Charles Runels: Let’s talk about something that I hate, I really hate, it’s dyspareunia or pain with sexual intercourse in women who are already suffered from breast cancer. Imagine the loneliness of having already gone through all the treatments for breast cancer, and now that you’ve survived, and you’ve lived through radiation, perhaps chemotherapy, perhaps surgery, and now you’re left with the inability to use estrogens that are needed to maintain the lubrication that’s involved with comfortable, sexual, intercourse.
Unlike decreased arousal, where a woman who loves her husband can accommodate, or decreased orgasm, where a woman can still enjoy sexual intercourse without orgasm, dyspareunia makes a woman actually avoid her husband. Her fear is often that if she arouses the husband, then the husband becomes more frustrated. I hear of women who will even avoid touching or holding their husband’s hand, even though she loves him, because of fear of arousing him, and then causing frustration because they can’t have sex. The things that have been tried for this … The thing is, it separates lovers.
Now, who am I? My name is Charles Runels; I’m the inventor of the O-Shot® Procedure, so I’ll just tell you right now, we’re coming to talking about how that might be a solution to this problem. I’ve been treating women for sexual dysfunction for the past 18 years. I’ve been a physician for 20 plus years, and I’ve done research in the area and I think we have something to help maybe.
But let’s go ahead and talk more about what’s been tried, and we’ll get to what’s new. If you look at a search on PubMed, which is the main way for finding research that physicians use worldwide. If you look at the different solutions that come up, not a lot of research in general, when you search dyspareunia and breast cancer, but if you look at the answers, it’s really very frustrating.
The conclusion of this one is, “Breast cancer survivors with menopausal dyspareunia …” In other words, they cannot use estrogens for fear of recurrence of the breast cancer … “can have comfortable intercourse after applying liquid lidocaine.” So, she’s back to accommodating, but not necessarily enjoying, and I’m not saying this is a horrible thing, it doesn’t mean it’s not something that can be used. But, if you look at the research that’s shown here, it involves basically, numbing things. It can get on her lover, and so they both can now put their genitals together which allow some closeness, but it really doesn’t allow the pleasure of sex, like it could be if you just made the pain go away instead of numbing it down.
So you look at this other one. Look at what they’re recommending here … Aqueous lidocaine. Not so good. These are the most relevant searches for this problem. If you look at this one, “Olive oil, exercises, and moisturizers.” So, when it comes right down to it, it’s a long way of saying that the current best practices are a combination of lubricating, numbing, and some sort of counseling. Counseling as in learning how to stay close without the pleasure of sexual intercourse.
My hats off to all the research that’s gone into finding a solution. I’m not angry at the solutions or the people that have tried to find these solutions. I’m very angry that this is the best we have. Starting about eight years ago, I started using Platelet Rich Plasma (PRP), first to inject Platelet Rich Plasma into the genital-urinary space, and we published some research about that, which you can find if you go to O-Shot®.info or O-Shot®.com, it wants … Puts you on the same web page, and then click on research. When you click on the research, you’ll see a list of various things that can be done to help with sexual dysfunction, and other problems secondary to that effect … Wait a minute … Then, at the top of that, you’ll see a paper that we publish, this is me, and we talk about all the reasoning why using Platelet Rich Plasma maybe of help, and we showed that we were able to decrease female sexual distress significantly, extremely significantly by using Platelet Rich Plasma to cause rejuvenation of the tissue. Platelet Rich Plasma has been demonstrated in multiple studies. Look at how many studies you have with Platelet Rich Plasma. Over 10,000 the last time I looked.
Yeah, there you go. 9,987 papers about Platelet Rich Plasma. This is not some new thing, and they go back over 20 years. It’s been known to help with healing of hard-to-heal tissue. The dentists have used it quite a bit. Orthopedic surgeons are trying to heal. Both of those specialties have to heal bone and cartilage, with not a good blood supply. And so it’s been used in that arena, and in 2010 I started using it for the vaginal periurethral space, and we published this study soon after that.
Now, there’s a new … We’ve been seeing this help for the past eight years, but a new study came out supporting it, and I want to get to demonstrate and talk more about what they did with this study, where they used Platelet Rich Plasma combined with hyaluronic acid for the treatment of vulva vaginal atrophy in post-menopausal women. You can see here they did not …. It wasn’t just about the atrophy. They followed dyspareunia, and saw female sexual distress improved significantly with that treatment. I propose that it would have improved much, much more had they used our protocol. But still, it was statistically significant. So we’re back to my protocol, but let’s … Let me break this down to what we initially did in our study, so that you can understand what they did.
In the study that we did, we took the Platelet Rich Plasma and then … which you get by doing a centrifuge, and then the centrifuge separates out Platelet Rich Plasma from the red cells, and I can show you a picture of what that looks like right here. So you start off with a tube that looks like just a tube full of blood, has an anticoagulant in it, and then when you get through with the centrifuge, you’ll have red cells at the bottom, but instead of a buffy coat and platelets on top of it, and plasma on top of it, there’s a gel that separates them so that now they’ll remove the plasma and inject it into the area. So, it mimics what happens every time you have surgery or injury. This is not a new idea, it happens every time you have to heal a wound that the platelets release growth factors, and then those growth factors cause recruitment and activational plural potent stem cells that migrate from the bone marrow and heal the tissue.
This is very well known in the orthopedic and dental space, so much so that it’s quit being about whether it works or not, it’s the best way to use it. You can see here’s one from the National Journal of Implant Dentistry, where looking at using calcium chloride to activate the Platelet Rich Plasma. Now, what does activation means of this FDA approved, and what does this all mean?
Your blood does not require approval by the FDA. It’s your blood. Just like your saliva, your hair and your skin. But if you’re going to isolate a part of the blood for re-injection to a human body, you should use a device that’s FDA approved for that purpose. Those devices vary based upon method that isolates the platelets and how the platelets are activated. For example, this one uses a gel that I just showed you, and to separate it. But others use filters, and double centrifuges and pipe fitting techniques and all sorts of things, so, that’s not the only way to do it. This one has a gel that separates. There’s the gel … the red cells from the plasma, and then the plasma’s re-injected.
Activation is widely accepted within the orthopedic and dental literature as being helpful, because it tells the platelets to release all those growth factors. That activation can be done with vacuum, calcium chloride, calcium gluconate, and with a hyaluronic acid filler, like Juvederm or the orthopedic versions, like Hyalgan, because the platelets interpret that to being a form of collagen, which causes the platelets to release those growth factors and cytokines.
This particular kit has a small amount of hyaluronic acid, which is again like a Juvederm, or Restylane, or Hyalgan, or Synvisc, or all hyaluronic acids, that comes with the kit, there are other kits that come with calcium chloride. Some kits don’t come with anything, and you have to add the calcium chloride or the calcium gluconate, or the HA yourself. So, this kit was sponsored by a company that makes a kit … Region makes a kit, that comes with an HA. The point I’m making is that there’s really two variables here, right? They’re injecting two things. Platelet concentrate, which they’re calling … That’s the word they’re using for Platelet Rich Plasma, and hyaluronic acid. That’s two different variables. So, don’t let that confuse you though, because the HA is just a way of activating, and you never cause rejuvenation of tissue of any significant degree with an HA, although there is a mild effect. The major effect is from Platelet Rich Plasma.
Now, how do I know this, and what’s my background? In addition to inventing the O-Shot®, also invented the Vampire Facelift®. This was something that most people don’t know, but when I was experimenting this, which Kim Kardashian did, and many celebrities have now done, when I was inventing this, I was actually doing this as a way to figure out how to use it in the genital-urinary space. Now, of course out of it came a useful cosmetic procedure, but as a wound care physician, I had already been looking at this in other arenas. For example, this one. Where PRP is used in combination with a HA for healing a wound, and others like it, where … But others like it, for example this one. Using PRP combined with an HA, and it helps heal wounds. But it’s the PRP that’s active and you have many, many studies showing PRP as a stand-alone for healing wounds.
So, if you go to PubMed and you put in Platelet Rich Plasma, and then you put wounds behind it, or wound healing, you get lots of stuff and most of these don’t use an HA as part of the process. And you can see it’s all about it heals muscle, there’s collagen, there’s new blood flow, and so it’s really a very well-documented way of regenerating tissue, all tissue types, nerve, blood flow, collagen, even fat cells.
There are 1,700 studies. Back to what we’re doing here with the dyspareunia secondary to dryness from lack of hormones, particularly estrogen, in the case of someone who’s had breast cancer, what we’re doing is using the PRP to recruit plural potent stem cells that grow the new tissue, and the HA as an activator. Go into more detail about what the studies show. They measured vaginal health index, which you can see I said that ought to do with fluid, the PH, the moisture, and they did a Xylocaine cream, but we use a Bupivacaine/Lidocaine/Tetracaine cream that works I think better than this. So, our pain ratio would be different. They injected four CCs in the vestibule in the first three centimeters of the vagina using a point-by-point technique. This is not needed. This would hurt more, because you … PRP spreads so easily through the tissue. You don’t have to do so many injection points. In the posterior vaginal wall, and the posterior wall of the introitus.
