and loss of sensation in the nipple, for those three I recommend you put something in those platelets before you inject them, so that you get complete activation so it stays where you put it.
Speaker 2: Okay, with that theory then, why do … Again, I’m not questioning, I just want to know the reason why, but when we do the vampire facelift, and we do the little sprinkles of HA on the cheek, and nasal labial, and lower face, and then we go over with the PRP, why can we not or do we just not do it like the wing lift, where we would add a little HA with it? Is it just for risk of occlusion or …
Charles Runels: I’m sorry, what?
Speaker 2: Because in those areas we …
Charles Runels: I don’t understand the question. I’m sorry, you beeped out in the middle of the first part of it. What’s the question?
Speaker 2: Why could we … Why do the facelift with the little sprinkles of HA and not mix it like we do for the wing lift? Is it just for risk of occlusion? Or …
Charles Runels: Okay, so that’s a good question.
Speaker 2: In the nasal labial, we’d want it to stay right there.
Charles Runels: Yes, so here’s the reason for that. The way … The reason for that. This comes out of just clinical experience. Once you mix … Once you make a mixture, let’s say that I mix one part Juvederm with two to three parts … Actually, we’re mixing one Juvederm, with five parts HA, when we do the wing lift. We would take in a half of cc of Juvederm and mixing it, making a slurry with two and a half cc’s of PRP. When you do that, you cannot sculpt with that. It takes on the … As you know, it takes on … That’s a very good question. Takes on the density of water, it’s aqueous. It’s not … You can’t mold it like you do with Juvederm.
It’s perfect for filling a space, just filling a … In the labia majora, where I’m not trying to sculpt in your particular shape, I’m just trying to basically reinflate the space. Although, I think it’s very important that you distribute it two thirds, one third. You have to distribute it so that it’s mostly at the top, two thirds at the first half, and one third in the second half where it takes on an odd shape, so two thirds, one third. Still, you’re just filling a space versus when I’m sculpting a cheek or the mouth, or lifting a brow, if I have some aqueous materials trying to make a sculpture out of water, you can’t do it.
In that case, I’ll make the sculpture with the Juvederm first, and get the shape I want, and then I’ll put the PRP on top of it. Another way to think of it is Juvederm alone, you can change the shape of the mattress, where with PRP you’re doing a more beautiful upholstery, you’re covering the shape of the mattress you make with the HA filler.
Speaker 2: Okay, so if I understand you correctly-
Charles Runels: In that same line-
Speaker 2: I can do more than-
Charles Runels: Let me expand on that. In that same line with the breast, if I’m just treating the breast alone, I’m just filling a, basically a space. It’s a circular … It’s a spherical space, basically. I’m just reinflating it, but if the woman has a defect because she has implants and they left her with a little asymmetry, that she’s got not too much fat on top of it, then I will use an HA alone first, and then put the PRP on top of it. Where if I have a woman who’s got breast tissue and I don’t need to change the shape or fill in a little divot, then that’s from an implant that’s gone crazy, or a scar from something, then in that case I just use PRP. I don’t even need the HA.
Speaker 2: Okay, so that doesn’t just place … Example, I saw the video where, I think she had implants and she had a little divot in the medial cavity there and you did an HA, so putting the, then, PRP over that or near is not going to displace that? I ask because, typically the facelift, we use the one cc and sprinkle that all over. I can do a full correction on somebody’s cheek, say, and maybe they need a full cc on one side, I can use more than one syringe in theory. Is that fine? I just was sticking to the one cc. Does that make sense?
Charles Runels: Okay, so I would take a notes as you go. If you’re doing … When you say, “sprinkle,” you mean doing those … Because I don’t want people to confuse this with the [inaudible 12:07] the Vampire Facial. You mean, “injecting small aliquots in different places?” You don’t mean, “sprinkling after micro-needling,” correct?
Speaker 2: Correct. I’m sorry. Yes. The small aliquot all over the face. Obviously, if somebody had a large deficit mid-face, that’s not going to be sufficient to maybe augment that whole side so I can use more than … Fully correct them with an HA and then go back and do that or?
Charles Runels: Yeah, again, I just want to make sure people understand what you say by, “sprinkle,” because I think your questions are very good and I intend to post this video because they’re smart questions that I get repeatedly. I’m going to put that up and maybe this time I … Hopefully, if I explained it well enough, that people will get it.
