It’s True! The P-Shot® Helps Men with Erectile Dysfunction
News provided by
Cellular Medicine Association
June 14, 2021
FAIRHOPE, AL, June 14, 2021 /PRNewswire/ — Sixty men volunteered to have their penis injected with their own blood by eight urologists from Aristotle University in Greece; the results—a double-blind, randomized, placebo-controlled clinical trial published in the May 2021 issue of the Journal of Sexual Medicine—showed that “Platelet-Rich Plasma (PRP) Improves Erectile Function.” More than two-thirds of the men who had their penis injected were pleased with the improvement in their erection and there were zero complications from the procedure. During the study, the sixty men who participated were not allowed to use any other treatments to improve erections.
Dr. Charles Runels (the inventor of the procedure, which is called the Priapus Shot® or P-Shot®) said, “It’s been a long decade with much resistance, but I’m hoping this new study helps more physicians recognize the potential benefits of the P-Shot® procedure.”
On September 12, 2010, Dr. Charles Runels registered his Priapus Shot® (P-Shot®) with the US Patent and Trademark office—announcing that he had found a way to inject platelet rich plasma into the penis to improve the health and function. Since then, multiple studies have been conducted and have shown benefit; but, adoption by urologists has been slow.
“We needed this study.
We needed this study. I’m a community physician with a small office who just happened to be blessed with the discovery of this therapy more than a decade ago. We have amazing and brilliant providers in multiple universities; but, even they have trouble securing financing for research since the procedure involves the patient’s own blood—there’s no drug, and so there’s no pharmaceutical company to finance the research. If this were a drug, you would see commercials about it on every televised football game—it’s that effective. Until now, surgery and prescription medicines have been the first choice of most urologists and family practitioners; with this procedure, there is not a drug to buy or sell and there’s no surgery. I’m grateful these brilliant physicians from Greece have strengthened the evidence that the P-Shot® should be considered along with the current therapies. Nothing goes away, but this important option should no longer be ignored” said Dr. Runels.
Dr. Runels also invented the Vampire Facelift® in 2010 and used his observations from that procedure to design the P-Shot® procedure and the O-Shot® procedure—all of which use PRP: which is known to improve the circulation, nerve conduction, and collagen production and so to improve the health of tissue in over thirteen thousand research papers in multiple tissue types.
“Though these brilliant researchers helped prove the concept of the P-Shot®, their research protocol had to be kept simple to improve the clarity of the conclusions; their published protocol does not include all of the components of the P-Shot® procedure,” said Dr. Runels
All of those physicians and nurse practitioners who are licensed to perform the P-Shot® procedure (in 55 countries) will be found at PriapusShot.com. Providers not listed there may be performing an inferior procedure or doing the procedure illegally. Dr. Runels and his colleagues of the Cellular Medicine Association, conduct and consult regarding research in the areas of esthetics, erectile dysfunction, urinary incontinence, orgasmic dysfunction, lichen sclerosus, & the treatment of scaring using blood-derived growth factors.
“Please beware, serious problems have happened when patients have undergone what was advertised as one of our procedures (Vampire Facelift®, Vampire Facial®, O-Shot®, or P-Shot®) from unlicensed providers who did not follow the protocols of the CMA,” said Dr. Runels.
Charles Runels, MD
Cellular Medicine Association
SOURCE Cellular Medicine Association
Topics Discussed Include the Following…
*Penile Rehabilitation post prostate surgery
*Shock Wave Therapy
*Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout
*Peyronie’s disease treatments
*Priapus Shot® (P-Shot®)
*Safety in the Office with COVID
*O-Shot® for Urinary Incontinence
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
About two years ago, I was teaching a workshop at my class and a urologist was there, who was head of the department at a prominent hospital/university. And in the process of talking about some of the procedures and some of the ideas in the group, I mentioned Dr. George Ibrahim. And when I did, the response I got was like I was talking about, I don’t know, St. Peter or [inaudible 00:00:51] or something.
So, our guest today, Dr. Ibrahim, has a lot of respect. He was teaching urologist at Duke for quite a time and then opened a private practice. Like all of us, he was in the fire, paid his dues, and then none of us want to stop. And so he’s built up multiple located … I think he has two locations now where he does our procedures and continues to teach for us. But it’s really been interesting to learn from him because the combination of his ideas about urology and combined with his ideas about our procedures have been unique and helpful. So I think without any further delay, let me just pull him onto the call so he can answer some of the questions that have come up and talk about some of the ideas that have occurred to him during his work. So let me just get him on the call right now.
Fine. Hello Charles.
There you are. Yes. Thank you again for being on our call today. Lots of people are on the call. I put out a sort of a teaser, let people know that you would be here. So, quite a crowd today. And a backlog of questions from people about things that I want your opinion about. Just so you guys know, Dr. Ibrahim and I spoke briefly yesterday, but most of the stuff that I’ll be asking, I’ll be as curious as anybody about what his thinking is. We haven’t had an in-depth discussion for a while. So, why don’t we just start off with the list I have here of topics that occurred to you that might be helpful. George teaches for us. And so he’s alert to the problems and the challenges that come when you introduce these procedures to your practice as well as to the science and the discussion that’s going on in the medical literature and among our group.
So, I have this list of potential topics. You can just start wherever you want, and I know everyone will be interested in your ideas. I can list them all for you if you want. The first thing I had here was dyspareunia, if you want to start with that one, because it’s such a hard problem. To me, that’s the worst of the sexual dysfunctions for women because they can fake arousal or even accommodate lovingly without a high sex drive. And an orgasm sometimes is not necessary. Women with pain will start to avoid their lovers. So let’s start with that one since that’s such a tough one
Well, Charles, thank you too so much for your introduction. I do appreciate you give me a chance to be here with you. This is an honor, and I hope we can make everybody’s time worthwhile. So to get straight to your topic, I really think that without addressing a female’s hormonal balance at that time of her age, you’re not going to make much headway. Borrowing a history of breast cancer that’s ER positive, there’s really no reason to not optimize the female’s hormones, everything from the lubrication that it brings to bring it back, the vaginal walls and helping with the tissue paper aspect that you see once a woman goes through menopause. These are the kinds of things that I really think, unless you’re going to be able to do that, you’re going to have a hard time.
I do think that the O-Shot can help, but unless she’s got some [ } on board, and that can be done topically and regionally. It doesn’t have to be done systemically, but I think that’s one of the first thing that at least that’s what I always tell one of these kinds of women that have suffered from this problem.
Yeah. I like to stress to people that so far in spite of several years of campaigning for it, I like to stress to people that it’s really all we’re doing, these [PRP/cellular] procedures, is just making that local tissue healthier, but there’s so many other parts involved in the sexual response from the spinal cord, to the psychology of our thoughts, to the hormonal [inaudible 00:05:24] you that has to do. Without hormones, we can’t even make collagen or have blood flow. Hormones make our heart pump. So, there’s this system, and I’ve been campaigning that we talk in systems analysis the way we talk about a neurological system and a cardiovascular system. And the reproductive system is not the same as the orgasm system or the sexual response system. So, stressing that to our patients so we’re not over promising them a magic shot, but helping them, although it can be like magic sometimes, but helping them understand there’s this whole system we have to think about.
Absolutely. And with testosterone going to zero in almost every one of the menopausal women I see are almost undetectable. There’s no way that there’s going to be any desire or lost. And while you might be able to help with the lubrication, without that mental stimulation or desire, it’s not going to be a fun experience. It might not be painful anymore, but it’s hardly enjoyable from what I hear from my patients.
So talk to us about how you think about, so you first start with optimizing their hormonal status. And there’s so many … The diagnosis, I’m almost regretting now starting with this because the diagnosis of dyspareunia is so complicated. But, maybe a fairly quick overview of how you think about that diagnosis, everything from dryness with breast cancer to surgical problems, so that maybe at least give an outline for the people on the call.
I think that the biggest part of the pain that a woman [inaudible 00:07:06] has and comes to fear when it comes to sex after menopause, is that the vaginal epithelium has become so atrophic. And without a nice beefy, robust, lubricated, thicker vaginal wall, so the vaginal walls, any kind of sex is going to be painful. And that’s where I’m going with it all.
Okay. So when you do your procedure with the O-Shot, because you know you can have the dryness for breast cancer or you can have a pelvic floor tenderness, you can have an episiotomy that’s tearing, not mentioning the things like ovarian cyst and uterine fibroids, but the things that we can address with an O-Shot, can you talk how you might vary the how you do the procedure with a woman who has tenderness that it’s in a particular spot versus just overall dyspareunia from say dryness?
What I’ll typically do, if she is in menopause and she has been away from any kind of estrogen production for a few years, I’ll try to see if she’s against doing systemic hormones to see if she would do around about three to four weeks of topical extra dial. A lot of folks like to use a combination of estriol and estradial. I think estradiol is much more powerful, but I try to get them to do about three to four weeks prior to doing an O-Shot, telling them that it’s going to make, the O-Shot’s ability to repair tissue and strength the things and all the magic that the O-Shot does, a lot more [inaudible 00:08:49] better blood flow in the face of the O-Shot if she can do some estrogen for a while ahead of time. So I’ll try to get you to do that for about a month. And then I’ll go ahead and do the O-Shot.
And oftentimes, especially in women that have been in menopause without being on estrogen, I will oftentimes warn them ahead of time, “Look, we’re going to see some results from one. It might be phenomenal, but don’t hold off on doing a second one within two to three months after the first one to augment the effect of the first one.” Especially, again, if she’s not been doing estrogen.
Okay. So, I know you have an upcoming class and I want to put this in the chat box so you guys will have access to it before I forget to do this. And Dr. Ibrahim, as I mentioned, was a highly respected teacher of surgical procedures. And I’ve seen him teach there in his office. And he’s patient and articulate and cordial and inspiring. So I highly recommend his class if you’re looking for some hands-on work. And he’s squeezed it into one day by leaving out the aesthetics part and focusing really heavily on the sexual medicine for both men and women.
I know this, in your course, you’ll talk some about radio-frequency and laser technologies. And I actually got a question today about Emsella. Maybe just expand upon your ideas about things to do along with when it comes to the machines. Because I know people are either have them or contemplating them. So radio-frequency, laser and magnets, could you talk about how you work those into your protocols?
Absolutely. And before I do that, I’m going to put the plug in for the workshop. It’s going to be March the fourth. We’ll just squeeze everything into one day. Fortunately, I’ve had COVID and my first vaccine, so has my physician’s assistant, and the majority of my staff. But, we’re going to do what we have to do. That all being said, I do use enhancement. Patients are given the option. Some patients only want to get another shot or a Priapus Shot®. Some have heard about some of these other methods. I’m not here to do a commercial for any particular device.
Combining Shock Wave with the P-Shot® Procedure (timing)
I chose a laser over radio-frequency but I’ve seen both of them were great. I just chose not to have two devices that accomplish basically the same thing. So, I use a laser, but I’ve no … It’s done essentially the exact same way as radio frequency. And I use that often when I’m doing my O-Shots. And then with men, even if they don’t want to sign up for an acoustic wave treatment series, are pretty much always we’ll do some acoustic wave treatment just prior to injecting them for their P-Shot because I think that the [inaudible 00:12:04] trauma that we’re producing and increasing the blood flow from that acoustic wave treatment absolutely helps keep the PRP in place and excite the growth factors to do the jobs that we’re hoping that they’re going to do.
That all being said, my staff loves doing these workshops. And we’ve missed it for all the travel restrictions this past year. And so we’re itching to get back in it because they have fun doing it. They love seeing me teach because I know that’s where I used to do it. You may say I’m always my most excited and happiest when I get to teach. And so it’s always a fun event.
Beautiful. Yeah. So if you guys are interested in that, click the link now because the link goes away when the webinar’s over and then you’ll have that page open. So, you will sometimes do a shockwave therapy at least briefly, even if they haven’t asked for it, just prior to a P-Shot. Let’s say that they go for it and they say, “Money’s not an object, I live down the street, Tom’s not a problem,” what would be your Cadillac treatment for a man with, let’s start with Peyronie’s disease, what would be your protocol?
Because here’s the thing, I get the questions all the time. We’re still working on getting enough research out there. We have some. People act like we have none, sometimes our critics. We actually have a pretty good list of papers now over the past five or 10 years, talking about our stuff. I’ll just give you the list for the Priapus Shot. And it’s not a thousand papers, but that’s a pretty impressive, I don’t know, it’s probably 20 papers out there talking about PRP in the penis now. But there isn’t this goal [inaudible 00:13:52]. It’s like if you run a 100 yard dash, you know when the race is over. But the effort to convince our colleagues that PRP is a viable option where it becomes standard of care for every urologist and every family practitioners treating Peyronie’s erectile dysfunction, there’s no discreet line that’s, okay, now we all start to do this.
Combination Therapies for Peyronie’s Disease
So, even more so if you start combining, okay, what’s the best algorithm if you’re going to combine it with shockwave. And there isn’t no published study that says, “This is the best, and this is what the recipe should be.” So when I get those questions, I’m always curious to what your protocol would be for someone with unlimited funds, unlimited time, how would you treat Peyronie’s?
That’s a great question. And I’m thrilled that you told people we all have different recipes for cooking a pound cake, basically. Because the science isn’t out there and I’ll give you my rationale reasoning for doing it. They’re offered the choice off easily. Again, just the Priapus Shot® or the acoustic wave treatment combined with a Priapus Shot®, when they choose the combination, which the vast majority do. Part of that, the reason is we make it much more attractive for them to do it as a package financially. But more importantly, I know that we’re going to see a better end result, have a happier patient. And I’ve said this, especially in my aesthetics practice, nobody is ever upset by spending more than they plan to spend if they get a better result than they thought they were going to get.
And so with that in mind, and just assuming they’re planning on doing both acoustic wave and the Priapus Shot® at the same time, for Peyronie’s, right off the bat, tell them this is not going to be a one and done situation. “Peyronie’s, Mr. Jones, that’s going to be something that we’re looking at. I want you to be scheduled for at least two of the Priapus Shot®.” Again, there’s the financial incentive that it’s not two times one cost. And I will typically start by doing the acoustic wave treatment. And I identified the plaque for our medical assistants who are the ones who deliver the acoustic wave treatments. And they’ve been very, very well-trained because my grasp of the penile anatomy and everything. But I have them concentrate a lot of the acoustic energy on the plaque itself.
And typically, we’ll have them do three acoustic wave treatments in a row. Mostly depending on how far away they live, typically a week apart. And when they come back to their third or their fourth acoustic wave treatment, right after they’ve had the acoustic wave treatment, I’ll do the Priapus Shot®. And just if people are taking notes, men who have acoustic wave treatments do not need to be numbed, but if I’m going to be doing a Priapus Shot®, I’ll go ahead and place my penile block before they do the acoustic wave for one reason, impatient. This guarantees that the guy sat around for at least 20 minutes letting the block sink. Number two, if I missed one of the nerves, they’re able to tell the medical assistant, “My right side of my penis is completely numb but I can still feel it on the left, and she lets me know when I come back in there and augment it.”