You can see here where they’re putting the injections. The thing about this is that it’s missing out on the anterior wall. Now, why would they skip the anterior wall? The reason is that there are multiple studies showing that HAs in the anterior vaginal wall, hyaluronic acid in the anterior vaginal wall can cause granulomas, it can lead to obstruction. That’s not a good thing. But by leaving out the anterior vaginal wall, you miss rejuvenating the Skene’s glands of the periurethral glands. Let me show you where those live.
If you look at the cross-section through the vagina and urethra, the Skene’s glands or the periurethral glands are very near the opening here on the front side of the vagina. So, if you’re doing all the injections back here, it’s not going to do anything with that. So, why is that important? Why is the Skene’s glands or the periurethral glands important?
Actually, let me get this where you can see it better. Here’s the urethra, here’s the vagina, here’s the periurethral glands or the Skene’s glands. Here’s another picture of it showing you where it may open up just near the opening of the urethra. Here’s another view of it, showing the Skene’s glands are right there, all of it on the front side, but these guys if you go back and look are injecting on the back side. That’s not a bad thing, they help the woman, but it’s a less than it could be thing. Now, had they injected the anterior vaginal wall, actually my feeling is that there’s not enough HA in that particular kit to cause a problem. I’ve used it, it’s a good kit, I don’t think it’s enough to cause a problem.
But, I don’t know that I’d want to risk it in someone without a study showing that I’m not going to see granulomas, like [Swissman 00:16:15] demonstrated before. So, when we do our O-Shot®, we inject PRP here, but we do not use an HA, so we use a PRP that’s activated with calcium chloride, like we talked about over here, using calcium chloride instead of an HA to activate. Back to our study, when they did this they activated with an HA and now these platelets have released their growth factors, we don’t even care about the platelets anymore, the growth factors are in the plasma, and that’s what gets injected here, after it’s been activated.
If you look what happens, it’s pretty spectacular that the effect of it … Now, this is PH and vaginal health, and you can see it levels off at about three months, which is what you see in most soft tissue studies. When they ask the women would you like to repeat it, 19 out of 20 of them said that they would. But then if you go back and you think well wow, what if they would have actually injected here, just like the men’s prostrate excretes a lot of fluid, it’s the main thing that makes the fluid when a man ejaculates, a woman’s Skene’s glands do as well. We actually have women who ejaculate for the first time after using PRP in the anterior vaginal wall. I think they miss some of the benefits. When we did our study, we had a larger improvement of female sexual distress than they did … they saw with their study.
But, I’m still very grateful. It’s a good study that shows that PRP with an HA can help, but I’m telling you, we’ve been doing it for eight years, and PRP injected the way we do with our O-Shot® does more than an improvement … The improvement in the female sexual distress that was shown here. So what the heck is the female sexual distress scale? This is what it looks like. You can see the most you could get … The more of the … All these questions, 13 questions are answered, and each question has a maximum of four, with a higher score means you’re having more problems. So, if you’re worried about your sex not at all, it gets a zero, all the time gets a four. So, the most you could get was four times 13 and we were able to see a large percentage of our people go from distressed to not distressed when we used PRP the way we do with the O-Shot®, which is anterior vaginal wall and the clitoris.
It’s a really important study. I think it backs up what we’re doing. But, I think that we have a better technique that we can use. I think if you want to know more about it as a patient, you would go to our O-Shot® website, which you just type in O-Shot®.com, or dot info either way, it gets you there. O-Shot®.com. Then, when you’re there, if you click on … You could read all about it. Read the research. You could see if you go to research thing here, you can see me covering other research projects that have to do with what we’ve done like in necrosis, urinary incontinence, all sorts of things. There’s a chapter about it in this textbook, and you can see some lectures where I’ve lectured various places.
That’s the place to read the research. If you want to see one of our providers, almost every page has a place on it somewhere that says that. Click here to find provider, and then once you’re there just click on your country, or your state and it will show you people in that area, or if you give it permission to know where you are, it will just show them nearest to farthest away. So, we have multiple countries, and multiple states here. So almost every state, and 50-something countries. Now, if you’re looking for someone who does other things, like treats lichen, use radio frequency, a laser, or has Emsella machine, then you’ll see those icons by their name as an indication that they treat that. So, this doctor for example uses laser and treats Lichen Sclerosus. This means that they’re a teacher for us, and I think that’s all you need to know. That’s where you go obviously, nothing works all the time ever, ever. Results do vary, so you should speak with your physician and speak with one of our physicians about being treated this way.
Now, if you’re a physician, you go here, under physicians and there’s a place to get free information. You just fill this out, and we’ll send it to you. Tell me where your office is, and you can get any kind of free information you want. If you actually want to go ahead and apply for either online or hands-on training, you go to O-Shot®.info/members, and that’s where we list a place for you to apply to become a member of our provider group. We have a very specific way of doing this. As you can see, [inaudible 00:21:22] every way that you inject PRP matters, and we have a very specific method that we teach. As a matter of fact, if you don’t see someone listed on our directory, then they’re not licensed to use our name, and they may be doing something better, but more likely they’re doing something not as effective. I highly recommend you use someone off of this list, and if someone’s using our name O-Shot® and not on this list, they’re pretending to be part of our group when they’re not. So, you can make your own conclusions about what that means morally.
Anyway, here’s where you would apply, O-Shot®.info/members, if you’re interested in being part of us. This is under the umbrella of the Cellular Medicine Association, where we do research. We spend hundreds of thousands of dollars every year researching the areas of female and male sexual dysfunction. We have teachers around the world. We also have online training that you can apply for. I hope that’s helpful to you. I think this is really important research, and I’m very grateful to these guys for doing this. But, there’s a lot more to know and we would love to help you learn more about it, whether you’re a teacher or a provider. Thank you very much for your attention.
I’m just back from an ISSWSH meeting, which I highly recommend that you guys do if you haven’t been yet. Here’s their website for the Fall course. Maybe once every year or two I recommend. You can see the content is pretty amazing. These are the handouts that they had. I thought I would just run through some of the highlights of the lecture that Andrew Goldstein gave on dyspareunia.
Dyspareunia, as you guys know, to a gynecologist, it’s like saying back pain to a orthopedic surgeon or an internist—the etiologies are so numerous that it’s almost the name of a symptom not a diagnosis. Although there was an article, an editorial, in the Green Journal Obstetrics and Gynecology about three years ago now where the editor said, “We’re not treating it as well as we can, and often times it really does go undiagnosed.” But even with that being the case, it’s worth looking at in more detail, the different diagnoses/etiologies
I’m going to unmute your mic, Kathleen, because I know you’ve been to this meeting (ISSWSH). You are going to have things to say about it. It would be very helpful to talk about it, I think. I don’t know if you’re able to talk. Can you hear me, Kathleen?
Kathleen Posey: Yeah, I can hear you. Can you hear me?
Charles Runels: Yep. We’re recording this because even though not so many compared to speaking, not a huge percentage of our people make it to the call, usually it’s in the neighborhood of 20 or 30 people out of over 1,000 people, I think it’s really worth thinking about pain/dyspareunia.
The good news is that often times when we have pain and it’s not easily diagnosed, our O-Shot® procedure seems to be working. Whether it’s healing damaged tissue or if it’s causing a decrease in inflammation like it does with lichen, I don’t know. But I thought we’d run through these known causes. I don’t pretend to be giving this presentation the way Andrew Goldstein gives it, but I’ll hit the headlights, the highlights. Hopefully, you guys can hear the lecture for yourself sometime in the next year or so.
This is the textbook that he helped edit about dyspareunia, which I highly recommend that you go through this. Eventually, I think there will be a chapter about an O-Shot. You can find this on Amazon.
This is the one, the version that he wrote for patients.
These are the known causes [see video]. Talk about this for a second, Kathleen. What on here do you see us helping with? Obviously, we wouldn’t try to treat fibroids with an O-Shot, but talk about this list for a second, and just the diagnosis of dyspareunia in general. Can you see it?
Kathleen Posey: Yeah, I can see it. I basically put PRP wherever the pain is. I map it out. I rule out the things like yeast infections, chlamydia, endometriosis, PID. I treat them just like we would treat those, but usually when there’s no reason, I just get out that Q-tip or just my index finger and say, “Where’s the pain? Does it hurt here?” Then I put the PRP.
Actually, a case I talked about a couple weeks ago was a anal cancer in a 40 year old that had radiation and complained of menopause and decreased lubrication. She went to a plastic surgeon who did Thermi-va on her, which only made her small vagina smaller. But mainly the pain was a posterior fourchette. I did put the PRP and did an O-Shot® because I do both. About two to three weeks later, her pain got better. That’s my method.
You can look at all these diagnoses. We know how to treat most of these things, but it’s the unknown ideology of the pain that I think the PRP helps. It doesn’t always. I had a classic vulvodynia around Hart’s line that was real painful, and she really didn’t respond that well, but that’s just one out of the many that I’ve treated. I’ll still try it on another patient like that, too. I wouldn’t limit it to that.