The other thing is, I just want to add this right now. Part of the danger of me teaching this is that I start to believe everything I say. This is my best ideas that I have gathered both out of my brain and from the brains of the amazing doctors in our group and their feedback at the present moment. I’m open to being taught something different and better in the future, but at the present moment, this is the best that I know and I recommend people try it this way, then innovate versus the other way around.
To answer your question, as far as full correction, what makes full correction … The first point is that if you do an HA alone and then put PRP on top of it, often you can get the effect, especially if you use the technique that I teach by being very selective about where you put it. You can often get the effect of two or three syringes of the filler by using one syringe combined with the PRP and get a better effect. Oh the other hand, someone comes to me … It does happen, especially in women over 50, in almost always in women over 60, if they have face that hasn’t been taken care of by a cosmetic physician, I will need two syringes. Seldom, I’ll need three for one treatment, but I will often need two. In that case, I will tell them before I start, “You have this, and this, and this.” I show them in the mirror. In your case, if they go really full correction, I would probably need another syringe of Juvederm and that’ll be an extra, and I charge the extra $500.
The Vampire facelift includes what we know how to do with PRP and one syringe of Juvederm, and anything extra, I charge them extra and I agree on the front end. Now, if they’re not ready for that, then I say, “It’s going to be beautiful. You’re going to look younger with one syringe,” but I’ll go for a fully correcting … I won’t partially correct so let’s say that they have … They need a whole syringe just for cheeks, I’ll use that syringe to get correction of the cheeks and then do what I can with the PRP down below. I’ll say, “Okay, I’m going to do … I’m going to get things in order up here, but you’ll probably want another syringe down around your mouth. If that’s not in the budget today, you’re going to look younger. You’re going to still look natural. Let’s do this, then come back and hit me up another month or two and we’ll put another syringe down below. Who knows, maybe you might like it well enough the way it is.”
That’s how I approach it from a business standpoint. Absolutely. Now on the other hand, I will often give people one syringe less than what I think they need. If they live close to me, because I have found people actually appreciate me under treating them, then I get them in the habit of just coming to see me. Often times, they’ll wind up liking what I did so well they don’t want the extra syringe and then they’re happy I didn’t sell it to them. It keeps them natural. If someone lives far away and they come back to see me again, it’s going to be an airplane trip, then I’ll go ahead and do whatever they need.
Did that answer all your questions? Seemed like there was another one. Was there another question you asked me?
Speaker 2: Yeah. Based on a lot of my practice … This isn’t a big one, but my BLT I have in a petroleum base. Do you … I’m sure on the face and any place else that’s fine, but maybe would that be a challenge for the either O-shot or P-shot, I suppose, just in clean up afterwards maybe? It’s as effective or do you have theory on that at all, or a thought? Does it matter? Does the cream typically breaks down it seems like?
Charles Runels: What breaks down? Your cream or the one I recommend?
Speaker 2: The BLT cream that I got. It just … I guess, separates, I guess is the best …
Charles Runels: Here’s the thing, when I talk to people about their cream it’s really funny. Everybody’s into … Everybody loves their cream. They all think they have the best cream. It’s really funny to me. I don’t understand that, but it’s true.
When I tell people I think when a cream is better than their cream it always reminds me of back in school when you’d say, “My big brother can beat up your big brother, and your mother wears army boots.” Think the joke’s, “My cream is better than your cream.”
The bottom line is use what works for you. Whatever cream that you use, they need to wash it off when they get home. That’s what I tell people. Go sit in a tub, wash that stuff off and have sex. That’s my after procedure instructions. Sometimes, they have amazing sex that they, just from the stimulation of … Think about when you have PRP … Excuse me, when you have a injury and you have this throbbing sensation where you’ve been scraped or whatever. All those nasal dilators and cytokines, now you translate that to periurethral space and the clitoris, you could have anything from mild dysuria to crazy, fun orgasms. That’s how, people. Go try it out for a date.
A little bit … Good thing about the cream, though … We always have baby wipes and panty liners. It is a shot and people always drip a little bit, just like we get shots in the mouth or something that could be bleeding. We do panty liners, baby wipes, and my nurse stays back there. They have girl talk and they get her all situated, my nurse back there with her, after the procedure to tell her she could have some bleeding.