So I’ll do the first Priapus Shot® in the middle of the acoustic wave treatment. And then I’ll do the last or the second Priapus Shot® following the same day of the final acoustic wave treatment and then see how they go from there, telling them ahead of time, we’re probably going to have to do some kind of maintenance afterwards, meaning maybe one acoustic wave treatment a month and maybe a Priapus Shot® once or twice a year, depending on how they are or what kind of results that they get from their Peyronie’s. And one more thing before I go much further. This is one of the times where I’m very insistent on the penile pump or the vacuum erection device.
[crosstalk 00:18:10]. That was my question.
Penis Pump Tips
Yes. Okay. We have templates that every patient gets, and it has a video and it has their instructions because they’re going to forget 90% of what you tell them in the office. But the first line of the penile pump instruction is, this is frustrating. You’re going to feel like you need a third hand to hold down your scrotum while you hold the cylinder and the other hand holds the pump. You’re going to figure it out. But I always try to teach them how to use the pump. At the initial conversation, set the time that they show up for their [inaudible 00:18:46] wave treatment and a P-Shot, they have already used the pump. The last thing I want them to do is to go home after a Priapus Shot®, I’m not going to let them do it while they’re still numb. So then the next day they try to do it and if it’s the first time they’ve done it, they’re going to be a little sore. And so it’s much better to teach the guy how to use the pump and become proficient in it before you start your other treatments.
Let me just jump in with a couple of amens here. First of all, I want those of you who haven’t seen this, I want you to see that there is a study from the British Journal of Urology that’s been out now for a decade that shows that people who had scheduled surgery for Peyronie’s disease, 51% of them canceled it with a pump alone. And so you’ve got some science to back that up, but there is some frustration with the pump. And George is the first that I’ve heard come up with a great idea that’s like a lot of great ideas, simple after someone thinks of it, is that oftentimes the complaints people have as side effects from the Priapus Shot, they’re really blaming the side effects of the Priapus Shot on their misunderstanding of the pump. So having them do that for a week or two or some amount of time before they get the shot helps them sort that out and less likely to think that the procedure went wrong. And that’s how you’ve done it for a while, right?
Absolutely. And ever since we started doing this way, the number of callbacks, I don’t like using the word complaints, concerns has dropped dramatically. Because there’s rarely a concern after a Priapus Shot®, but the pump, if they don’t use it correctly, they over … I literally take a black sharpie and mark out a good portion of the dial and say, “There’s no reason to ever go past this line.” You don’t even have to go all the way to this line, but don’t ever go pass it because some guys would think, “Well, if one’s better, then four must be even much better.” And they would overpump and then it would not be good.
Yep. So, another, Dr. Ibrahim, on the call. I’m going to unmute him. He has a question. Actually, I’ve got a pretty good line of questions here. So, let me see, where do you get … Here we go. Dr. Ibrahim, you’re unmuted. If you want to go ahead and just ask your question. I can read it if you don’t have your mic on.
Okay. The only questions I see are links. So I don’t know what kind of question [inaudible 00:21:41].
Well, I can read it to you. I’ll just read it out. It looks like maybe his mic is not working. He just wants to know the ideal candidate for the P-Shot, what medicines are you giving after the shot like you putting on daily Cialis or something, any over-the-counter things you’re doing? I think that’s it. So medicines afterward, over-the-counter things, and what’s your ideal candidate for the procedure?
I don’t mean this flippantly, but I think all of us, we all know if you start with a really good canvas, you’re going to be able to get a nice painting. The ideal candidate is the guy who barely needs half [inaudible 00:22:21], I’m assuming, the P-Shot. Somebody who’s got great vasculature, good blood flow, great neurologic issues going on, they’re not smoking, they’re not overweight. But that’s not reality really, but that’s the ideal candidate, is the one that he’s not up to the performance he was at 22 but he’s still doing a good job. That’s the kind of guy I love seeing walk in the door because that’s going to be the home run.
The much older guy, the 78, six, year old man with history of renal problems, terrible Batchelor disease, diabetes, [inaudible 00:23:01] and all that. As far as over-the-counter stuff, and that is not what I give them, it’s what I tell them not to do. We have another handout telling them no [inaudible 00:23:15] and we list as many as we can because people don’t know that Excedrin is aspirin. And telling them, none of those for a week ahead of time. And for at least a week, if not more, after we do the procedure.
As far as a low dose daily Cialis … Now that the PD5 drugs are generic basically, it’s a lot easier to tell somebody to do it. I typically ask them right off the bat, have they ever tried one of the other or any of them? And a good many will say, “Yeah, I tried Viagra and I couldn’t stand the headache, but Cialis tended to not work as well, but I didn’t have the … I was [inaudible 00:24:02],” or vice versa. And I will write for some [trockies 00:24:08] just because that’s what I got used to back when these drugs were not completely generic and you couldn’t really write for pill form and get away with it. So I do have trockies that have either and/or Cialis or sildenafil in them, that I will tell them, “This could help you with everything that’s going on here.” And the biggest part of that is helping to increase blood flow. And I do tell them, especially in the beginning, it’s not a homework assignment they have to do, or they can tell their wives, “Yeah, it’s a homework [inaudible 00:24:40].” They must do but I wanted to have as many erections as possible after a Priapus Shot® as they can have to stimulate the blood flow.
Yeah. That’s my aftercare instructions too, go home and have sex. Let me just quickly rattle off what I tell people the easy and hard cases and you expand on it, correct it, a different opinion, whatever. This is not a place for everybody just to try to agree. We’re swapping ideas. I tell people, “Avoid the person that a thousand or a million times zero is still zero.” So I tell people, “Avoid treating or at least make it a small percentage of your treatment, so you don’t get to discourage, the person who can they do Viagra or they do TriMix and just nothing happens. They never get in the morning erection, they’ve had diabetes for 20 years because they probably have vascular disease all the way, iliacs to the heart, aorta, whatever. So, and all we’re doing is treating the penis.
Who NOT to Treat with the Priapus Shot® Procedure
Although I have heard people say they get great results with some of these patients, keep them to a minimum so you don’t get discouraged. And if that’s your first three patients with a P-Shot, you’re going to be discouraged. I try to avoid the person whose main goal in life is to grow their penis to some significant amount more than what GOD gave them, because it’s hard to make that person happy. I want the person who has Peyronie’s … The thing is our easy list is still everybody else’s hard list. I want the person who has Peyronie’s because I have a high success rate. I want the guy who had prostate surgery, who’s now been dismissed by the surgeon. Here’s where I really want you to help refine my ideas or correct them or expand them.
I want the guy who’s had prostate surgery, who had erections before the surgery, who’s now been dismissed by the surgeon and he’s not happy with what’s going on. And then add in the P-Shot to the usual penile rehabilitation of a pump and daily Cialis. And I want the guy who’s got an erection, but it ain’t what they used to be, but he’s got something. He takes Viagra. He takes TriMix or he’s trying to avoid getting started on it. And then with that person, I’m going to be able to maybe cut the dose in half. He’s okay if his penis gets a little bigger, but it’s not his main primary goal in life. Expand on that, especially the penile rehabilitation, where would you correct me or expand upon what I just said?
[inaudible 00:27:12] I’m going to start with the first thing you said about … The example I used with my staff, and not necessarily in front of the patient, but they get the idea of why I don’t take that patient home. The patient that walks in and they’re so excited to see me, “I’ve heard so much about you Dr. Ibrahim, nobody’s ever been able to help me with this. I’ve been to so many different dah, dah, dah, and nothing’s ever worked.” And I’m thinking to myself, “And you just met the next doctor that’s probably not going to work [inaudible 00:27:39].” And I’ll listen, but nine times out of 10, it might be somebody I choose not to take or I start from the very beginning with all the, I can give you no guarantees, dah, dah, dah, kind of deal.
The thing about size, I do feel that there’s too many folks that, I don’t want to say members of our club, but I’ve seen too many other providers that offer the Priapus Shot®. And the biggest thing on their website is how we’re going to magically increase the size of your penis instantly. And I let patients know when they’re coming to see me, I go, “You’ll notice I don’t make any mention on my website about increase in size whatsoever.” I go, “We might see an increase in flaccid size. We both know that there can be an increase in both erection and flaccid sizes, but I never use that, is, “That’s why I’m glad you came to see me. I want to help you gain more size.” [crosstalk 00:28:46] If it happens, I tell him, “We’re both going to be excited, but that’s not how I’m going to measure your success. We’re going to the prostate surgery.”
The P-Shot® after Prostate Surgery
Absolutely. I was a big prostate cancer urologist, but that was my forte. And I didn’t do it at the time. But if I was dropped back where I was teaching prostatectomies, men would go home with a penile pump for no other reason, to continue to get more blood flow because they’ll stop having those nocturnal erections a lot of times because of the damage to the nerves. Even when the nerves are spared, it’s going to take some time for them to fully recover. And a lot of times they’ll never recover because as I was taught way back when, when we didn’t do many nerve sparing, that the nerves are part of the prosthetic capsule and nerve sparing is cancer sparing.
So, today, especially with the robot, many more men are left with their neurological function intact. My biggest question I ask them at the beginning is, how has it been since your surgery? And if it’s anything less than six months, I go, “Okay, well, what I’m going to do for you is not going to hurt anything, but you might want to wait and see how you are at six months because you might get all your recovery back.” But the question is, do you get any kind of blood flow when aroused? And if they’re like, “Yeah, but it’s just [inaudible 00:30:19]. It’s not hard enough.” I go, “Okay. All right, good. I can work with that.”
But if the answer is nothing, then I tell them, “Okay, well, I’m going to be able to help you. There’s no question.” And by that, I’m not telling them yet because they don’t want to hear about injections, but I’m thinking in my head, “All right, I’ve always got TriMix in my bag.” But if the [pitch knob 00:30:40] doesn’t work or depending on what other kinds of [inaudible 00:30:46] they might have going on, I might just say, “Let’s just help you out and get right down to the business. And let me show you how to do these injections.”
Yep. Okay. All right. Let’s see. My thing’s blowing up with questions here. I’m just going to look. Let’s see if Sarah’s microphone will work. She’s got three or four questions. If not, I can read the questions to you. Sarah, are you there? Okay. All right. Let me just read her questions. So do you have the patient pump the same day as the shot or have them wait until the next day?
Hey, [inaudible 00:31:25], can you hear me now?
Yeah. Go for it.
Great. So, one is, how much time-
Where are you Sarah? Just got a hell of a snow a little bit.
I’m in Denver. And Dr. Ibrahim and I were in a shockwave treatment or shockwave treatment together. I don’t know if you remember Dr. Ibrahim. Sat next to you. Anywho, my question was, when you do the P-Shots in the middle of your shockwave therapy, how much time after the P-Shot before resuming shockwave treatments. It seems like the protocol has changed over the years.
And I do remember that workshop. So, nice to hear from you again.
So I heard a couple of different questions. One was, sounded like, when do we resume pumping after the P-Shot and then what was the one about … What did you say about the GAINSWave [inaudible 00:32:24]?
Do you have them take any time off after your first P-Shot prior to resuming your shockwave treatments?
Okay, good. I’m glad you asked that. I don’t. So if they’re set up for their acoustic wave every week and I do their acoustic wave treatment on the Wednesday that they’re coming in normally and I do their Priapus Shot® that same Wednesday that they’re scheduled to get both of them, the following Wednesday, a week later, they go ahead and they get their acoustic wave treatment. If it was two days earlier-
Okay. Thank you. [crosstalk 00:33:02] the function of the P-Shot to have that trauma, that soon after huh?
Well, typically because I’m doing the first of the Priapus Shots during the acoustic wave series of 56. That first one, I typically would do right in the middle of the series at number three or four. And then I don’t do the final one until after their last treatment.
Right. Okay. And do you do your shockwave treatment first and then the P-Shot after that on that third session?
Yes. I do the acoustic wave first with my rationale being that [inaudible 00:33:45] what trauma that we might be causing helps the Priapus Shot and its growth factors stay around the area and focus on the parts of the penis that we want to rehab.
Okay. Completely agree. In that same training that we went to in Florida for GAINSWave, at that time, they were saying, wait four to six weeks after that first P-Shot before resuming treatment. But, you don’t think that’s necessary before resuming shockwave treatment.
Correct. And I don’t have any literature to support what I’m saying. And I can’t imagine they’ve got any literature.
I don’t think they do [crosstalk 00:34:26].
I know that the results that I’ve had doing it the way that I described have been fantastic. And have I done hundreds of these doing the protocol that they showed us, I don’t know, it might’ve been just as good. But, I’m not going to mess around with what’s working for me. But, I’m an open mind. If somebody tells me that they have compared such durations and differences, I’m all ears.
Okay. And then regarding the second question about pumping, I [inaudible 00:35:01] Dr. Runels that you generally recommend, I think you would have them pump perhaps immediately after the P-Shot at the appointment and at that same GAINSWave treatment or training, they recommended differing pumping to the next day because of the potential of having some bleeding and that traumatizing the patient. What is your protocol, Dr. Ibrahim?
Okay. So when I learned it, when I was at Fairhope, we were pumping immediately afterwards. I’m doing a penile block on these guys now, so I don’t want them pumping until they’re not numb. Because, like we said, at the very beginning about the pump, one of its problems is the pump causing pain and bruising and issues. And if they’re totally numb, they don’t know what’s going on. I think, especially when I’ve done the acoustic wave prior to doing the Priapus Shot®, that there’s enough trauma now. And let’s just wait till the next day when they’re not numb to resume pumping.
Yeah. Interesting. I used to do the block and have completely for the last year, just continued that. I use a really good topical and the Pro-Knox and they do amazing. But, just throwing that in there.
In fact, I’d love for you to contact me and let me know the source of your topical, because as we all know, it’s not the lidocane or [inaudible 00:36:33] or benzocaine or whatever. It’s the base that makes the biggest difference in a lot of these pharmacies. That base is a closely guarded secret. I’ve got some great ones that work on the [inaudible 00:36:45] because I haven’t found a good one for the penis in your right. You might not have said it, but I’m thinking in my mind, “I’ve done thousands of penile blocks.” And the goal is to get near the nerve, but I’ve hit the nerve enough times to where I’ve caused some residual discomfort from doing the block.
I have too.
But I actually learned the technique from the block from you from one of your videos. And yeah, I’ve gone through many derivations because I do aesthetics as well for topical numbing. And I’ve just within the last year found one that I feel like is a home run. So I’m happy to share that with you. And then my last question is, are you injecting any exosomes versus PRP in the penis?