Charles Runels: Beautiful. Let me add to what you just said.
First of all, I agree. Most of the people, by the time they get to us for an O-Shot®, the patient’s already, before they are willing to pay cash, they’ve already been to other physicians and had lots of tests done. The good is that most of these things, if they were there, have already been treated.
The other thing I would add, which I know you do this, Kathleen. I know you treat some people for free, as do I, and that we’re both careful not to keep money if people don’t get well. I highly, highly recommend that everyone do that. If you’re treating pain and someone doesn’t get well and you keep their money, they feel like we stole from them. Even though we’re not used to giving back copays or whatever, insurance doesn’t refund money if we don’t … Obviously, we know we can’t get everyone well, highly recommend that if you treat someone for pain, and they don’t get well, either repeat it or refund their money.
By the way, the reason I’m talking to Dr. Posey for those of you that don’t know, you’ve been involved with the group right now for quite a few years. She’s been teaching it to other gynecologists. She’s a gynecologist, board certified, out of the New Orleans area, who has recently presented some research where she treated lichen sclerosis with a combination of surgical procedures and PRP, and teaches that method. A lot of experience seeing many thousands of women over the years as gynecologist and very well-trained, busy surgeon in the day. Back in the day, I know you were a high … Anyway, lots of experience.
Back to this list. Back to the list. The endometriosis, obviously, you wouldn’t treat it. The psychological, that hopefully is going to be teased out with your conversation. I wouldn’t try to treat psychological, obviously, with PRP. But let’s get to some of these pictures, though, because I think a lot of our providers don’t really know what to look for. I know that you’ve seen quite a few people who are being followed by a gynecologist-
Charles Runels: Some of these women, saw gynecologists who never diagnosed the pathology the gyn just went for the pap smear and never stopped to look at what was going on.
You just mentioned … This, by the way, is his algorithm for pain. I don’t show this, obviously, expecting anybody to memorize this whole thing from my overview here, but I just want people to realize there’s some thought that goes into figuring out pain. They’re not just willy-nilly treating someone without making sure that someone, if they’re not a gynecologist or a dermatologist, that someone hasn’t thought through a differential diagnosis … If there’s a rash for example, it should be biopsied. Someone should be thinking about that.
This first one is a big one. There is a pain disorder that’s associated with low testosterone. This is stressed over and over when I talk to people who treat a lot of vaginal and vulvar pain. The vagina and the vulva needs testosterone to stay healthy, and there’s a actual syndrome associated with pain and birth control pills, which almost always drops testosterone levels. Some women are susceptible to that, and some are not, but that’s something to think about.
This vestibulodynia of different ideologies is a whole subject in itself, but interestingly, I did meet a woman at this last ISSWSH meeting who had a woman with long standing vestibulodynia that was of this [neuroproliperative 00:09:01] type that responded to our PRP. Somehow it decreased that inflammatory whatever makes things go on here. This is a whole area for research that we need to take up, talk about. But obviously this is not a healthy looking vestibule. When you have this erythema around Hart’s line, then it’s worth thinking about testosterone creams. I think it’s worth trying our PRP as a way to modulate that.
Again, I’m just skimming through this just so you can see this should be thought about. This is that Hart’s line that you just heard Dr. Posey talk about that one. That’s inflamed, and this responded to using testosterone and estrogen creams.
Our O-Shot® is not the cure all, end all, be all, but I think it’s an extra tool that can be used in the thoughtful treatment of these problems, so I just-
I just wanted people to get a look at what some of this neuroproliferative. Vestibulodynia is a horrible problem. Basically, someone stays inflamed to the point that then if the inflammatory agent is removed they still stay inflamed.
A lot of times, they’re treated with creams that have some sort of propylene glycol or paraben in it that causes the inflammation. You’ve got inflammation, you treat it with a cream that actually causes a chronic inflammation to the point that when it stops, sometimes they’re left with a continued process that turns into this.
I think that was the main thing. The other thing to think about is here’s the pelvic floor muscles. Normally, these have been treated historically by palpating, as you heard Dr. Posey talk about, palpating and finding the place where a person’s tender, just like you would look for trigger points in a tender back and in the same way that physiatrists are now injecting PRP to treat this.
When you find that tenderness, you can now inject PRP. That will usually hurt worse for about a week and then it goes away. You have anything to add to these pelvic floor injections?
Kathleen: Not really. I’ve never really done them. I refer to pelvic floor PT, but I will say that even of the lichen sclerosus patients I’ve seen, a lot of them have pelvic floor dysfunction. You just touch them and their levator ani muscle just almost goes into spasm. It’s interesting, a lot of women when they’re touched, they wanna squeeze that butt together and I’m telling them, “Look, put your butt down into the table.” There’s a lot of comorbidity there with vulvar pain and then these muscles getting involved is what I see.
Charles Runels: Just to add to that, we do have people in our group who work with the pelvic floor therapists. I know you have them in New Orleans. Our little town doesn’t have one. But that’s a good referral source. One of our people actually had a pelvic floor therapist put a satellite office in their office actually they had a good working relationship [inaudible 00:12:30]. His O-Shot helps her therapy work better. That’s worth looking into.
The way that he established that relationship is he just had her bring one of her patients over and he treated the patient with the therapist in the room so she could see what was involved. Then she went back and did this therapy as she normally would and had a nice result. It’s a way both to help their therapies work better and to help everybody’s business. Let’s see.
Kathleen: At the conference in Boston, they talked about putting Valium in the vagina.
Charles Runels: They did.
Kathleen: Did they talk about that at all?
Charles Runels: They did. It didn’t seem to be as helpful, at least the feeling I got from the lectures, as using Botox. That was something that was talked about.
We don’t have the research showing that our PRP works with pelvic floor trigger points, but it should apply, since that research has been done in the physiatry literature with back pain.
They did talk at ISSWAH about trigger point injections of Botox and they mention diazepam and suppositories, but Botox seemed to be the first choice on the menu (before diazepam).
100 units is what they talked about using, which would be one bottle of cosmetic Botox. Some are doing it under anesthesia. I know Andrew Goldstein was saying he likes to use it without general anesthesia so he can tell better about where to put it.
Let’s see. I think that was the main thing I wanted people to see was just that. Oh, yeah. He does a vulvar vestibulectomy but he says he does a whole lot less of these than he did in the beginning of his career when people were not using testosterone creams.
It was really talked about a lot, especially in someone who’s on birth control and how common it is that that gets dropped in people who develop these pain syndromes, not just this vestibulitis pain syndrome. But this is a last resort, obviously, but it’s something that’s done just to know what’s out there. It can be done if somebody develops this pain that just won’t go away.
I think that we’ll find that there’ll at least be a subset of these people that get better with our O-Shot. We’ll see. I think that was the main thing I wanted to show. I don’t feel like it’s my place to just put all this stuff out since it’s their intellectual property, but I just wanted people to see that there’s a lot of stuff out there and it’s worth, I think, attending one of their meetings. It’s called ISSWSH, International Society for the Study of Women’s Sexual Health. Maybe go there once every couple of years and get a good update.
Amnion with the Priapus Shot® Procedure
Okay. We didn’t have as many questions this week as we normally do. We had one question that showed up on the Priapus shot website about has anyone used PRP combined with amnion with the Priapus shot. Some of us have, but I don’t think I have enough experience yet to tell you that it’s working better. I think it would be worth trying if someone didn’t respond and you were treated Peyronie’s disease especially if you’re trying to heal scar tissue, or someone just wanted to get the best that you knew to do.
Again, amnion is not stem cells, it’s where you’re harvesting the proteins from the amniotic membrane and then they gamma-radiate it. There’s nothing living in there. You just have the cellular proteins, the amino acid peptide chains that code for wound healing. That research has been done. I think just as a general help, I always like to add in a couple things that have to do with marketing and something to do with business.
Press. Men’s Health
We got a really big hit that’s worth talking about when it comes to the Priapus Shot® procedure. If any of you guys are doing this, it’s worth talking about. Dr. Gaines is in our group and he popularized the Gains Wave™, which is combining the Priapus Shot® with shockwave therapy.
You can see the guy in the Men’s Health article talks about the Priapus Shot® itself, or the P-Shot®, and it’s a very complimentary article, somewhat sensational, but he’s an entertainer. This is “Men’s Health,” this is not “The New England Journal.”
Obviously, we don’t make claims we can’t fulfill and you want to have a consent form and make sure that your explanation is not the same as “Men’s Health” magazine, but Lord knows we get huge amounts of negative press that’s absolutely uninformed and factually wrong. Someone wants to make this a little bit entertaining by talking about his penis he claims was 10 inches when he put it in the pump, I don’t know, maybe it was 10 inches. Who knows? But I’m not one to dispute him.
It’s a nice article that at least can start the conversation and maybe lead to you helping some people who need your help for their erectile dysfunction. That article’s there if you just Google “Priapus shot in Men’s Health.” Some of us are combining the shockwave therapy when people want it. Just so you know, if you look on our director, PriapusShot.com/members/directory, I added a logo so that if you’re using shockwave therapy people can find you.