The other thing, though, is that I do think my cream’s the best and your mother wears army boots. I mean, really your mother probably doesn’t wear army boots, but I do think my cream is the best. They don’t pay me to say that. I really think they give probably …
Often times the service is aggravating, but it’s adequate. When I take that cream around and I teach with it, people tell me over and over again when I use it on their mouth, when I do the facial procedures, they’ll say, “OMG! Yeah, this is crazy! My mouth is already numb. This works better.” There’s something that’s not just … This is important, it’s not just they percentage of Benzocaine, Lidocaine, Tetracaine, it’s the carrier as you know. Whatever, however they make that stuff that we’ve got, it’s absorbed well, it’s not too runny, it’s not too pasty. Occasion, they’ll be a little irritated by it when you use it in the vagina, but not often. Yeah, my cream’s the best and your mother wears army boots.
Speaker 2: All right. Then just last, I know on one of the videos I saw if somebody has to have a second shot, I do have … What would be … If it’s not working at all, they get zero. Nothing from an O-shot. Their hormones are within check. I mean, I went through everything. They eat relatively healthy, 50 years old, no pain, just wanted to give it a whirl and got nothing.
Charles Runels: Okay, so I’m going to give you an answer and then I want to show you something too. This is really, really important.
Speaker 2: That’s my last question.
Charles Runels: I’ll ask four questions. I’m going to put this recording … This is so smart. We’ve never met. Sylvia trained you, huh?
Speaker 2: Yes, it was awesome. She did such a fabulous job.
Charles Runels: Well, I’m so glad. I love it. This is what I’ve noticed, that people who do the best with our procedures call us. I don’t know if it’s a-
Speaker 2: Well, and that’s just the thing. I’m telling everybody that’ll listen to me, I just have seen so many fabulous results. I mean, I haven’t done … Maybe a hand full of the O-shots, but the face, I just … The before and after’s I have … I don’t over-promise, I’m very conservative injector. I can’t speak to anything that I wouldn’t do to myself or family, just my clients trust me. I just want to make sure I’m giving them the best information, consistent information, just for continuity of care. They might seem like little questions, but I just wanted to make sure. I just … I don’t want to say it’s a miracle, but it’s pretty darn close.
Charles Runels: Well, they’re smart questions and as I was saying, the people who do well with us … When I mean, “well,” I mean they make a profit and they have [inaudible 21:52] patients who love what they do. Those people always ask me questions. They call. They call my staff, they call me. When I have three full time business consultants, they work the phone all day long. They’re on the phone asking this question so don’t … I want you to not hesitate to call back.
The people who do well, they might call us half a dozen times. Okay? As we do questions like this, this is what I’m about to show you. As I do answer questions and they answer questions, we are putting a lot of things online. I want to show specifically a video that I made, just for the last question that you asked which was what to do if that first … Or if you have one that doesn’t work and I think I’m over [inaudible 22:38] one. Hold on a second. I want to show you.
Speaker 2: Yeah, the first … Oh, that’s great. I didn’t look, peruse this area. The first shot, I did not give her, the second one I did. She was embarrassed to go back to the first gall.
Charles Runels: This is what I was going [crosstalk 22:56]. I want you to see where I am because other people’s going to watch this video. This is how to do it. This is our survey. When you put five people in the survey, I put a center of excellence badge by your name on the directory. It does make the phone ring more.
Here’s where you, there’s a blog where you guys can talk to each other and ask questions. Often times, you will find your question there. Here’s webinars that I had done where a lot of the common questions are covered like this. This is where I’m going to put the video we’re doing now, right here because this is where I tell people to go. I’m not saying that every question will be there, but often times they are. Here, “What to do if my first O-shot patient doe not get better.”
Well, it could also [crosstalk 23:41] second, third, or fourth, but that’s the question about how to deal with it, how to deal with the money part of it, how to deal with the whole situation because it is … It depends on who we’re talking to, which provider, because some are more … I think they become more skilled, they become more selective, intuitive about who they can help and who they can’t.