I am. And that’s a topic that that Dr. Runels and I left off, especially, some of the agenda. I do.
Great. I do as well. So I’d love to chat with you offline about that.
Wait a minute, I will say this out loud. I am a huge fan. A huge fan.
So, Sarah, just so you get an idea of what we’re thinking. There are things like the exosomes and STEM cells and things that I’m most afraid to pronounce out loud. And it has to be thought about in terms of, of course the way Dr. Ibrahim does in terms of where you are and who’s the person and what’s the powers that be is saying, and is there an IRB and all that. And so it’s the kind of thing that I like to keep those conversations less broadcast so that people don’t get the wrong idea and get in trouble by not following the same kind of guidelines that George is following. So, I think the best way to find out his ideas about that is to show up in his class. But I appreciate your questions very much. I’ve got a long list. I’m going to jump to the next person, but thank you for jumping on the call. Okay. Did I lose you?
Nope. Thank you so much.
How to Vary the Injection of P-Shot® When Treating Peyronie’s Disease
All right. All right. So another, I think his mic isn’t working, but we’ve got another question here from Dr. Eric [Byman 00:39:17] who says that he would like to know how … And this is a frequent question. I’m glad you asked this Eric. How do you vary the way you’re injecting your PRP when you do the P-Shot and how you’re doing, I think you touched on briefly, how you’re doing the shockwave when you’re treating Peyronie’s or do you?
Okay. For me, yes. All right. If I was not treating a plaque specifically, I would deliver almost all the PRP along the … Yeah, I do between three to five max sticks on both sides depending on the endowment. And then a little bit in the glands. I think the glanular part of the Priapus Shot is more for sensitivity because obviously the glands does not play any role whatsoever in erections. It does get a little bit more [inaudible 00:40:20] a little bit bigger, but that’s not where the meat is. When it comes to Peyronie’s, I’m going to take maybe a third of the entire amount of PRP that I have. I’ll split what’s left after that third to do this half injections. And then I will directly inject the plaque two to three to four times, depending on its size, directly with the PRP.
Okay. Thank you. So we have another question that I’ve never had before. A lot of these questions … By the way, I’m putting into the chat box the address of someone, let’s see, who is … Dr. Peter Metropolis just gave us the address and phone number for a pharmacy. Thank you, Peter. For someone who has a cream that he’s found to be helpful doing the Priapus Shots. So you guys might want to try that one. The question is, someone got a TriMix … Let me just see if I can unmute the person who asked this, because this is complicated. You may have follow-up questions. Okay. Dr. Lydia Dennis, let me unmute you because this is one I’ve never heard before. Dr. Dennis, there you go. You should be able to speak if your mic is turned on. If not, I can read this.
Okay. I’ll just read the question. Six year old guy with erectile dysfunction, previously on TriMix. I’m not sure what that means. But, was he on it when he came to your office or he stopped when he came to the office, but he was previously got a P-Shot on January the seventh. And two weeks later, says the TriMix no longer works. The penile pain, no pain or bruising after the P-Shot still having spontaneous morning erections. I don’t know how to explain that. My first guess is that maybe he’s overusing the pump and he’s waking up with an erection, but his TriMix isn’t working. I don’t know. Can you think of a way to explain that one?
Okay. I pulled my TriMix out of my refrigerator and I know it was fresh. And I ask him how many units he’s doing at home. If it’s an inordinate amount, I might not start with that. But I’ll then inject it myself [crosstalk 00:43:03]. Because they say they inject and gosh knows, are they doing it right, where are they doing it, and has that TriMix been sitting out for how long, how old is it? Always, that’s part of another handout that we have, letting people know that TriMix begins to lose its power both with time and temperature. So you might’ve kept it cold but if it’s four months old, it’s not going to be nearly as potent as it was today. You opened the bottle the first time. If it lays out on the counter for three hours, same thing. It’s not going to be nearly as potent as when you pull it straight out of the refrigerator. So, before I believe that it’s not working, I’m going to try it myself. [inaudible 00:43:48]
All right. So, I’m not sure Dr. Dennis’ mic is not working. So, hopefully that’s helpful and seems to make sense to me. When someone tells me for example that PRP cause damage, it’s like saying you suffocated on oxygen because PRP causes tissue to become healthier. So it doesn’t mean it’s not happening, it just means there’s something else going on that has to be figured out. It’s not likely the PRP has actually damaged something.
Yeah. It’s like the people who tell you they’re allergic to Benadryl or epinephrin. Okay. Well, we all know what’s happening there. You’re getting sleepy. Benadryl or epinephrin, your heart’s racing, but they’re not allergic to it. If somebody is blaming the P-Shot, well, it’s also the person that was having problems to begin with, but now you get to be the crutch and he can blame you for it rather than himself for his inability. And I’ll tell the person, “I’m doing the best I can. I know where I’m putting things. I get to teach other physicians. I’ve been doing this as urologist for forever, but I’ll be glad to give you a list of folks that do a similar procedure that I do. And they may be able to help because I don’t know if I can.” Because at the end of the day, we all know you can’t help everybody, especially if they’re looking for a reason for something not to work.
So, I have enough left on your outline to keep us busy for many hours. I’m going to try to get through as much of it as it can. And again, I’m always grateful to pick your brain on the ratio of knowledge and experience to cordial and easygoing with you is out the roof than nobody else maybe that I’ve worked with. So I always enjoy picking your brain. All right. So next on our list is … But, if there’s something you feel like you want to jump in, go for it because I don’t want to structure it so much. You don’t have a chance to just run. We have experienced people on the call, but we also have quite a number that are new.
So if you have any quick tips, maybe we could jump to that now. With the COVID things going on, your ability to continue to make a living, it’s really interesting. I’ll get some people that are in the group that are just prospering like crazy, more than ever, truly. And then others that are dropping out. Literally, it breaks my heart going broke and closing their office. And it just breaks my heart because think about the irony of that; a doctor closing their office because people are getting sick. That’s something wrong when that happens, but it’s happening. And so help us talk to that person. How can you continue to do business and prosper, even though people were getting sick? What an ironic question, but help us out with that.
That’s great. And this should be brought up for folks who aren’t doing some of these things. Part one, when patients start to cancel an appointment or want to reschedule because they’re worried about COVID, staff, they have been very well trained by my office manager on, “Mrs. Jones, please, this is going to be one of the safest places you can be.” First of all, everybody in the office is used to washing their hands before they see anybody. Wearing masks and gloves is part of what we do day in and day out. That’s before COVID ever hit and we had to worry about PPE. We already had it all.
Number two, you’re not going to be in a waiting room with other folks. In fact, you won’t wait at all. And you’re going to pull up into the parking lot. You’re going to give us a phone call. And then one of my staff will check them in over the phone, make sure that we have a current payment, credit card, usually. They will actually even run the credit card for the anticipated, what the visit is going to be for telling them that there might be an adjustment depending on what we end up doing up there so that they’re not going to have to sit around. Their followup is going to be scheduled either before they’re ever seen, or once they go back to their car. They’re on the phone, again, with the MA. So the contact that they’re having with us face to face …
Because there was a time in North Carolina when I was limited to, I can’t remember if it was six minutes or something that I could be in the room at one time. And patients began to love it. They would walk in. They walk straight back to the room. They’d get on the table. I’d say hello to them. This was not for brand new patients. Brand new patients is a different story, but these are people who we’ve already had a relationship with. And we just get right down to business. And I’d apologize for not being able to spend more time with them, but the new rules made it. So I had a bit of time I could be in the room.
Now things are relaxed and we can spend a lot more time, but a lot of patients began to love it. So, we continue now to check our patients in and out before they ever get either up in the office or they come in, they’ve already been checked in and then they go back to their car and we finished the checkout without them sitting in a room, without other people hearing about their business. The privacy aspect’s been a lot better. So, we’ve done very well. We had two months. It was horrible and I was worried about who’s going to … I’d have to let go. And I’m happy to say nobody was let go. The new method has been a phenomenal forced change that we’ve had to do and it’s come over very well amongst our patients.
Thank you for that detailed explanation, because it really breaks my heart to see doctors going out of business because we have more sick people. And I’ve put up here something that makes sense, but I want people to know there have research to back up what makes sense. So here we have published. You can see this was in the January 1st issue of what you would expect. People who are stuck at home are getting depressed and there’s been multiple research papers out about that. They’re getting depressed, there’s more abuse, there’s more substance abuse and physical abuse and child abuse, but the people that are having sex are doing better.
And I’ll put this up here because, especially in the beginning of COVID, but it continues to this day, people are almost embarrassed about talking about the fact that we take care of sexual problems as if somehow that become unneeded because people are sick with a virus. It seems to me it’s more needed than ever. We need comfort. We need love when things are tough and we’re the people that help make that happen. So can you expandable, have you seen some of that or what’s your idea about … My point is nobody needs to make an excuse about going to work and talking about sex, even though people are dying.
You know what, I’d never would’ve thought to bring that up, but you’re absolutely right. Just to carry out that in, on the aesthetic side, now that everybody’s doing Zoom meetings and they’ve got 4k and high-def cameras looking at their face from two feet away, anything and everything above the nose, people who are doing that have never done it. Because the other is what you just said about the sex part, with so many families that have both spouses working, but now they’re both working from home and they found themselves in an environment where sex is okay at two o’clock in the afternoon, they want to do it. And a lot of couples coming in together. In fact, I’ve never had more couples at one time. Usually it’s one of the partners, almost always the female, that gets started and then the other one comes in after the fact. But I’m seeing more and more new patients enter as couples to optimize their sexual intimacy together because they’re spending so much more time together. And yeah, that is something that I would not have thought to bring up, but I see it a lot now.
So we only have seven minutes left. Thank you for hanging with us for the whole hour. I got two questions that have been sent to me. Well, first of all, this is something I know that you’ve had a lot of experience with surgically before there was ever an O-Shot. So talk to us about in seven minutes, your ideas about the O-Shot, where it comes into the treatment for stress and urgent continents. And then last, have you had any thoughts about the new magnet Emsella treatment?
Treating Stress Incontinence and How the O-Shot® Procedure Integrates with Mid-Urethral Slings
So let’s talk about the incontinence. First of all, you see the literature that talks about 51% of women over the age of, just making up, 40 something report incontinence. And whenever I give talks, I go, “That’s the biggest wrong number in the world.” If a woman has gone through menopause or she’s ever, let’s say 50, and she’s had one or more vaginal deliveries, they’re incontinent. But they’re all used to it. Their mother wear her pants when she caught the sneeze. Their best friend wears her pants when she’s jumping rope. And so, so many women don’t even complain about, “I have this today.” Healthy as hell, thin, fit, 50 year old woman, three vaginal deliveries. It’s on our form. I don’t care if you’re coming in for Botox. It’s one of the questions on the form. Do you leak when you cough, sneeze, laugh, job, et cetera, then in parentheses stress, urinary incontinence?
And she didn’t even think to mark it, but I looked at her history and her age and I just couldn’t conceive up. And sure enough, she says, “Oh yeah, whenever I do jump rope, which is like three to four times a week, I’m always leaking.” And I go, “Well, let’s talk about what we can do.” And so it’s far more common and I advise everybody to make sure it’s on your list of questions, because if you’re going to be part of your club and you’ve learned how to do the O-Shot, then I will address their incontinence at every single visit until they tell me either, I don’t want to hear you talk to me about my incontinence again, Dr. Ibrahim, or they go ahead and [crosstalk 00:54:34].
And [inaudible 00:54:34] is, is I have done enough slings, enough mesh, enough tax in my career. And [inaudible 00:54:42]. They were horrendous and they had brought with issues. If I had had the O-Shot when I was in residency, I would have done a third of the female vaginal incontinence procedures that I did as a resident. One-third. It would have knocked out probably at least half, if not two thirds, of the cases that I had done. Because so many women are completely dry after one or two O-Shots. Every one so far has been dramatically improved if not, parentheses, cured. And again, I thought of how long is that going to last? I don’t know. I don’t have that crystal ball. Some, they’ve never had to come back and some come back once a year and some in between. So-
The other surgeons in our group will tell me that even if the woman chooses to go straight to a sling, they’re usually still almost always grateful that they were offered a non-surgical solution first. Because there’s this urban feeling that surgeons want to cut, but actually surgeons want to get people well. And sometimes that means surgery, but there seems to be an appreciation for a surgeon that has something other than a scalpel in their bag. And then if they choose to go straight to the swing, they’re happy that they were offered something else. And so I’m glad to hear you supporting that idea. And you’ve seen it even work with urgent continence. I’ve heard that, but it’s interesting that you’ve seen it as well.
So when somebody comes in, they might stress incontinence stress, even though we’d give them the examples. And I find out that it’s urge. You’re itching to go. You’re back of the cold section of the grocery store, and you’re looking for the bathroom and, “I got to go, I got to go.” And you wait yourself before you can get there. That’s urge incontinence. I’ve had some women say, “Look, I’ve had a friend. She had urge incontinence. You told her ahead of time. Look, I can’t promise you anything for urge.” I go, “But it’s not going to hurt it. And if anything, it might make sex better.” And if it helps her incontinence, both of us are going to be thrilled to pieces and damned if it didn’t help her incontinence. And so I can give you the anatomic reasons why stress incontinence is held by the other shot, but I have no idea how urge it is. And I’m not talking about the incontinence. I’m talking about the urgency, the neurologic feeling in the head and the bladder that have to go. It helps with that. And I have no idea how come.
Yeah. I’ve got some, as I’m sure you do, some theories about that, but we’ll save that for the … I’m telling you guys, every time I’m in the room or on the phone with this man, I learn a lot. He’s innovative, but he knows the science as well as anybody on the planet. So if you’re looking for a hands-on class, I can’t tell you, you just need to go see him. So last thing and then we’ll close it down. What’s your ideas about the magnet that’s being used to help incontinence?
To be very quick and short about it, of course I download it and I do not own one.
Okay. All right. So guys, I think that we better shut it down. And lots of people are busy and I’m always honored. Everybody’s busy. So I’m honored that you made the call, honored that Dr. Ibrahim made time for us, and I’ll make sure this recording is posted somewhere soon. You should get an email automatically, but if you don’t just look forward on the membership site soon for the video and the transcript. Thank you for being on the call Dr. Ibrahim. I’m always grateful to you.
Thank you so much, Charles. I do appreciate your kind words and I appreciate your comments on the workshop.
Yes, sir. Bye-bye.
Dr. Ibrahim is Western North Carolina’s only physician certified by the American Academy of Anti-Aging Medicine. He has been specifically trained in the use of bio-identical hormones, having passed both written and oral exams. A former Duke University Clinical Professor of Urology, Dr. Ibrahim’s experience with hormonal balancing goes back decades.
George Ibrahim, MD is a well known, board-certified urologist who has been professor at Duke University.