Also, I know Dr. Posey uses the- That right there, that’s our shockwave logo.
Our Directory and Helping People Find You
If you are doing shockwave therapy and want the logo by your name, let me know and I’ll add it.
If you go to the O-Shot® directory, we have a logo now if you’re doing radio frequency. I think what’s gonna happen is as the research becomes more available, as we do more research, then people are going to want different flavors of our procedure based on their problem. I know there are some things that one of these machines, like Dr. Posey just mentioned, someone who had dyspareunia had a small, constricted introitus, that’s not the place to use your radio frequency device.
But you can see I added this. This is what I added, Kathleen, to indicate you’re doing radio frequency. If you want one of those by your name, just send it to support. I’m gonna put it in here…
I just put it in the chat box. You just send that and let us know and we’ll put the little thing. This means you’re treating lichen, this means you’ve put five people in our research project or a survey, this means that you’re using radio frequency device, and we have one for laser’s too. I need to update.
This is the legend so that whomever’s using this directory knows what these little symbols mean. I just added this last week, so I need to add that to the legend so that people know that means you have Thermi-O or radio frequency device.
So, let’s see Dr. Desmond Ebanks just put something in the chat box. So, the automatic pump he uses, I don’t, the guy talks about this pump like it’s the bomb. Who knows if that’s part of his journalistic license, but he talks about this pump as being a pretty intelligent thing, so I’ll ask Dr. Gains what brand of pump they’re using.
Let’s see whats the other question…
which shockwave device do you recommend? As far as the shockwave device, what I have right now is the E-Vive. There are others out there, I think they’re all made by, or most of the main brands are made by the same company. They’re kinda re-branded, depending on who’s selling it. So I think a lot of it comes down to who you want to work with. And who’s having a good deal, and good support. But right now, I have the E-Vive, which is the one Eclipse sells, in my office.
Let’s see, Dana Kirk just said here, okay, so here’s the question from Dana. She says, “Often the Vampire Facial®’s being administered for acne scarring often have some leftovers. Anyone injecting into the larger pock marks? If so, is it worth activating?”
Ok, so this is a good question about acne. When I treat acne, I use micro-needling. But two tips on that….
First of all, if it’s in their budget to do Juvederm. If you think about what happens to the divet, or say the divets in say a basketball, if you put more air in it? The divets become more shallow, just from expanding the ball. So even before you treat the pocks marks, or treat the acne scars, if you’ll use some Juvederm, if they can tolerate it, as in, do they have any room for some improvement in the cheeks, and if it’s a female, almost always they do, unless they’re obese, they’ll have some. You can add to their cheeks and things look better. And the acne scars are already smaller (before you actually treat them). At least the ones in the cheek area.
Then, micro-needle with PRP (Vampire Facial®), but also go intra-dermal and sub-dermal with your PRP, subsize/undermine the scar, just like you would if you were treating acne scars before we had the Vampire Facial®, so taking the bevel of your needle and sub-sizing the scar releases it some. I
Inject a little PRP sub-dermally, inject some intra-dermally, and then micro-needle on top of it. Intra-dermally as in blanching the skin.
And all those combined will get a really nice result. Usually I treat them every six weeks for three treatments, and they love it.
As far as activating it for the face, I usually don’t (I used to do so). Because I don’t think it adds to it enough to warrant the extra pain. In the face. But I do activate the PRP in the O-Shot®, the P-Shot®, and for loss of sensation in the breast.
The Order to Do Shock Wave, Radiofrequency, & O-Shot® or P-Shot®
So Sherry, I don’t see your question, it just says … maybe you can type it again. Okay, wait, here it is… “Does it matter which order you do the p shot, the shockwave therapy, and did the p shot … okay….”
So, the way I think about the energy, whether it’s shockwave, laser, or radio frequency, the way I’m thinking about it is, if you’ve ever used, say, insulin or growth hormone, if you just take, if you buy Omnitrope or a growth hormone, or Genitropin, whatever brand. These are small amino acid or peptide chains. It will tell you not to shake, to gently stir when you put the water in. Just shaking the vial, it mechanically shears the amino acid protein chains, so it’s like taking the words of the sentence and just chopping them up and turning them into letters. And now that amino acid chain no longer acts as a small peptide signal. Right? So these amino acid chains act as signals that plug in to receptors on the cell, and that’s how growth hormone, that’s how insulin, it’s how all those amino acid chains work.
Over 200 made by the pituitary gland that we know about. Peptide chain signals. So, imagine if you did that, I have no research to back this up, but imagine if you injected a peptide chain, and then now you hit it with shockwaves. In the same way, imagine what happens to an egg when you put it in a skillet and fry it. Obviously those peptides or those proteins are being changed.
So the bottom line is, I like to use the energy, whether it’s shockwaves, lasers, radio frequency, whatever it is. Use that on the tissue first. And then immediately afterwards, same visit, then apply your PRP. Now if you want to, if you did the shockwave yesterday, or last week, or three weeks ago, or a month ago, and you wanted to do PRP after that, that’s fine, you’re not hurting anything. And if you want to, if you did the PRP three weeks ago and now you want to add the energy, you can. But in my opinion, as soon as you add the energy, you are probably shutting down whatever growth was taking place, from the PRP that you put. So it’s like you’re stopping, it’d be like you just watered a seed, the stem cells are [inaudible 00:25:26] stem cells that you just put there. And now if you’re trying to generate more growth by damaging tissue, now you’re crushing the little sprout or whatever tissue is growing. You’re crushing it or injuring it, in my opinion, if you didn’t do the shockwave therapy before it has a chance to mature.
So I would try to do them back-to-back on the same visit. And not do anything else mechanical to disturb the growth of the pluripotent stem cells until at least six weeks out, maybe even eight. To give what you did a chance to work.
So if you did the P-Shot® three weeks ago, yeah, you could do the shockwave now, but you’d probably be stopping whatever further benefit might have occurred from that original P-Shot®. It might be better to give it at least another three weeks before you did the shockwave therapy.
How Your Losing the Chance to Take Care of at Least 30% of the People who Visit Your Website…
Okay. Let me give you guys, I don’t see any other questions that are up. I want to give you guys one quick marketing tip, and then unless somebody has another question, we’ll shut it down.
This one has to do with when people get to your website. It is something you can ask your web designer for. This is my old internal medicine website. And this is just a form and here’s the scenario that will happen. And this is why this form is so important. You don’t have to make it, I just want you to know it exists, and this is a ten minute job for your marketing person. And if you don’t have one of these, you’re losing about at least 30 to 40% of the traffic that you could be getting to call your office.
So let’s say that you’re in, let’s say that you’re, you do an o shot, or you do a vampire, or you just do a pap smear on someone. And they go back home, and they go to Thanksgiving dinner. And they tell their mother, sister, friend, cousin, whatever, how wonderful you are. And they say, oh, what’s their name. And they say, oh, it’s Dr. Posey.
So now they take out their cell phone, or they remember the name and tomorrow, day after Thanksgiving, they google you. And they wind up on your website. If all you have is stuff for them to read, they read it and they go away. And there’s very good chance that a week from now, they’re not thinking about you. It’s all done. They will never become your patient.
If you put something on here that they can have for free, that costs you nothing, not a free consult, it’s gotta be something that costs you nothing. If you put something on here that they can have for free, and we’ve all done this before, that’s worth something to them, but costs you nothing, somewhere between ten and 30 percent of the people who land there will do that.
And then, now you have their email address. They start getting your newsletter, and a certain percentage of those will eventually become your patients. So it gives you a chance- this is not the main way you get your patients. Most of your patients are gonna be word of mouth, or someone googling you. But this plugs the hole, and it will increase the number of people you have by about 20 to 30 percent, that come in through your website, by capturing those people who would have never called you, had you not created this form.
And the way you ask for it, is you decide something you’re going to give away, first of all. It could be, and I, it should be a podcast or an email, or downloadable book. It doesn’t even have to be your podcast. What I’m giving away here is a podcast where I’ve just recorded for an hour the benefits of walking. So it says, number one weight loss melt secret, free immediate download. So that takes them, you ask them for the first name and email address, and when they give you that, now they’re on your email list, every time you send out an email, they get it. And as soon as they do that, and you can sign up for this so you can see how it works, as soon as they enter that data, they’re taken to the place to download that.
So, it could be an email, excuse me, it could be a podcast or a video that you made. I know Dr. Posey made one on incontinence. So it could be free video on the treatment of incontinence. In exchange for first name and email. And so you tell your, here’s what you say to your web person, if you want to do this, you should write this down. And this works for Constant Contact, A-webber, Ontraport (what I use most), Mail Chimp, all those different places.
All those different places, it all works the same. And you can go online and figure how to do this yourself, but it’s a 30-minute job at most for whoever does your websites for you. You say you want a form and you want it to be in the right upper-hand corner of your website. On the homepage at least, maybe on all your pages, but at least on your homepage. And it should offer the thing that you’re giving away. And it should only ask for their first name and their email address, that’s it. If you ask for last name, you’ll lose about half of them. So first name and email address.