When I survey all of our providers across the board, the hard problems and the easy problems, they get about 60% of the patients amazingly love it. That includes the hard stuff after the first shot and 85% after the second one.
Well, antibiotics were hospital acquired pneumonia, that fails 20% of the time. [inaudible 24:27] appear in the hospital with your pneumonia, you have a 20% mortality rate. We are still … Even if it’s only 80% effective, we’re still doing amazingly well because we’re treating hard to treat problems. You realize the people that pay us cash are people who have not gotten well with their gynecologist or their family practitioner that, that insurance pays for. We’re taking their hard patients. We’re taking the hard patients and getting them well 60% the first time and 85% after the second shot. That’s across the board.
If you look at the easy stuff, like urinary incontinence in a woman that’s 35 to 55 with good pellicle integrity, we’re probably 85% on the first go around, but that still leaves room … There are still people who do not get well. I’m glad you asked the question because they don’t always get better and I have a way of handling that. My bottom …
I want you to watch this video because I don’t want this one to go on much longer and I’ve already covered it here in great detail. I want you to get used to going here and asking questions. You can see people are commenting about stuff. They’re posting here. Also, if you see Recent Post … There, you see here I’ve put something, “Why you should always offer a money-back guarantee.” That relates to what we’re doing. I talk here about Amnion. I have a other question. There’s a lot … There’s more than you can watch in a day.
You can also … You don’t want to spend your … Make a hobby out of being on this website. A good way to find what you’re looking for is to … There’s a search bar in here somewhere and you can actually search by topic and it’ll pull it. Where is it? Right there. See that little search bar?
Speaker 2: Yeah.
Charles Runels: You can put the topic in and it’ll pull up all the posts, all the videos, everything and will help you answer that question.
Here’s the basic principle, then we’ll let you go. The basic principle is I’m going to make my people happy. When I do this shot, I tell them. I tell them flat out. I mean, almost without exception. It’s probably without exception, but I know it’s pretty close to 100%. As I’m leaving the room, I will have a very serious look on my face because I want them to know I mean it. I will say, “I want you to love this procedure. You paid good money for this. You can’t just sort of like it, you have to love it. If you don’t love it, I want to know about it. I want you to tell me so that I can make it right and we will either repeat it or if you want to give up, I’ll just give you your money back, but I want you to love it or I don’t want to keep your [inaudible 27:07].” I’ll tell them that very, very passionately.
Now, your patients … The good patients don’t want the money, they want to get well. If people were dishonest, Walmart would be broke because they have 100% back on everything. People are most important, not dishonest. Occasionally, somebody will steal from you. You’ll know it, it’s the way of the world. You just let them go, give them their money back and you move on. Most people, you will get well and most people will want you to keep the money because you got them well.
When I see people … Not see people, but when I get emails from people who are angry, who sold them our providers, it’s often because they didn’t get results. A lot of times they never even let the doctor know they didn’t get results. I open that window because I want to know so I could try to make it right. Maybe it’s another O-shot, maybe it’s I need to send them to a sex therapist, or look at their hormones again, but if they know that I want to know and they’ll participate with and that’s how I go.
Now, I put more details about that and how I handle the money part of it on this page right here. As far as I know, since I went all cash in 2003, I don’t have anybody’s money who’s not happy with what I did. Okay?
Speaker 2: Okay.
Charles Runels: Although, I do have a negative comment on my Gmail … Excuse me, my Google Office where one of our providers kept somebody’s money and they’re so angry, they went and bashed me.
Speaker 2: Oh no!
Charles Runels: I can handle bashing, it’s okay, but what I don’t like is that there’s an angry person out there. I don’t really give a rip about the bashing, but the fact that somebody would … Got treated by one of our people … I think often times it’s not one of our people, but if it was one of our people and then that person kept their money and the guy didn’t get well, or woman didn’t get well, it’s not good. No reason for that.
Speaker 2: Right.
Charles Runels: [crosstalk 29:12]-
Speaker 2: Thank you for your time.
Charles Runels: Okay. Thank you for amazing questions. I’m going to post this to one of the websites. Keep me posted and let me know if I can help anymore.
Speaker 2: Sounds good. Thank you very much. Bye, bye.
Charles Runels: Okay. Bye, bye.
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Charles Runels, MD
Cellular Medicine Association