Research showing “COVID-19 lockdown dramatically impacted on psychological, relational, and sexual health of the population. In this scenario, sexual activity played a protective effect, in both genders, on the quarantine-related plague of anxiety and mood disorders.”<–(it’s ok to treat sexual disorders during the pandemic–it’s needed) (click to read)<—
Cellular Medicine Association
Thank you very much for your interest in participating in the P-Long Study,
And in staying informed about future research.
Here’s where to apply to participate in the P-Long Study.
For updates about this and future research regarding male sexual function, If you have not yet subscribed to our “Men’s Sex Research” you may supply your information here…
Topics Discussed Include the Following…
*Starting the conversation about sex with your patients–in order to grow your sexual medicine practice
*How to choose between radiofrequency and lasers for vaginal therapies
*Research about using PRP to help post-menopausal women to conceive
*Research about using PRP to help with Asherman’s syndrome
*How and why your aesthetic practice can thrive and grow in times of disaster
*C.S. Lewis on Functioning During Times of Disaster
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
C.S. Lews on Thriving During Times of Disaster
In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”
In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.
This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.
— “On Living in an Atomic Age” (1948) in Present Concerns: Journalistic Essays
Live Birth in Woman With Premature Ovarian Insufficiency Receiving Ovarian Administration of Platelet-Rich Plasma (PRP) in Combination With Gonadotropin: A Case Report (click)<–
Intrauterine Infusion of Human Platelet-Rich Plasma Improves Endometrial Regeneration and Pregnancy Outcomes in a Murine Model of Asherman’s Syndrome
Cellular Medicine Association
Topics Discussed Include the Following…
[note, these weekly meetings are usually only held with our CMA members, we occasionally post the meetings for any provider who may wish to enjoy with the hopes that they may both find benefit to their patients and that they may consider joining us]
*Beauty analysis math & science of face & labia.
*The Beauty & the Beast
*New review paper of the aesthetics of the labia
*Tune Up your PRP protocol from a basic science paper
*FDA & PRP
*Strong warning about profiting from PRP kits and teaching PRP procedures [don’t]
*The Story of Altar™
*Up-coming hands-on classes with live models
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Beauty Analysis. Face & Labia…the Math of Beauty
If math applies to the face, does it apply to the labia?
Charles Runels: So first, let me say congratulations to Dr. Alinsod, who just published another paper. We definitely want to get to that. I think let’s start by teeing that [research up] with some ideas that I think are widely accepted about the face. This is a website that is put out by Dr. Marquardt, who did some studies about what [mathematically] makes the perfect face, which you kind of have to think, “Well obviously, we were all made to be beautiful, and so, is it okay to decide what’s perfect?”
We’ll get to the labia. But I think most people are accepting that there are certain ideas that we recognize to be beautiful, although of course our affection for each other changes the beast into the beauty in the fairy tale. And of course that happens … It’s a metaphor for what happens when we fall in love with each other.
We know genetically we’re usually attracted to someone whose eyes are of similar color to our mother or something else about the face [that may be genetically determined by our brains]. There are certain mathematical things that go on, as Dr. Marquardt has shown with much of his research.
For example, the upper lip is usually about half the width of the lower lip [in the face of those we consider most beautiful]. I’ve put a link to this, or I will put a link right now into the chat box. Most of you guys are aware of this, because if you’re doing our Vampire Facelift, because I talk a lot about Dr. Marquardt’s work. He was an engineer before he was a physician, and did a lot of really accurate measurements with calipers before we all had computers on our desk and then translated that over. If you look at what he actually talks about here, how if you go all the way back even to, you can see, in former times …
It’s worth browsing this website because even if you look at artwork from ancient days, on every race, every race every continent, you’ll see the artwork very carefully closely matches what we talk about is beauty. I bring that up not just because many of us are doing the faces, but because it’s a major idea that is coming about in the cosmetic world, as most of you guys know. Dr. Alinsod just published something, and I’ll let you take a look at it, and I’ll provide a link to it. Let’s see. Let me pull this up for you. There you go.
So this just came out. Dr. Alinsod and Dr. Güneş … I suppose I probably said that incorrectly … published this paper where they talk about the ideas of aesthetics for the genitalia.
It’s interesting that in the days of Fifty Shades of Grey and such, in my opinion that, we can readily … The reason I started with talking about the face is…
it’s very unlikely anyone had any problems thinking about the idea that certain measurements [of the face] might be genetically embedded to our perception of why it [an individual face] might be beautiful.
And yet, when you swap that same idea [which also applies to the] figure and the breasts, when you swap it to the labia, people start to balk.
There’s a very strong political movement, both pro and con, and some of the thought leaders like Dr. Alinsod are trying to play a scientific role and leadership role and taking lots of heat for it, and teaching the world that maybe if it’s okay to think in that way with a face, it’s okay to think about it [in regards to] the labia. And so, in this review article, he talks about surgical and non-surgical ideas relating to aesthetics.
The references are very helpful, and I will put a link to this in the chat box right … Actually, it will be on the page for the recording for this once the transcript is posted (click to read).
But the couple of ideas that I would point out, and then I’ll open the mic for discussion. The things that caught my attention were, first of all, how strongly some of the ideas are opposed
and then just in general how [in following] the idea of making things more beautiful, we have stumbled upon how it [creating beauty] also is making things more functional.
Dr. Goodman was on one of our previous journal clubs, where he talked about his research showing that women actually have better orgasms and better sex when you do some of the things we’re talking about now, when it comes to just [improving] the appearance [of the labia in the eyes of the woman]. Let me swap something over. I want to show you an example from my practice. Let’s see here. So this is from the Vampire Wing Lift™ website, which if you’re doing the O-Shot®, you should have also a listing here. If you don’t, let us know about it. But if you go on the before-and-after photos, there are several here that were supplied by our providers.
Here’s from Carolyn [Delucia, MD, FACOG], and you can see there are others over here. But the one I want to bring up is this one, because I know the woman. She’s actually one of our providers. If you look at this, you’d think, “Wow. This is a lot of volume loss,” and you might think the rest of her body may look not so young by looking at her labia majora.
The truth is this woman was so fit that if she … If you saw her at the gym, you would think, “Okay, that’s a 60-ish-year-old woman, and that’s the way I want to look when I’m 60-ish,” because of course when women lose the fat in their body and stay lean, they also lose it in the cheeks [which is one of the reasons we do HA fillers and the Vampire Facelift®].
But what hasn’t been talked about is they [lean women over 35 years old] also lose it [faty] in the labia majora. And so, simply by adding volume back, with the combination of PRP and an HA filler, we’re able to easily restore this more youthful look in a very quick procedure. Now of course, Dr. Alinsod talks about surgical ideas as well in that paper I just showed you. I highly recommend this book, which also has a … And this will be the bottom when I post the transcript in the video for this webinar. I’ve already put the links here. But this book has a section on both the surgery as well as PRP and radiofrequency and laser and all the rest.
So, it’s not just for surgeons. I’ve never seen this price. It’s usually $230. I’m not sure why it’s dropped in price like that, but it’s a good time to buy it. I think I’ve talked enough.
Let me see. If anybody else wants to comment before we move to the next topic, please let me know. But I want you guys to know about this because it’s one … I would show it to your patients. Give them permission to do whatever feels natural to them. We’re not taking people and making them feel self-conscious about their body, as some might imply.
We are taking people who want to make all parts of their body well and functional, not just their bicep or their spine or their brain. Or why should we think about optimal brain function, optimal flexibility, cardiac, VO2 max, anaerobic threshold and not think about sexual function? It’s a pretty obvious, rhetorical question that some people have trouble with. So, empowering your patients by giving them links to our references, and I will post the one I just showed you at … If you go to just any of our websites, like you go to OShot.info or Vampire Facelift® or any of them, you’ll see a research tab at the top.
Even on Vampire Wing Lift®, we have actually a paper showing benefit from that procedure, Juvederm with PRP, combined in the labia majora. So there it is right there. Okay, so, I don’t see any hands up. I see Dr. Harrison on the call. I’m going to unmute you because Dr. Harrison told me about a really fascinating paper about the basic science of PRP. So, let me pull it up so you could talk about it. I’ll put a link to this one, as well. Let’s see. Why don’t I just go ahead and put that. I’ll put this one in the chat box as well.
All right. So there’s a link to get it.
So here we go. I’m going to unmute you, Dr. Harrison. Are you there, Dr. Harrison?
Dr. T. Harrison [Theodore Harrison, MD MBA ABAARM]: Yes, I’m here.
Charles Runels: There you go. Talk to us about this paper.
Dr. T. Harrison: Well we thought this was a really interesting paper. One of my Canadian colleagues sent it to me about a week and a half or two weeks ago. We have a little research group here in Victoria, British Columbia, where we have our little lab. We do a few experiments from time to time on different PRPs to try to find out what makes the best and how to make PRP and stuff like that. So when this came across our computers, we thought it would be interesting to see what these guys said and see if there was any way to make it practical, because this is a lab paper from Argentina.
It’s not very practical the way it’s presented here. What these guys did essentially was they took PRP, and they use a double-spin method for making PRP, which is unfortunately not described in the paper. But it’s referenced to a previous paper that they did, so you can find out how they did it. But anyway, they took PRP, and they did a couple of things to it to see if they could make it better. The first thing they did was they took it down to four degrees. They put it in a refrigerator and they got it down to four degrees for half an hour.
Then they tested it to see, with the various growth factors, and there are some pictures there about they tested migration and embryonic cell growth and how it affected it and the like. Yeah, you can see right there. Those pictures there are the first ones from the cold. The top graph is cell growth, the middle one is migration, and the bottom one is new blood vessel formation. They found that if you took just the … Well the control there on the left-hand side, that’s just fetal bovine serum. So there’s nothing in it.
Then the middle one is PRP releasate, which is to say, they took PRP and they activated it with calcium. I think maybe they tried thrombin too. Then the third bar from the left is washed PRP releasate. That is, they took PRP, and they did a second spin so that all the platelets formed a pellet now at the bottom. Then they removed the plasma from it, and they washed it with some kind of lab solution stuff, not really necessary in my opinion. But then they reconstituted it and activated it after exposing it to cold.
Then you can see what the results were. They got more migration, they got more angiogenesis, and they got more human embryonic cell growth from it. Also in the references, they have a good reference to the paper that gives good overview of what cold does to platelets. And essentially, what happens is, when platelets get cold, they get a lot more sensitive to activation, and they’re pretty sensitive to begin with. I mean, almost anything can cause a platelet to activate. I mean, I made a list once and it had like 20 or 30 things documented that cause platelet activation.
The only thing that keeps this from turning into a clot in five minutes is the fact that there are anti-activation proteins circulating in the whole blood. So that if a platelet accidentally tripped off, it just doesn’t set off the cascade and clot your whole vascular system. But, the fact is that they got a lot more results when they took away the plasma, and they got a lot better results when they made it cold. The second thing they did was take away the plasma.
Now, I’d heard a lot before that plasma helped PRP or helped the platelets in PRP. But these guys have some pretty interesting results here that show that if you take the plasma part away, the PRP actually does better. This is the washed platelet releasate part that they have there.
Dr. T. Harrison: Have there. So that was kind of interesting too. It doesn’t look … I can’t really tell from their data whether they cause lysis or not by doing these things. We know that lysate performs better than PRP by itself, and I guess I should define a couple of things here. Everybody on the call I’m sure knows what platelet rich plasma is and platelet poor plasma is. But there’s also a couple of nuances. There’s platelet releasate and platelet lysate. Platelet releasate is what happens when you make PRP, and then you spin it down and you add calcium to it. And then you spin it down again, and take off the remains of the platelet. So all you have left is the plasma, and what got dumped into the plasma from the alpha granules and delta granules after it’s activated with calcium, or something like that. That demonstrably performs better than just PRP by itself.
Now, platelet lysate is what you get when you take PRP and you spin it down, and you take all the plasma off, and you lyse the remaining platelets. So in that case what you get is a hodgepodge of everything that was in the platelets. I mean, it lyses the platelet cell membrane, but it also lyses the alpha granules, the delta granules, the lysosomes, the mitochondria. I mean everything that was in there just gets dumped into the mix. But what happens, this results in much higher concentrations of the growth factors and cytokines. And the research so far tends to go toward lysate being even more powerful than PRP, or PRP releasate as far as growing human embryonic stem cells. I mean human embryonic cells, our concern.
So these guys did the cold, and they found that that made the releasate more powerful, and they took away the plasma, and they hypothesized … and that made things better too. Again more immigration, more angiogenesis, more human embryonic cell growth. And they hypothesized that there were inhibitors in the plasma that were keeping the PRP releasate, the regular PRP releasate, from it’s full potential, you might say. And then when you got rid of the plasma, and then activated the cells and or lyse the cells, then you didn’t have these inhibitors anymore, and that’s why the plasma-free PRP I guess releasate you’d call it worked better.
And then they did one more thing. They also tried adding cryoprecipitate to the PRP to see what that would do. And they made the cryoprecipitate by basically freezing their PRP, or spinning down the PRP, taking off the plasma, and then freezing that plasma. It’s basically fresh frozen plasma. But they froze it for 24 hours. And then they warmed it and centrifuged it again to get the precipitate, which is mainly fiber and fibrinogen, von Willebrand’s factor, and a few more proteins like that. And so they took that precipitate, and they added that to their PRP as well. And they didn’t quite document so well what happened there, but it does seem like these proteins form a matrix which allows better migration. And it also has a little more effect on proliferation, though I think it didn’t have much of an effect on angiogenesis at all.
So basically they got three different ways they could make PRP better. You know, make it cold, take away the plasma, and add cryoprecipitate. So, I dunno, for office purposes, making the cryoprecipitate’s probably not very practical. But the other two are probably pretty easily doable, so we ran a little experiment ourselves here. Basically we took some PRP and we took a 3 cc syringe of PRP and we wrapped it in an ice brick. You know, one of these bags full of something that freezes really easily that you put in the freezer and then you put in a cooler or something. We just wrapped that around the 3 cc syringe, froze it, and then we took out the or empty 3 cc syringe, and we put in a 3 cc syringe full of PRP, and we took the temperature to see how long it took us to get down to four degrees. And it took about four and a half minutes to get the temperature of the PRP down to four degrees, same temperature as they used here.
And then we ran it through the hematology analyzer to see what happened there. And we found there was probably a little lysis. But not much else happened. It didn’t look like they were activated yet at that time. So for practical purposes, it looks like you can make PRP cold in about four and a half or five minutes. So that might work in the office pretty well.