And then you let them know that you’re putting out a new health lessons every two weeks. Don’t call your newsletter a newsletter. Nobody really cares about your news. Give them a name that implies some sort of benefit. So I call this Health Lessons. You can call yours whatever. And then tell your person to put that on the form.
If you supply them the link to the thing you want to give away … You realize also on Amazon, there’s a lot of books for free. You could literally find a book that you can read on Kindle for free and give that away. But I recommend you find something either audible of a podcast or a video. Preferably something that you did. And that’s it. That one thing is gonna increase the production of new patients by your website by 20 to 30 percent. Now we talk more about this sort of thing in my workshop where I teach marketing, but there’s your freebie right there that is just some of the best stuff.
Okay. Let’s see if there’s any other questions and then we’ll shut this down. We didn’t have a lot of questions on the websites. Okay. I think that’s it. You want to add anything? And thank you for helping us, Dr. Posey. I know you’ve had a lot of … I think more experience with treating lichen with PRP than anybody.
Do you still treat the clitoris even if the woman is there for urinary incontinence?
By the way, the way I think about this, it’s all the freaking O-Shot, it’s just we’re varying the way we do it. Just like you do a hysterectomy and you vary the method based on who you’re taking care of. It’s all the same thing. But Dr. Posey made a good point and this is worth remembering, because some people asked me if they’re there for incontinence, do you still treat the clitoris? Or if they’re there for sex, do you still treat the anterior vaginal wall? Or if they’re there for lichen, do you still do the rest of the O-Shot? Or for pain, do you still do the rest of the O-Shot?
There’s two reasons why you treat all of it. One is people lie about sex. Everybody does. And so if someone says they’re there for incontinence, maybe they’re not. Maybe they’re just too embarrassed to tell you. Or maybe they’re living alone, single and they don’t want to tell you they have a lover. Whatever reason. Maybe they just decided it’s not your business. And of course, you would want to treat the clitoris if you’re treating for sex, but you would also want to treat it for incontinence because if you look at the anatomy, the clitoral tissue actually comes around and forms some of the structure for urinary incontinence.
Also, it could be that those nerves of micturition that come down through that area are helped and our clitoris is acting like the wick to help rejuvenate those nerves of micturition. We do know that we have people with urgent incontinence that are getting better as well. And we’re not sure exactly why.
So I always treat the clitoris even if it’s for incontinence. And of course, if you read Grafenberg, the urethra is very erotic in women and you would definitely want to treat (even if there for sex). Also, you have the female prostate gland or the Skene’s glands, so you would definitely want to treat the anterior vaginal wall, not just the clitoris if you were treating for sex because the urethra is such a sexual organ as well.
And if you’re treating lichen and you’re hopeful that it’s going to get better, and you’re down there anyway, why wouldn’t you go ahead and treat the structures that have to do with sex so that that can be recovering at the same time you’re treating the lichen itself?
One big plug though, if they have sclerosis or phimosis, where you cannot pull that clitoral hood back, which many of them do, then you can go ahead and treat them, but make sure that you don’t stop there and you refer them to Dr. Posey or someone else in our group who knows how … If you don’t know how, someone else who knows how to free up that clitoral phimosis. So if you can’t retract the clitoral hood all the way back to see the shaft, if all you can see is the tip of the glans or if you can’t even see the glans, then they need a surgical consult from one of the people in our group so that that can be exposed and be more responsive. It’s hard to have good sex if you can’t get to the clitoris.
Okay. I think that’s enough rambling. Anybody else have any questions? If not, I’m gonna shut it down. Thank you for your help, Dr. Posey. Thank you guys for being here. I’ll put a recording up by the end of the day.
What can you measure with a ruler that gives a clue about a woman’s ability to have an orgasm?
Kathleen: I just wanna say something that I hear … I mean it’s going off on a little bit of a tangent. But to me, a lot of times, they want the O-Shot because they want that penis and vagina orgasm. And yes, it does help that somewhat, but I’m really … I look at a lot of vaginas, and I’m really paying attention to that distance between the clit and the vagina and/or urethra. And it really … You oughta start looking at it, Charles, because it varies with women. Some of them, it is like five to seven inches.
Charles: Yeah, it’s huge.
Kathleen: When I talk to those people, they have never had a penis and vagina orgasm. It might be something to really examine the person before. And if you really talk to them about why they really want the O-Shot, I’m seeing 70 percent of them really want that penis and vagina. And it’s being advertised or said it’s gonna make them have that. Just be careful because if that distance is a long way, yeah, the orgasm will get better. But to bring you to surgery, in my opinion.
Charles: Let me add to that. First of all, what you said is backed up by research. And that research I think is actually on our O-Shot website. But there was MRI studies showing that the further the clitoris is from the vagina, the harder … It was a correlation between … It was done about two years ago. You know this research, so you’re seeing it actually in your patients.
Now, and I’ll also say that of the things that we treat, trying to help a woman achieve penis and vagina orgasm, who is able to have it with a vibrator, is one of our more difficult problems. I think our success is probably in the 30 to 40 percent range in that group. Where if you’re treating incontinence in a younger woman, stress incontinence is probably closer to 80 to 90 percent.
So I agree that something ... And it brings up another point in that I recommend, especially in the beginning, that people stick to the problems that we have the high success rate, so the provider doesn't become discouraged. I know you were very motivated and trusting it. But way back, years ago, when we didn't have so many people doing this and we had less research to back it up. But anybody, even with our current researcher who is just starting out, they should probably avoid treating, I think, until they have some success under their belt, the people who never had an orgasm because those are the people who are more difficult and probably they're always gonna need testosterone on top of what we're doing, I think.And the people who we just mentioned trying to have an orgasm with penis and vagina sex, they're more difficult. Stick to the stress incontinence, the dyspareunia, the lichen sclerosis, the women who can have an orgasm and wants to be stronger, those are our more easier cases. And in all cases, always, always, always, in my opinion, if they don't get well by the end of 12 weeks, then either offer them another treatment or give them their money back because we can make a profit and take good care of people without having to have people feel like we ripped them off.
Anything else, Kathleen?
Kathleen: I didn’t mean to say it wouldn’t help because I do think it helps and I do think you can even … I think the O-Shot, by putting it in the vagina, does shorten the distance a little bit. And maybe millimeters like what the P-Shot is doing. And it can get better, it just can’t … When you really see a big long distance, I would ask them and then I would just say, “Your orgasm is probably gonna get stronger, easier to obtain, but it may not help that.” I don’t know, it’s hard to give them a negative … I wouldn’t give them a negative embedded command. Just watch it if they’re there for penis and vagina orgasm.
Charles: I’ll tell you what I tell everybody. It’s good advice. And what I tell everyone when I’m leaving the room is I’ll say, “You just spent whatever amount of money it is. And for that much money, you have to love it. And if you don’t love it, I want to know about it.” Because of course, I’m gonna be following up with them. But what I found when I follow up with some of the people … So when people contact me and they tell me they’re not happy, I refer them to the doctor who took care of them because I’m not their doctor. So I don’t need to be involved. But it’s helpful for me to know who took care of them. Then I call the doctor and talk to them and see if I can offer help.
But back to this thing about satisfaction and setting expectations. I think that what I’ve seen happen sometimes when people are not happy is they never let their doctor know. Because maybe they’re afraid they’re gonna hurt their feelings or there’s gonna be some sort of conflict or something. I think it’s helpful to actually tell your patient, “I want to know. I want to know if you don’t love it because I want to take care of you, and I don’t want you to feel like that our energy and time and your money has been wasted.” And that really helps a lot, both with you getting them well and helps prevent them sliding away disgruntled without you ever knowing about it.
And in the process, you can say what you just mentioned, Kathleen, that if it’s a more difficult case, it’s worth telling them, “This is something that a percentage of,” if you’re dealing with someone who’s trying to have an orgasm with penis and vagina sex, “This is something that doesn’t work as well. We have a much higher percentage with treating stress incontinence, but we do have successes that by our surveys, are in the 30 to 40 percent range. If you want to try it, we’ll do it. But I want you to love it. And if you don’t, let me know. And we’ll either repeat it or we’ll figure out something else, including, I won’t keep your money.”
And in the end, although you give back money occasionally, you wind up making many more people happy and making more money and you sleep better at night.
Okay, I think that’s it. Thank you guys for your attention ’cause this thing … What we’re doing here, I think, is really changing medicine and I’m the facilitator between all you guys thinking about it and all the feedback and all the good research. So keep it coming and I’ll try to keep pouring our money back into it.
We have two double-blind placebo studies going on now. We’re having a little trouble filling the orgasm study (click to help), so I’m gonna put out a link to that again. So if you guys know people who live in the Washington D.C. area … Bottom line though is we’re investing into the research. We’re investing into supporting our group. And I think you’re gonna see medicine change a lot in the next five years from what we’re doing. Okay, you guys have a good day. Thank you, Dr. Posey.
Charles Runels: Okay, let’s get started. The first question, we’re on the Vampire Breast Lift website, is actually a comment from Wendy Hurn.
Vampire Breast Lift® Questions…
She says, “I have performed several of these procedures to date and have amazing results around six weeks. My own, which is performed nine weeks ago, was amazing. Fullness and firmness with cleavage area many have commented upon. After breastfeeding in the past, I am delighted, so can pass this on to my patients with confidence.”
Thank you very much for writing Wendy.
This is one of those things where it almost seems too good to be true. I’m always grateful when our providers encourage each other. One thing about this when you do these procedures, just be sure you realize there’s a correlation and there’s causation and if you hand out 1,000 Tootsie Rolls to women who walk down the sidewalk, there will be some of them who get breast cancer. If you called it a Breast Lift Tootsie Roll, they might blame it on your Tootsie Roll. I think you can make a very strong argument that PRP is perhaps protective against cancer. We also have the strong research that if you look at the research part of the vampirebreastlift.com.
If you look at the Research tab, you’ll see there’s very good, very strong, research showing that when you mix PRP with fat and transfer it to the breast, there is a trend towards less cancer and there has been two really strong studies showing no increased risk of biopsy or recurrence rate in people who have had breast cancer and then being reconstructed, so it appears to be a very safe thing, but I would still do the same things that you would do for documentation if you were transferring fat to the breast. Most people know you transfer fat to mix it with PRP, so do those same protocols, just make sure the woman has been two things. Make sure seems been recently screened and that whoever keeps track of her breasts says that she’s good to go and number two, make sure you get a good consent form.
Second thing, but hopefully one of you guys will eventually do the research. I think that if you did, if you look at this trend towards less cancer, I think if you did a study where you injected the left breast of a thousand women, you would see a higher rate of breast cancer in the right breast. We don’t know that yet, but that’s what I suspect.
Next one is a question from Dr. Climikoski.
He says, “I have a patient who’s had breast implants and has loss of nipple sensitivity. Her primary concern is to regain the sensitivity back. She asked me, ‘What percentage of people that receive the Vampire Breast Lift do in fact have significant improvement in the sensitivity and are pleased with the results?’ If you provide me with an idea of this percentage, that would be helpful, as I’m a new provider for this procedure and don’t have my experience to draw from. Thank you.”
The answer to this one, I think, is … Again, we don’t have the research. In my practice, it is very near 100%. I’ve actually never had a failure when I was treated someone for loss of sensitivity after implants, but if they had extensive reconstruction, then all bets are off. When I talked to our providers, I hear everything from 50% are improved up to near 100%. I just wouldn’t promise this benefit if it’s for someone for extensive reconstruction, and with everything you do, I highly, highly, highly recommend that you offer a money back guarantee. When I treat this, usually it’s a woman who’s coming for improvement appearance and this is something she wants in addition to that. And so, she’s still happy if her sensitivity isn’t back like she thought it was, maybe, when she was 17. I’ve yet to have a woman tell me it did not make things better than before the procedure.
PRP Science-Techniques (what if the needle clogs?)
Next question is a woman who had … She just wrote this in to me. She says, “I had a 30-year-old,” this came an email but I thought we’d cover it here, she says, “I had a 30-year-old for her O-Shot. We used the Eclipse to spin the blood. My patients PRP was irregular in consistency and had clumps of what I thought had to be platelets. The 27 gauge needle and the syringe, for that matter, clogged a few times. I tried to force out the clumps from the syringe, but I’m wondering why this could’ve happened. Any comments appreciated in advance.”
There’s two things that could be causing clogging. I’ll tell you what they are and I’ll tell you how to deal with this because it can happen to everyone. First, it could be actually the platelet-rich fibrin matrix. I have seen clod up as quickly as two minutes out. This is why when I do this procedure, so in other words when the platelets are in the syringe, just sitting there, they can wait for about six hours in theory and still be okay to use, but once they’re activated; thereby, exposure to thrombin, calcium chloride, calcium gluconate, hyaluronic acid filler, or being excreted from the syringe back into the body exposed to collagen. All those things can cause the platelets to now degranulate, release the growth factors, and then the fluid of the plasma becomes congealed to hold the growth factors in place.
This is called platelet-rich fibrin matrix. It looks like goo inside your syringe. You may want to spend a syringe, activate it, and then just let it sit there and not use it so you can see what this looks like. It looks like little string or a little rubber band or something with a precipitate that forms in the syringe. It’s only probably 10%, 20% of the volume of the syringe will be clotted, but it makes a nice little linear precipitate in the syringe if you just let it sit and congeal. That’s what you’re making.
Now, if there’s turbulence and you’ve activated it can look clotted up in little clumps and that is what you’re seeing if there’s a delay. If you immediately take it out of the centrifuge and you see some little stringy things, maybe that’s platelet-rich fibrin matrix, but I’m not so convinced that sometimes it’s not some of the actual gel itself. I’m told that that’s not the case, but I’m not so clear that what that is and it could be the gel. In any case, I’ve never had it clog the syringe unless I’m slow about getting into the person’s body. When you’re drawing it out, use a … I use a 18-gauge needle to pull it out of the tube and then I have 25-gauge needles, literally within reach, so if I’m sitting there doing the O-Shot or whatever procedure have 25-gauge needles close by. If it starts to gel up and I can’t get it through the needle, then i just grab one of those and swap it out or sometimes you can just swap it before another 27 and whatever matrix is clogged the needle will be stuck in the needle, so when you get a new one, you can keep going. That’s the way to deal with that.
Try to have your patient all the way ready before you ever activate the platelet plasma when you do the O-Shot. Have 25-gauge needles within reach and fresh 27s and you should be okay. Oh, one other thing about the gel. We’ve had a few cases of urticaria. I’ve seen about, well, I’ve seen one myself in the face and I had another man who had some urticaria after Priapus Shot. In both cases, it went away with a Medrol Dose Pack. I’ve had two cases of urticaria reported to me by our providers. One after the face and one after an O-Shot where the woman got some urticaria of the inner thighs. All resolved without sequela using a Medrol Dose Pack.
If you look at the medical literature in some of the orthopedic literature, they talk about this happening and postulate that perhaps there’s a urticaria reaction that some people have to their platelets, but perhaps it’s from the gel itself. I just bring this up as a possibility. I don’t know why it happens, I just know it happens and that’s how you treat it. Maybe some of you guys can help us do that research.
Anything you would add to that Kathleen?
Kathleen Posey: No, but I actually think … I agree with the 25-gauge needle. I actually think I’ve used the 25-gauge needle more so than the 27 because the gel does really get thick and it makes it harder to push.
Charles Runels: So you use the … just routinely use the 25 for the anterior vaginal wall?
Kathleen Posey: Yes.
Charles Runels: While I’m here, just for those who may watch this video because this is all will be recorded and I’ll just post this to where people can see it. This gives a really nice simple diagram about where the material goes. I wonder sometimes if people are using enough. If you use the gel tube, I think you should probably spend three for each side of the breast. The price is set to where you can afford to do that. Basically, 15 milliliters of PRP for each side however you make your PRP. Some of the … I don’t know who knows, but I think some of the people who report not seeing much result are not using enough of this stuff. Let’s see. I think that’s all we had on the breast lift. Let’s look at some of the questions. By the way, anybody on the call who wants to ask a question, just click the raise your hand button and I’ll let you just say what it is you want to ask. Now, we’re on the O-Shot. That was the breast lift. Let’s go down the unanswered questions. By the way, if you ever want to ask a question, this is where to post it. Some of these have gone unanswered, but oftentimes our more experienced people will jump in there and answer a question. This is the way you get more than one opinion.
Priapus Shot® Questions…
Okay, so Dr. Ness has two questions. He uses the EPAT for erectile disfunction, along with PRP, after the fifth treatment and before the sixth. Should we inject PRP more often, say after every treatment? Also, has EPAT been used on women to augment the O-Shot? We’ll do this first question. I actually had an email from one of our urologists this morning. I’m seeing several variations, but most of the variations involve using PRP after the first treatment and after the last treatment, whatever your protocol is.
There was another research paper came out this past July in the Journal of Sexual Medicine showing that this works, but there’s no one that has done, okay, this protocol versus that. We’re still trying to figure this out. There’s a research paper for someone. Obviously, there’s two variables there, how you inject the PRP, or where and when, and how you do whatever physical therapy you’re doing.
More O-Shot® Tips…
I don’t know if anybody has anything to add to that, but the bottom line is that do whatever your normal protocol is, and then do your PRP after the first one and after the last one. Same thing with any sort of these physical therapies, lasers. Whether it’s shockwave therapy or it’s … and your frequency. I know you have the Thermi-Va, Kathleen. When are you adding in Thermi-Va when you do O-Shots?
Kathleen Posey: Well, I add it when they want to have improvement in the labia majora or want to decrease the size of their vagina. What I have noticed consistently now, having done enough of them, I really think when you decrease that distance between the clitoris and the vagina and/or urethra, the orgasms get stronger. I think, I’ve done enough now to know. The patients are telling me now, the ones that have had the Thermi-Va with the O-Shot, that the orgasm has gotten even more intense than the O-Shot, so I think that’s an added bonus.