And the other thing of course is just taking the plasma off, so it doesn’t inhibit the growth factors and cytokines that are released when you make releasate, or when you make lysate for that matter. And that’s just easy to do. You just after your second concentrating spin, or maybe during your second concentrated spin, you just spin it hard enough so the platelets form a pellet down at the bottom. And then you just take off all the plasma. And then you can reconstitute it with water if you wanna get a lysate. Or with D50 if you want to get a combination lysate releasate. Or maybe with normal saline if you wanna just get a releasate out of it.
So that’s pretty easy to do too. So from a practical point of view in the office, you could do about two thirds of the things that these people did to make their PRP more effective. And you can see from the graphs, that they got anywhere from 30% to 50% improvement in their PRP results when they did these things. So it looks like it might be pretty effective stuff.
This is only one study, and I hope other people will do other studies that’ll confirm this. But it is pretty exciting that you can increase your PRP effectiveness this much with some pretty simple things that you could do in the office.
Charles Runels: That’s very fascinating, and I was not even aware of this paper, so I’m sure everyone’s cheering you for, and just the fact that you told me that you went and counted by reading the research 30 different ways to activate platelets, I’m impressed and very grateful. My impression is that if anyone studied this paper in detail, they would have to come away understanding platelet rich plasma in a deeper way whether or not they adopted the techniques or not. You know, just the reading of the introduction to me was encouraging. Just as a reminder, as they go through as their intro for the study, the safetiness of it, and they go just these three words: recruitment, proliferation, and differentiation of stem cells. We all know that, but just to be reminded, all those things are happening, especially to those on the call who are new to platelet rich plasma. That’s what you’re doing. That’s a powerful statement.
And then on this next page, as you were mentioning, they say surprisingly, I think that’s an understatement to say that in something called platelet rich plasma, the plasma’s actually decreasing the effectiveness of angiogenesis. And they talk briefly here about why that could happen and give a reference. Anyway, you’ve done such a wonderful job of talking about it, I’m not going to muddy the waters anymore. But could you expand more on, having read this now, has it changed your practice as far as your daily … and you know Victoria Canada, like when you take the boat from Seattle up to that beautiful, amazing place right there. Is that where you are?
Dr. T. Harrison: Yep, that’s where we are.
Charles Runels: Wow, I was there once. I don’t see how you get any work done living in such an amazing place. It’s so beautiful there. I would just be outside, gawking all the time. So how has this [research under discussion] changed what you do? Or has it?
Dr. T. Harrison: Well, we haven’t really tried this on patients yet, but we’re definitely going to, because it’s really easy to just put your PRP in a freezer brick for four or five minutes. And it only adds a little bit of time to the preparation, and it’s pretty easy to take off the plasma after a second spin, and then reconstitute it with something. Now the question that we have is what do we reconstitute it with? Because we did a study earlier this year, which we presented at the AALM Conference, where we took PRP and we diluted it 50/50 with different concentrations of dextrose. Because we’re really interested in prolotherapy and using this in joint. And dextrose has been the main deal for prolotherapy for many, many years, ’til people started using PRP. We thought the two might be synergistic, so we decided what would happen if we added them together?
So we did different dilutions, from basically to sterile, distilled water, all the way up to D50. And we mixed them half and half with PRP, regular PRP, to see what would happen. And of course when we mixed it with water, we got about 80% lysis of the platelets. So it was almost a perfect lysate. Not quite, I don’t know why those last 20% of platelets didn’t lyse, but they didn’t. And at D5, D12.5, and D25, we got about maybe 15%-20% lysis. There seems to be something in dextrose that platelets are sensitive to. At least some platelets are sensitive to.
But when we got to D50, and we added one cc of D50 to our one cc of PRP, we still got 20% lysis, just like we had with all the other dextrose concentrations. But the other 80% of the platelets activated. The lower concentrations of dextrose did not activate the platelets, but at D50, all the platelets activate. The rest of the platelets activate. So you get a combination of lysate and releasate at that concentration. So that’s what we’ve been using for prolotherapy.
Charles Runels: Interesting.
Dr. T. Harrison: Now, for other uses, I’m not sure whether that would work or not. It certainly gets you activation, and dextrose is good for platelets, because platelets use dextrose. They eat it. They feed off it. And when you give PRP normally, the platelets don’t just dump all their alpha granules and die. They continue to live for about five to seven days, and they release further alpha granules in waves. So it’s not all the alpha granules that get dumped. And when you activate with calcium or with thrombin, it’s only the first wave. Because the alpha granules contain both pro-angiogenesis factors, and anti-angiogenesis factors. They are pro-inflammatory and anti-inflammatory. And they have both pro coagulation and anti-coagulation factors in them.
So it wouldn’t make any sense to dump all the pro’s and anti’s at the same time. And so they don’t. You get a first wave that’s probably mostly the pro-inflammatory, pro-coagulation alpha granules, and then you get a second wave, maybe within the next day or two, that has the anti-inflammatory, and maybe the pro-angiogenesis ones, and then so forth. They go through five to seven days of releasing new waves of alpha granules as they do their job. And it ends up the last wave is gonna be the anti-angiogenesis as they knock off all the little blood vessels that they made that they didn’t need anymore once the healing is all finished.
But when you make regular PRP and inject it, that’s what you get. The platelets stick around, they release their alpha granules in waves, it’s sorta like the normal healing process. When you make a lysate, all those guys just get dumped together. The pro’s and the anti’s and everything else, from the lysosomes and mitochondrian. It just all gets dumped together. But it seems that the much higher concentrations of growth factors that you get from that outweighs the presence of the anti-coagulants and the anti-angiogenesis. You know, the other factors that would normally work against the new migration growth, cell growth, and all that sorta stuff.
So, so far at least, it looks like lysate’s the most powerful PRP preparation. And so we’re thinking maybe we outta cool it, or maybe we oughta wash it, and then cool it, and then reconstitute with water, and see how much of a lysate we can get from doing that to get the maximum potential out of the PRP.
Charles Runels: Wow, what a wealth of knowledge. You should be teaching. It sounds like you probably are, but if you ever want to teach our procedures, I would certainly show up as a student to see how you’re thinking about it. One other question. If you look at this just as a reminder, and you’re doing this, when they talk about how PRP is used in regenerative medicine, it mentions of course muscle damage which you guys are doing as doing prolotherapy, I’m sure you’re treating that already. So if you were, as we’ve developed our O-Shot® techniques around the pelvic floor and the vagina and the urethral space, if you were treating a woman who had dyspareunia and had pelvic floor tenderness, or if you were just treating incontinence and using PRP in combination with an Emsella machine, where in theory, you’re causing strengthening of the pelvic floor, in those two cases, if you would … Because the thought is, of course, that perhaps you could inject the pelvic floor if you’re trying to strengthen it and then do your m-cellular treatment with the electromagnetic stimulation of the muscle, and maybe get a better result than if you did just one of those alone.
Note…we offer an icon on our directory to identify O-Shot® providers who also offer Emsella, radio-frequency, or laser in conjunction with the O-Shot® procedure. If you are offering these combination therapies, please let our office know so we can add the icon to your name on the directory (firstname.lastname@example.org).
Where would you inject, and how would you treat your PRP before doing something in the pelvis or vagina, where the idea was treating either dyspareunia or pelvic floor laxity, to help incontinence?
Dr. T. Harrison: Well, if it was for stress incontinence, I’d be fairly cautious because, you guys have run into cases where basically, you caused urinary obstruction from people injecting too much PRP around the urethral area. And since this is more powerful PRP, I’d want to sort of proceed cautiously there, using this sort of enhanced PRP stuff.
Now, for pelvic muscle floor, I don’t think that would be so much of a problem. And if you inject along the top of the vagina, out to the sides, along the course of the urethra using these more powerful solutions, you might actually be able to strengthen the whole pelvic floor that way.
Charles Runels: Or, if you were, say, treating pelvic floor tenderness, a trigger point injection for dyspareunia with pelvic floor trigger point reproduction of the pain, you would do … When you say that way, would you do your lysate with water and cold technique? Would you expect that to work better?
Dr. T. Harrison: I think I would expect it to work better than just plain PRP. Yeah.
Charles Runels: Yes.
Thank you. That’s helpful. To think about the overflow incontinence just to … Thank you for bringing that up, just for the rest of the people on the call, if you haven’t heard of that, we’ve had so far, I know of three cases. In every case though, the reassurance is that the volumes injected were 7 CCs or more, and so it’s yet to happen with our recommended 4 CCs. If you look, inject 4 CCs, it may not sound like much, but if you injected say … Imagine injecting, if when we do the face, we just inject one, it’s a pretty large volume. So, our thinking is, it’s probably more from a volumetric fact, but I appreciate your caution, would maybe if you had more platelet-rich fiber matrix formed, because of changing the consistency, perhaps that might cause it as well.
The other reassurance is that, in all three cases that I know of, that it within a week of an overflow obstruction basically from having created artificial hematomas, is really what you’re doing, it resolved, and the people did very well with the eventual resolution of their stress incontinence.
It’s pretty scary, though, when your person comes for stress incontinence and then they have to wear a diaper for weeks, because they’re dribbling all the time.
So, people don’t usually like that.
Dr. T. Harrison: Yeah, and the other thing you want to remember with using at least the plasma-free technique here is, you’re not going to get a fibrin clot, because you’ve taken all the fibrin, fibrinogen, and stuff away, so if you’re using it for maybe things where you want the PRP to all stay in one place like the O-Shot and scalp type things, where you don’t want it just wandering off, and diffusing really rapidly, you might not want to do this.
Charles Runels: Interesting. Yeah. Very good.
What a wealth of knowledge you are, I would want to spend the next two hours talking with you.
One of our physicians, Pamela Kulback, who’s one of the interventional radiologists in our group, typed in the question, about using, perhaps, the centrifuge. That is itself cool.
Do you know of such a device? Or do you have something in your-
Dr. T. Harrison: Oh yeah. We don’t have one, but refrigerated centrifuges, well they’re a bit expensive of course, but they’re easy to come by. All the labs have them, and you could do it that way.
The thing is, if you put the PRP in a refrigerated centrifuge, you would refrigerate it before you removed the plasma, because the plasma is still in there when you do that, and you might pre-activate some of the platelets when you did that.
So we prefer the technique of getting rid of the plasma first and then making it cold, so that we don’t have the plasma interfering with stuff while it’s in the centrifuge.
Charles Runels: Beautiful!
Well, stay on the call because we may want to pick your brain again. I think that covered the research we were going to talk about today.
FDA Approval of PRP
There was one question on the membership site that brought up the FDA question again, so I just want to remind everyone where I put that, of course thankfully, the FDA doesn’t drift all the way up to Victoria, but some of us have to think about that, so I’m going to open this where you guys can see where it lives.
And again, this will be posted to all the membership sites. But I’ve kept this page as up-to-date as I can (if someone finds another paper, let me know) but I’ve put here actual articles by the FDA where they have talked about, in very specific terms, they do not regulate platelet-rich plasma.
In the United States, they do regulate the devices and I think you’re safest in the US by using a device that is approved by the FDA to prepare plasma to go back into the body.
Now, in other countries, maybe that’s not such a big deal, assuming you have the depth of knowledge you just heard displayed.
There actually are people in the US who have a different level of laboratory that they’ve had approved by the FDA, essentially, the FDA has come in and said, “Yeah, you’re able to do this.”
But unless you have that in the States, I’d recommend you use one of the kits.
So the short of all this, and again, I have multiple references here, where the FDA is talked about … this isn’t second-hand knowledge, they’ve done articles for the New England Journal and their own website, and I have a video that explains at least my idea about it, and a transcript.
So anything that has to do with the FDA and PRP, we are in good standings.
The one thing that I would be careful about that I see going on and it’s nothing unethical about the intentions, but as far as the FDA goes, you could get slapped around some, is, if you are a physician and you are doing these procedures, and you are also selling therapy kits to physicians, as in, you are teaching usually, and you are either directly or indirectly profiting from selling PRP kits, in my opinion and in the opinion of the FDA (so I’m giving you a very gentle warning), the FDA has shut down sales people who teach what to do with the plasma because you’re teaching what the FDA has not said the device is able to do, they’re [FDA] only saying the device can make the plasma. The FDA doesn’t approve specific use for it.
WARNING! So if you’re profiting from the device, and you’re teaching something that no one’s proven the device is capable of doing, whether you’re the salesman who’s selling and teaching, or you’re the teacher who’s teaching and selling, you should be looking over your shoulder, because the FDA could come slap you around in a pretty dramatic way.
But other than that, as far as using it, if someone else is selling it to you, they’re profiting from the kit and now as the physician, you’re deciding what to do with the blood or the blood products, the FDA is very plain. They’re not at all bashful about telling you, they have no interest in telling a doctor what to do with blood, as long as you’re not manipulating the tissue to the point that it becomes a drug, and part of the point of a lot of these articles is that, when it comes to stem cells in the US, once you do a certain amount of manipulation, it gets reclassified, and now they are very interested in what you’re doing with it and again, unless you’re in a study, you should look over your shoulder in the US.
So that’s the quick version of that.
We’re coming up on the end of the hour.
If anyone else has some questions they want to throw in, I’m getting close to our topic list here.
This, we just posted, I’m not going to waste your time getting there again, but with [inaudible 00:40:24], I posted a video, actually had a interview with the guy who patented the ingredient … a cancer researcher at Harvard, then a cancer cell biologist at Berkeley, it was shocking to me when he told the whole story about how this product came about. I knew there was a lot of thought in it, but I didn’t know that it had directly six years of research on that level and a $2 million NIH study behind it, initially for the study of wound healing, which of course is related to cancer, as it involves cell growth.
I feel blessed that we [member of the CMA provider groups like the Vampire Facelift® and Vampire Facial® and O-Shot®] have the exclusive on this.
So it’s an idea to use post-treatment for the face, for the labia, (even for the penis) and I just wanted to remind you that it’s there and we also have classes coming up,
so if you want to check that out, and I think after that, that’s all I have to say today.
I can’t tell you how grateful we are, Dr. Harrison, for that amazing discussion about platelet-rich plasma. That’s just maybe the most detailed, informed explanation maybe that I’ve heard of the research on these calls so thank you for being on the call.
Okay so I don’t see any other questions, so I’m going to shut this down. You guys have a wonderful week.
Cellular Medicine Association
Topics Discussed Include the Following…
*Can you pump too much? Do you really need a pressure gauge?
*Where to buy a penis pumps wholesale & how to adjust price
*Do you have to use the pump after the Priapus Shot® procedure?
*Other side effects of the pump.
*Dr. Delucia & The number one reason doctors do not get free press?
*Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration
*Briars, Woods Walking & Medical Innovation
*How to measure web traffic. One of my secret tools.
*A way to get a free appearance on your local TV station
*Dr. Michael Goodman talks about innovation in medicine & funding research
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Penis Pump Research
Charles Runels: Let’s start by talking about penis pumps. I received two pretty interesting questions in the past week about penis pumps. One of them had to do with … Oh, by the way, we’re also wanting to speak a little bit about amnion research, and an article that came out today giving us some free press about the O-Shot, and about how to use that press, to leverage it for your own practice.