I wish somebody would do the research to prove that it’s that distance because there’s such a problem when somebody has a baby and things get stretched out AP-wise. What you’re really stretching out is that length between the vagina and the clitoris, and then you’re constantly, as a gynecologist, “I used to be able to have orgasms with penis in vagina. Since I’ve had children, I cannot have orgasms with a penis in vagina.”
I’ve even seen C-section patients that haven’t had a vaginal birth, they’re still stretching out. They still have [inaudible 00:13:19]. They’re still having problems. I think, basically, probably gravity, but they do over somebody’s lifetime take away from your ability to have different types of orgasms.
Charles Runels: When it comes to you, do you do Thermi-Va and then O-Shot immediately following on the first visit, or how do you do your series when you’re combining those two therapies?
Kathleen Posey: Most of the time, I do the O-Shot and the Thermi-Va at the first visit, but sometimes it just depends. If they come in there and just say, “I’m here for the O-Shot,” I do that, and then after I do my exam, and I find they’ve had three kids, and I feel like they could benefit from the Thermi-Va, I give them the pamphlet and talk to them about that. So I’ve done it different ways. I’m not real consistent on … because there’s usually three treatments of Thermi-Va, and I’m not real consistent when I do the O-Shot with it. It can be the third treatment.
Charles Runels: I recently talked to Dr. Alinsod about this too [he does something very similar] and I know, Dr. Posey, you’ve done a lot of these. How long have you been doing O-Shots now, three years?
Kathleen Posey: Four.
Charles Runels: Four, yeah, so you’ve had … and I think probably more than anybody on the planet, your experience with lichen sclerosus combined with PRP is you’ve probably seen more patients than anyone. I don’t say this is for gospel because no one’s done the research, but when I speak to other providers, including Dr. Alinsod, they will sometimes do Thermi-Va, then another Thermi-Va, and then the last one of Thermi-Va, they’ll do Thermi-Va followed by O-Shot, or they’ll do ThermiVa and O-Shot on the first one, and then another Thermi-Va, and then, if they’re doing well, on the last one they just do a Thermi-Va. If they’re not as where they want to be, they’ll add an O-Shot to that last Thermi-Va treatment.
As far as the business part of this goes, a lot of our providers, when they come in, they’ll offer the O-Shot at the regular price, and then if they want to add in the Thermi-Va, they’ll cut the price of the Thermi-Va treatments in half, and sell it all as a package. Anyway, that’s become extremely exciting what people are seeing combining those two.
The general principle though that you never break, I think, is that you don’t do a heat, energy type treatment immediately after the O-Shot or the heat denatures those amino acids, small peptide, chemotactic factors, so you can do them both in the same day, but if you do both, you always just do the O-Shot after the heat therapy. I know you know that Dr. Posey but some of the new people may not.
Kathleen Posey: I have one thing. Can I add one thing
Charles Runels: Yeah, sure. Please do.
HUGE TIP (Small Vagina & Thermi-Va)…
Kathleen Posey: I just treated a patient this week that the Thermi-Va people sent me: Had seen a plastic surgeon in New Orleans, decreased lubrication after chemotherapy for colon cancer. She was in her 40s. No exam. So she gets here, and she’d gone from having intercourse three times a week to barely being even one. It was very, very painful.
Her vagina was so small, and they had done the Thermi-Va, so they were making it smaller, so all her symptoms got worse after the Thermi-Va. Actually, a lot of her pain was in the posterior fourchette. I just treated her this week, but I gave her another shot because I said, “Look, I’m going to see,” but you really have to select the patients and do the exams. If the three of us says, “Okay, I’m going to increase lubrication and decrease pain,” well, if the problem is your vagina’s too small, you’re going to make her worse.
She was worse, so the plastic surgeon complained to Thermi-Va. Thermi-Va says, “Well, where’s her exam?” They go, “Well, I didn’t do one.” They lived in New Orleans, so the plastics doctor called me and said, “Well, will you see her?”
You just really have to take each case individually because she was crippled because of a really small vagina. I don’t know if the O-Shot helped her. I did the traditional O-Shot, and I treated her with pain. I just wanted to throw out all these pain symptoms. I did another one today, which was episiotomy pain, and it’s helped her. She’s a year out and this is her second time. I do do the O-Shot, as well as treat where the pain is.
Charles Runels: Yes, all those are good tips, excellent tips, actually. I’ll just add to that that there probably should be, and maybe you can help us think about this, a … What’s the right word? Sort of a chart where you can picture down the one side is all the therapies, and then across the top are all the different problems, and you pick which do you do? Do you do radiofrequency or laser or PRP or dilators or hormones or whatever? And you can picture a pretty extensive chart.
I agree, not everybody … I don’t even use the word “tight” or “loose” vagina. To me, it’s all about matching your lover, and not everybody needs a smaller vagina, and when it comes to pain, for some reason our O-Shot just seems to be amazing, even when the etiology isn’t always known. But I want to emphasize what you said, if they can put their finger where it hurts, always put a cc of PRP there, and then do the regular O-Shot in addition to that. For example, your lady that had the episiotomy scar. My experience has been that, after an episiotomy, they’re usually good to go. So she lasted a year, and now it’s come back and hurting her again?
Kathleen Posey: Yes, it lasted a year. What she had was an episiotomy scar, and then some scarring around her posterior fourchette as well. It hadn’t come back as bad, but she just said, “I don’t want to have painful intercourse. It worked so well before, just repeat it.” I looked, it was a year ago. That was her second shot.
Charles Runels: Beautiful. That’s encouraging. So it wasn’t all the way like it was, but it wasn’t-
Kathleen Posey: No.
Charles Runels: … it had started to come back. There’s that negative feedback loop that can just make anybody avoid sex, especially, I think, women who have pain, and so breaking that feedback loop is so important. Just anecdotally, another patient I heard about from one of our providers, who’s-
Charles Runels: Just anecdotally, another patient I heard about from one of our providers who stays here with, usually with O-shots, she said she had a lady who had an episiotomy scar that had, not only hurt, but would bleed and tear ’cause the skin was so thin. The tissue was so thin, for years. And, no creams and all sorts of things had been tried with no result. And in this case, it took three injections 8 weeks apart, before the bleeding and the pain was gone. So, 8 weeks, pain’s a little better but not gone. Another one. So a series of three O-shots. So, I’m thinking in some cases the tissue may need more than one procedure.
And then lastly, I know we don’t have it here yet, but I know in Europe they have HA that’s made for the vagina. And then I’m wondering in those cases, it might be helpful to do both. So, like we do with our vampire user HA posteriorly with pure AP on top of it to help build that tissue posteriorly when we have an episiotomy scar. All thought they should not be used anteriorly unless it’s under an IRB protocol because of the risk of granulomas. Okay, let’s do the next question. Anything else you could add to that, Kathleen?
Kathleen Posey: No, that’s fine, thank you.
Charles Runels: Okay, let’s see. So, Cindy Crosby says, “My first question is piggy-backing of a question I read in the previous post. If there are there any post-op instruction pamphlets for vampire clients, please email. Second, I had an O-shot and the client had two large babies with two episiotomies. The anatomies very difficult to maneuver. The urethra’s approximately four centimeters long, it’s in the middle of what appeared to be a build-up of scar tissue. Has anyone experienced this and what was the solution?”
I’m gonna turn this one to you Dr. Posey.
Episiotomy Scars & Pain…
Kathleen Posey: Well, I agree, these can be tough. I would put a red rubber catheter in there and find out exactly where her urethra is. And therefore you would know where to put the PRP. Those are hard because, she probably had a cystocele and if you’re not used to looking at them, you’re not gonna know your anatomy because, it gets very distorted. That’s-
Charles Runels: Mm-hmm (affirmative). So, I think you told me once about a lady who did not get benefit for incontinence and then you brought her back and put in a catheter and then things. Describe for them what you do.
Kathleen Posey: Right, I mean that lady had, I mean you don’t want to say a looser … We have a large vagina had cystocele rectocele I put it where I thought it should be the first time. And she just said it didn’t work and she got on the O-shot website, said my name … This is a long time ago.
Charles Runels: (laughs).
Kathleen Posey: Trust me, okay. She got on and said, “This is horrible.” And I think they gave her a discounted rate. So I brought her in, and I said, “Look, but it didn’t work, you’re going back on.” And she did.
Charles Runels: So you brought her back and repeated it, and she went, and she got better. And so, what you did was put in the catheter? Tell me exactly what you did.
Kathleen Posey: Yeah, I took a small red rubber catheter, you put the other end up on the abdomen, so you don’t get pee everywhere, and then you see exactly how distorted that urethra is, because the urethra is distorted in that patient. And it takes the vagina with it, okay. And so you have to see where to put it. And sometimes it can go off to the left or the right, it isn’t straight in the middle. And that was her problem, it had gone off to the side, and so I just put it in never never land.
Charles Runels: So, in the second procedure, your intention is to put the lumen of the needle in between where the catheter was and the outer service of the vaginal wall? Is that what you did?
Kathleen Posey: Yes, which was probably part of the cystocele and it’s gonna look like it’s scarring, it may not have a normal look by itself.
Charles Runels: Beautiful, very helpful.
Okay, let’s see. Dr. Tuttle, “Dear Dr. Runels I have a new person who wants an O-shot, so a daily load dose of methotrexate. Will O-shots still work? Will we get enough PRP, will it work in the presence of this suppressant drug?” She’s using the Emcyte machine.
Okay, so. The general rule I follow is: Would this person recover from surgery? Could you do surgery on them? And if the answer is yes, so can you do it with HIV? Yes. Could you do it with a profound thrombocytopenia? No, not a good idea. So, I don’t know … What’s your thoughts on this one, Kathleen?
Kathleen Posey: I don’t know, but the only P-shot that didn’t work at all was on an 82-year-old with a platelet count of 75,000, and I did two. But I don’t really, I don’t know. I would try it, it’s worth a try. I’d give them money back if it didn’t work.
Charles Runels: Yes, see that’s how I do it. And if you’re new to this, you’re listening to this talk, the first two months, I would just do the easy cases. And of course nothing’s 100% but you have a really high success rate. If not the first shot, the second shot, you’re gonna get it at least 80, 90% of your people well. If you’re treating incontinence with good pelvic floor integrity, dyspareunia, lichen sclerosis, those people are going to get better- people who can have an orgasm but it’s not as strong as it used to be.
If you’re treating someone who’s never had an orgasm in their life, that’s a hard case. Or something like this, where you’re not sure what’s going to happen. I agree, you’re not going to hurt her with this. She would heal, you could operate on her, but is it going to affect this procedure? I don’t know. So this would be a more uncertain case. I would be more hesitant to take these cases until I’ve been doing them. Otherwise, if you do something that’s hard and your first two don’t work, you lose confidence in what you’re doing.
But, on the other hand, I will often take someone who I don’t see any logical reason why I’m doing harm, and then I take them, exactly what you just heard Dr. Posey say, under the condition … I just tell them right off the bat that, “You know, I hope I can get you better. And I’m willing to try this. And if I don’t get you better, I won’t keep your money.” And worst case scenario, you lose a little money but you’ve learned, and you haven’t hurt them, and you’ve helped them find a solution, and you’re still profitable in the next procedure.
Let’s see, I think we just had a question typed in. Okay, yeah, so … Okay, here we go, thank you. So, Dr. Carp I’m gonna unmute your mic, Dr. Carp, so that you can talk with us. Hold on just a second.
Go for it, you there?
Dr. Carp: Yeah, can you hear me?
Charles Runels: Yes sir, perfectly.
Dr. Carp: Yeah, I do all kinds of surgeries on patients with methotrexate, you know, the significance. So I wouldn’t be concerned in the terms of a complication with injecting it. I don’t see how it should have any impact on the expected results with the PRP.
Charles Runels: Beautiful. Thank you for that. When you do your surgery, you don’t anticipate it affecting them healing. So I’m not doing operations every day, so I don’t know that. So, you wouldn’t expect it to have an effect on wound healing. So therefore, we’re both thinking that one variable should not change what the effect of the O-shot would be.
Anything else? Because I know you’ve been doing this awhile, too. Any comments on any of the other questions that we’ve fielded that you want to add to?
Dr. Carp: Not really. I think that, certainly as was pointed out, if they’ve had some uvula-related issues in the rectoceles, et cetera, it does make it more difficult anatomically.
Charles Runels: Mm-hmm (affirmative) yeah. I think it’s never an embarrassment to turf … I love that we have a gynecologists and a urologists as part of our group. And to those in our group who are not, if they see someone where the anatomy is not what you’re used to seeing, I would feel free to … You know, I’ve referred people to Dr. Posey, she’s about two and a half hours from me. And people that … For example, when the clitoris is phymosed down, that’s not something I should be tackling. And so, I send them her to a gynecologists.
And so I encourage those in our group to look at the others in the group that are close to you, so that we can work together.
Let’s see, there’s another. We’ve covered breast lift, the O-shot, there’s some questions that have accumulated about the priapus shot. Let’s go through some of these. Let’s see, okay.
“I was just wondering, can you freeze PRP and then thaw it later before activator procedure? We did a P-shot today, we used pure spin, which do about 20 CCs, and we used 10 of it, so we had some left over and didn’t want to throw it away.”
I know some of the ophthalmologists are putting in the fridge and using it for eyedrops for dry eyes, and using it for a couple weeks at a time. Maybe the answer to this is yes, but I wouldn’t want PRP that had been frozen … You know there’s enough profit built into our procedure that you could afford to spend a kit later. If you wanted, what I would say instead of this is that, there are those in our group that, when they use a priapus shot are using more material.
The only reason these volumes came about is back when I started doing these procedures, back in early 2010, so eight years ago, a one tube of Selphyl, which is what I was using at the time… so, my cost of goods was pretty high. So it was based on what I could find, the amount that could spread through a penis, and I found 10 was what it took to actually infiltrate the entire corpus cavernosoum of an average-sized man.
But others in our groups are using more, so I would say instead of wasting it, just double the volumes and use the whole 20 CCs if he’s average size or larger, and you should get a result. The only place I would say not do that, between the O-shot and the P-shot, is absolutely do not do that with the anterior vaginal wall because, I know of three cases now where our providers got a little overzealous and had an overflow obstruction. It went away and the person winded up doing well, and good results for their stress incontinence, but they went from stress incontinence to an overflow obstruction to wear a diaper for three or four days because of too much volume.
I think anything more than 4 or 5 CCs in the anterior vaginal wall is probably too much. But in the penis, go for it.
Anybody want to add something to that?
Lichen Sclerosus in the Penis…
Okay, so Dr. Leonardo says, “How do you treat lichen sclerosis on the glands? The video does not address this. Do you perform the same injections with the P-shot or would you micro-needle it?”
You know, Kathleen you’re treating a lot of lichen in the labia and around the clitoris, what’s your … This is just a larger clitoris, right? Or you could say clitoris is a smaller penis. What would you say? How would you answer this?
Kathleen Posey: I would inject it right in the areas of the lichen sclerosis, wherever they may be.
Charles Runels: Yep. I would too. I would feel … In a normal priapus shot, you would just kind of … I imagine the glands of the penis, literally like a sponge, and of course the underside of it that’s connected to it is the corpus spongiosum, so it does behave like a sponge.
But I agree with you, if there’s a sclerotic area that you can see or the patient can feel subjectively and put their finger on. I would go intradermally, as best you can, into the sclerotic area and treat it like you would sclerosis anywhere else.
I think, again, we just put out the first paper, I guess it was a couple years ago, and this last paper in the American Academy of Dermatology in January of this year. It’s not like we have some huge body of literature about the best way to do this. It’s part of the reason I like these calls because there’s smart people in this call, and you guys can help us figure out what the best way is. But that’s my best idea for now.
Anybody have anything else? Okay.
“I have a patient who has IPP. What is the injection recommendations, techniques, for lidocaine? PRP amounts of each … Locations along the shaft and the depth … In addition, has cold syndrome, for numerous reasons …” whatever.
I would not use the vacuum pump, and I would not try to inject the shaft at all. And I would consider long and hard whether to even do it at all. Because if their implant fractures that night when they have sex, you could be blamed for it.
But if you do this, and Dr. Banno and I would do this, and most of our providers would do this … I would keep it just to the glands, and come in laterally like you do with the regular P-shot with just the bevel going into the carona of the glands. And just infiltrate the glands, and let that be it. Nothing else, or I think it’s too risky.
Anybody want to add anything to that?
Anyway, watch this video for more details. It’s only five minutes but you’ll get it straight from one of the urologists in our group who teaches. By the way, Dr. Banno teaches urologists how to do implants. It is his specialty. And he has told me that he started making the priapus shot as part of his pre-op before he does the implant because he’s getting more rapid healing and better results, as far as that sensation, and not having that cold feeling.
Any other questions? I think that might be the last one that was turned in. I know we’re only 38 minutes in, but I didn’t come here to try to teach anybody anything. I’m just trying to give us a forum. And our intention is to do this every week because the questions accumulate. And that way, someone other than myself can help think about them.
Anybody on the call have anything else to say or question to ask? Because now is the time and I’ll unmute you and we’ll have it out here for people to comment on.
And I’ll post this video, so who knows? Maybe some other people in our group … We’re pushing 2,000 members now in 40-something countries. We’ve got so many specialties and multiple medical schools, lot of smart people just like you guys are. So, maybe we can get other questions or other ideas.
But anybody have any other questions?
Okay, well I’m on stand-by and I hope this was helpful. And I’ll post the video, and we’ll try to do this every week. So if there’s something that comes in between, this will be the place to get it answered.
Honored to help out, and you guys have a good week. Bye-bye.
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