First about the penis pump. This is a sampling of some of the research that’s out there about penis pumps (click), and some of this research answers questions that were posed to me. One sent me a photograph of a penis where they did a Priapus Shot, this story, guy has an erectile dysfunction score of about 15 or so. So he has some function, but it’s not like what it used to be.
So he comes in for a Priapus Shot® [procedure]. After the shot, the pump was applied. Then, when they took the pump off, the patient had some looked like vesicles on the glands’ penis, filled with clear fluid, three of them, and some increased bruising, more than what would be expected from just the injection. The question was, what might’ve gone wrong?
My first question was, what pressure was put on the pump? This provider had … By the way, there was no permanent damage, so I’ll just go ahead and tell you the ending of the story is good. But the provider, rather than follow our protocol, which is that you apply a negative pressure of 7-10, provider had found somewhere on the internet the recommendation of a pressure of minus 15. The cause of that, that’s what created those vesicles and the increased bruising.
Can you pump too much? Do you really need a pressure gauge?
Along those lines, I wanted to show you one article that shows that over inflation, as you might expect, there’s one of many. There’s case reports out there of people doing stupid things like hooking their penis up to the home vac system, and it just gets ripped off. Obviously, we’re not going to do anything like that in our office. But this is just a simple case where a 66 year old gentleman used a vacuum erection device, but he bought one without a pressure gauge.
I think that’s really dangerous to have people using something that you cannot measure. They get overzealous, maybe there’s loss of sensation already from diabetes or injury. They can’t tell what they’re doing. If you do a Priapus Shot®, by definition, you’ve probably put some topical anesthetic or maybe did a block, and so they don’t have the pain as a feedback.
I think it’s really dangerous, in my opinion, to either use or recommend that someone use a pump without knowing what they’re doing. Now, if you go back and you look at the research, which this is representative, but there’s others I’ll mention shortly. You’ll find that it is, if it’s done the proper way, this has been a therapy that’s been around since 1974 or so, and it’s known to be a safe and effective treatment. Provided that you use it intelligently, just like almost everything we do in medicine, there’s a sweet spot in less is less effective, and more is damaging.
Same with this, and if you’ll go back to the old protocols that people were using, they were going sometimes up to a pressure of 15. It starts to sound like people comparing notes with lifting weights or something. Where is it better to do high intensity heavy weights for short repetitions or small weights with high repetitions? It sounds a little bit like people comparing notes at the gym.
I think there’s still room for thinking about this, but there’s couple of papers in the Journal of Sexual Medicine that you can go look at. The patent, which I think was very tightly edited by Irwin Goldstein, where it showed that using a vacuum pump increases the effectiveness of Viagra and Cialis. Men taking those therapeutic medications get a better result if they use a pump, intelligently, which makes sense. You’re just basically stretching out a water balloon to make it easier to blow up, but if you look at the old protocols involved, sometimes going to pressure 15, but most people think now, if you’ll look at the protocols being used in penial rehabilitation therapy where you also find a lot of this pump research.
Rehabilitating the penis post prostate surgery. The usual protocol’s a negative 7-10, and some guys, they seem to be really sensitive, and that’ll complain of pain at three or four, that’s okay. Just something that increases the erection equivalent or maybe slightly more than what would be experienced with a normal erection using the vacuum pump. That seems to be the place to where people see some improvement.
There was also this article, and another, looking at … Yes, this one. This is the journal of sex … Wrong one, I’m sorry, excuse me. This one.
Yes, so this was The British Journal of Urology, nice paper where they took people who had Peyronie’s disease scheduled for research, 31 people, and over a course of 12 weeks they had them use a pump twice a day. Half of them canceled their surgery, because just the mechanical makes sense. You have the scar tissue, stretch it out every day, a couple times a day, it might straighten it out, and it worked. When I talked to Ronald Virag who published the most recent, I think, landmark study about using PRP for Peyronie’s, which you can find if you go here, you go to our website, priapusshot.com/peyronies
By the way, I think this relates very nicely with the work that Andrew Goldstein did for us, with lichen sclerosus, because it all relates to the PRP down regulating the autoimmune response. If you go to, let’s see. If you just go /peyronies, which I recommend you give this website to your patients, because I put on here everything that I could find in the literature that had been shown in a really nice study to help with Peyronie’s. One of which was the Priapus Shot, which we can now say now.
If you go to just click on the references, so give them that, PriapusShot.com/peyronies so they will include all of those things in their protocol. For example, there’s a higher incidence with smoking. They’re sort of undoing the things we do if they don’t quit smoking, or at least try to do that. Not this one, this one.
Dr. Virag, who I think is amazing, he’s a legend, because he was the first guy to think of doing the TriMix injections, vascular surgeon turned ED expert, because of that idea. Here in this study, he showed that using PRP works better with fewer side effects than Xiapex, really nice research including some objective data using imaging. I’m kind of going in a circle here, but if you talk with him, which I have, shared the podium with him a couple times. If you talk with him, he’ll say in practice he combines PRP with the pump.
Circling back to what the original topic was, we have a pump study showing that mechanical traction helps Peyronie’s disease. Then we have this really nice study showing that PRP helps Peyronie’s disease, and when you talk with Dr. Virag, he’ll tell you that in practice he combines the two. Of course, when you’re doing a study, you just want one variable, but in practice, that combination is really nice, which is what we’re promoting when people come to us. Back to the pumps, you need to know what you’re doing, in my opinion.
Where to buy a penis pumps wholesale & how to adjust price
I think you use a pump that has a pressure of somewhere between … that you could measure, and then you have them put that pressure somewhere between 7 and 10. Now, I’ll show you where some people have trouble finding this, for some reason, so I’ll show you where I have a link. Where you can buy it wholesale, penis pumps, and I’ll tell you how some of our people are using this to create, not only a better outcome, but more profit, which is really nice when you can help people tremendously, and also the combination of doing more creates more profit. Let me get to this and show you.
If you go, sort of coming in the back way, so let me have one more click before I show you what you’ll see. When you login to the Priapus Shot membership sight, and then when you land, you’ll be on the dashboard, which is the next page I’ll show you. Here. Then when you click on the how to do the procedure part and scroll down, unless it’s somehow fallen off the page, which somehow computers do that sometimes, I’m not sure why, but if you scroll down, there should be a clicking link here somewhere where you can buy that. That’s it.
That is a wholesale, place to buy wholesale pumps. There’s a hand pump, an electric pump. This pump, not saying that you should have to use this, but I like this pump, because it’s a heavy duty metal device, and it has a pressure gauge on it. But, what some people are doing to increase both profit and outcome, is ordering this electric pump, which has a retail value of around $500, give or take.
If you go, this is the wholesale sight of this website, if you go to the retail sight, this has a perceived value of around $500. So some are buying this at wholesale, giving it to the patient, and charging, instead of our usual 18 or $1,900 for the Priapus Shot, charging them $2,200, but you’re giving them a device that’s worth $500. The overall perception of value, and the real delivery of value is actually more. This works well, because you can just set this.
One guy who came to me who had some nice results, he said he just set this and read the Wall Street Journal for an hour a day. I know that’s more than most people wanna devote to a pump, but the point is that if you set it at a nice low … and he used the pressure of seven and had really great results before he ever got his Priapus Shot. I feel like I need to talk more about this, because this is something that sort of freaks people out, and they’re not familiar with it. The other thing that I would tell you is that most people, if you get somewhere around 2-2.2, this is the diameter of the cylinder.
It’s going to fit most people, and seldom will people need the other tube, so maybe you buy one of those to have it on hand, one of each of these, but if you keep the tube to the 2.2 on hand, most people will fit one of those. You kind of see what you’re dealing with, and if it’s the average sized penis, you give them one of those, and give them this. Most of us are giving them a pump as part of the procedure, and just figuring it into the price. Anyway, that’s all there for you.
I kind of cut that deal for you guys, and if you wanna see the retail side of that, this guy Dr. Kaplan, Joel Kaplan out in San Diego. I went and checked him out, I like to meet people personally and see them. It’s interesting, if you go to his “office” it’s a huge warehouse literally stacked up 30 feet high with penis pumps, and about five people manning the computers. He’s making so much money with these pumps, because he delivers a nice product at a good price, but this is the patient side of it, which I like them being able to get to, so I don’t become the pump service repairman.
Whatever pump you give them, I like it to be something they can get … if something breaks on it, they can just order another cylinder without calling your nurse and turning her into the pump mechanic. If they want to get a different size something, because they grew, which happens sometimes, or whatever, it’s all on here for them to measure and do all that. This is the company from which you’re getting the wholesale version of this, it also gives them a way to see that you’re actually giving them something. I said $500, it’s 495 for this system that you’re giving them, or depending on what you’re attaching to it.
Somewhere between 4, 500 bucks, roughly, that you’re giving them, along with your procedure. All right, so that’s one problem, and you have research that shows the pump is helpful mechanically for Peyronie’s. If you go back to PubMed and you look at this, because the other question I get is, “Do we have to do the pump?” I actually had three questions this week about pumps.
Do you have to use the pump after the Priapus Shot® procedure?
One was, “Do we have to do the pump?” No, you don’t really even have to do the shot, right? They could just watch game shows and not have sex, but if you want to get the best effect of this thing, if it’s Peyronie’s, we have good science showing that it could be helpful as a standalone. If you have erectile dysfunction, we have studies showing that it could be helpful.
If it’s done intelligently. If you have prostate surgery, we have good studies showing it’s helpful, and if you want to read that, you just go to PubMed, and put in penile … That’s not PubMed, let me get back to PubMed. You put in “penile rehabilitation,” and a lot of science about how to recover post prostate surgery, and you’ll see that almost all of these protocols involve some combination of Cialis, low dose daily with a pump used daily.
Now, let’s just stop and quit thinking science for just a minute and just think commonsense. I’m a big fan of Richard Feynman, because he had two Nobel Prizes in physics, but he wasn’t into the limelight. He would actually use a fake name when he was going to lecture at universities, because he only wanted the mathematicians in the room. He didn’t want anybody showing up just because he had a Nobel Prize in physics, but he was a big fan of commonsense.
You do the math, but then you stop looking at the math, and you think what I’m looking at, is it commonsense? If you think about what we’re doing, as far as just mechanically allowing a balloon to be easier to blow up, then it makes commonsense that it would be helpful. Now, the other thing, can we take the commonsense thing one more step? There was a time, not so long ago, that I can actually remember, being 58, I can remember as early teens, 12, 13 year old, trying to figure out how to make muscles grow.
There were still people, at that time, who thought that lifting weights was somehow not good for you. If you go all the way back to the ’50s, it was actually … athletes were discouraged from lifting weights. But you had physical therapy post stroke. Physical therapy post stroke, after an injury, trying to recover strength.
It wasn’t until the 1980s, when I was in medical school, that the first article came out that actually said, “Yes, anabolic steroids actually make you stronger.” If you go back before that, they were saying that, “Well, maybe it’s just water weight, they’re not really that much stronger.” But the athletes all knew that was wrong, and I was working as a trainer in the gym, and we’re looking at people lifting the whole side of the gym, so I knew that was not right. Commonsense said it was not right.
Now, back to penises. If we have something that seems to be working for rehabilitating the penis, so if you use that analogy with weight training, why wait until the injury? Is what I’m saying. You don’t wait ’til you have stroke to go get rehabbed with your muscles, you lift weights to try to maintain strength so you don’t fall and break your hip, or you go walking, or some sort of weight resistance, so you don’t wind up like astronauts, where your bones break for standing up, which happens to the elderly.
Back to this. I think that the old will become new. Penis pumps were a thing before we had Viagra, I think they’re becoming a thing again, as we start to rethink how physical therapies might help penial help. Okay, that’s me just kind of trying to think like one of my heroes, Richard Feynman, with commonsense, without looking at the literature. But go read the literature, think about it.
The questions I got were, this week, three of them, “Do you need the pump?” The answer is, you don’t really need it, but you’ll probably get a better results if you use it intelligently. The one exception of that is probably if you have loss of sensation, just anecdotally, what I’ve noticed is those guys, if their only complain is loss of sensation, you’re maybe better off without using the pump. I figured this out, or noticed it in multiple patients.
That also makes sense if you’re trying to grow fragile nerve endings, perhaps the mechanical stretching may not be so helpful. That’s the exception to that things we’re using the pump for. The other question was about … Should you use it? My answer is probably yes.
Can you over use it? Do you need to get something with an actual gauge on it? Yes, I think you do, and this guy claims he’s got something that’s FDA, a device that’s been evaluated by the FDA, to where you actually have an accurate pump on it. You don’t want to get blamed for somebody else’s impotence, which is what happens if they over pump, consistently.
Other side effects of the pump
The other side effects are that their skin can become darker, so you just tell them that, and it will reverse if they stop pumping, and they can get some edema if pump for a long time, even if they don’t over pump on the pressure. Should you use it? Yes, for everything, maybe except for loss of sensation. Get something with a gauge on it, and I’ve shown you where to get it wholesale from our website.
Now you have a protocol that you can follow. There’s also a nice little video here that kind of talks you through it. Normally what I do is, I’ll do the shot, I’ll get the pump going, most people are afraid of them. I de-stigmatize that thing by calling it yoga for your penis, and that seems to, I don’t know.
Maybe one of you guys should do that penis yoga, but I think that seems to kind of calm them down a little bit, and I recommend that they not try to hide it. Just take the thing out and pump it up when you’re watching TV with your sweetheart and try not to make it into some big giant secret. The worst thing about porn is people keep it secret from their lover, and then it takes on this mystical thing that turns women into porn widows, where their husband’s off jacking off to porn. Where it loses power and usefulness, I think, when it becomes more shared.
Here’s one of my favorite articles about penis pumps–showing that the use of one increases transcutaneous oxygen concentration (click)<–
Okay, so I went off and made lots of circles there, but that’s my ideas about the pump. Now, let’s see, what else did I promise you guys? Maybe I should open up … Anybody want to comment about that? That’s on the call, I know there’s some people on here that have done really nice work and had lots of success.
If you just click the button, I’ll unmute you where you can talk to the group, I have a really nice group tonight, and you probably want to comment more about the pump thing. Okay. The other thing I promise we talk about is just to show you guys where some of the amnion research lives. Oh, you know what?
Free marketing for the O-Shot® [Orgasm Shot®] procedure
Let’s take a break from the research for a second and show you some free research thanks to one of our many amazing people, Carolyn Delucia, who is on the call. I’m gonna unmute you Carolyn, ’cause we have two crazy good articles. Before I unmute her, let me just show you, this is a gift from Carolyn, who’s created a really nice relationship with this lady who’s been writing about our stuff, I think, very intelligently. Here’s one that came out March the 11th, about the O-Shot, and here’s one that came out, check this out, April the 2nd about vaginal rejuvenation.
Wait, let me click on this thing. I went down too far. It talks about many of the things that we do, so this is a … I think an intelligent way and a balanced way that doesn’t over promise things. So, this is another nice thing to show your people, and so, how do you show people?
But before I get to going here, maybe Carolyn can talk a little bit about not just the procedures … I just un-muted you, Carolyn, but maybe just kind of some words of wisdom because she’s been teaching for us. She’s managed to get some amazing press. Part of it is because she’s in a nice town, but part of it is that she hustles and she knows how to talk with the press. Okay, are you there, Carolyn?
Carolyn Delucia: Hi everybody. Kind of shocking to be unmuted here but that’s okay. We love you, Charles. When it comes to getting press, I’ve been very fortunate to have gotten by accident noticed by one of the … Daily Elite, I think, was the first one, and once that happened, I was invited to give opinions on many articles. I think that the point there is if they ask you, say yes, and answer their questions quickly, and they are kind enough to alert you when they actually publish something that you have said, and it gives you, without any merit, truly an expert status, which is kind of comical, but we do these procedures day in and day out, helping our patients, and never really expecting anyone to notice, but if they do, it’s a way of letting everybody else know that this is available, and it’s been my soapbox for quite a number of years now.
Charles Runels: So, can I bring up something because … I won’t interrupt you for too long, but I want you to address a couple of times as you talk.
Carolyn Delucia: I’m done.
What’s the number one reason doctors do not get free press?
Charles Runels: So, one of them is this. There is an unspoken rule among physicians that is a really scary rule, and I’m going to speak it out loud. Here’s the unspoken rule: You don’t really have a right to be in the spotlight until you’ve published for many, many years, and maybe you have a professorship or something somewhere, and if you jump around, and you get a lot of attention before that happens, maybe you might be breaking a rule. Now, there’s no one who comes in and arrests you for that, but there’s uncomfortableness about that, and do you think I’m making that up, or what’s your experience, and how do you deal with that?
Carolyn Delucia: I think that the only reason why, without tons of publications, that I’m able to speak on this topic is that everybody else is afraid to, and I feel that women have got to know that these treatments are available even if it’s before all the literature comes to fruition, and I think that keeping it secret and not speaking of it and not being … I think for OBGYNs, mainly, our issue is that it’s not yet approved or officially condoned by the American College of OBGYN. So, with that, it’s making everybody a little bit uncomfortable to try it, and to speak of it, but we’re seeing such amazing results, and internationally, the literature is there. Whether I’m publishing it or not, I can certainly refer to plenty of literature defending these procedures. Whether they’re completed in the US already or not, they exist, and the results are in the great promise that we see in our patients.
Charles Runels: So, let me-
Carolyn Delucia: So, I don’t care.
Briars, Woods Walking & Medical Innovation
Charles Runels: So, I want to point out something, and let you elaborate this, and I want to pull in Dr. Goodman because he’s on the call, and as you know, he did some of this research, and was in it before we were in it, and I think the ways …
I always imagined myself when I was six. I used to go bird hunting with my dad, and we would go … Down in Alabama, the forest is so thick, and there’s a lot of … I don’t know what you call them up north, but we just call them briars down here, and those briars will just literally rip your skin, and I remember my dad walking ahead of me, and stepping on things, and knocking the briars out of the way so I would still be cut enough to where I’d feel like I went to the forest, but he sort of blazes the path for me, and so I feel like we, the people in this call, are blazing that path, but I think Dr. Goodman was kind of the daddy up there that took a lot of the heat before we got involved.
But before I pull him onto the call, I want to say that there was something key to you’re saying more in tone than in words, but you hinted at it in words. You believe in this, and you feel like women need to hear it, and I think that part of what makes what we’re doing important, maybe, to somebody is that you know this is at least working for some people, and there is some research and a growing body of research. Some of the anchor stuff actually done by Dr. Goodman, who I’m going to hopefully speak up in a second. I’ve got him muted for now, but they need to know, and because we’ve seen families and lives change because of it, we’re sort of willing to take some hits, and we do take hits, right?
Carolyn Delucia: Yes.
Charles Runels: We do all take hits, and we bleed. Metaphorically, we bleed, and the people on this call, I think, have a right to say, “At this point, we’re still in the early innovator stage, trying to get the research.” By the way, I was on the call today with Johnny Peet, and I think we’re going to very soon blast off with placebo study with incontinence. Andrew Goldstein is proceeding. I just kind of revived our recruitment for our double blind placebo shot for the O-Shot for orgasm, and our group is contributing literally hundreds of thousands of dollars to helping make some of this happen. I haven’t paid Dr. Peet anything yet, and he thinks he can do that one fairly economically, but the point is we’ve got some funds. Our group is financing a lot of this because there’s no pharmacy to kick in, and we’re risking taking the heat.
So, I think the thing that was in there that you, being humble, didn’t emphasize much, but the biggest thing to be talked about in the press is, one, getting a little attention, but then having the courage to actually do it. So, my hat’s off to you. I think part of the reason Italians ruled the world twice is Italian women so I mean, you’ve got the courage [inaudible 00:30:38] to do the thing, right? So, I’m doing to pull in Dr. Goodman and see what he has to say because I’m …
Now, one other thing about these words. I know Dr. Goodman, for every reason, has a right to the rejuvenation. I think that Dr. Matlock actually may have a trade mark on this rejuvenation word, and we just launched a website called Vaginal Reconstruction. It’s going to be just for our surgeons in the group that do the O-Shot, and it’s going to be … It’s in the preliminary stages, but I have plans to drive a lot of traffic so people aren’t confused about what’s surgery and what’s rejuvenation.
One of my big favorite authors is Thomas Moore, who wrote Care of the Soul, and he has a book about writing where he says [In Thomas Moore on Writing], “Everybody sort of has their own personal dictionary.” So, my grandmother always called a car “fliver.” I don’t know where that word came from. We all have different meanings for word, but the thing here is that when people have a lot of time and energy and money invested into a word, it’s an important thing, and for example, when I started using the word “facelift” associated with an injection procedure, I caught a lot of criticism from the surgeons who wanted facelift to mean just a facial surgery, and I understand that. I mean, I have a crazy respect for facial plastic surgeons. That is not an easy thing to put a face back together after you go through a windshield, and I would never pretend to do that, but I sort of took that word and made it mean something else, and then I thought anything lifting the skin away from the skull should mean facelift, and so there is some emotion tied around this word, I think, for a good reason.
So, I’m going to unmute Dr. Goodman, and just recognize him as someone who took the heat before I even knew this was a ring to get into, and he was getting punched up and doing some research. So, I’m going to unmute Dr. Goodman, and he will have-
Charles Runels: Hey, Dr. Goodman. Are you there? Michael? Hello? Dr. Goodman?
Okay, so are you there? Okay, so we’ll see. Maybe he’s not able … Maybe his microphone’s not working right now, but anyway, so anything else you want to say, Carolyn?
Carolyn Delucia: I think you’ve said it all, Charles. I really do. I think that the most important thing is that women are aware that these procedures are available, and that is not a cure nor a promise, but it may be a help, and I think that the main point is getting the word out, and that’s been my journey.
Charles Runels: Yeah. So, thank you for speaking up, and thanks for being courageous. Now let me see if I … If you don’t mind, Carolyn, can I just leave you unmuted, but let me see if I can give you guys a couple of tips on what to do with this because now this is here. It’s talking about lasers. It’s talking about surgery, and it’s talking about, of course, the O-Shot so it’s all here, and even though I take heat, the good thing I’ve learned to do, although not as well as I would like, is to realize that even bad press can at least bring attention to it, and if you’re okay with bleeding a little bit, and it brings attention even if you catch criticism, it’s okay to let that go.
So, what do you do, I guess, when you have this? How do you take this, and turn it into patients coming into your individual office? There’s a system I have. First of all, you want to look at Alexa, and see if it’s worth noticing. So, can you see that pop-out screen, Carolyn, that shows-
How to measure web traffic (one of my secret tools)
Carolyn Delucia: No.
Charles Runels: Okay, all right. So, you guys can’t see it. Okay, so I’ll just show you. If you go to alexa.com … I guess the first thing that I like to do is to make sure someone’s listening. If I look at a website, whether it’s good or bad, and it turns out it’s someone’s little blog that nobody’s reading, it doesn’t really matter if I post something to it. I’m not sure this allows … I don’t think it does, but most of the webpages where something like this happens, it allows you to comment. This one allows you to make a question, answer a question, but usually, there’s a place to comment, and why take the time to comment if it’s a blog that no one’s reading?
So, I use alexa.com. You go to A-L-E-X-A.com, and then you can just copy the address from where you were just at, and put it in here, and it will give you the traffic. So, here’s the traffic on this website, and it’s ranked 27000th in the US. That’s really very high. That’s very, very high so that’s worth noticing. So, that tells me that if there was a place to make a blog post here, that people are going to read it, and then that gives me a free ad perpetually after that. Is there … I’m going to show you an example if you Google “vampire breast lift” because I’ll give you an example of another article that Carolyn did where a lot of us got some press out of it. So, breast lift Cosmo is the one that really allowed us to make a lot of comments. Power to Cosmo for Cosmo …
So, if I told you, you could get an ad on the Cosmo website for free, that would be worth huge amounts of money because to have a display ad on Cosmo would cost you many thousands of dollars, but when Carolyn got this article about the breast lift, at the time, I don’t know if it’s still here, but at the time … Let’s see if they’re letting you do it. Well, it went away, but usually, they let you … There was a place to make a post.
The point I’m getting at, if there’s a place to post a comment, you do it, and you do it in such a way that it’s not an ad. You just make an intelligent comment on the article, and then you will have basically a display ad on that website, but before you do that, the first test is to go to Alexa, and see if people actually visit that blog. So, Cosmo, if you do an Alexa thing, it’s not showing you, but it comes out at 1000, and 27000 is this one. If you do say, for example, Botox Cosmetic, it’s about 130000 to 150000 in the US. Our O-Shot is usually about 50000 so we’re not this much traffic, but we’re much better … Anyway, there’s a lot of traffic so it’s a respectable site, and you would make a comment if that’s possible.
*Next step is that you then take that link for it, and you just write an email that goes very simply something like this, and this is what you send to your patients, “Hello, I thought you might be interested in this procedure that helps urinary incontinence. Here’s a nice article about it. If you or someone you love,” always put you or someone love, “has this problem, and is interested, please give us a call or shoot us an email,” …
*and then you put a link to the page. It’s that simple. You don’t have to become Thoreau. You just write a very simple article like that, and post it, and then you can take that same thing, and I’ll show you how you can put it on Facebook very easily.
You just copy the address, and then if you want, you can just click the Facebook link and it puts it there, but if you want to very quickly make something more individualized, you just go to your page, and watch what Facebook has the … See, I’ve already done this, but I wanted to make a more intelligent comment about it, if you put the link in there, it pulls up the page, and then you can just make a comment about it into that box, and you’re not seeing the pop-up box, but it pulls up a pop-up box, and I’ll just show you an example, and then when you post it, now you can see. I just typed in an example right there, but I could’ve put something like, “Come see us about this procedure,” or whatever suits your personality, but all I did was in this, right here, I posted the HTML address into that space, and then it pulls up the picture, but it allows me to type something else there so that’s how you do it. I better take this away. That’s how you do it to Facebook or Instagram or wherever.
So, for me, it’s an email that’s two or three lines as if I were writing it to my mother or my girlfriend or sister or something, and then with a link to the thing with a plea for them to either call me, or let someone they love know about it, and they will think about that. It gives them the chance to help their sister or their best friend or whatever, and they will forward it to them. Okay, and now you’re using the national press to promote your practice.
A way to get a free appearance on your local TV station
*One last thing, and this one’s a big one if you have the courage to do it. Then what you do is you should have in your pocket, in your cell phone, the phone number of the health reporter for the news channel in your town, and then you call them, and say, for example, when this hit Cosmo, if you would’ve called your local channel and said, “Hey, there’s a thing in Cosmo about the vampire breast lift,” and you’ll notice they said this was the most looked at thing on Cosmo that month, but think about it. What could possibly pull more traffic than the word “vampire” and “breast” and Kim Kardashian during the Halloween season? I don’t know what other perfect lining up of things you would have to do to be able to generate traffic.
So, all of those happen. You got crazy amounts of traffic, and so, at that same day, and this is your step-by-step thing so I’m about to give you the next step. First, it’s a two line email to your people linked to the thing, asking them to call you or to forward it to someone they love that may have the problem. Second, you post to Facebook or whatever social media you’re doing. Third, you call the local news reporter and you say, “Hey, that thing that just happened or that’s on Cosmo, I’m doing that,” because, if you notice, the news reports on the news …
It’s really funny. You watch CNN, they’re talking about what the Fox News people are saying. Fox News is talking about what CNN and NBC is saying, and you’re watching the people on CNN, one reporter interviewing another. When did that get to be news when two reporters interview each other? But you see it all the time, but the point of that is that the news is hard up for news. It’s hard to think of something new every day, especially in your local town where there’s just not as many people to make things happen. So, when you give them something that is timed to the national press, that’s the point of all this, they will usually gobble it up, and they will call you for more things if you have the courage to do it.
All right, so, anything else you could say about that, Carolyn, and then I want to get back to the science a little bit.
Carolyn Delucia: No, not at all. I think that’s fantastic. Great advice.
Dr. Michael Goodman talks about innovation in medicine
Charles Runels: So, still have you unmuted, Michael, if you could hear me. I’m not sure if you’re there or not, but I’d love for you to jump in here about some of this research that we’ve talked about. Anyway-
Michael Goodman: Charles?
Charles Runels: Yes? Hello?
Michael Goodman: Can you hear me?
Charles Runels: Yeah! There you are! Beautiful!
So, back to this article because I don’t know if you heard me because I couldn’t hear you, but I’ve been bragging on you because I know that you must’ve taken a lot of heat back in the day. Talk to us some because I know I’ve heard Andrew Goldstein talk about that first paper you put out about how some of the cosmetic procedures made physical sex better. Talk to me some about the … And you’re too humble to talk about to talk about your courage, but at least some of the conflict you had to deal with, and give us a little sage advice because you’re the guy who was taking the briars and who created the path.
Michael Goodman: I heard you earlier, actually. I was in the garden sitting, my spring lettuce-
Charles Runels: You’re making me hungry.
Michael Goodman: Yeah, I had my headset on. For some reason, I didn’t connect so I came inside, and I’m on the-
Charles Runels: Thank you.
Michael Goodman: So, I can hear you now, and thanks for all the comments earlier. As far as early on, the journals and organized medicine really don’t like to things that happen outside of the university, and happen outside of officialdom. So, way, way back when [Camden John 00:44:58] and Harry Rich and several others and myself started doing advanced operative laparoscopy, and we’re dealing with ectopics in the late 70s, and doing hysterectomies and ovarian cystectomies and so forth in the early 1980s, and we tried to publish our first series back in ’84, I think, it was near ’84, none of the journals would have anything of it. In fact, the Green Journal called us cowboys, and basically wouldn’t hear of what we were doing.
We had the audacity of operating at a conference through a scope, and removing ovaries through the scope, and Harry Rich and I doing hysterectomies through the scope, all of which is just sort of standard practice today, and it was the same thing when plastic surgeons started to do breast augmentations for cosmetic reasons, and it’s exactly the same thing today, and it’s interesting. There is a decent amount of evidence based research in the Aesthetic Surgery Journal and in Journal of Plastic and Reconstructive Surgery and in the great journal, the American Journal of Obstetrics and Gynecology, and then certainly in the Journal of Sexual Medicine, there’s tier one evidence about changes in sexuality and in body image in women undergoing vaginal aesthetics.
It’s evidence-based that yes, there’s improvements in body image, and yes, there’s improvement in sexual satisfaction, and it’s all there in the literature, but ACOG really won’t hear of it, and when they quote the literature, they don’t quote any of these articles, so it’s pretty selective. That’s, you know, Charles, you run into that, and a lot of us who have done things, who have been in community medicine rather than in academic medicine. I have an academic appointment, but I’m a community physician.
Those of us that are community physicians, our voices aren’t heard as much. The interesting thing, when you look at results from procedures or results from treatments, everything has to be evidence-based. I’m definitely someone who believes in evidence-based medicine, but I’ve come to realize that anecdotal information is not chopped liver. The reality is that certain things will never, unfortunately, get the stamp of approval of evidence-based because there’s no money for funding.
That’s where the Cellular Medical Association comes in, and where it’s been, where you’ve been so helpful in that, is providing some funding money. When you take a look at things like treatment of PMS, you know, the official treatment of PMS is either risperidone, which is an anti-anxiety medication, or SSRI antidepressants. Those are the only things evidence-based that work for PMS. Why? Because there’s no studies that talk about caffeine avoidance, and talk about exercise, and talk about progesterone therapy.
There’s no studies that talk about progesterone therapy because nobody’s going to pay for them. They’re not patentable, and that’s what it sort of ends up being. If you have something that’s patentable, you can get money for research and you can prove whatever you want to prove. So much of the stuff in the literature is not comparing one treatment with another, but it’s just evaluating that singular treatment.
I mean, I’ll quit now while I’m ahead rather than use up all the air time, but I think what you’re doing as far … What we’re all contributing in as far as doing studies about the effect of the O-Shot®, and these treatments that no one will put money into because things aren’t patentable. You can’t patent the use of platelet rich plasma in Gräfenberg’s area and in the clitoris, and so there are not going to be studies unless someone like you or someone else takes the plan and says, “No, we’ve got to, let’s put some science into this.”
There’s always battles to be fought, and unfortunately, medicine is going into such a place where it’s sort of run by insurance companies and doctors have very little say and end up being employees, and it’s really hard to spend time with women and understand what their goals are, understand what’s bothering them, understand what their goals are, and try to meet those goals. One other thing, Charles, you still there?
Charles Runels: Yeah, and don’t feel restrained with time. You may not realize it, but you know, your thoughts are very encouraging to us as we just got through speaking. Carolyn’s been … I hope you guys know each other. I think you do. You know Carolyn Delucia, right? You guys know each other?
Michael: I don’t know if we do. Carolyn, do we know each other? I don’t know.
Carolyn Delucia: I don’t think we’ve ever met face to face. I don’t think so, actually. We’ve been at a lot of conferences together but never actually met.
Charles Runels: I’m glad you guys are meeting at least this way, because it does take … It’s scary sometimes, to be doing what we do, but yet we do it because we know that some of our women will be helped profoundly by it, and we try to do it intelligently so that we … We’re doing it in such a way there’s minimal harm always, of course, first do no harm. But it’s scary, and Carolyn has been hauled in and taken some blows, and out there. So, it’s good for us to hear, back in 1984 when I was still in college, that you were out blazing trails and yet you survived it, and you’re smarter and tougher because of it, so it’s good to see, and it’s very encouraging to me and I think probably to the others.
Carolyn Delucia: Absolutely.
Charles Runels: Of course, it’s not me doing it. There’s nothing I could be doing. I’ve become mostly a facilitator of conversation and a note taker and basically a pipe for the money to flow through to the research and the marketing and the lawyering. Anyway, I don’t really take credit for any of it, but just being maybe an admirer of people like you and [Bill Say 00:51:56] and all those guys who were out there taking the hits when I was still wiping my snotty nose.
Michael: [inaudible 00:52:04] a major role [inaudible 00:52:06] that we’ve taken with Andrew Goldstein, and Andrew and I have been friends for a long time. There’s no way he would have been interested in this and taking his ability to write up a good [inaudible 00:52:23] and get things published. That wouldn’t have happened without your facilitation. What I was trying to search for before was operative gymnasts, that’s what we called them in an editorial in The Green Journal, operative gymnasts, because-
Charles Runels: Operative gymnasts, like people who do flips on the balance beam?
Michael: Operative gymnasts; back in those days, laparoscopy was used for diagnosis only and tubal ligation, period. The fact other things were being done through the scope was heresy, but a lot of things start that way. You know, we were talking about the term vaginal rejuvenation.
Charles Runels: Yes, talk about that.
Michael: Yeah, I go way back with that term. The term initially, as you noted, the term initially was put forth by David Matlock, and I don’t know how many on this call know David. I’ve known him personally for about 15 years, and Davis is the penultimate marketer. I mean, no, maybe not the penultimate. You may be at this point, but maybe back in the day, you know, David has an M.D. and an MBA, a masters of business administration, and this was back when docs were not supposed to market at all. It was just sort of bad form to speak about your own practice and to market.
David had the audacity to try to patent the term laser vaginal rejuvenation. He was unable to patent it. I think he was unable to trademark it also for various reasons, but that term, vaginal rejuvenation, was, when David was talking about it, had nothing to do with machines, had nothing to do with radiofrequency, had nothing to do with laser. It was doing a surgical vaginal tightening operation. It was a modified, it was pretty much what we’re doing today with some modifications. It was a modification of a posterior colporrhaphy by adding in a levatorplasty, adding in the bulking of the scar tissue underneath the vulvar vestibule and perineum and distal vagina.
Where the laser came in, and that was his kick, where the laser came in was he was using a touch laser fiber as a surgical tool. Now, laser vaginal rejuvenation has nothing to do with the fractional CO2 lasers or erbium lasers that are used today. That’s not what laser vaginal rejuvenation is. It’s use of a touch laser fiber as a cutting tool. You can use a scalpel, you can use a scissors. I use a radiofrequency needle, same difference, it was use of a laser as a cutting tool for a surgical procedure.
That was there, and I remember John Miklos and I had an open discussion at one of the vaginal aesthetics meetings many years ago, where he was beginning to use the word vaginal rejuvenation. At that time, I spoke up against that saying, “That’s a can of worms.” For example, I’ve talked about this before, if you have a 65-year-old woman and she’s maybe 12, 13 years post-menopause and she hasn’t been on hormone therapy. She’s a widow, and her poor vagina has become very atrophied, she barely can put her little finger in there, and she’s met someone and she wants to have sex, and you work with her with vaginal estrogens, and you work with her with dilators, and over time, you get her vagina back so she can have sex, you’ve done a vaginal rejuvenation.
[inaudible 00:56:31] with the word vaginal rejuvenation is that it’s become a marketing term, and no one knows what the hell it means. If you ask 10 people what vaginal rejuvenation is, you’ll get 10 answers and unfortunately, patients feel that vaginal rejuvenation is going to cure their ills, whatever they are, whether they’re sexual ills, whether they need tightening, whatever it is. Vaginal rejuvenation is such a nonspecific term, and I still … Because it’s so nonspecific. I mean, what does it mean to you, Carolyn? What does it mean to you, Charles? What does it mean to everybody?
It’s not specific. Does it mean surgery? Does it mean levatorplasty and a full perineoplasty with elevation of the perineal body? That’s very different than using DHEA suppositories or estrogen in the vagina for your rejuvenation, and that’s very different from using, from resurfacing tissue. You resurface the face, you can see those changes. You’ve gotten rid of acne pits, and you’ve gotten rid of blemishes and so forth.
What does resurfacing of the vagina with laser mean? What does it do? What is resurfacing of the vaginal mucosa with radiofrequency? What does that mean? How often? We do it [inaudible 00:57:54] times, a month apart. Where did that come from? Why shouldn’t it be more? Why do we just do it two? How often do we do it? What kind of results do you get? Unfortunately, I’m seeing patient after patient after patient, well, just two patients after patient, I’ve seen several patients that have put out several thousand bucks and say, “You know, I felt a little different for a few months. Maybe there was something there, and it really didn’t do much.”
They put out a couple thousand dollars for vaginal resurfacing that really didn’t suit their needs. That said, I’m talking to doctors who say, “You know, my patients love it. I’m doing diVa,or I’m doing ThermiVa or I’m doing one of the other Vas, and the patients seem to be happy, and the greatest thing is they keep coming back and the money keeps flowing in.” But, are we really helping patients? I think sometimes we probably are, but the term is so nonspecific that we really have no idea what we’re doing, and it’s very hard to get any even anecdotal, even a compilation of anecdotal results, because one person’s rejuvenation is not another’s.
Charles Runels: I have a suggestion about what might, what I think might be evolving, and I have a lot of respect of course for you and the other guys like Dr. Matlock and Dr. Bill Seay and those guys that blazed the trail. But I think what I’m seeing is that you’re exactly right, rejuvenation has become more like, instead of the specific thing that it was intended to be, it’s become more of a, as you said, almost meaningless umbrella that can mean whatever is being done.
The reason I have this pulled up, I have a suggestion based on data. I like to look, and this, I’m giving away one of my secret weapons here. I’m a big believer in, how do people think about words? That word Vampire Facelift was not haphazard. I had the procedure, but I thought about the name for it for about a week of studying numbers to learn about words. I’m giving you one of my secret weapons, it’s called Wordtracker. You go, you log in to Wordtracker. It costs you a little bit, but you log in and you can put in a word, and you can see how many times people are using it.
I have a suggestion based on this. If you look at vaginal rejuvenation, it’s been used about 33,000 times in the past month, in the United States, of people looking for something. Now, these numbers talk about competition, so for example this is the number of Websites where it’s in the title and it’s in the text, and there’s a back link coming back to it, so just the word vaginal rejuvenation.
Now, notice this number, 33,000 in the past month, and then here’s some related ones. Here’s, and I’m telling you, this is worth gold what I’m showing you guys, now if you put in vaginal reconstruction, I don’t think there’s anybody that can make this into something other than a surgery. I don’t think anybody’s going to imagine I’m going to reconstruct, although maybe on a cellular level, I think … Not maybe, I think we are on a cellular level reconstructing things when we use platelet rich plasma and when we do energy therapies. But, I don’t think anyone’s going to ever evolve into thinking reconstruction is anything other than changing the mechanics and the surgical procedure, and it’s a pretty amazing vein of gold.
Now what I mean by vein of gold is this. In the early days, when Bill Clinton was elected president, there were only 33,000 Websites on the planet. If you made a Website that had to do with anything that a lot of people were looking for, you were the sole source of a lot of people looking for that thing, and they would be dropping dimes in your pocket or coming to your door, whatever it was you wanted them to do.
Now, there’s a Website for almost everything, and there’s very few veins of gold left out there where not many people are talking about something that a lot of people are looking for. This is one of the tools I use to look for those veins of gold. If you look at vaginal reconstruction, it’s not 33,000, but it’s still over 5,000 people, and there’s only two Websites with that in the key word, and one of them is ours, VaginalReconstruction.com. Then, these numbers are crazy good, because the higher the number the more competition, and this number is only 3.12.
If you look at this last one we were looking at, at vaginal … If you remember, if you go back to vaginal rejuvenation, I’m giving you marketing advice here, but maybe not just marketing, but ways to educate our patients. Rejuvenation, and so if you look at this one, that same KEI number is almost 100. The other one is only three, and that means that there’s a whole lot more people trying to capture this amount of volume.
Even if the volume is less but still significant, if there’s not many people catching it, you’re going to get a lot of traffic. I have given as a gift VaginalReconstruction.com, which costs me I won’t say how much, but it had a noticeable number of zeros behind it, and I bought that domain using our funds from the O-Shot® to create a Website just for the surgeons. Now, there’s always a selfish reason in everything, so if you go to VaginalReconstruction.com, this now belongs to us.
I’ve just put something as a placeholder until we develop it, so I got a little something from Red, and something from Michael, and a textbook, and another textbook, and a little bit from Carolyn up there in New York. But, my rule is going to be only surgeons who do the O-Shot® can be on this Website, so it also feeds the O-Shot® side of people who don’t do surgery. But, it’s a way to capture that really low KEI number so there’s the significant numbers of people who are looking for vaginal reconstruction get funneled to the excellent surgeons in our group.
So, that’s what we have going, and what I’m suggesting is that you can decide yourself what vaginal rejuvenation means, but I don’t think anyone’s going to ever get confused about what vaginal reconstruction means, and that if you start using that in your posts, if you’re a surgeon, I’m going to make that, if I’m able, into a word that starts to dwarf the 33,000 that’s used for vaginal rejuvenation, or at least approach that same number. That is my intention to make that happen, so I’m kind of showing my cards to this group because this is a group that’s all friends and in the same thing. We’ve gone over an hour, so I think I’ll probably shut it down here. Hopefully that was useful to you guys.
The last thing on my list that I promised was to show you where it lives, the research that has to do with the Amnion. I’m not going to talk about it much, because I’ve already gone over the hour, which I don’t like to do. But there’s a link, you know what? I’ll just put it in the link under the recording from this thing. But we have, on the cellular medicine site, a really nice list of the research that has to do with Amnion. I’m interested what happens with you guys as you start to maybe use that as a combination with your PRP and your hard to treat cases.
I better shut this down since we’re over an hour. Thank you very much, Carolyn, and thank you very much, Michael. I don’t know if you realize it, but it’s a huge encouragement to us to hear about how you blazed a trail and continue to do so. You guys have a good week, thank you.
Carolyn Delucia: Thank you, thank you.
Charles Runels: Goodbye.
Both Dr. Delucia & Dr. Goodman offer hands-on workshops and can be found on the following directory…
Cellular Medicine Association
Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
Dr. Runels: Thank you for having me.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful