*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.
*Vampire Facial® techniques reviewed in Facial Plastic Surgery Clinics of North America, August 2019 *When to activate PRP with Calcium (chloride or gluconate) *Tear Troughs & Bags Under the Eyes *PRP with or without Amnion in the Neck *Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure *Selecting the Best Patients for the O-Shot® Procedure *Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure *2 Guiding Principles That Bring More Patients and Provide Better Care *Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure *Pelvic Floor Spasm *A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Vampire Facial® Procedure in Facial Plastic Surgery Clinics of North America
Dr. Runels: This should be a really wonderful meeting tonight. We’ve got new research, and we have the amazing Dr. Edward Tangchitnob who is out in California, award winning for his practice, and brilliant gynecologist, and surgeon, and teacher of our procedure. This should be an interesting call. We have some new research I want to just bring up very quickly. First, let me bring Dr. Edward onto the call. Let’s see, hold on just a second. I’m going to unmute you here. There’s a couple of research things that are out that I think are really nice. Hold on just a second. Let’s see.
Edward, I’m not sure what’s going on with your mic. I don’t know if you will need to call. It looks like your audio might be turned off or something. Let me go ahead and bring up the research and as soon as I see your mic light up I’ll unmute you. Let’s see if there is something here. Anyway, so I’ll be watching for that. I can see Dr. Tangchitnob on the call but I don’t … Okay, there it is. There’s your microphone. Here we go. Beautiful. There you are. Can you hear me.
Dr. Edward T: I can.
Dr. Runels: Beautiful. Look at this. Just a review article but it came out in here it is, in Facial Plastic Surgery Clinics of North America, August 2019. I don’t think you could see a better endorsement. I mean, there’s the abstract. “Platelet rich plasma has gained popularity in facial plastic surgery because of it’s healing and growth factors.” But then this is the part I love, “One of the most popular uses facial skin rejuvenation in the form of injections and topical application during microneedling …” That would be in for a facelift and facial, “… and the promising nature makes using it for injection or conjunction with microneedling a good addition.” Beautiful. That sounds like a pretty strong endorsement in that journal, or in that periodical. This is the article I wanted you, and I put a link to that. Actually, I didn’t yet, but let me put a link to that into the chat box, you guys.
Using Scientific Research to Educate and Market To Your Patients
That’s a good one to take … If you just take this link ( https://www.sciencedirect.com/science/article/abs/pii/S1064740619300331?via%3Dihub) and you put it in an email or a Facebook post and you shoot that out to your people and say, “Hey, here’s some research that came out this month.” Here’s a little trick about … It’s just commonsense, actually, for how to talk with your patients, is make, when you have this this counts as news. We’ve all heard on CNN or whatever news channel you listen to where they talk about something, they usually report it out of the New England Journal, because the guy on the street knows that’s a reputable journal. But, often it’s the news reporting on the news. This is news, and you could call up your news channel and say, “This is what I do.” You could also just post this to your social media, or an email to your people and say, “Hey, look what came out this month, more nod of approval from the the powers that be, that this is something that’s useful, and this is what I do.”
I want to shoot over … Any comments about how you’ve been doing that, Edward? I know you’ve had some success with your marketing. Talk to us about how you’ve done things like this.
Dr. Edward T: I think that there’s a lot of information out there at the fingertips of all the patients. They’re getting bombarded constantly from their Twitter feeds, their Instagrams, their Facebook. I think everyone, and anyone, really can be the so-called expert on a particular topic. When I’m emailing my patients, and I make a habit of it every two weeks using Ontraport email client,
I think that we have a very captive audience, because the patients already know and trust us, and the open or the click rate is a lot higher, especially when it comes from us. I’ve also played around a few times with the subject line. I’ve done split testing to kind of see what kind of topics and what kind of tone of the subject, or the copy, can resonate with my patients. I’ve been actually surprised a few times in the split testing. That was something I kind of picked up along the way.
Just to kind of give you an idea, a year ago I didn’t even know what Ontraport was, or an email client was, let alone what split AB testing was. But, as I’ve come along on this journey I’m finding that my ability to communicate to my patients in sophisticated ways is being appreciated. The way I’m measuring it is that I’m able to see that the number of conversations, booked appointments, and paid procedures is going up. Just as you’ve said before, the more we seem to email and communicate the more the patients are aware of the procedures that we’re performing, and the more that they’re aware that their procedures are available from the physician, or the practice they’ve trusted all these years, the conversion rate, I think, is a lot higher.
Dr. Runels: Yeah, let me expand on a couple of important points you made that I failed to make. One is that people are bombarded, but for your patients, you being whomever is on this call, and for my patients, and Edward for his patients, they are more interested in … Because they’re bombarded it’s confusing to them. As you just said, Edward, they want us to curate that and point out to them what’s important and occasionally, I think the ratio should be mostly what’s good, but occasionally point out to them something that may be popular that you don’t think is as useful. As a general rule that’s more of a waste of our energy to talk about what’s not good, but being the curator I think we tend to think, “Why do they care about what we think since they’ve got CNN, and the Mayo Clinic Newsletter, and the Cleveland Clinic Newsletter?” I actually talked to a man today that helped the Cleveland Clinic start their newsletter. They’re doing exactly what you just said, for people who wind up going to the Cleveland Clinic they want to know what the Cleveland Clinic thinks.
My patients, and Edward’s patients, and everybody else on this call, they’re more interested in what we think than what the Cleveland Clinic thinks. So, sending that out every couple of weeks, and making it something that reports, this is your perfect … This is what you wait for, and you don’t have to wait long on their procedures because we’re in the news so much. But, you shoot this out and now you’re not spamming people, you’re reporting on the news just like CNN does.
The second thing you said is that just the general idea that when I said expand on this, the idea that email still is the powerful way. Even when you post to Facebook it doesn’t get shown to all of your friends, and they’re so bombarded, and it’s limiting the conversation. Sometimes it gets banned if it’s some picture about, or something about, sex. The old email to your patients is still, in my opinion, the most powerful way to get things done.
When to activate PRP with Calcium (chloride or gluconate)
Okay, let me pull up this other … You know, I think I’ll hold off on the other research. There’s something here about … I just wanted, since you’re an expert surgeon I wanted to talk some about how PRP’s been used in surgery. Let’s skip over that and maybe do a question. This one comes up occasionally about calcium chloride. “I used to use calcium chloride. I started with Selphyl,” so the short answer to this is if you Selphyl it comes with a kit. With the others you can either order it as, it’s the same calcium chloride that’s in your crash cart or, and here’s … I’m on the O-Shot website. The reason I’m not pointing it out to the Vampire Facelift website is I quit using calcium in the face. It makes it hurt more. If I have a Selphyl kit I just leave it out.
But, you can use the same calcium that comes in a crash cart and mix it in with … So, I took it off the Facelift site, but you can mix it with the PRP. This is a video showing you how to do it, so you can take that ampule, mix it in to just a 10 cc syringe and then use that syringe as a dispensing vial into an empty syringe and then put your PRP into that, obviously not cross-contaminating that. You can make this into a multi-dose vial.
There’s a source of it at mrcrashcart.com. It’s where you get your calcium chloride. That’s 10% calcium chloride. Also, you can get it at McGuff, which is the same place where we get our syringes, and it’s on this supply list that sits up here. There’s your supplies in the PDF file right there, and where I get some of it. There’s the phone number, there’s the email for McGuff, and that’s basically if you order everything on that you can do pretty much all of our procedures if you have a PRP kit.
What’s your … Edward, I know I really stress using calcium chloride for the O-Shot® and the P-Shot®, and if you’re trying to grow nerves. Say you lost the sensation in the breast. I’ve quit stressing it. I don’t see people talking about it much with hair anymore, or with the face. Is that still what you’re doing, or have you altered that in any way? What are you doing when it comes to calcium chloride, or calcium?
Dr. Edward T: No. I still follow the teaching that I was given originally, which is exactly what you had mentioned. I’m finding, particularly, with the Vampire Facelift®, for example, the ability to kind of spread over the cheeks and in the nasolabial folds, as well as run down very finely in the tear trough, I don’t use calcium chloride to activate. It would be a little bit to viscous, in my opinion.
Tear Troughs & Bags Under the Eyes
Dr. Runels: And there is that idea that, which you just mentioned, is that with the O-Shot® you want it to gel quickly and stay in a pretty small area, relatively speaking, where with the scalp and the face you want a more diffuse spread. This right here, I think, is a really important point. Dr. Hamilton has someone who has some bags under the eyes after injecting. I recommend, and the question is, “What do you do?” Absolutely I’ve treated a lot of people who came in with … The tear troughs, not so much in the lower lid, but in the tear trough area if it is convex I can almost guarantee you there’s filler in there. I’m seeing people say, “No, it’s not filler,” and then I put a hyaluronic base in it, just a little dot, and it goes away. When I say a dot I mean one unit on a 30-unit insulin syringe is what I do with a 31 gauge insulin syringe and just put 0.01 mL in there, or one unit on that insulin syringe, and it goes away.
But, if you don’t have a lot of experience with using fillers I just wouldn’t use. I would use PRP as a stand-alone in the tear troughs, or do a mixture of one part JUVÉDERM® and nine parts PRP, so 0.1 of JUVÉDERM® and 0.9 of PRP in a 1 cc syringe, swished around, and use that and this is less likely to happen. But, it is fixable. I know you sent me some amazing pictures, Edward. Do you have any of those handy that you could show us? And, you can talk about what you’re doing, because I know you’ve developed some pearls around the face. Do you have any of those handy that I could just hand you the screen and you could talk to us about what you’re doing?
Dr. Edward T: Sure. Give me one second here.
PRP with or without Amnion in the Neck
Dr. Runels: Yeah, that’s cool. I’ll talk about this next question while you’re pulling that up. “Any protocol for injecting PRP with or without Amnion into the neck?” I think we covered this, actually, on the last call, but just to review. I think if you’re working with the neck I’d do three things. Again, if it’s a turkey neck they need a surgeon. I send lots of people for blephs, and for neck lifts, and facelifts. If it’s just necklace lines, or if there’s some platysma looseness that I can fix with Botox® then I go for it, and people love it. I charge for the PRP part of it 600 bucks. What I’ll do is … I treat it like a scar, basically. So, in the necklace lines I’ll put 27 gauge needle into the necklace line and inject intradermally and subdermally with PRP, and then microneedle PRP on top of that.
Then, if you’re going to mix Amnion with it, I just use one of those half cc Vampire Amnion. You know we have our own brand now that’s about one-fifth the price of what most people charge and it’s good stuff. You put a 0.5 cc of that, or a half a cc of that to 5 cc of PRP and mix it up and then inject it. Then, Botox® 2 units along the line about every inch or so apart, and then put them on a good cream, put them on our Altar® Cream. If you want to go all out, put them on Retin-A 0.1% cream at night and our Altar® Cream in the morning and they get amazing results. You found some pictures for us, Edward?
Dr. Edward T: I did.
Dr. Runels: Okay.
Dr. Edward T: Let me see if they-
Dr. Runels: Yeah, I’m going to hand you the … By the way, you guys, Edward teaches a great class where … Actually, let me just give you the screen. I want you to show us your pictures and then we can talk about your class. Let’s see.
Dr. Edward T: I’ve got a great story about this first case, if I have control of the screen here.
Dr. Runels: All right. It should be offering it to you right now.
Dr. Edward T: Do you see what I see here?
Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
Dr. Runels: Yep? I got you. She’s 55-60 year old woman treated with Vampire Facelift®.
Dr. Edward T: Originally, to take us back, this patient found me. She had actually moved, her and her husband from Tennessee and found me for an O-Shot®.
Dr. Runels: Beautiful.
Dr. Edward T: We ended up doing an O-Shot® on her and there’s so much crossover with the PRP procedures that she asked about the Vampire Facelift®. Naturally, we ended up doing a facelift on her. Now, this was one of my great kind of before and afters, because she had such a great result both from kind of the textural component as well as the shape. Staying with the classic form here I ended up … I just used one syringe. I used [inaudible 00:16:07]. I did some [inaudible 00:16:08] around her PRP, and that’s the result she got. My pearl is with this particular case I remember … I think that I was able to achieve the lift I did really by pulling, doing a pulling technique. When I first started doing these injections I would go right on the periosteum, right where the zygomatic arch is.
I still do that, but now I pull up very aggressively, and I draw Dr. Hinderer’s lines, which you can see here kind of mid [inaudible 00:16:41] down to the lateral aspect of the nose, and the lateral canthus down to the mouth. See where my finger is, this pointing arrow what I do is I lift and pull up really, really high on the skin and you can actually see where that line used to be, the one I drew when you kind of pull the skin up taut. I inject where the line used to be. What I mean by that is that for patients who are over the age of 40 who have a little bit more heaviness and need more lift I’m really kind of pulling up and I’m using the filler as a tack.
Dr. Runels: Interesting.
Dr. Edward T: I think before I was, basically, just filling down to the level of the bone hoping that it would just raise the skin. But with this technique when I’m drawing Dr. Hinderer’s lines I’m pulling the skin as high as I can. I inject with my right hand, so I pull with my left hand, and then I kind of see where that line used to be and I inject there. Obviously, when you pull the skin up with your left hand here, the line you drew goes up. So, the line you can imagine that used to be there is where I inject. That’s kind of the after that I get here. There’s a lot more kind of superolateral projection doing this pull and lift technique. I started developing this because as I’m getting into the more longer-lasting fillers such as Voluma®, that’s actually how Allergan teaches it. Now, I’m combining this lift and pull technique with the Vampire Facelift®, which was my introduction to facial aesthetics when I first learned this from you, Charles.
Dr. Runels: Beautiful. So, can we go through that again? So, you draw the lines and then you pull-
Dr. Edward T: What I do is … Right. So, I draw the lines and then I pull up on the lateral aspect of the cheek just as high as I can with my non-injection hand. Where the line used to be, now that it’s been moved up, that’s where I inject.
Dr. Runels: While you’re holding it up?
Dr. Edward T: While I’m holding it up.
Dr. Runels: Okay, beautiful. You’re directing all along the lateral zygomatic arch there. Is that what you’re … Okay.
Dr. Edward T: I’m doing the 0.15 and the 0.5 is classically descried by the Vampire Facelift®. I think I’m getting more bang for my buck when I’m thinking about using it as a tack rather than as a fill, and then I put the PRP over it and it seems to work really well with that lateral superolateral projection.
Dr. Runels: That’s some beautiful photographs. What are you doing around the tear trough area? I hear lots of different techniques for the tear trough. I like that technique where you’ve taken the best of Allergan’s teachings and then one upped it with your Vampire ideas. Talk to me about … By the way, if I were defining the Vampire Facelift® it would be like this. Take a syringe of filler, do your best work with it, polish it off and think of that as reshaping the mattress, keeping in mind the ideas that you just mentioned about shaping the, restoring the youthful shape of around the eye and the mid cheek area especially, because that’s where research shows that we first get an idea about our perception of how old someone is. So, that’s where you start and then you think about the other things that are described on the website based on your understanding of the face and your understanding of your best technique.
I never expect everybody to do it exactly the same way. We all have different eyes on different days and with different people. As long as those techniques are used then they’re going to have the best result possible. It’s just what’s going to happen. So, that’s the Vampire Facelift®. Around the tear trough, and we all have a different way of seeing it, but we’re all following that basic principle, using HA, make your best useful shape, polish it off with PRP, and then if you need more HA that’s fine go for it, but let that be additional cost to the patient since it’s additional cost to us, and that way we’re all going about the same guidelines as far as our pricing, as well. The tear trough, though, is where I see the most variability, so talk to us about what you’re doing since that was one of the questions tonight.
Dr. Edward T: Absolutely. I get very, very medial all the way up almost to the nose, and then I inject and I’d watch the PRP fall backwards. I don’t activate, by the way. One of the risks that I … Actually, one of the side effects of this particular technique is I almost always get a little bit of bruising, and so they get kind of that darkened shadowing after I do a Vampire Facelift®. It goes away and I assure them of that, but I’ve been getting really great outcomes with it. I also get better outcomes I’m finding when they come back four to six weeks later, and I only inject their tear trough with PRP. I think sometimes the first PRP injection might not be enough, particularly if they are almost on that borderline of needing a lower bleph. I also finish it with Lytera®, which is a skin cream made by SkinMedica® that helps with pigment. I learned that one from an oculoplastic colleague of mine who gave me that pro tip.
Dr. Runels: Beautiful. Thanks for the pearl. That’s why we do this at night. Let me ask you for a little bit more clarification, though. You started that explanation by talking about doing something more medially. Can you talk more about what you meant by that.
Dr. Edward T: Absolutely. If I may use my … If you can still see my screen here, I’ll use this picture. My needle originates or goes in here and goes all the way to the most medial aspect of the eye near the nose here. I’m going to zoom in here slightly. To me I see this triangular shape here that I want to fill, because when I go through this crepey, or there’s almost always kind of crepeness here of the skin. The bag, or the space here, is so thin here it fills so well with that unactivated PRP that it filled all the way up to here and comes back. I don’t know if that was by design or not. I suppose to try to get rid of your tears as you kind of tear, but it’s natures way of very efficiently kind of whisking away excess fluid there. I’m just kind of leveraging that shape.
Dr. Runels: Interesting. Would you say the name of that cream again that you’re using, and you’re using it for the crepe papering in the lower eye area? Is that right?
Dr. Edward T: Correct. It’s actually Lytera® 2.0. It works great because it works well for the color. In those patients who have an ethnic predisposition to bags under their eyes this alone works fantastic. That’s where I got the idea to begin pairing this with that part of the Vampire Facelift® that involves injection of PRP under the bags of the eyes.
Dr. Runels: Just so you guys know. You may have picked up already, Edward has a strong background in mathematics as an engineer and then is a world-class and award-winning robotic surgeon and gynecologist there in Southern California, and does a really beautiful job of teaching combination therapies, teaches BioTE®, so he teaches hormones and he teaches lots of ways of thinking about how these procedures can be combined with energy sources and surgical techniques. With that introduction, can you pull us up some pictures and talk to us some about your ideas about the O-Shot®, starting with maybe, if it’s handy, maybe that picture you have of the urethra, which I think is amazing. But, talk to us more … I want to get back to marketing, because you’ve been really successful with the marketing.
Selecting the Best Patients for the O-Shot® Procedure
First, talk to us some about your ideas about patient selection. I never want to get away from the idea that the better we are about patient selection, that’s the first step to having great results. All of us want to have wonderful results and be paid appropriately for doing, basically, miracles with our patients. Can you first start with explaining this picture and then some patient selection pearls?
Dr. Edward T: Absolutely. To kind of go a step back, as an engineer I think that it’s very important to define and measure all the activities we do. As a physician I try to look for those tools in our clinical toolbox to measure these outcomes. When I had done my fellowship in robotic and urogynecologic surgery at Scripps Clinic in San Diego, one of the kind of key aspects of my training, even before I started doing pelvic surgery, was urodynamics. Urodynamics to me is the gold standard for actually assessing the different kinds of urinary incontinence. Does the patient come with a pure stress urinary incontinence? Do they come with a overactive bladder picture? Or, is it more commonly the most common kind, which is mixed, which is actually the most difficult to treat. So, when I do my assessment of the patients for their candidacy I think it’s ideal when you do the full work up, although it doesn’t happen every single time, to have some kind of urodynamic evaluation.
The area that I look at, and I’m most interested in … Actually, I’m going to scroll down here, is the intrinsic sphincter deficiency assessment, or the urethral closing pressure, because I really want to know at the urethra what the degree of damage or the degree of strength that resides. To me at one end of the spectrum you have a very healthy urethra that upon closure can actually withstand the increased pressures that are created when the patient laughs, coughs, or is a little bit heavier. That’s a young patient, maybe they’ve not had kids before. They cough real hard they’re not going to leak, because the urethral pressures and that intrinsic urethral strength is quite strong.
On the very other end of the spectrum, you have a patient who has intrinsic sphincter deficiency in which the urethra takes on more of a complete pipe shape and function. In the case of the patient with intrinsic sphincter deficiency, when you perform urodynamics on them you will see that their urethral closing pressures are way less than 50 mmHg. They’re actually quite low. In my opinion, the patient who is healthy, who can be continent when they cough really hard, versus the patient who has intrinsic sphincter deficiency, somewhere lies in between the ideal patient for doing an O-Shot® for urinary incontinence.
I’m thinking, in my mind, Charles, that the patient who doesn’t have a lot of tone to begin with … You could probably do four or five O-Shots® on them, several lasers, even putting a sling on them, and it may not work. Why? Well, I think by nature that urethra it’s too damaged or it’s not functional. Many of our procedures that are noninvasive, such as doing an O-Shot®, or doing two, or even giving them testosterone in the form of a pellet that causes hypertrophy of the muscles that surround the urethra, may not work. In fact, when you kind of do the literature search, one of the gold standards for performing a treatment on someone with intrinsic sphincter deficiency is to do a TVT, or perform a TVT, a transvaginal tape, in which it’s a lot of back support against that urethra does not work that well.
If you look at … I’m a big fan of the mini-sling, the Solyx. For those of you who are on the call right now, mini-sling is a very small sling that’s usually called the minimally-invasive sling, because it’s so small and doesn’t pierce through any of the spaces, may or may not give as much of that backstop support for someone with ISD.
What does that mean for all of us performing and looking for the ideal O-Shot® patient. Well, I would actually really use the history to try to guide us. How long has the incontinence been going on? Are there things that you can do, or things that you’ve tried? Some patients have been very good about doing Kegel’s muscles and Kegel training. They get some improvement upon doing these Kegel muscles. They just can’t get to it every day. I mean, we have such busy days. To do Kegel muscles with intent it’s just so difficult. That patient is a good O-Shot® patient, because they can demonstrate that with some exercising they could bring back that tone.
Someone who has had … I actually saw a patient today. She had had two C-sections. I’m about to do an O-Shot® on her next week. I think she’s a good candidate. We just did her urodynamics. We’ve proven that her urethral closing pressures are well above 50 mmHg. It makes sense in her history that probably with time, age, and the decrease of hormones that that tone or incontinence is changed. I think she’s going to be a fantastic candidate for an O-Shot®. These very soft findings in the history, not all of us have urodynamics ready to do in the office, I think really guide our ability to find that O-Shot® patient. Sometimes it might take another O-Shot®, for example.
Dr. Runels: Can I ask you two quick questions? First, for the person who doesn’t have the ability to make those measurements could you elaborate more on what clinical history or physical findings they might use that you’re correlating with those measurements? Second, do you have the beginnings of a data bank measurements before and after an O-Shot® that we could publish somewhere?
Dr. Edward T: I’m beginning to collect that score, because very early on, which is why I’m referencing this picture, I wanted to find a way to measure, if not visually, at least quantify the difference in the closing pressures after doing an O-Shot®. Now, this particular publication, or this article submission, was a case report of a 48-year-old gravida 5 para 2 … Actually, wow, last year. Almost by design a year ago that I had published, and this was after we did an O-Shot® in the operating room for a patient we did robotic surgery on. You can see here before the O-Shot® I put the cystoscope in. This was a 30-degree Stryker cystoscope, and you can see what the urethra looks like before the O-Shot®, and this is immediately after. I can imagine with time that the O-Shot®, the effects of the O-Shot® platelet rich plasma probably would just improve the tone of the urethra.
I actually don’t have, and I wish I did, pictures in a series of what happens at 30, 60, and 90 days, because I don’t know how I would consent a patient to do cystoscopy just to see how the O-Shot® is doing. More rather, bringing the patient in and just kind of asking what their incontinence level is.
The second part I think you were asking is, looking at a questionnaire, which is what we did, I’d be happy to share with the group, too. There’s a great one developed by LABORIE who makes my urodynamics equipment. It’s a checklist of about ten questions that, basically, look to see, Do you feel like you have to pee as soon as you put the key in the door? We call latch-key urinary incontinence, which really speaks more towards overactive bladder. Or, Do you leak when you cough? How many pads are you using a day? You could almost get a gestalt on whether they have stress urinary incontinence or overactive bladder, for which the two treatments are different. I am seeing almost in colloquial, or kind of informally, that the patients with overactive bladder are needing to use less Detrol, something about their O-Shot® and rejuvenating some of the vaginal mucosa immediately underneath the bladder helps with overactive bladder.
Dr. Runels: Anecdotally we’ve had some people with very severe cases that have made remarkable changes, so hopefully you can get us some objective numbers that we can publish somewhere. Can you give us your pearls about actually doing the procedure, and thank you for showing those pictures and, yes, we would like to see that survey you’re using for measurements.
Dr. Edward T: I’ll get that to you and maybe you could distribute it out to-
Dr. Runels: I’ll just post it on the web … Is it copyrighted? Is it something we can post?
Dr. Edward T: It’s pretty general.
Dr. Runels: Okay, I’ll post it to the membership site for people to download. Would you talk to us about your pearls about how you think, what you’re thinking, when you actually do an O-Shot®?
Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
Dr. Edward T: Absolutely. So, when I talk about … I’ve experienced in two realms and I’m very fortunate because, I think I’ve told you this before, my hospital system has been extremely supportive with regenerative medical techniques that I’m doing in the OR. My story in terms of the OR, versus doing it in the office, which I’ll talk about in a second, really stem from a product made by Stryker. Stryker made a product called Vetigel® and Vetigel® is a combination of autologous PRP in which the scrub tech or the nurse that would have to draw the patient’s blood and then mix it human thrombin and that’s what our GYN oncologists and I were using to put on the vaginal cuff before I even took your class, Charles. This is …
Dr. Runels: Interesting.
Dr. Edward T: … before I took your class. We were finding that the rate of vaginal cuff dehiscence and post-robotic hysterectomy spotting went to nil. One of the most frequent calls that we get as a gyne robotic, or any kind of gyne surgeon, is post-hysterectomy spotting, because the cuff has little pores through it. We were just plugging the Stryker Vetigel®, which is really just PRP plus thrombin, over the cuff and the patients had less pain. They were not spotting. We had less calls. We were happy.
Then about three months later it made me so sad because Stryker pulled the product off the shelf. In my very engineer mind I said, “You know what, this is just too good of a product to not have on the shelf,” so I started looking at other companies. We use Regen. We were able to replace a pre-existing product in our hospital OR with a similar product. I think I found a very pleasant loophole, right, because I had to have something to replace it, so we found something to replace it that ended up being a lot cheaper.
Dr. Runels: You’re referring to Regen when you say there’s something to replace it? Regen Therapy?
Dr. Edward T: When I do it with my hysterectomy, I do make it with a gel, and I [inaudible 00:36:47] calcium chloride, and I add about 0.1 of thrombin, that is autologous thrombin.
Dr. Runels: Yes, and Regen, just so you guys know, Regen has a kit that comes with thrombin …
Dr. Edward T: Exactly.
Dr. Runels: … or a way to make thrombin, and they also have a setting on their centrifuge to make a gel. Am I understanding properly? Is that what you’re doing? Are you using that thrombin kit?
Dr. Edward T: That’s exactly what I’m doing, but I’m doing that above the vaginal cuff. When I undock the robot and I’m done with the … Actually, I did the same exact same for a stage IV endometriosis patient today. She’s on the floor. She’s doing great, and after I undocked the robot then I used my PRP kit, and I do a classic O-Shot®, and that’s it.
Dr. Runels: Interesting. Beautiful. That’s pretty amazing combination therapy. Do the people that are getting hysterectomies from you, do they realize what a higher standard that you’re taking this procedure to? I guess they do. Tell it to me more about, do they find that out when they show up for surgery? Are you advertising this combination or way of doing hysterectomy, because it sounds like what I would want my loved one to have?
Dr. Edward T: I think that at the end of the day I’m guided by the same principle that my father, who I operate with still today, actually we just did the case together, has always taught me, which is be very patient centric. I just want to take care of my patients. The money part, and the finances, and the marketing sometimes, as you know, Charles, can get in the way of that.
Dr. Runels: Yes.
2 Guiding Principles That Bring More Patients and Provide Better Care
Dr. Edward T: It’s kind of a very means to an end, I suppose. But, when I start counseling the patients about what we do I start out by saying that we want you to recover as quickly as possible. So, when I lead with that, and I also followup with the fact that we utilize the newest and latest technology in regenerative medicine, the patients begin to understand that their body actually does have a natural mechanism to heal itself. If not using parts of their own body, why would I reach for something on the shelf if I didn’t have to, if I could use their own PRP, and their own thrombin, autologous, to help them heal? I think when it’s set up like that it’s an easy sell.
Dr. Runels: Well, and part of the reason I brought it up was that I feel like, as your father said, Part A is that the want to be patient centric and make sure that we’re always doing the best with the least amount of risk. Then, Part B is that, I think, it’s our responsibility to make sure that our patients know what we’re capable of doing. I think that’s a different way of thinking about it than the way, and I know that’s the way you think, as well, but some people think, “Oh I just want to do it but I don’t want to have to sell it,” but if you use a different way, and it has to be sincere, of course, but if your way is not trying to get people to do things, but your way is taking responsibility for educating people in what you’re able to offer them as an option, and then they decide what they want based on a fully-informed description of the possibilities.
That, I think, is really what we’re supposed to be doing anyway, whether we’re taking insurance or not. If it happens to be something that somebody could pay you for, well that’s wonderful, but it’s kind of what we’re supposed to do anyway, and that is the best way to “sell stuff.” As you know, I never script these conversations with our teachers, because I like the serendipity of discovering along with the people on the call what might be possible. Have you had any of the gynecologists reach out to you, or do they even know it’s a possibility the ones who come to your class for you showing them this way that you’re doing a hysterectomy, or is your description you just gave enough for them to take it and run with it?
Dr. Edward T: Well, I think that they understand it. I always get a very academic nod to what I’m doing but to your point, Charles, some of the GYNs that I train, they’re my colleagues, they’re a little bit slower to adopt, because we’ve been kind of put into a corner with our Board certifications, and you’re supposed to do it this way. I’ll be honest with you, if that’s how we did hormones then we wouldn’t have any progress.
Dr. Runels: Yes.
Dr. Edward T: If all we did was treat to the exact specifications of what [inaudible 00:41:25] put in brackets, none of our patients would feel better. We would still have all these issues.
Dr. Runels: Is there something you can measure, for example, that postop spotting that you were talking about? Is there something you could measure where you could do the next 40 patients, 20 with and 20 without that? It would the great to have some sort of paper where we could let people know what you’re doing. You know, I just put a link in PubMed where there is some discussion already. I couldn’t find the one … There’s one out there somewhere about using PRP as part of the hysterectomy process. I guess it came out of the people who did the research for the last product you mentioned, but I can’t find that paper right now. Anyway, I won’t dwell on it too much, just to let you know it’s something else that would help the whole group, because there’s lots of GYNs and urologists in our group.
Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
Okay, we’ve got a couple of questions, and I’m going to unmute Stephen Carp who has a question for you. Let’s see if I can unmute him here. Let’s see. I’m just going to let you ask him instead of me trying to slow down the mail. All right. Dr. Carp, you’re unmuted. Go for it.
Dr. Stephen C.: How are you? Good evening.
Dr. Edward T: Hi.
Dr. Stephen C.: I’ve got a patient that came in, been a long-time patient, who came in just looking for a potential solution. Had endometrial cancer. Had a hysterectomy with radiation and has some scarring that’s tender, and discomfort, a few cm proximal to the introitus that’s probably from about 5 to 8 o’clock or so. She came in because she’s actually a physician and wondering if PRP might be something that could help soften that, might help with that area. Have you had any experience with any PRP in post-radiation in the pelvis?
Dr. Edward T: I have not, but when I think about the three or four cases of patients who have had traumatic vaginal deliveries, they create quite a bit of scar tissue in that fourchette. The success cases I’ve had for those particular ones required more than one O-Shot®, and by O-Shot® I mean doing the classic O-Shot®, but then also doing focal 1-2 cc of activated PRP right into that area of the scar tissue to soften it up. I would also go so far as to maybe use vaginal dilators and, depending on the comfort level of the oncologist, there’s a great product that has compounded DHEA that could definitely soften that fourchette. DHEA with history of gynecologic malignancy is still kind of up in the air, but I have a lot of breast cancer survivors. We’re right next to City of Hope, my practice, and we were using a lot of these nontraditional therapies to help these patients out. I can imagine the irradiated tissue is very similar.
Dr. Stephen C.: Yeah, I would think so.
Dr. Runels: Let me add to that in that my position that I am grateful every day is now becoming described in the Earpiece for lots of brilliant people like you guys. I’ve had quite a number of people, probably a dozen different providers, call me and tell me about similar cases, several cases of dyspareunia post radiation. One case in particular comes to mind where a woman had repeated tearing and pain in an old episiotomy scar, and just like you just said, Edward, it took three treatments with injecting, basically infiltrating the areas if you’re getting ready to suture it intra and subdermally with PRP, and then waiting four to six weeks and doing it again, and doing that three times, and then the woman was without pain and without bleeding. It was something that was a nuisance for quite a number of years. Another case of radiation that had some scarring and pain around the anus, as well. Yeah, so it’s been done and it’s been helpful, and hopefully some of you guys will publish a case report.
I had a case ... While we are talking about dyspareunia, I had a case of scleroderma that got well, but just one. These are … No one person has enough to do a series, but maybe we should some case reports, or try to pool it. What else? Anything else, Dr. Carp?
Pelvic Floor Spasm
Dr. Stephen C.: I’ll just as an addition to that, have you had any experience, especially with urogynecologic, with Botox® for the spasms that they get in the pelvic floor?
Dr. Edward T: I have not done that, although many of my colleagues have. One of the risks of doing that is if you do it too much they go into retention. I have not done that particular method. I have used CO2 fractionated laser. I’m a big FemiLift physician. I use FemiLift quite a bit for overactive bladder, as well as the compounded vaginal estrogens work very well. I think there is a great deal of dysfunction at the level of the vaginal epithelium, that thin layer that separates the bladder from the vaginal canal that needs to be addressed. It gets irritated in these patients with overactive bladder.
It’s really interesting, because one of the gold standards that the insurance covers is the administration of Detrol, or an anticholinergic, which many of my patients within about 30-60 days will self-discontinue due to the side effects, the dry mouth, the dry eyes. They might have less overactive bladder but [crosstalk 00:47:28]. There’s some brain slowing, especially in the older population.
Dr. Runels: Yeah, there was actually a paper out about six months ago that was pretty compelling that there really is an increased risk of dementia long term, as well.
Dr. Edward T: I can see why. You, basically, create that parasympathetic overabundance or push the parasympathetic system to try to dry everything out, well it’s probably going to slow your brain function down, as well. The patients are getting forget. I think it’s very high risk in the older population due to polypharmacy.
Dr. Runels: Anything else, Dr. Carp?
Dr. Stephen C.: No. Thank you.
Dr. Runels: Thank you for the excellent question. There was quick question from Dr. Vora about Emsella, and the answer is, “yes,” some of us are combining Emsella with results. Some are using the intensity vibrator that has contraction component to it. Are you doing any of that, Edward?
Dr. Edward T: So, I was using the [Visa 00:48:30] Plus for a while. I don’t know if you’ve seen that as a at-home device.
Dr. Runels: Yes, talk to us about it.
Dr. Edward T: So the Visa Plus is something that the patients were using. They would take home, use as a light therapy that helps with collagen generation and urovascularization. There’s two versions of it. There’s a version that’s available in the United States, and then a stronger version which I think is only available in Canada, is one of the examples of, I think, an at-home treatment that the patients can use.
Patients always want one and done. From the very beginning I try to tell them, especially when it comes to some of the dyspareunia associated with the menopause state, once estrogen runs out and the vaginal epithelium begins to change it takes a variety of different approaches that begins in the office and really continues with the patient at home. I might do an O-Shot® on them and have them go home with something called … There’s a commercially available medication called Intrarosa®, which is compounded DHEA, or I would use vaginal estrogen. They’re going to work on that at home for the next 30 days. They may come back. I do another pelvic exam. Maybe the grade of the atrophy changes, or improves, or they could have one more sexual encounter that month. To me that’s a win. Then we will add a vaginal laser.
The in between treatments, whether it’s a device such as the Visa Plus or these creams are very, very important, whether you’re talking about vaginal health or you’re talking about aesthetics in the face. I think really beginning to set that as a proposition to the patient, “You’re going to be doing things at home, that are going to help.” Certainly having multi-modality.
I have colleagues of mine in Southern California having great success with the Emsella®, to strengthen the pelvic floor, as well as doing an O-Shot®, looking back at our … We have about 300 patients on pellet treatment right now. Many patients will cite that their urinary continence has gotten better within the first treatment of testosterone. How do I know that? It’s because they won’t show up to their urodynamics test, and so I know something is there. Having that multi-modality approach for urinary incontinence, intimacy, even aesthetics I think is going to be key.
A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Dr. Runels: Beautiful. We’re going to talk … We have about nine minutes left and Edward has some interesting ideas about when it comes to marketing with trademarking and not just our procedures but you as a provider and expanding upon that idea. So, we have about eight minutes left, Edward. Before you do that, though, I just want to tell you guys that Edward is, obviously, brilliant and excellent teacher, and excellent as a provider for our procedure, so highly recommend his classes. He’s got one coming up July 27, which is pretty close, but I don’t know if he’s got slots left, but I’ve put a link to that. If he doesn’t have slots in that one I’m sure he has another one coming up soon. With that, Edward, if you don’t mind, talk to us some about, I know you’ve thought a lot about that idea. Can you expand on that some and then we’ll close it down for the night?
Dr. Edward T: Absolutely. So, as I’m going through the mental exercise and thinking about how to combine all the different procedures and finding that a combination of different approaches that hit different aspects of what I’m doing is the best, I really did a deep dive and found that my main focus is intimacy, how to restore it, how to improve it, how to educate patients on it. I was very happy when my trademark, actually I have a copy of it here, by the U.S. Patent Attorney Office was accepted now with for the second year in a row. I’m ready to defend it, because I came up with this idea of Timeless Intimacy. You can see here, this was actually from my-
Dr. Runels: One second. I took the screen back. I’m going to give it back to you. Now you can show us. Go for it.
Dr. Edward T: I applied for a Trademark. It was actually more of an activity than anything else, and it was successfully accepted by the U.S. Patent Attorney Office. This was a recent email, actually July, by my attorney and I was able to submit it again for the second year in a row. The Timeless Intimacy trademark basically encapsulates performing a minimally invasive vaginoplasty, performing an O-Shot® and followed by a laser, in this case a CO2 FemiLift at a particular setting to help heal and to help reconfigure the vaginal vault to take on a more youthful function. I would always tell the patients, if you want a certain tightness or a certain kind of friction coefficient in terms of the sexual intimacy that you were at 21 we’re not going to go past that, right. We want you to be in a place I would say, ideally, between 20 and 30, in a place before you had children, in a place before you entered menopause, such that you could resume intimacy again comfortably and pleasurably with your partner.
As a part of that I then went on to develop Timeless Health Solutions, Inc, which is my Med-Spa or my functional wellness practice. That’s now being developed as its own entity. It has its own collateral. There’s a voice that’s being developed in which the girls in my office are trained to pick up and talk to the patients with a particular voice.
I’m finding who I am as I’m going along in this journey, that originally I started as an engineer. I think I have a very compelling story to use technology and, basically, give that technology and distribute it in such a way to help patients. I’ve become a surgeon in the last few years, a robotic surgeon in the community, helping women have surgery in a minimally invasive way and get back to life sooner, and putting it all together. I think that’s really what the Timeless Experience is. I think it’s really garnered a lot of attention in our community. I know it’s being recognized at the level of [inaudible 00:54:48] hospital systems. I’ve been recently kind of given this idea, this honor, of being a social media expert in women’s health. Now I have this wonderful platform to get all these ideas of regenerative medicine, minimally-invasive surgery, and to be able to talk about intimacy in a way that’s never been done before in my community.
I’ve been very kind of passionate. This was actually what I was going to talk to you about tonight, and I’m going to highly the second point here. I would say, Charles, right now in the last few minutes that I’m in lean startup mode, and I looked at my colleagues, my engineer friends up in Silicon Valley, and there’s this wonderful book by Eric Reese called The Lean Startup. What that means is creating these very small … Let’s see if I have a picture of it. … MVP, that is a minimum viable product, and really getting it out there to see if the population, or the market, is interested in it. What that means for us as busy physicians is before we buy that next laser, or before we buy that next cool sculpting machine, can we create these minimum viable products and test our market, and how convenient is it that our market are the patients who have been following us all this time.
Dr. Runels: Yes. Yes, we already have an audience.
Dr. Edward T: We have a captive audience. In this world of marketing you actually have to pay for these focus groups.
Dr. Runels: Yes, and let me emphasize that real quick. I don’t want to slow down your momentum, but everyone needs to remember, you are marketing to your people. If you [want to 00:56:27] market to the whole world that’s fine, but you need to start with your people. If you don’t have a group of people that you call your people, in my opinion, it’s difficult to have a steady flow. You start by building a fan base of people who love you, because you’ve done good things for you. Now you can do what you’re talking about. Okay, keep going.
Dr. Edward T: I think every once in a while when I get stuck, Charles, I put my engineering hat on and I think about what an engineer would do, because if I think about what a doctor would do, I would probably take on another [inaudible 00:56:58] contract and working harder and I’d probably be- [crosstalk 00:56:59] Just being honest with you. I’ve already seen this. I saw what happened to my father, right? I think desperate times call for desperate innovative measures, and I put my engineering hat on and I found this, and I’m just sharing this with our group, lean startup. In the last minute here I encourage …
Dr. Runels: You know what. Keep going, go a little over. That’s fine. I think this is good stuff.
Dr. Edward T: … and want all of us in the call, the physicians, to really become lean again. I think that all of us as physicians need to find a way that we retract because the environment right not conducive to us expanding aggressively. We must all come together and retract and regroup, much in the way that Sun Tzu says in The Art of War about looking at our enemy and knowing that we are not ready, and we are not powerful enough to be out there and fight. So, we have to retract, and in this very lean startup manner regroup and see what anchors us.
Dr. Runels: Yes.
Dr. Edward T: It’s very easy because all of us in quarter four … I know I’m speaking to everyone on the call right now when the tax comes all of us who are on the call most of us are in private practice, and we are lured by the laser companies, and by a big company to do that capital investment just to decrease our taxable income. Really understand what it is that our market is demanding. We can do that by creating these very small value propositions and testing it. That’s why doing a class on injectables, or learning how to do an O-Shot® is so valuable, because it may be caused that initial fee, the tuition, and that’s it. That fee is the minimal [crosstalk 00:58:47]
Dr. Runels: Then you take the money from that and do the next thing, yes.
Dr. Edward T: You got it, because what makes you think, and forgive me for saying this, that you’re going to be able to make a vaginal laser which can cost up to $100,000 work if the patients in your group don’t even want an O-Shot®? To that same degree, what makes you think buying the newest fractional CO2 facial laser is going to be appropriate when the patients don’t even want you to do a Vampire Facelift® on them?
Dr. Runels: That’s right. The guy who taught me Botox® was doing … He was the top Allergan account in the world, we talked about this before, and he always said, “Get your Botox® practice going then buy the facial laser.” So, exactly that’s the right strategy. When you get to where you’re one or two O-Shots® a week now you can take the money and take the flow, and you know that your laser’s not going to gather dust, or you’re radiofrequency. I’m loving this. Tell us about the next thing on that list.
Dr. Edward T: I guess the next thing, …. Forgive if I’m going over here but-
Dr. Runels: No go for it. We like it.
Dr. Edward T: In addition to retracting … This is what I’ve been doing. I’ve been retracting, rebuilding, regrouping, and creating my brand. The brand tells a strong story that I’m infusing technology with medicine. I actually had a doctor friend of mine, Charles, reach out to me, and she asked me how I’m seven places at once? I said, “What do you mean?” She’s like, “I’m watching your Instagram, man, and you’re like seven places at once. I’m like, “Thank you, I’m not.” I have virtual assistants. I try to automate and eliminate, and I’m doing this because I have a virtual architecture and I check in with this lovely girl in the Philippines. I give her a list of things to do and in the morning it’s all done because of the time zone difference. It could be something as simple as arranging for my dry cleaning, or figuring out a logistical issue for a seminar that I’m going to be teaching out.
But, when I’m able to do that and create that virtual architecture she learns from me. We talk about, as engineers, machine learning, and we talk about artificial intelligence. You don’t really need that when you could actually have bonafide intelligence. These virtual assistants, it’s a skill and I’ll be honest with you, coming out of fellowship I didn’t really know how to manage people that well. I’ve learned more about managing people, and learning how to lead working with these virtual assistants than I have in all the time I’ve graduated, because you learn about time management, because now I know what the value of time is in a quantifiable way. I’ll give you an example.
I found out that it’s actually a lot easier to click with my thumb Expedia and book a flight, and look for a flight than it is to go in almost two hours back and forth in different time zones to get my virtual assistant to book it. That’s a great example, right? But, for something that takes a lot of different steps, like research, I’m trying to find a cheaper way to bring in needles or syringes to my office. That’s an hour affair. I’m putting that to my virtual assistant, so now she does my supply chain and I’m like, “Oh, there’s something called supply chain. Let me learn about how to do supply chain management.” It didn’t cost me that much, and so that becomes part of my virtual architecture. It becomes part of my virtual corporation, my virtual timeless structure, and that’s the virtual architecture that’s rising me, or raising me, to make me look like I’m in seven different places at once. It’s because my virtual architecture is raising me, it’s giving me more time.
Dr. Runels: Beautiful. Both the virtual assistant and someone in the office who functions like an executive assistant, not just doing the nursing work, but they are willing, and expecting to do things like drive your car, or go buy your groceries, that sort of thing, I think when you value your time at at least $1000 an hour, which everyone on this call should be doing, then that person if they save you an hour a day, you can pay them a reasonable rate and still do well. What’s next on that list?
Dr. Edward T: I suppose the last thing … Let me give you the website that I use, and I explore …
Dr. Runels: You can just throw it in chat box and everybody will have it.
Dr. Edward T: It’s onlinejobs.ph. You actually see it.
Dr. Runels: Okay, there you go. Onlinejobs.ph. I concur with you in that the people in the Philippines they like Americans and unless they’re having a typhoon where they lose their internet they are as a rule usually reliable, and they are grateful. You can pay them what for her is not so much, and you can be helping someone have a whole different lifestyle in the Philippines. I highly recommend what you’re doing.
Dr. Edward T: The last part of my pitfall, so I will try to wrap all this up, because between becoming lean, creating a virtual architecture, becoming proficient with all of these advanced regenerative medical procedures, and learning how to do aesthetics with an artful aye, I’ve also learned along the way. A lot of the pitfalls, I think, stem from paid advertising. I think in the group whoever is still listening left, all of us, I think, have all tried to pay-
Dr. Runels: By the way, it’s everybody. Nobody’s dropped off. They’re listening.
Dr. Edward T: Anyone who’s tried to pay for advertising finds it very difficult to measure a return on investment, because in my mind as a physician if I pay for advertising it means that there will a measurable return for a booked and paid patient. However, with marketers and paid advertisers out there, their metric is leads, or …
Dr. Runels: Yes.
Dr. Edward T: … clicker rate. Things that are not as relevant clinically to us and to our bottom line. I think there’s a big discord.
Dr. Runels: They don’t pay the groceries. Clicks don’t pay the groceries do they?
Dr. Edward T: It took me a long time to learn that at the very visceral level, that we have a disconnect here. That disconnect is what’s actually preventing, in my mind, marketers and physicians from really aligning together. I think that if there was a better, more kind of physician-centric way to create paid advertising … You know it’s good that all of us on the call know the basics of marketing and advertising, but the the end of the day we are doing all this to try to get back to what we signed up for, which is to help patients and do medicine.
Dr. Runels: Yes.
Dr. Edward T: As a pitfall I think what I’ve been guilty of is going down too far and kind of veering off course, and there’s so many tools, and so many virtual assistants, and so many Ontraports, and mail … I mean, there’s so many digital pools out there that I think every once in a while I have to pull myself back, not as an engineer now, because that’s all we do is create tools, right, for better solutions, but pull myself back to the medium, which is the physician in me and go back to doing medicine. I would say that’s a pitfall that I’ve realized that it’s very easy to go down that rabbit hole and find that next digital tool, that next widget, that next app, and forget what we kind of signed up for.
Dr. Runels: Just let me expand on that just a little bit and then let’s call it an night. All wonderful stuff, Edward, by the way. There are so many tools, and I’m literally at a class now in Cleveland that cost me 30 grand. I’m in a class today, earlier today, with a guy that made $900,000 in two weeks online. These are high-end people, high-end in that they know how to make money online. It’s interesting, what I’ve noticed is the people who are making 10 million or more on the internet, they’re still doing the basics, and it’s not just online. The other thing that these guys with real businesses with tell you is that you bring it offline as soon as you can. It’s handing out the brochures to your patients, or your just physical card and saying, “Hey, if you know somebody else I can help, would you give this to someone.”
Using the tools, just the basic tools of a video so you don’t have to keep explaining it, emails that you send to your patients every couple weeks so they know that you’re there, that are not fancy, that are messages that give them the things you would say to them if they were in your office anyway about what you want them to do to be healthy, and what you’re able to do for them with explanations and clicks to show them the research. So, a video, a web page that’s helping you let them know what you’re able to do, and then instead of doing all your time marketing you’re doing something, it’s a practice, and so you’re practicing it. But, here’s the fun part, you’re practice of marketing is actually making you a better physician, because you’re teaching your people how to be well leveraging digital tools.
I know if people are on the call that have done it on Instagram and Facebook and all the other tools, and I’m not saying you don’t do those things, but for these procedures what you just said is the formula that works, an email, a video, a web page. Deliver good messages and then while that’s doing you have more time and more money to go take care of your people, sometimes for free because the money’s flowing.
Edward, always a pleasure. I know people, I’m telling you the stick rate was amazing tonight. Everybody was listening, so I know they loved it. One last thing, guys. Edward does a mean class and you can tell he’s on top of all dimensions of this. So, have a great night, and I’m honored always to have your attention. Bye-bye.
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.
[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.
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.
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.
But the couple of ideas that I would point out, and then I’ll open the mic for discussion. The things that caught my attention were, first of all, how strongly some of the ideas are opposed
and then just in general how [in following] the idea of making things more beautiful, we have stumbled upon how it [creating beauty] also is making things more functional.
Another reference concerning the math of beauty
Dr. Goodman was on one of our previous journal clubs, where he talked about his research showing that women actually have better orgasms and better sex when you do some of the things we’re talking about now, when it comes to just [improving] the appearance [of the labia in the eyes of the woman]. Let me swap something over. I want to show you an example from my practice. Let’s see here. So this is from the Vampire Wing Lift™ website, which if you’re doing the O-Shot®, you should have also a listing here. If you don’t, let us know about it. But if you go on the before-and-after photos, there are several here that were supplied by our providers.
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.
So here we go. I’m going to unmute you, Dr. Harrison. Are you there, Dr. Harrison?
Dr. T. Harrison [Theodore Harrison, MD MBA ABAARM]: Yes, I’m here.
Charles Runels: There you go. Talk to us about this paper.
Dr. T. Harrison: Well we thought this was a really interesting paper. One of my Canadian colleagues sent it to me about a week and a half or two weeks ago. We have a little research group here in Victoria, British Columbia, where we have our little lab. We do a few experiments from time to time on different PRPs to try to find out what makes the best and how to make PRP and stuff like that. So when this came across our computers, we thought it would be interesting to see what these guys said and see if there was any way to make it practical, because this is a lab paper from Argentina.
It’s not very practical the way it’s presented here. What these guys did essentially was they took PRP, and they use a double-spin method for making PRP, which is unfortunately not described in the paper. But it’s referenced to a previous paper that they did, so you can find out how they did it. But anyway, they took PRP, and they did a couple of things to it to see if they could make it better. The first thing they did was they took it down to four degrees. They put it in a refrigerator and they got it down to four degrees for half an hour.
Then they tested it to see, with the various growth factors, and there are some pictures there about they tested migration and embryonic cell growth and how it affected it and the like. Yeah, you can see right there. Those pictures there are the first ones from the cold. The top graph is cell growth, the middle one is migration, and the bottom one is new blood vessel formation. They found that if you took just the … Well the control there on the left-hand side, that’s just fetal bovine serum. So there’s nothing in it.
Then the middle one is PRP releasate, which is to say, they took PRP and they activated it with calcium. I think maybe they tried thrombin too. Then the third bar from the left is washed PRP releasate. That is, they took PRP, and they did a second spin so that all the platelets formed a pellet now at the bottom. Then they removed the plasma from it, and they washed it with some kind of lab solution stuff, not really necessary in my opinion. But then they reconstituted it and activated it after exposing it to cold.
Then you can see what the results were. They got more migration, they got more angiogenesis, and they got more human embryonic cell growth from it. Also in the references, they have a good reference to the paper that gives good overview of what cold does to platelets. And essentially, what happens is, when platelets get cold, they get a lot more sensitive to activation, and they’re pretty sensitive to begin with. I mean, almost anything can cause a platelet to activate. I mean, I made a list once and it had like 20 or 30 things documented that cause platelet activation.
The only thing that keeps this from turning into a clot in five minutes is the fact that there are anti-activation proteins circulating in the whole blood. So that if a platelet accidentally tripped off, it just doesn’t set off the cascade and clot your whole vascular system. But, the fact is that they got a lot more results when they took away the plasma, and they got a lot better results when they made it cold. The second thing they did was take away the plasma.
Now, I’d heard a lot before that plasma helped PRP or helped the platelets in PRP. But these guys have some pretty interesting results here that show that if you take the plasma part away, the PRP actually does better. This is the washed platelet releasate part that they have there.
Dr. T. Harrison: Have there. So that was kind of interesting too. It doesn’t look … I can’t really tell from their data whether they cause lysis or not by doing these things. We know that lysate performs better than PRP by itself, and I guess I should define a couple of things here. Everybody on the call I’m sure knows what platelet rich plasma is and platelet poor plasma is. But there’s also a couple of nuances. There’s platelet releasate and platelet lysate. Platelet releasate is what happens when you make PRP, and then you spin it down and you add calcium to it. And then you spin it down again, and take off the remains of the platelet. So all you have left is the plasma, and what got dumped into the plasma from the alpha granules and delta granules after it’s activated with calcium, or something like that. That demonstrably performs better than just PRP by itself.
Now, platelet lysate is what you get when you take PRP and you spin it down, and you take all the plasma off, and you lyse the remaining platelets. So in that case what you get is a hodgepodge of everything that was in the platelets. I mean, it lyses the platelet cell membrane, but it also lyses the alpha granules, the delta granules, the lysosomes, the mitochondria. I mean everything that was in there just gets dumped into the mix. But what happens, this results in much higher concentrations of the growth factors and cytokines. And the research so far tends to go toward lysate being even more powerful than PRP, or PRP releasate as far as growing human embryonic stem cells. I mean human embryonic cells, our concern.
So these guys did the cold, and they found that that made the releasate more powerful, and they took away the plasma, and they hypothesized … and that made things better too. Again more immigration, more angiogenesis, more human embryonic cell growth. And they hypothesized that there were inhibitors in the plasma that were keeping the PRP releasate, the regular PRP releasate, from it’s full potential, you might say. And then when you got rid of the plasma, and then activated the cells and or lyse the cells, then you didn’t have these inhibitors anymore, and that’s why the plasma-free PRP I guess releasate you’d call it worked better.
And then they did one more thing. They also tried adding cryoprecipitate to the PRP to see what that would do. And they made the cryoprecipitate by basically freezing their PRP, or spinning down the PRP, taking off the plasma, and then freezing that plasma. It’s basically fresh frozen plasma. But they froze it for 24 hours. And then they warmed it and centrifuged it again to get the precipitate, which is mainly fiber and fibrinogen, von Willebrand’s factor, and a few more proteins like that. And so they took that precipitate, and they added that to their PRP as well. And they didn’t quite document so well what happened there, but it does seem like these proteins form a matrix which allows better migration. And it also has a little more effect on proliferation, though I think it didn’t have much of an effect on angiogenesis at all.
So basically they got three different ways they could make PRP better. You know, make it cold, take away the plasma, and add cryoprecipitate. So, I dunno, for office purposes, making the cryoprecipitate’s probably not very practical. But the other two are probably pretty easily doable, so we ran a little experiment ourselves here. Basically we took some PRP and we took a 3 cc syringe of PRP and we wrapped it in an ice brick. You know, one of these bags full of something that freezes really easily that you put in the freezer and then you put in a cooler or something. We just wrapped that around the 3 cc syringe, froze it, and then we took out the or empty 3 cc syringe, and we put in a 3 cc syringe full of PRP, and we took the temperature to see how long it took us to get down to four degrees. And it took about four and a half minutes to get the temperature of the PRP down to four degrees, same temperature as they used here.
And then we ran it through the hematology analyzer to see what happened there. And we found there was probably a little lysis. But not much else happened. It didn’t look like they were activated yet at that time. So for practical purposes, it looks like you can make PRP cold in about four and a half or five minutes. So that might work in the office pretty well.
And the other thing of course is just taking the plasma off, so it doesn’t inhibit the growth factors and cytokines that are released when you make releasate, or when you make lysate for that matter. And that’s just easy to do. You just after your second concentrating spin, or maybe during your second concentrated spin, you just spin it hard enough so the platelets form a pellet down at the bottom. And then you just take off all the plasma. And then you can reconstitute it with water if you wanna get a lysate. Or with D50 if you want to get a combination lysate releasate. Or maybe with normal saline if you wanna just get a releasate out of it.
So that’s pretty easy to do too. So from a practical point of view in the office, you could do about two thirds of the things that these people did to make their PRP more effective. And you can see from the graphs, that they got anywhere from 30% to 50% improvement in their PRP results when they did these things. So it looks like it might be pretty effective stuff.
This is only one study, and I hope other people will do other studies that’ll confirm this. But it is pretty exciting that you can increase your PRP effectiveness this much with some pretty simple things that you could do in the office.
Charles Runels: That’s very fascinating, and I was not even aware of this paper, so I’m sure everyone’s cheering you for, and just the fact that you told me that you went and counted by reading the research 30 different ways to activate platelets, I’m impressed and very grateful. My impression is that if anyone studied this paper in detail, they would have to come away understanding platelet rich plasma in a deeper way whether or not they adopted the techniques or not. You know, just the reading of the introduction to me was encouraging. Just as a reminder, as they go through as their intro for the study, the safetiness of it, and they go just these three words: recruitment, proliferation, and differentiation of stem cells. We all know that, but just to be reminded, all those things are happening, especially to those on the call who are new to platelet rich plasma. That’s what you’re doing. That’s a powerful statement.
And then on this next page, as you were mentioning, they say surprisingly, I think that’s an understatement to say that in something called platelet rich plasma, the plasma’s actually decreasing the effectiveness of angiogenesis. And they talk briefly here about why that could happen and give a reference. Anyway, you’ve done such a wonderful job of talking about it, I’m not going to muddy the waters anymore. But could you expand more on, having read this now, has it changed your practice as far as your daily … and you know Victoria Canada, like when you take the boat from Seattle up to that beautiful, amazing place right there. Is that where you are?
Dr. T. Harrison: Yep, that’s where we are.
Charles Runels: Wow, I was there once. I don’t see how you get any work done living in such an amazing place. It’s so beautiful there. I would just be outside, gawking all the time. So how has this [research under discussion] changed what you do? Or has it?
Dr. T. Harrison: Well, we haven’t really tried this on patients yet, but we’re definitely going to, because it’s really easy to just put your PRP in a freezer brick for four or five minutes. And it only adds a little bit of time to the preparation, and it’s pretty easy to take off the plasma after a second spin, and then reconstitute it with something. Now the question that we have is what do we reconstitute it with? Because we did a study earlier this year, which we presented at the AALM Conference, where we took PRP and we diluted it 50/50 with different concentrations of dextrose. Because we’re really interested in prolotherapy and using this in joint. And dextrose has been the main deal for prolotherapy for many, many years, ’til people started using PRP. We thought the two might be synergistic, so we decided what would happen if we added them together?
So we did different dilutions, from basically to sterile, distilled water, all the way up to D50. And we mixed them half and half with PRP, regular PRP, to see what would happen. And of course when we mixed it with water, we got about 80% lysis of the platelets. So it was almost a perfect lysate. Not quite, I don’t know why those last 20% of platelets didn’t lyse, but they didn’t. And at D5, D12.5, and D25, we got about maybe 15%-20% lysis. There seems to be something in dextrose that platelets are sensitive to. At least some platelets are sensitive to.
But when we got to D50, and we added one cc of D50 to our one cc of PRP, we still got 20% lysis, just like we had with all the other dextrose concentrations. But the other 80% of the platelets activated. The lower concentrations of dextrose did not activate the platelets, but at D50, all the platelets activate. The rest of the platelets activate. So you get a combination of lysate and releasate at that concentration. So that’s what we’ve been using for prolotherapy.
Charles Runels: Interesting.
Dr. T. Harrison: Now, for other uses, I’m not sure whether that would work or not. It certainly gets you activation, and dextrose is good for platelets, because platelets use dextrose. They eat it. They feed off it. And when you give PRP normally, the platelets don’t just dump all their alpha granules and die. They continue to live for about five to seven days, and they release further alpha granules in waves. So it’s not all the alpha granules that get dumped. And when you activate with calcium or with thrombin, it’s only the first wave. Because the alpha granules contain both pro-angiogenesis factors, and anti-angiogenesis factors. They are pro-inflammatory and anti-inflammatory. And they have both pro coagulation and anti-coagulation factors in them.
So it wouldn’t make any sense to dump all the pro’s and anti’s at the same time. And so they don’t. You get a first wave that’s probably mostly the pro-inflammatory, pro-coagulation alpha granules, and then you get a second wave, maybe within the next day or two, that has the anti-inflammatory, and maybe the pro-angiogenesis ones, and then so forth. They go through five to seven days of releasing new waves of alpha granules as they do their job. And it ends up the last wave is gonna be the anti-angiogenesis as they knock off all the little blood vessels that they made that they didn’t need anymore once the healing is all finished.
But when you make regular PRP and inject it, that’s what you get. The platelets stick around, they release their alpha granules in waves, it’s sorta like the normal healing process. When you make a lysate, all those guys just get dumped together. The pro’s and the anti’s and everything else, from the lysosomes and mitochondrian. It just all gets dumped together. But it seems that the much higher concentrations of growth factors that you get from that outweighs the presence of the anti-coagulants and the anti-angiogenesis. You know, the other factors that would normally work against the new migration growth, cell growth, and all that sorta stuff.
So, so far at least, it looks like lysate’s the most powerful PRP preparation. And so we’re thinking maybe we outta cool it, or maybe we oughta wash it, and then cool it, and then reconstitute with water, and see how much of a lysate we can get from doing that to get the maximum potential out of the PRP.
Charles Runels: Wow, what a wealth of knowledge. You should be teaching. It sounds like you probably are, but if you ever want to teach our procedures, I would certainly show up as a student to see how you’re thinking about it. One other question. If you look at this just as a reminder, and you’re doing this, when they talk about how PRP is used in regenerative medicine, it mentions of course muscle damage which you guys are doing as doing prolotherapy, I’m sure you’re treating that already. So if you were, as we’ve developed our O-Shot® techniques around the pelvic floor and the vagina and the urethral space, if you were treating a woman who had dyspareunia and had pelvic floor tenderness, or if you were just treating incontinence and using PRP in combination with an Emsella machine, where in theory, you’re causing strengthening of the pelvic floor, in those two cases, if you would … Because the thought is, of course, that perhaps you could inject the pelvic floor if you’re trying to strengthen it and then do your m-cellular treatment with the electromagnetic stimulation of the muscle, and maybe get a better result than if you did just one of those alone.
Note…we offer an icon on our directory to identify O-Shot® providers who also offer Emsella, radio-frequency, or laser in conjunction with the O-Shot® procedure. If you are offering these combination therapies, please let our office know so we can add the icon to your name on the directory (email@example.com).
Where would you inject, and how would you treat your PRP before doing something in the pelvis or vagina, where the idea was treating either dyspareunia or pelvic floor laxity, to help incontinence?
Dr. T. Harrison: Well, if it was for stress incontinence, I’d be fairly cautious because, you guys have run into cases where basically, you caused urinary obstruction from people injecting too much PRP around the urethral area. And since this is more powerful PRP, I’d want to sort of proceed cautiously there, using this sort of enhanced PRP stuff.
Now, for pelvic muscle floor, I don’t think that would be so much of a problem. And if you inject along the top of the vagina, out to the sides, along the course of the urethra using these more powerful solutions, you might actually be able to strengthen the whole pelvic floor that way.
Charles Runels: Or, if you were, say, treating pelvic floor tenderness, a trigger point injection for dyspareunia with pelvic floor trigger point reproduction of the pain, you would do … When you say that way, would you do your lysate with water and cold technique? Would you expect that to work better?
Dr. T. Harrison: I think I would expect it to work better than just plain PRP. Yeah.
Charles Runels: Yes.
Thank you. That’s helpful. To think about the overflow incontinence just to … Thank you for bringing that up, just for the rest of the people on the call, if you haven’t heard of that, we’ve had so far, I know of three cases. In every case though, the reassurance is that the volumes injected were 7 CCs or more, and so it’s yet to happen with our recommended 4 CCs. If you look, inject 4 CCs, it may not sound like much, but if you injected say … Imagine injecting, if when we do the face, we just inject one, it’s a pretty large volume. So, our thinking is, it’s probably more from a volumetric fact, but I appreciate your caution, would maybe if you had more platelet-rich fiber matrix formed, because of changing the consistency, perhaps that might cause it as well.
The other reassurance is that, in all three cases that I know of, that it within a week of an overflow obstruction basically from having created artificial hematomas, is really what you’re doing, it resolved, and the people did very well with the eventual resolution of their stress incontinence.
It’s pretty scary, though, when your person comes for stress incontinence and then they have to wear a diaper for weeks, because they’re dribbling all the time.
So, people don’t usually like that.
Dr. T. Harrison: Yeah, and the other thing you want to remember with using at least the plasma-free technique here is, you’re not going to get a fibrin clot, because you’ve taken all the fibrin, fibrinogen, and stuff away, so if you’re using it for maybe things where you want the PRP to all stay in one place like the O-Shot and scalp type things, where you don’t want it just wandering off, and diffusing really rapidly, you might not want to do this.
Charles Runels: Interesting. Yeah. Very good.
What a wealth of knowledge you are, I would want to spend the next two hours talking with you.
One of our physicians, Pamela Kulback, who’s one of the interventional radiologists in our group, typed in the question, about using, perhaps, the centrifuge. That is itself cool.
Do you know of such a device? Or do you have something in your-
Dr. T. Harrison: Oh yeah. We don’t have one, but refrigerated centrifuges, well they’re a bit expensive of course, but they’re easy to come by. All the labs have them, and you could do it that way.
The thing is, if you put the PRP in a refrigerated centrifuge, you would refrigerate it before you removed the plasma, because the plasma is still in there when you do that, and you might pre-activate some of the platelets when you did that.
So we prefer the technique of getting rid of the plasma first and then making it cold, so that we don’t have the plasma interfering with stuff while it’s in the centrifuge.
Charles Runels: Beautiful!
Well, stay on the call because we may want to pick your brain again. I think that covered the research we were going to talk about today.
FDA Approval of PRP
There was one question on the membership site that brought up the FDA question again, so I just want to remind everyone where I put that, of course thankfully, the FDA doesn’t drift all the way up to Victoria, but some of us have to think about that, so I’m going to open this where you guys can see where it lives.
And again, this will be posted to all the membership sites. But I’ve kept this page as up-to-date as I can (if someone finds another paper, let me know) but I’ve put here actual articles by the FDA where they have talked about, in very specific terms, they do not regulate platelet-rich plasma.
In the United States, they do regulate the devices and I think you’re safest in the US by using a device that is approved by the FDA to prepare plasma to go back into the body.
Now, in other countries, maybe that’s not such a big deal, assuming you have the depth of knowledge you just heard displayed.
There actually are people in the US who have a different level of laboratory that they’ve had approved by the FDA, essentially, the FDA has come in and said, “Yeah, you’re able to do this.”
But unless you have that in the States, I’d recommend you use one of the kits.
So the short of all this, and again, I have multiple references here, where the FDA is talked about … this isn’t second-hand knowledge, they’ve done articles for the New England Journal and their own website, and I have a video that explains at least my idea about it, and a transcript.
So anything that has to do with the FDA and PRP, we are in good standings.
The one thing that I would be careful about that I see going on and it’s nothing unethical about the intentions, but as far as the FDA goes, you could get slapped around some, is, if you are a physician and you are doing these procedures, and you are also selling therapy kits to physicians, as in, you are teaching usually, and you are either directly or indirectly profiting from selling PRP kits, in my opinion and in the opinion of the FDA (so I’m giving you a very gentle warning), the FDA has shut down sales people who teach what to do with the plasma because you’re teaching what the FDA has not said the device is able to do, they’re [FDA] only saying the device can make the plasma. The FDA doesn’t approve specific use for it.
WARNING! So if you’re profiting from the device, and you’re teaching something that no one’s proven the device is capable of doing, whether you’re the salesman who’s selling and teaching, or you’re the teacher who’s teaching and selling, you should be looking over your shoulder, because the FDA could come slap you around in a pretty dramatic way.
But other than that, as far as using it, if someone else is selling it to you, they’re profiting from the kit and now as the physician, you’re deciding what to do with the blood or the blood products, the FDA is very plain. They’re not at all bashful about telling you, they have no interest in telling a doctor what to do with blood, as long as you’re not manipulating the tissue to the point that it becomes a drug, and part of the point of a lot of these articles is that, when it comes to stem cells in the US, once you do a certain amount of manipulation, it gets reclassified, and now they are very interested in what you’re doing with it and again, unless you’re in a study, you should look over your shoulder in the US.
So that’s the quick version of that.
We’re coming up on the end of the hour.
If anyone else has some questions they want to throw in, I’m getting close to our topic list here.
This, we just posted, I’m not going to waste your time getting there again, but with [inaudible 00:40:24], I posted a video, actually had a interview with the guy who patented the ingredient … a cancer researcher at Harvard, then a cancer cell biologist at Berkeley, it was shocking to me when he told the whole story about how this product came about. I knew there was a lot of thought in it, but I didn’t know that it had directly six years of research on that level and a $2 million NIH study behind it, initially for the study of wound healing, which of course is related to cancer, as it involves cell growth.
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.
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.
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
In early 2010, a salesperson called on me, John Deeds, and showed me a brochure about a centrifuge approved by the FDA to prepare PRP. He said, “Use PRP like Juvaderm®. You get new volume and new blood flow, and there’s never been a serious side effect.” … CONTINUE READING
Is the O–Shot FDA–Approved?
Of the female sexual dysfunctions, dyspareunia will most disturb a woman’s relationships. A woman can accommodate a decreased libido and anorgasmia, but she will often completely avoid any contact when she suffers from dyspareunia. But, when it comes to treating the various female sexual dysfunctions, anorgasmia offers the biggest challenge to cure. Testosterone helps … CONTINUE READING
When a Patient Isn’t Pleased With Their Results
As far as I know, anyone who was unhappy with a procedure that I did (going all the way back to 2003 when I first went to an all–cash practice) was refunded every penny that they gave me. That feels good to me. It’s better than if I still had their money. … CONTINUE READING
Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.
I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.
Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.
Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …
The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.
With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.
About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.
Charles Runels: This one?
Kathleen: No, go to the last picture. Keep going. Another one.
Charles Runels: That one?
Chapter 15 (O-Shot®) Chapters 16 & 17 about radiofrequency and laser
Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?
Charles Runels: Yes.
Kathleen: You see that, Charles? That band?
Charles Runels: Yes.
Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.
I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.
Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-
Charles Runels: Yeah.
Kathleen: That to that, to that.
Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.
I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.
I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.
The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …
Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.
Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?
Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?
Charles Runels: Yes.
Charles Runels: I can. I can hear you.
Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.
Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.
Charles Runels: Yeah. Okay.
Kathleen: There’s another picture, a previous picture.
Charles Runels: This one? This one?
Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.
Charles Runels: This one?
Kathleen: Yes. Yes. Can you hear me?
Charles Runels: What point do you want to make about this one?
Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.
Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.
Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.
If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.
Kathleen: Charles, I’d like to-
Charles Runels: The other thing while I was on the subject. Go ahead.
Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.
Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.
Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.
Easy Vs. Difficult Cases to Treat with the O-Shot® Procedure
I wanted to just list out while I’m at it and talking about the O-Shot, what I would consider to be the easy things that we treat versus the more difficult. I get a lot of questions about follow up and when do you retreat or not retreat and that sort of thing, so just wanted to recover that. Here’s our easy one. Nothing is 100% but these are the ones I think where over 80% of the time either after the first shot or the second one, you’re going to have an extremely happy patient. Maybe over 90% of the time in some cases, would be [inaudible 00:16:47], decrease orgasm, and someone who’s already able to have an orgasm. This would be the lady, she can have one but it’s not like what it used to be. Decreased orgasm but can have orgasm.
Then, it would be urinary incontinence and someone where things are intact, where bladder’s not falling out into the room. Even urgent continence, we’re seeing some great results. It’s usually a mixed bag for both, but then [inaudible 00:17:43]. I know that’s a basket diagnosis, but I mean even in the ones where it’s uncertain ideology, that doesn’t mean we don’t try to work it up. The person who’s had a work up and no one’s really sure what’s causing it and they’re still hurting, that for some reason that person seems to do well with us often. The one with pelvic floor tenderness, trying [inaudible 00:18:19] injection, you inject a trigger point with PRP so pelvic floor tenderness for mesh pain. I know you’ve got some ideas about that. I’ll let you talk about that in a second.
Mesh pain and the more difficult ones, the ones where if you’re new, I wouldn’t even try these people for the first two or three months, you don’t get discouraged, I treat these people but I think in these cases our success rate is maybe closer to 50% and maybe even less, 40% depending on the person’s age and other factors. It would be never had an orgasm in their life. I think those ladies are a little more difficult to treat. A person who wants to have penis and vagina orgasm. They can have one from a vibrator, but they can’t have one with sexual intercourse. Of course, we don’t have control of the penis of that equation. Both of these two ladies, we have successes, quite a few successes, but I think that our success rate on these ladies is probably less than 80%.
Can you comment some on this mesh pain? Are you still there Kathleen?
Kathleen: Just, yeah I’m still here. Can you hear me? Hello?
Charles Runels: Yes, very well. I can hear you.
Kathleen: I’ve done it when they had perianal pain from the nerve endings around the rectum, and I’ve just injected it all around the rectum. I’ve just injected it all around the rectum and it seems to work real well. Isn’t the doctor in Europe – [crosstalk 00:20:12] yeah, isn’t she putting PRP around the pudendal nerve to ultra sound for mesh people. The lady from Spain.
Charles Runels: I heard a couple people talking about doing an old school pudendal nerve block. There was one study where the mesh was taken out and then infiltrated the field with PRP, but no one has done the study yet, showing our procedure helps it. Although, we’re seeing that even injecting the anterior vaginal wall where the mesh is. You’ve has some experience with how the mesh becomes wrapped around the pudendal nerve or something; can you talk about that? [crosstalk 00:21:00] Or something you read in –
Kathleen: One of my patients is a general surgeon at [inaudible 00:21:13] and there was an autopsy on a mesh patient, and the mesh was all entrapped with the pudendal nerve when they did the autopsy. But, even taking it out, it just has to come out in pieces. It’s so difficult. From my understanding, from that pain, injecting PRP around the … I wouldn’t do it. There are some people, that I think, do it. In Europe.
Charles Runels: [crosstalk 00:21:45] When you do it, is there some worry about injecting?
Kathleen: Yeah, just the anatomy. There’s too much you can screw up. I just don’t have the experience with ultrasound and looking around the vessels where the pudendal nerve is there.
Charles Runels: When we do pudendal nerve blocks … We did those in labor and delivery years ago. I’m hearing that just that will calm it down. Is there something about that that makes you nervous? I would have thought that was a pretty safe thing to do.
Kathleen: I think that’s safe. I’ve just done most of my deliveries with epidurals and not pudendal nerve blocks. No, I think that would be safe.
Charles Runels: Okay.
Kathleen: I would like to see what they’re doing [crosstalk 00:22:40].
Charles Runels: While I’m at it, I’ll make the list for the P-Shot® … What? I’m sorry what did you say?
Kathleen: I didn’t say anything. Nothing. I didn’t say anything.
Charles Runels: Oh, okay.
Easy vs. Difficult Problems to Treat with the P-Shot® Procedure
So, while I’m at it, I thought I’d do a list to the easy wins for the P-Shot®. So that would be decreased erection … And a reason for making this list, again, is all of us want to take care of people and not just take their money and make them well. When I don’t get someone well I give them their money back. I try to mostly take care of people I think I can get well. If you’re mostly taking care of the hard cases, I’m losing money. I recommend that you mostly take care of the easy wins, especially in the beginning, so that you don’t become discouraged.
I’ve seen a couple of our providers, just right out of the box, try the really hard cases. If the first two O-Shot®s you do are in women who’ve never had an orgasm in their life, and they don’t work, you lose confidence in the procedure. So stick to the ones that we know have a high percentage of success.
For the Priapus shot, we have decreased erection, but can still get an erection. In other words, on that erection scale from 5 to 25, they’re above 10, at least somewhere in that neighborhood. They’ll bump up about seven on that scale from your shot.
Peyronie’s disease. The interesting thing is, our easy win is most other physician’s hard win, so you still can be a hero and do wonderful things for people if you stick to the easy stuff.
[inaudible 00:24:35] Closed prostate surgery to help with recovery, but it’s in the person who could get an erection prior to surgery, of course. You do the whole protocol, and that’s on our Priapus shot website. Where you include both for Peyronie’s and the prostate surgery, including the pump and maybe even low dose Cialis as part of the protocol.
Again, lichen, we’re going to get lichen too. Lichen sclerosus, not planus … Although, I think you treated some lichen planus didn’t you? Kathleen?
Kathleen: Yes. Yes.
Charles Runels: [crosstalk 00:25:26] We had that anecdotal initially; I should put this up here. I treated a woman with extremely severe scleroderma, and they can have horrible problems with intercourse. It was a life changing thing for her with one procedure. Lichen sclerosis in men is an easy win.
The hard wins for men, I think, if their main reason for getting the shot is for penis growth … Although, sometimes that can be very rewarding. It can be frustrating, often times, in the men who has the most urgency about growing. So the men who has the three inch erection responds, in my experience, less dramatically than the guy with the six or seven inch erection or a five inch erection.
It’s a percentage of growth than the absolute. So if there is 10% growth on the smaller penis, it’s less noticeable results. Then the person who has long standing diabetes or whatever cause of erectile dysfunction, basically he has no response at all. [inaudible 00:26:55] There’s no response at all to Viagra or TriMix, and that person who probably has some vascular disease proximal to the penis is not likely to get well.
Those are my easy wins and hard wins for the Priapus shot and want to stick to these easy wins in the beginning.
Anything you’d add to that, Kathleen?
Kathleen: Nope. I think you got it.
Charles Runels: Okay.
How to do your own webinars to educate your patients…
I always like to cover something with marketing too. Let’s see if I have any new questions from the [inaudible 00:27:32]. There weren’t that many on the websites on this time around. Let’s see. I don’t see any coming through.
I think there is something meant to be noticed about, as far as the marketing goes, what I’m doing right now. This is a wonderful way to create interest before I was part of this amazing group of physicians. I would do webinars, just like this, for patients.
Back in the day, before I started doing the internet, it wasn’t webinars. It was a conference call. I would record the call and put that on the website. So, if you, as a marketing idea, the best marketing is to teach people how to be well. If you put out an email to your patient, whatever it is you want to talk about … Maybe it is dyspareunia or erectile dysfunction, or urinary incontinence, or something that we’re not even talking about here; maybe it’s something to do with the way you do Botox. If you want to do a webinar like this, the software is very simple to do both setting this up, as well as recording it. Then you have something that can go on your website and play, and play, and play.
I thought I would show you guys where I do this. I know you have to log in to go webinar.com to get here. This is the software … GoToMeeting.com or GoToWebinar.com and they have plans that are not that expensive. Then, you send out an email to your people, you schedule it … and what you’ll find is, that even if just one person shows up, that the content you deliver is on a different level than if you sat down and just said “okay, I’m just going to record an audio or a video about urinary incontinence.”
Then when you’re done, you have the video and you can tell your webmaster to put that on your webpage somewhere. It looks like this. Most of you guys have seen this, but when I do these webinars, I put the recording either on the membership site or I put on our Cellular Medicine Association website. It just sits there to play.
This is probably the best advice I can give you about marketing to your patients. If you teach people about the disease and how to get well, then they will trust you to take care of their disease. If you go through the trouble to teach them how to be well, then they’re much more likely to trust you to take care of them.
So, the short version: teach people about the disease and they will trust you to take care of their disease.
It’s really an amazing time that we live in that we can just, almost no money, wherever you are on the planet, you can just sit down and have a conversation like this with your patients. Then when you’re done, you have a video that you can play for them perpetually on your website.
I think that’s all I have for today, unless you guys have other questions. I’ll put the transcript for this up within the next 24-hours and a link to the book that I recommended, and I’m always honored that you’re here.
Thank you for the help, Kathleen.
Kathleen: Thank you too.
Charles Runels: Alright, you guys have a good day. Bye.
Charles Runels: I thought it may be helpful to start offering suggestions about what I’m reading, and what others in the group are reading and writing, so that our weekly meetings become not just sharing our procedures but approach being something like a journal club or a reading club, book club. That’s why you see what’s here on the screen now. I just got this in the mail. I bought it before it was published. It just came today, so I’m extremely pleased with this. The reason I’m so interested in centrofacial rejuvenation is something if you know, if you’ve attended my class. That is the most important part to improving … It’s the number one place to improve the appearance of going back in time in appearing younger. It’s the eye to the mid-cheek.
Some of the procedures in here are surgical. Chapter eight has some beautiful diagrams offering midface volumization with fillers. It talks about the anatomy, and highly recommend this book. I’m putting a link to it in the chat box, and I’ll put a link to it on the page where I put the recording, but very well done. Other chapters are helpful in [inaudible 00:01:53] videos. Part of what brought this up is I had a question today. I had some cosmetic questions. Let me pull those up. Then I’ll field questions from you guys. I copied this out of a email that came to me. Number one, “Why use none activated platelet-rich plasma on the face? Can we use activated prp and when?” Again I’m going to put it here and recommend that you guys check it out. This question, I’ll cover it again because it’s helpful.
Finding the Answer to Questions
If you go to Cellular Medicine, actually I want to just show you where a lot of these questions live. I’m happy to go over it, but if you have a way to search and find it very quickly without waiting for me to answer, then that would be a better thing. Some of you guys don’t know how easy it is. If you go to CellularMedicineAssociation.org, and you just put in the search box right here, so you can say activation. Hopefully, I’ve got that in there somewhere. There you go, so it’s like an index. I don’t have something that says index but it will pull up … Because I’m having all these transcribed, it will pull up any transcription that has that word in there, and so that’s a good way to search for things.
You could also go to the membership sites, so if you went to VampireFacelift.com into the member section, and this is the backside so you wouldn’t see this. You would land on, I’ll show you. You would land on the dashboard, so it would look like this right here. Then see where it says, “Post,” you could just click and you post. There should be a search box. I guess there’s not. I need to put one on this one. Most of the membership sites have the search box, so my bad. I’ll put one there. You could also go through here and look at just there’s the titles, recent comments, and there’s key words. This one needs a search box. Anyway, that’s the two places to look on our main website, the Cellular Medicine Association.
Looking at recent posts, and you’ll get the most recent stuff, but on the membership sites, the other place to look, it’s just look under the directory. I mean go to the dashboard, and then look under webinars. There’s the dashboard. No, not taking you back. Anyway, that first dashboard where we were at, it’s a directory, workshops, forums, and then there’s a page for webinars. Then at the bottom of every page there’s a question and answer session. You can see there’s a place to post it, so go in there. The good thing about doing that is you get answers from other people, not just from meif you do that. There’s one about calcium chloride. “Does it help? When do I use it?” Then you can see well, here’s the answer and it takes you to a recording from one of our webinars.
Activation or Not Activation of PRP?
I like doing it that way because it makes sure, it give everybody a chance to contribute, so it quits being about Charles. I’ve been fortunate enough to play around with plasma for eight or nine years, but newer people in our group are also doing that and have different expertise so it’s helpful. Here’s the answer to the question of why use nonactivated platelet-rich plasma. The reason for not activating it is the calcium makes it hurt more. Calcium chloride just hurts. The other reason to not use it as in activate the plasma is that you do get around 65% activation without activating it because when you put the plasma, inject it into the tissue, the exposure of the platelets to the collagen of the tissue itself activates it as it would in a normal [inaudible 00:06:47] if you had an injury and the platelets come outside the body, it activates the [Thorman 00:06:51] cascade, exactly the same thing.
You get 65% activation if you just take the inactive platelets in the syringe and inject it subdermally or intramally, and it doesn’t hurt as much. It seems to work well enough for the hair and the face. Most people are not activating. The reason we changed that and activate with the [Priapus 00:07:16] Shot, and with the O-Shot, and with when we’re trying to regrow nerve as with decreased sensation in the areola of the nipple, is because we’re thinking that because it’s more therapeutic type effect, and because we’re trying to maintain the material in a smaller space. Geographically we want it to stay close to the urethro so in a very small area the calcium makes it activate more quickly and more thoroughly. That’s the reason. No one can fault you for activating it with the face as well. It’s just a cop out to make it not hurt as much.
Can you “use prp in the vaginal lining?”
Number two, “Can you use prp in the vaginal lining?” I have used it everywhere, and I see one of our gynecologists is on the call, so I may get Kathleen Posey to comment on this too. Can you use prp in the vaginal lining? You can pretty much use it everywhere as best I can tell. I can’t find any ill effects except in one case where it was injected into the eyeball trying to do something with the retina, so don’t give anybody a shot in the eyeball. Otherwise, I have injected circumferentially. I’ve injected in the labia minora, the labia majora, posteriorly. Anecdotally, we’ve had two people in our group see help with rectal incontinence in a severe postpartum tear. That was years out and still saw some improvement in rectal incontinence. We’re using it all over.
The only reason I quit putting it completely around the vagina circumferentially is that in the beginning it was so costly I was trying to avoid injecting more places than needed because it cost us so much to make the plasma. I found, so 80/20 rule, I could get actually all the results I needed by just injecting around the clitoris and along the anterior vaginal wall thinking that’s where a lot of the sensation is as in Grafenberg, not just the spot but the whole urethra being sensitive, the Skene’s glands, that’s where a lot of the sensation takes place. It’s also up there near the inner part of the clitoris and all the nerves [inaudible 00:09:45], just a lot of magic happens there.
Not so much the anterior vaginal wall, there’s not that much lining there. I mean, excuse me, there’s not that much sensation there. Having said that, I’m going to see what Dr. Posey has to add to that. Then we’ll get back to the face, the best way to treat nasolabial …
Charles R.: … that and then we’ll get back to the face, the best way to treat nasolabial folds. So if you don’t mind, I’m going to unmute you, Kathleen, and see because I know you’ve done a lot of these. Are you able to talk, Kathleen? Are you there? You may not have a-
Kathleen P.: Yes. Hi. Hi.
Charles R.: Good to hear from you.
Kathleen P.: Hi. You too. I have injected it there not a lot [inaudible 00:10:26] end up with some left over, I’ll inject it in the labia minora, the labia majora. And it just depends, if they’re having pain in that area, I’ve definitely used it a fair amount and it does help decrease the pain.
Charles R.: In the lateral vaginal wall, you mean?
Kathleen P.: I have a little-
Charles R.: He didn’t really say vaginal. He just says vaginal lining, doesn’t he? I’m sorry. Go ahead.
Kathleen P.: Yes some … Yeah. I’m more doing it in the posterior vagina. I don’t know if it hurts sticking it in lateral because the vessels and stuff. I worry about hematoma. I wouldn’t go too deep if I were to inject it there.
Where to go to create an “interview video” for your website
Charles R.: Okay. You know what? While it’s on my mind, if you will do this, Kathleen. And I’m going to put it here so others may want to. If you go … so far I’ve only done this with three, excuse me, two of our providers, but I’ve never made it public. I’m trying to make it … I’ll show you what I’m doing. If you go to the O-Shot® website and you on the … over here on the recent posts, you can see I’ve talked to Dr. Goodman about some of his surgical techniques and how he thinks about orgasm and how the different procedures he’s using and I’ve just recorded it and put it there for patients and doctors to learn from. There’s nothing … becomes a very good explanation of the surgeries for potential patients as well.
So back to … oh, you can’t see it. [inaudible 00:12:04] where you can see what I’m talking about. There. So this is a post on the O-Shot® website and it just comes in recent posts and I’ve done that … I’ve set it up to do with [inaudible 00:12:21] and we had some … we weren’t able to record it well and I’ve done it with another one of our providers, but I’m going to put here … it’s so hard. Everybody’s schedule is so busy, but any physician who has … who wants to be interviewed, I see it as a great way to … cellular … let’s see … it’s a great way to get the word out about what we’re able to do and, just as importantly, what we cannot do and how we’re thinking about the science. And here’s where to set that up…
So I’ll show you what happens when you set that up and where to go. So if you take that and put it into … and I’m hoping you’ll set this up, Kathleen, so I can interview you because you got so … I’ll pick your brain a little bit at a time when we do these webinars, but you got so much information about lichen and the other stuff.
Okay so if I put that in there, it takes you here and then if you go to 30 minute phone meeting, book that, and we may actually be on the phone longer than that but just … and you can see you can just click that and pick a day and that fits your schedule and then I’ll record it. You don’t have to have PowerPoint slides. You can if you want, but any doctor in our group who feels like they have a message they want to deliver that would be helpful to doctors and/or patients. I like the interview format because it gives me a way to showcase our physicians and, because I’m seeing a lot of the questions that come by email and such, it gives me a way to get a more balanced answer to these questions rather than me doing all the talking, which is just not the way it should be. Okay, let me get back to these questions. So if … I’m going to put that in the chat box too and, hopefully, you’ll set that up, Kathleen. So anybody else can call because you got so much … how many years have you been doing this now? Three? Four?
Kathleen P.: About four.
Charles R.: I know no one … I don’t know anyone who’s inject … who’s treated more people with lichen sclerosus [using the O-Shot®] and you’ve got a strong surgical background too, as strong as it comes so let’s set that up. I’m overdue to do that. Okay, so back on topic. I’m just going to leave your mic unmuted there, Kathleen, and get back to finishing these questions. Let’s see. Go back to here.
What’s the best way to treat nasolabial folds–PRP, fillers, or threads?
Okay. So now for a face question. What’s the best way to treat nasolabial folds? With therapy or threading or with filler? I think this one is … let me pull up a picture. Let’s see if I … I think a picture would answer it better. Let me find a picture I have permission to use. Because this is definitely a case a picture’s worth way more than me babbling on and on.
Okay, here. So if this is the problem that you’re trying to make go away, the question was: is it better to use fillers or plasma or some sort of thread lift or surgery? There’s lots of different things. What can you do for that? So the main principal I follow is that this cheek area is more important than whether there’s a line present here or not. You’ll see nasolabial folds in children, but this is not necessarily an age line. It become a sign of age, when relative to the rest of the face, when you see that this … let’s see if I can draw on this. Let’s see what I can draw. Good. Okay. So when there’s a stripe, there’s a heavy strip, you can see it kind of goes like that there, with this being flat over here. And when you see that, it’s not the line that’s making people look older and you can kind of see the appreciation of a line right there, but not so much visible there sort of like a dash line. There’s definitely a line there under the eyes and then there’s this line and then this looks relatively flat. When you see that, that’s a person for whom either fillers or platelet-rich plasma is going to help.
If I’m trying to decide which will be appropriate, then I go by how much volume loss is there. If there’s quite a bit of volume loss here, the chances that I will maintain … the shape will look beautiful if I just fill it up with plasma, but the chances that I can maintain that shape become less good than if there’s a lot of volume loss here. If it’s someone who’s never had anything done and they’re … if you’re looking for numbers, if they’ve never had anything done and they’re 40 and up, then they’re probably going to need some fillers there, especially if they have a thin face. If they’ve got a full face and they’re younger or even if they’re over 40 or 50 and they have a full face, sometimes you can get by with the plasma alone. But the bottom line is that adding volume here is going to pull this up and round it out so there’s not a heavy stripe here. And then even if you have a line here, it’s going to be less distracting and not really age causing.
And so that’s kind of how I judge it. So I either use plasma plus prp if they can afford it and they have a fair amount of volume loss or if they’re … if I use prp alone, it’s usually in someone where the volume’s pretty close to where it needs to be and they kind of just want to be fluffed up and usually that’s … they’re 35 or under or they’ve had some work done already or their face is already full just because of their body weight. So most of the time, I’m using both. As far as the threads go, if you do the threads, I would still consider doing this because now you’re doing something similar to a surgical “facelift” but relative to the bone, even though you’re pulling this fold out, you’re pulling the tissue close.
Charles Runels: Even though you’re pulling this fold out, you’re pulling the tissue closer to the bone. You’re really collapsing the face relative to the bone and though the line looks better, you have some risk of causing skeletization and not that round, full feeling look that’s in a younger face.
In the end, all three, the answer to that question is, they all three work. That’s the way I decide. I would seldom use a thread without using fillers or most of the facial plastic surgeons now, almost all of them, even if they do a surgery and pull the skin back, they’ll do it in culmination with fillers to maintain the shape so you’re not just chasing a line. You’re creating a younger shape. I think that answers that question.
I think there’s another one here. Anybody want to add to that, just click the button and I’ll unmute your mic for you. Let’s see. Let’s get back to that question. I think I answered it, just to be sure I did all that. Yeah. That answers that question.
There’s one in here that some of our callers. That’s a good question. Why do you not have a dashboard similar to the others with supplies and videos with a facelift like the other procedures? It’s just simply because I’m the one that’s doing it. I apologize. I just haven’t done it yet.
What they’re referring to is if you’re on the facelift, the dashboard is not as organized with O-shot and P-shot. It’s all still there, but you just have to look around for it more. I’m actually trying to recruit someone who can help me with the websites. I’m still doing them all myself. I started doing websites in 1998 and I can’t find …
So far, I haven’t found anyone that suits me. They’re either over-qualified because they’re actually writing code, which is what I need or they’re under-qualified and they can’t write it. If anybody knows a good web design person that wants to move to Fairhope, then send them this way.
Treating Bell’s Palsy with the Vampire Facelift®
Let’s see. Any other questions? There was one that popped up on the Vampire website from Dana. Let me pull that one up because I answered it. Here it is. I went ahead and answered it, but let’s cover it here because it was a good question.
Dana says she had a beautiful 56-year-old patient who had general aesthetic questions. This is really important because I’ve never covered this in a webinar, by the way, so I’m so grateful for this question. She said, “She’s not new to injectables, but has not received any kind of treatment for the last six months because she has left-sided Bell’s Palsy.”
“Previous management for her palsy’s included prednisone, anti-virals, acupuncture. Her friends think she’s showing improvement. Although this wasn’t the reason for seeing me, I’m wondering if PRP might help with the Bell’s Palsy. When you search on ClubMed, it appears not only to be safe, but possibly helpful.”
Yes, is the answer to that. I haven’t counted, but I know at least two people, maybe three, that have told me that dramatic improvements. As you know, Bell’s Palsy can come-and-go, so maybe it was just luck of the draw treating a lot of diseases that wax-and-wane, who knows?
I would get a really good consent form because obviously if you’re not treating Bell’s Palsy, if you just gave her a Tootsie roll, it could get better or worse and has nothing to do with your Tootsie roll. In the same way, there’s always a chance it may worsen even though the science indicates it should get better.
I’d get a good consent form, which we have on the websites now that we’ve even enhanced our consent forms. If you haven’t downloaded them lately, download one. We’ve also made an Amnion version. There’s a Vampire facelift and there’s a facelift with Amnion. There’s an O-shot and O-shot with Amnion for those of you who are considering adding that to your procedure.
Should you stop anti-coagulants before doing the P-Shot® or the O-Shot®?
Let’s see if there’s any other. Here’s another question. Any reason to stop anti [inaudible 00:25:46] prior to P-Shot® or O-Shot®? Here, I’d treat this like an injection, not like a surgery. Most people who are on anti-coagulants are on them for serious reasons.
I had an internist mentor who always said, “The most dangerous medicine an internist ever prescribes is Coumadin.” You can make the case with just a baby aspirin itself. The last time I looked, something like 35,000 people per year bleed to death from gastric hemorrhages from aspirin.
They’re dangerous drugs. People are not going to be on them for frivolous reasons. Therefore, I usually just don’t even get into it. I just hold pressure longer. Tell them they have more bruising. The bruising is also PRP. It could enhance the effects. We’re just going to hold pressure and I do all procedures as I normally would.
The only thing with aspirin, if it’s possible for you to stop. I know that’s not the question, it’s anti-coagulants, but if it’s possible to stop aspirin or non-steroidal a week or two before, that’s better because it’s going to interfere with your platelet function.
Platelets have a longer half life than a week, so I wonder sometimes about that time frame, but that seems to be the standard recommendation is to stop for a week before and to stop steroids, if you can. I do the procedures and I hold pressure.
I was going to, if there’s not any other questions. Let’s see.
Kathleen Posey: Actually, Charles, I have a question.
Charles Runels: Go for it.
Kathleen Posey: I wanted to say, I did do one Bell’s Palsy patient. She had tremendous improvement, even after a year. But, my question has to do with …
Charles Runels: Wait a sec. You got beeped out for some reason on the sound. You said she had tremendous improvement and then what came after that?
Kathleen Posey: Even after a year. She had the Bell's Palsy for a year and still had some residual left. It was able to take away the residual palsy, which to me, was amazing.
Charles Runels: Beautiful. I’m glad that Dana asked that question. Thanks for throwing that in. Go ahead. You had a question too?
Treating Interstitial Cystitis with the O-Shot® Procedure
Kathleen Posey: I have a question about interstitial cystitis. What’s been the group’s treatment plan on that and how successful do you think that is? I mean, I’ve done a few, but I’m running about 50/50. I was just wondering. I mean, just do a regular O-shot? I mean, that’s what I’ve been doing.
Then, also, the same patient had an urethral caruncle. I put PRP in there. I actually think it grew, but anyway. I told her to go ahead and have it surgically removed, which the urologist was refusing to do but the pain was so related to that caruncle. I just think it needs to come out. Just wanted to know if you knew anybody else that had experience on the line with UC?
Charles Runels: I think what I’ll do. I’ll tell you what I’ve heard, but I think what I will do after this call, is I, as usual, I will send out an email to let people know the recording is there. I’ll ask for more comments from our urologists and gynecologists who are treating UC.
To tell you what I’m hearing is, I’ve had now three separate … Well, two urologists and one uro-gynecologist call me excitedly to tell me about multiple patients in all three practices, not just one, but multiple patients, who became completely well after many years of suffering with pain.
That doesn’t mean, of course, that everyone they’re treating is getting well. I don’t think the placebo effect on someone who’s tried everything under the sun and can’t get better and finally they get well with your one thing. My guess about it is that it’s multi-factorial and what’s working with us, is those that have …
Charles Runels: … the factorial and what’s working with us is those who have some sort of chronic inflammatory/infectious process going on with the Skene’s glands but I’m completely guessing with that. The others may have something that has to do with the bladder itself that we’re not reaching with our procedure. How we dissect out the subset that responds versus that don’t I don’t know but I keep offering to finance a study and if you want to do that and try to … Let’s try to work up a protocol and get it approved, someone in our group needs to do that study. I’d like it to come from a gynecologist or urogynecologist, which I’m not, so that it’s paid more attention to. To help you with it, I’ll post it and try to drum up more interest and let’s talk to each other about it so I appreciate you bringing that up.
Let’s see what else we got. I think that’s all the questions.
How to Get on Your Local TV News
I always like to do a little marketing tip or two. We’ve had a few people lately … Let’s see, I’m not sure what you guys were looking at, let me get you back looking at the web page. Just one minute. We’ve had people on the news, quite a few lately actually, and along with that one was on a radio show. It’s not always TV news, one was on a radio show yesterday and so two really nice luncheons lately. I thought I would pull them out and tell you guys both how to make this happen in your own town and the advice I give people when they call me and say, “Okay, give me tips about what to say on the news.” Then if you just know it’s here the next time I’m still always happy to talk with you. If you know it’s here the next time you get that call you can go refer to this.
I’ll fix it where you can see what I’m looking at. Here’s one of our doctors, she’s a gynecologist, Dr. Singer, and she’s doing the O-Shot and you can see she’s come out of sometimes with the laser treatment. Now, first I’ll start with how you get on the news itself and maybe I’ll just tie it kind of step-by-step what to do. First I would get the name of the person, just your local news channel. You want to call the news and say, “I’m a local physician and I just want to be available for comments or help any time you’re doing a health story that involves whatever you do.” For Kathleen it would be women’s health. If you’re an anti-aging doctor you could say anything that has to do with aging in men and women, whatever you want to be known for.
Then you say, “May I speak with your health reporter?” Here’s the thing. You would think, well they would laugh at you and say we’re too busy. The truth is it’s very, very hard to come up with news and I can prove it to you. Just watch the news and see how many times one news reporter is interviewing another news reporter, it’s very often. How does that make news if they’re interviewing each other? They are really hard up. How many times do you see one … They call it breaking the story. One news channels breaks a story and then all of them talk about it for the next week. It’s hard to come up with something new and interesting every day. Then when they do a lot of times they need an expert to comment. If they have someone on speed dial, and this is what you tell them.
Get to Know your Local Health Reporter
First you ask to speak to this person and you say you want to make yourself available if she ever has a story and needs a comment on or off the record. You tell her or him that you always answer the phone and then you give them your cell phone number and you tell your staff, “If you ever get a call from this news you want to be told immediately.” They are not to take a message, they are to get you to the phone immediately because if you don’t take the call they’re usually on a really tight schedule and they will call someone else and you’ll miss the chance for … I literally have millions of dollars of free publicity just because. They’ll tell me, “You know, I was going to call so and so.” I just ask them and they’ll say, “Yeah, I was going … My deadline, I’ve got an hour to get this done and if I hadn’t answered I would have just been out of the story.”
Tell Your Staff to be ready
You tell your staff … Make sure they have your short list, you probably have that already. “These are the people you’re to never take a message.” My short list is my children, my parents, my sisters, my attorney, and anything with three letters; the IRS, the FBI, the DEA, anything that has three letters get me to the phone. That includes CBS, ABC, NBC, and any news reporter of any kind, doesn’t matter how big or small, bring me to the phone. Then after you get the news reporter on the phone you just tell them that, make yourself available. Now, if you want to make news, if you want to be on the news for free you try to tie it to the national press and I put … If you go here, I think I’ve got it on here, let’s see.
Tie to National News
If you go to the marketing part of this … Anyway, it’s somewhere on here. There’s a webinar about how to take advantage of the national press and marketing … Let’s see, what is it? Insurance practices, avatar, anyway somewhere on here. You’re right, it’s easier to find the O-Shot but the thing is if they have … Let’s say that the press does a story on some new treatment for incontinence, it could be any treatment. Well, you call them up and you offer to comment on it, on your local station about that treatment. Of course, you’re going to talk about your O-Shot too. I actually changed the Health Department policy in my county after someone had an injury in Atlanta, the swimming pool. They had no Health Department inspection here back in the 90s and I said, “Let’s do a story,” and we did a story about how there was no Health Department inspection. It would not have been a story had there not been a recent death in Atlanta from their dirty swimming pool.
You watch the national news and when something happens nationwide that relates to what you’re doing you call your local channel and you offer to do a story about it. That can include national press about our stuff. When this hit the news recently, this one. This is a local station but we have clearer … When we hit the national press I will send out an email. When the email comes out and says … Let’s see. Back in October we made a Real Magazine Website and plugged in others about the Vampire breast lift. When that happened you could have called your local TV station and say, “Hey, the Vampire breast lift was just on [inaudible 00:37:53] website or Allure,” whichever one you want to mention or both, “And if you want to do a story about that I do that procedure here in our city.” Then they will interview you often because you have a local comment about a national matter so that’s how you get in.
Getting Ready to be on the News
Now when it’s time to talk how do you get ready to actually be on the news? Here’s some quick tips and you’ll know where this is. It also applies if you’re just going to be, say, giving us a talking somewhere, and it helps you plan the talk. Here’s the tips on that and I think I’ll type them out for you. Let me pull this up because it’s simple but it’s really helpful. I’ve been on the news more than I like to think about in different countries, in Serbia and London and New York. Anyway, the bottom line is this is the process I go through before I’m going to be interviewed.
I first think about … I imagine not everybody in TV land, not everyone. I imagine one person that I love and I pretend that person is watching and I forget everybody else. If it has to do with men’s health I imagine my son’s watching. If it has to do with women’s health I imagine my mother or a woman that I love and I pretend like that’s the only person and that person is on the other side of the television. That couch is my language so that I don’t sound salesy, I don’t sound anything except sincere and engaged and eager to communicate what the message is. That gets the frame … That is so important and I’m not just saying this. This isn’t something I’m just talking about, I literally do that every time I’m in front of a camera or a microphone if you’re being interviewed by the radio. I was interviewed on Shade 45, which is, it’s a rapper station.
That’s the only time I’ve ever been interviewed where I was the most conservative person in the room. They were talking to me about orgasm and it was a call in station and so it was pretty interesting. It didn’t matter, I was still imagining not talking to everybody out there, being interviewed by radio stations in South America where they have a translator or in Columbia, Mexico. Every time I just think of one person that I love and it’s the only person that matters. Then how do you, what about the content, what do you have in front of you? I think about the problem that my thing is going to solve and I imagine that person with the problem.
Let’s say I do a talk about the O-Shot, then I’m thinking about incontinence or orgasm or whatever it is that is to be the expected topic. Then, and quit speaking about me trying to be pretty or smart or say all the right things, it just becomes about me trying to communicate to that one person I love on the other side of the camera. I know this is all a mind game but it works and it’s the reason you’re there or you just go home. We’re here to solve problems for people and so, not to try to be pretty, they got movie stars that do a lot better job of that than I do, be funny or entertaining. I’m a physician, I’m there to teach people how to solve health problems so that’s the mind frame you get and I forget about the rest of it.
Then I think, and this one’s key I think. I think of key words and phrases that I think would be helpful. Let’s say that … And I write this down and then look at them before I go on camera. Let’s say if it were O-Shot I might think, I would think of the words O-Shot, I might think of the words relationship, relationships healed. I might say psychological pain, you get the point? I would make a list of all the friend … I would day provider group, that’s protected, be careful about seeing someone outside the group. Two and three word phrases that I would want to try and weave into my conversation and realize, no matter what they ask. Ask me about the weather. You say, “Well, is it hot outside?” I would say, “You know, it’s unusually cool down in Florida today, which is exactly what happens to relationships when sex doesn’t work.”
Ask me what color my car is. It’s black. “You know, that’s exactly the mentality people have. They have a black, depressed mood when they don’t get sexual relationship fulfillments in their marriage.” My point is, no matter what they ask you you can weave these phrases into the conversation if you have them in your head before you go on. Then I always thank the person, usually I’ll thank them up front for … It’s not a long thank you, it’s a … Because people get bored by, “Thank you so much for having me.” Nobody wants to hear that crap. What I would say is, “Thank you for being brave enough to talk about sexuality on your show because many people are afraid of that and we know how important this is for relationships.”
You throw little kudos to the host for being brave enough to talk about uncomfortable things and they always like it obviously because they can’t brag on themselves. Then it sets the tone and they know their viewers are looking up to them with a little more respect because of something you said. That’s kind of my, that’s my … Then oh, last thing is you want to invite them to do something; contact you, you want to make sure you have the website because here’s the other thing, here’s the bad, I’ll show you the bad news. Here’s the bad news. If you don’t do … This will go away in about 24-48 hours unless you post the recording. Anyone [inaudible 00:44:51] her TV show. It was good for a boost, it lasted less than a week.
The doctor show will last less than two days. A good news report, and I’m watching the traffic on a website. A good news channel … Actually, sometimes the doctor show you can’t even see the blip because a lot of people aren’t watching daytime TV but a good, very populated website will last two, three days and then it’s gone away so why be on the news if it only gives you traffic for 2-3 days? Once you have it then you take these videos like this and you post them on your website. You see where it says … Oh, I had a link copy. Anyway, there’s a way to actually embed this onto your website and hopefully Dr. Singer has that.
Now, every time a patient on the website that says, “Oh, this lady is [inaudible 00:45:47] enough to be on the news,” and then they hear her explain it in an engaging way with her news interview and it just sits there and educates patients day after day, year after year. Then, that’s when you get some traction and that’s really when you go on the news. It’s not you get a little grip. If that was all you got, honestly, I don’t know if I’d waste my time. That footprint that stays out there and gets showed by all of us on the website, that goes … Oh, are you all seeing what I’m seeing? This can be shared and embedded so that that sits on her website and that is what keeps owning on educating people.
I think that’s it unless somebody has more questions. I think we’re going to stop it there, see if there’s any other questions. The take home do for this one, for today’s thing is that we’re going to try to drum up some more talk about the chronic interstitial cystitis because we’re at least three years overdue for doing that study. If you want to get on the news, at least let yourself be known, make introductions to the health reporter in your town. Then when something happens nationwide you can call, they already know who you are, he or she does, and they know to call you if they have a need for a comment. Then there’s the book that I recommended if you’re doing faces for, that’s newly published about the mid-face because I really like the way he talks about that.
Let’s see if there’s any other questions. Thank you guys, it’s always an honor to have when you spark people interested in what we’re talking about. I’ll post a recording if that’s helpful. Goodbye.
Charles Runels: All right. So we had quite a few interesting questions over the past few weeks so let’s just jump right into it. The first one, Dave Harshfield sent me some guidelines that he keeps up with. He’s the head of an orthopedic groups that does a lot of regenerative medicine and he and others have [inaudible 00:00:22] to me these latest updates that came up by the FDA. So I thought I should show them to you because they should be very reassuring to you about what we do.
So here’s the question. If you haven’t gotten this question [inaudible 00:00:35], you will get it. Like I said, we’re going to cover about the FDA, we will cover a couple of marketing things, and then I’m going to go over a receipt that you can you when you give back to people who may not be happy. Everyone’s not going to love what we do and I have a receipt that makes people happy, it keeps you legally clean that I’ll show you. Then we’ll go over some resource that has to do with Platelet Rich Plasma scaring. Plus a few other questions. So let’s see. There are quite a few of you on the call and hopefully some of you can participate with helping answering some of these questions.
Is the O-Shot® FDA Approved?
But first, let’s talk about the FDA and how to answer this question about “Is the O-Shot FDA approved? Is the Platelet shot FDA approved? Is the Vampire Facelift FDA approved?” So the beginning of the answer to that question is that the FDA does not control your body fluids. Doesn’t control your hair, your [inaudible 00:01:42], your saliva. That belongs to you. Your fingers, your toes. The FDA is the food, drug, and device administration. However, if you [inaudible 00:01:52] enough to the material that it quits being your body and becomes a drug, then the FDA does have jurisdiction and the FDA has jurisdiction over the devices you might use to prepare the blood.
So, the analogy I use and some of you have heard me say this in my classes is that if you have suture material that you’re going to use to suit your surgical wound with, you couldn’t just buy material at the sewing machine store. You’d have to use material that was approved for use in the human body. But once you have that device for suture material in your hand that’s now approved by the FDA for using in the body how the wound is sutured is determined by the surgeon who’s sewing the wound. It’s not the jurisdiction of the FDA. They do not govern medical procedures and they do not govern body parts.
So how the FDA delineated what they will govern is with a phrase called “minimal manipulation.” They just came out with these policies. You see that’s stated for immediate release November the 16th. So just last week, they came out with this and this is important news and it’s, I think should be encouraging news for most of us.
So comprehensive regenerative medicine policy framework. Now this gives a pathway for those of us who do skin cells to move forward. But the thing’s most [inaudible 00:03:32] procedures [inaudible 00:03:34] involve the Platelet Rich Plasma and we want to know what’s the FDA doing about this. Now they put on [inaudible 00:03:45] medicalassociation.org, which is our umbrella organization, and look in the recent post, you’ll see FDA physicians for Platelet Rich Plasma stem cells. So here, I have a video and some papers have already been out for quite a while about the FDA. Some of the research articles are up in [inaudible 00:04:04] journal talking about the difference. But I remember one time, the FDA considered regulating eggs so [inaudible 00:04:14] an egg was [inaudible 00:04:16] to be more than minimal manipulation and thankfully the gynecologist said and [inaudible 00:04:20] specialist said no, that’s not right. You shouldn’t be regulating eggs. So the point I’m making here is there’s a blurry line between what’s minimum manipulation and what isn’t.
Here is where I put a link to the most recent position paper. So when you click on that, you will land on this page and you can read the [inaudible 00:04:41]. But if you slide down to this page and click on this one right in your final guidelines for … Let me make sure I get this right. The same surgery procedure, exception, questions and answers regarding [inaudible 00:04:57], if you click on that, it takes you to this. This is where they talk about Platelet Rich Plasma. If you slide down, the exception I’m talking about is how do you decide what is an exception to the minimal manipulation. What do you have to do to it before it becomes a drug? If you slide down to number 13, they tell here “Platelet Rick Plasma and other blood products are not considered even in the ball game … ” You don’t even have to think about an exception because that’s your blood and so blood products, the FDA should, in my opinion be regulating some things. They should definitely be regulating the devices, in my opinion, that we use.
If you’re going to do something with blood and then put it back into someone’s person, that should be carefully regulated by the FDA. Those who might somehow want to make a homemade version of that without understanding what they’re doing or realize that you can spend a lot of money and have a laboratory that takes it to a higher level that most physicians have. But if just somehow you’re going to modify a laboratory kit and do things with mechanisms that were made to analyze blood and somehow just decide you’re going to do that and use it to put blood back into someone’s body, it’s just not good medicine. But assuming you’re using a FDA approved kit to prepare the Platelet Rich Plasma, here it is in black and white. Okay, the FDA considers that to be blood products and they are all hands off about that. So hopefully that answers that question.
Now a real quick marketing thing that you guys … Some of you’ve done and others have not. I’m going to type it into the chat box. If you go to [inaudible 00:07:03].com/cellmed, this is probably the best marketing tip I can give you. If you click on that link, it takes you here. [inaudible 00:07:17].com/cellmed.
By the way, this is really, I think, nice software that anybody can set up on their own that allows you to schedule your appointments for your office even if they’re paid in advance. It allows you to schedule appointments before you even get paid and will integrate with your personal calendar so that’s your software tip for the day. If you put something on there, it looks on that before it decides if you’re free and you can set up all sorts of rules like if you’re going to be off on Wednesdays at three or whatever. So we can use this software to schedule with the [inaudible 00:07:55].
And right here, [inaudible 00:07:58] orientation, the people who fall out of our group and tell us that they are not seeing the phone calls, without exception, there are people who have not done this free [inaudible 00:08:12] where we spend an hour on the phone with you and your marketing person or your marketing person alone and we will do this as many times as you need to until you’re seeing results. It’s free. It’s part of being in the group.
No extra charge for it. We want to see you successful and we’ll give you a tour of the website. A lot of times, there’s tools on there. It goes marketing tools, pre-written notes and providers just can’t see it all. They get overwhelmed of all the emails I send them and just get confused.
So we have three full time people with business degrees in our office that have all been with me at least a year and they are not just experts at this business but they’re experts at how our providers are doing those and they’re just waiting and eager to help you because they know [inaudible 00:09:12]. We have more money for research, we have more money for supporting you guys, not just [inaudible 00:09:23] with marketing and supposed to help you educate your patient. So we’ll put in a plug for that.
Does PRP Cause Scarring?
Let’s go to some science real quick. So these are the questions that I’ve received a few times in the past week. Some of these comes in waves and this past week, I had a wave of questions about Platelet Rich Plasma causing scaring. I think sometimes things get out there on the internet and [inaudible 00:09:55] something on the blog or something, I don’t know what happens. I would think you would just to go pub med and search for scarring. I’ve done this multiple times over the years just to make sure that I’m not telling people wrong. I just put the link to that in the chat box. But obviously our first rule is “do no harm.” The truth is that we all hurt people and we don’t mean to but I had two people crash their car just driving to my office. People can’t get out the [inaudible 00:10:31] without getting hurt. They sure can’t go to the doctor’s office and the best of physicians hurt … We hurt people sometimes. But we want to as much as possible, of course, round down at night and know that we have not hurt people.
So part of the beauty of Platelet Rich Plasma is [inaudible 00:10:50] and I’ve tried to keep up with this, if you hurt someone with Platelet Rich Plasma, if you do with Rich Plasma, you actually have an incredible case as the first case in medical history as best I can tell. So when it comes to scars, for some reason, occasionally laypeople worry that somehow the Platelet Rich Plasma’s going to cause scarring. This is a general thing to worry about because it causing tissue growth. So you might wonder as a physician even or weaker physician or a specialist, you might wonder will this cause scarring. I think it’s [inaudible 00:11:32] for you to see here and if you can quickly [inaudible 00:11:36] through, this is 50 papers that have been published. You can scan through these papers and what you’ll find is Platelet Rich Plasma treats scarring. You’ll see that it being used to be keloid and split face studies use to treat scarring from acne scars, pox scars, surgical scars. It remodels the [inaudible 00:11:55] to make it become more normal.
To a layperson, you could describe scarring as basically tissue that’s healed together, but it’s healed the way that the tissue no longer has a configuration. All of these studies, this is the first page. I think it’s three pages. So it goes on for three pages worth. All of these studies are demonstrating an improvement. There’s burn scars, laser treatment, adhesion scars. You can see that there are also improvement. You can’t prove [inaudible 00:12:37]. It’s easy to put the positive and the negative. What it can do is show you 50 papers that show that PRP help scarring. I’ll find one that shows that it causes scarring. So if someone finds it, show it to me.
But how does this relate to what we do? If you do a procedure, let’s say you do a O-Shot and someone says their pain is worse, what do you do with that? For example, one of our providers is actually on the call, and I’m going to unmute her mic later, told me she had a patient who had back pain after an O-Shot. But when she got the asking, the woman had after the O-Shot, she was so excited about it, she and her husband had [inaudible 00:13:25] sex and she had injured her back. So the point I’m making is that if you see a magic trick, if you see a [inaudible 00:13:33] or a magic show [inaudible 00:13:36] appears so what you know is that something you’re not something about that situation.
So when someone tells you that their pain worsened with Platelet Rich Plasma or their erection got worse, it means that there’s something happening that we’re not seeing because Platelet Rich Plasma does not damage tissue. So the case of the erection getting worse, as far as I know, the cases about resolved when the person quit using the pump. So it wasn’t the PRP. I was the overuse of the pump. If you hear that complaint after a [inaudible 00:14:15], have them to stop the pump for a couple of weeks and them maybe start it back every other day or half the pressure.
For the O-Shot, I occasionally hear that people’s orgasms go down. I wish we had more data though so my guess is probably one in 500 something but I do occasionally hear someone’s orgasms seem worse. I only know of one where it never occurred and I don’t have an explanation for that. But you can make an easy case for why it might happen in the beginning because we’re vaguely created artificial hematoma. What happens if you have a hematoma on your arm, the sensation is not as great in the beginning. So why do some people have hypersexuality and more sensation and others have less? I don’t have a good explanation. But that’s my best guess at what’s going on and why it usually revolves [inaudible 00:15:14] it resolves and then they recover, get it back to baseline, or most of the time better than baseline.
So we have a consent form. We actually recently updated the consent forms. Our consent form’s always been strong but they used to always be more organized, more strengthened, and now we read part of this procedure. So you’ll see things listed that you’ve never seen. A long list of complaints and things that we’ve seen, we’ve added to the long list of complaints and we still include a line that says, “This is not a FDA procedure,” because some people still thinks the FDA approves procedures. So in the consent form, we say that it’s not. I’ll show the consent form list. So if you go into oshot.info and sign in … So when you get there, it’s going to look like this. I’m going to just pull it up really quickly. Then we’ll answer several more questions and then we have a [inaudible 00:16:25] promised to show you.
So you log in. This is the back side but when you log in, you’ll see something that looks like this. This is where I’m really begging you guys. The more the survey data we get, the more we’ll understand, I think, how often some of these things happen and what’s the [inaudible 00:16:44]. Once again here, you’ll see the legal when you go to legal. Our new consent form is there and this is me describing the routine, which I’ll get into now and how to use it. So there’s the consent form and we’ll just finish this out now as far as the scarring goes. As far as I know, saying that you damaged something with Platelet Rich Plasma is similar to saying that you have suffocated from oxygen because logically, it’s hard to understand since Platelet Rich Plasma remodels things back into a normal [inaudible 00:17:22].
But here’s the consent form and I’ll put up … You see it’s pretty straight forward and you can see there’s as long line of things. Basically, it just listed everything we could think of that a person complain of because do we say that PRP doesn’t cause fatigue. We haven’t done 10,000 people with a [inaudible 00:17:45]. But we do have almost 10,000 papers. Let me just pull this up again for you guys to realize. If you got to pub med and put in Platelet Rich Plasma, I think it’s interesting to see the body of knowledge. When I started doing this eight years ago, this used to be 5,000 personnel [inaudible 00:18:08] and just [inaudible 00:18:10] exploding.
So back to the video. There. So you can see we put the pen and we also put that we don’t really know. Something can happen we’re not anticipating. I can conservatively say that if you look at the number of people we have, the number of procedures we’re doing, we’re at 2,000 procedures by now easily, just O-Shots alone. The region company alone says [inaudible 00:18:44] PRP kits for a year so the number of procedures that PRP is phenomenal. Millions of procedures done yearly. Yet when you look at pub med, you cannot side one serious side effect. Not one serious thing that’s happened except recently when they had something bad happen in the eye. I can find the [inaudible 00:19:08] report [inaudible 00:19:09] mixed something weird with PRP [inaudible 00:19:13] and it got an infection. But you can’t blame it on the PRP. It sounds like some sort of home [inaudible 00:19:19] or something.
As far as the PRP procedure, [inaudible 00:19:24]. So when I show people this consent form, of course I sit with them and I tell them that these are things to go wrong and we don’t really know. We’ve done thousands of procedures and so [inaudible 00:19:38] at all. There it is. So that’s the consent form. Now back to this [inaudible 00:19:45]. Let’s say that someone does not get … David just put something here. Let’s see what he says.
Okay, so, here is me at one of our workshops talking about why I’ve given money back. As far as I know, anybody that I’ve ever seen since I went to cash procedures in 2003, I gave … [inaudible 00:20:22] PMD stats, so 15 years ago … You know as far as I know, anyone who was unhappy with a procedure that I did, I returned every penny that they gave me.
People get nervous when I say that, but, most people are not dishonest. Yeah, people have stolen from me, people steal from me [inaudible 00:20:40] sure. I run my life … Although I don’t make it easy for people to steal from me, if I base my whole life on keeping people from stealing from me, it would not be a pleasant experience, and I would not be able to freely give as much, or offer as much. If people are mostly not … If they were mostly dishonest … If most people were dishonest, Walmart would be out of business in one week, because they have … Since opening, they had that 100% money back guarantee for anything you return.
Why I Give All Money Back ANYTIME ANYONE is not happy with the results…
Even when I did weight loss, and I would have 3 weight loss classes [inaudible 00:21:18] did a lot of weight loss there at one time. I had a guarantee that you could have every penny back you had [inaudible 00:21:28] doctor fees up to 365 days from starting the program. And once or twice a year someone would want all their money back, but, having that made me more careful about who I took care of. I didn’t want to take the reverse side of that equation, I was careful not to take money from people I didn’t think I could get well, but I would take money from some, and still do take money from people occasionally.
Here’s the interesting, other flip side of it, or aspect of it is that if you are ethical, and as far as I know everyone in my group is ethical, or I would have asked them to leave the group … But, I feel like we have a very ethical group, and if you are ethical, then you will sometimes hesitate to take care of people if you’re afraid it won’t work. But, if you have in your heart of hearts that you know you’re not going to keep their money if it doesn’t work, and your cost of goods is relatively small, so that you’re going to make your money back on the next procedure, then what happens is you are actually more willing to take care of the harder cases.
Just make sure you don’t care of all hard cases. Just mix it up so that you mostly take care of the easy cases that you know you can get well, and occasionally take care of people for free, as we all do, or take care of the hard cases when you know your likelihood of getting them well is less than 50%, but you have enough mark up on your cost of goods that you’ll still be profitable in the next procedure.
So, you can hear me talk more about that there if you just log in and go to Legal, and here’s the receipt that we use. And, again you can get your … This is sort of my disclaimer, so you should … My attorney requires me to say to you, I’m not your attorney and you should have your attorney look at this. But this is what we use in our office, and it’s very simple, just two lines.
So, when someone has an outcome that’s not what they wanted, then I tell them come in and Let’s talk about it. And I’m very sincere about that, and I try to see what else might help them. If it’s not something that I have to offer that would help them, then I say “I’m sorry that this didn’t work for you, and there’s no way I want to keep your money if you’re not happy with what happened here. So here, let me write you a cheque.”. And I write them a cheque for a full refund, every penny of it, and then I have them sign this. So it says “I’ve had no adverse consequences from the … Whatever procedure … On this date. Because I’m not realizing the benefit, subjective benefit, I’ve been offered and accepted a full refund of this many dollars on this date.”
They sign it, and my nurse signs it, and we’re done. And then everybody’s happy, they don’t feel like I ripped them off, and I’m not just giving them a receipt, as you can see, I’m making it so that we’re legally also clean from each other. And, I very ethically, put my full brain, and all of my volition into helping them find another alternative, because they would have not given me this money if they didn’t have legitimate [pain 00:24:45] that’s bothering them.
And by doing this, some people have this idea erroneously that if you return money it’s making you subjective to a lawsuit. Not so, again I’m not your attorney, but all the attorneys that specialize in med spas and medical care that I’ve spoken to say not so.
Any time you are doing your best to not harm people, whether it’s medically or monetarily, you are making yourself less likely to have litigation. I get a dirty letter or an email from someone who’s angry about one of our providers, in every case it will be that the provider … Not only did the person not have the outcome they wanted, it’s that they didn’t get their money back, and they feel like they were ripped off.
So make use of the receipt, it sits right here on the Legal page to be downloaded. And make sure that you do mostly a high likelihood of success procedures, which are listed on these recent post on the CMA, and our How To Do web pages.
So that’s the receipt. What else am I needing to cover. I think that’s the main things from [inaudible 00:26:09] the things [inaudible 00:26:11] by email. I have a few more questions, but let me handle some from you guys for a second. Let’s see. Actually, David let me … let me get to that in a second, because I have another question here that I want to cover.
So this one has to do with hair. I’ll just let you look at it. The question that was sent to me. So it says “Hi Charles, I’d like to pose the question for [open mic 00:26:43] discussion.”. By the way, this is a … If you cannot make one of the [open mic 00:26:46] discussions, this is the way … This is a nice way to send it. Just email it, I’ll cover it when we do the webinar, and then it gets recorded and transcribed. So “I’d like to pose a question, what’s the latest on adjuncts for treatment of hair loss with PRP?”
Treatment of Hair Loss
A couple years ago we were using [ACell 00:27:03], vitamin D, and vitamin B, and still this is the recommendation. So, the .. Of course, [Dr. Harrison 00:27:12] reads the research, you guys read the research. The question is am I hearing anything from the grapevine because I’m in the nice of position of being able to get email from all you guys, that are brilliant and out there working, and so it makes me switchboard, and I’m always taking notes.
What I can tell you is I am not hearing any great new recipes. Most people have dropped the [ACell 00:27:35] out of their recipe. Now if you go to our [inaudible 00:27:39] website, on the How To Do page, we have a recipe if you want to use it, from some of providers [inaudible 00:27:45] where they mix vitamin D, and B complex, and other things.
But the [ACell 00:27:51] bothers me because it’s an animal product. You know, it’s a pig bladder matrix. And I was in a research protocol where there was cross immunity to a small pox vaccine that was grown on cow … Cow pox, and we were testing a genetic [recombinate 00:28:10] version, and I had someone who showed up with a myocarditis from that cross-reactivity. And they eventually stopped the study, so who knows how many of us got myocarditis back in the day, when that was the way to vaccinate for small pox.
The point is that, I can tell you that there’s [inaudible 00:28:28] paper showing no side effects from using PRP. I can’t tell you that about [ACell 00:28:33]. I don’t like what it does to the possibility of something going wrong, and, I just don’t use it anymore.
So, I did pull up a couple of papers here, and I’ll just let you see some of them, to let you see … What’s … These are, I think, representative of many more. So, if you look at this … The word is out, is what I’m getting to, is that it does work, and people are mostly using it as a [inaudible 00:29:10]. The … As far as [inaudible 00:29:15]. They mix … They’re doing it in combination with laser for the hair, you know the laser caps. They’re doing it in combination with … With Minoxidil, or Finasteride, as you can see here.
But in this study, these are people who failed topical Minoxidil and Finasteride, and then they gave them PRP, and they had a response. So, in this group, they went 3 monthly sessions followed by 3 [inaudible 00:29:43] monthly sessions, and that’s what I usually see. Some … Once a month [inaudible 00:29:49] 3, and then every other month, then once every 6 months. It gets a little bit more variable after those first 3 treatments.
Here’s another paper. And again, so in micro … so instead of injecting, they’re doing micro-needling with PRP versus topical Minoxidil. So I get that question a lot. Should you micro-needle it or should you inject it subdermally, or what do you do with it? And I just do everything. I’d goes … I block it by doing a little ring block, which is on our website. And then I do subdermal and then micro-needle [inaudible 00:30:28] to play with the core on top. That’s how I do it. And when I see the people who come from the hair clinics [inaudible 00:30:32], that’s what I’m seeing them doing.
Now those who are hair transplant surgeon, I heard lecture at one of the venues, said women are very responsive. He just treats them once and tells them to be patient. So I haven’t seen this study yet, that says that one treatment, the patients needs to wait six months to a year. I haven’t seen the study that shows one treatment and then wait a year versus a treatment … [inaudible 00:30:57] a lot of times three and wait a year.
So who knows who can do that. We’re over treating the need to do the next two. We just need to do one treatment, wait in women. But the common thing with women, that seems to work best that I’m seeing it do … subdermal injections, micro-needle on top, PRP on top of it, put them on 2% Rogaine, tell them to be patient. And yes, most people are doing that, followed by another treatment in [inaudible 00:31:26]another treatment after that. That’s what I’m hearing is the protocol and I don’t see any other magic mixtures. It’s still out there [inaudible 00:31:36]scalp studies and they’re showing nice results even for alopecia [inaudible 00:31:40] it works better than trying Tryptizol alone, so that’s for hair.Let’s see … Some of the websites had some questions too so let me get back to those.
So this one says, “Is it okay to use a laser light for treatment on patients who had a P-shot or hair restoration?”. I think that a topical laser light to help hair growth is of course something you could do starting immediately and that has been shown to help as a stand alone, and so, I haven’t seen it with PRP, with laser cap versus no laser cap but it will make sense that if either one of them works alone it might work better combined because this is not a heat treatment. It will be different if it were [inaudible 00:32:36]sort of laser like[inaudible 00:32:39]laser or pixel laser where you’re actually [inaudible 00:32:44] tissue like a [inaudible 00:32:45] with vagina, in that case you want the heat to go first followed by the PRP immediately and I would give at least four weeks before I do another PRP treatment or another laser treatment because you have to give … I think the pluripotent stem cells time to develop, and the soft tissue studies I see they seem to max out at about twelve weeks with most of the time eight weeks.
[inaudible 00:33:16]obviously studies that demonstrated that [inaudible 00:33:21]where with orthopedic procedures it’s a much longer time to maximal benefit with soft tissue I think you’ve achieve most of the benefit in eight weeks. Four weeks is the minimum amount of time that I would wait before I re-treated with laser because I think that’s undoing the progression of the benefit of PRP. So that’s that question. Let’s see what else we got.
Is Platelet Rich Plasma as Good as Platelet Rich Fibrin Matrix?
Got some more questions here.Okay, here is some. So this is a interesting question that I [inaudible 00:34:14] let’s do this one now. The question is ” Is there an advantage of platelet rich plasma over Platelet-rich fibrin matrix?”. And this to me a play on words or [inaudible 00:34:30] because everybody’s PRP turns into Platelet-rich fibrin matrix when it’s injected. Platelet-rich fibrin matrix is just the PRP growth factors con jelled into plasma and [inaudible 00:34:48] peptide chains that are in the[inaudible 00:34:53] are causing this [inaudible 00:34:53] to cause this matrix formation and that’s what causes the wound healing. But then some document out there that somehow that needs to be made in the syringe before it’s injected and the truth is that if [inaudible 00:35:07]in the tissue the inject PRP is exposed to collagen. The way I describe it to patients that’s the [inaudible 00:35:13]around the scab when you scrapped your knee, that’s what’s holding the tissue together when you’re healing a wound. Some people who sell kits that [inaudible 00:35:26] that matrix in the syringe seem to indicate that maybe that’s what needs to happen, I’m not so sure that’s the case.
The question then becomes, do you get adequate activation if you let it activate after you’ve injected and the platelets are exposed to collagen and then put in the matrix or do you leave it exposed to PRP and the collagen in the syringe and then inject it.[inaudible 00:35:55] has cure that comes with Calcium, so you’re activating the PRP before you [inaudible 00:35:58][inaudible 00:36:00]has cure that comes with HA that we can’t use here but it’s available in other places where there’s no FDA, where it comes with an HA which activates the PRP so you’re making the matrix before you inject it. Here we add calcium by the cals [inaudible 00:36:18] before we inject it and the ratio is .05[inaudible 00:36:23] 10 percent calcium chloride to [inaudible 00:36:28] of PRP or in other words divide the volume of PRP by [inaudible 00:36:32] and that [inaudible 00:36:32]volume of calcium chloride ten percent you should add.[inaudible 00:36:37] I do think you should[inaudible 00:36:43] you’ll get about, when you[inaudible 00:36:48] and you get closer to 100 percent activation if you add calcium chloride before you inject.So we’re activating [inaudible 00:36:55]substitution everything else we’re putting at 65 percent activation[inaudible 00:37:00] to that question is we are all making platelet-rich fibrin matrix anytime you use[inaudible 00:37:07] it’s just how you make it[inaudible 00:37:10].
Okay let’s see, we’re answered that one last time. Some of the videos [inaudible 00:37:23]behind the camera. Yeah that’s true, I’m sorry about that.[inaudible 00:37:29]I think if you look at the videos [inaudible 00:37:30] you can see everything by putting the videos together [inaudible 00:37:34]there’re sections of the videos[inaudible 00:37:40]and the truth is the people who come to our hands are [inaudible 00:37:43] do take it a different level. There’s something in particular you’re trying to see that aren’t available please let me know [inaudible 00:37:53]everything that’s build to be known by how to do it is there so if there’s something you’re not seeing tell me and I will shoot another video to take the place of the one the spot that you’re not seeing.Even though every second’s not visible every part is important about to do it should be visible. Okay so I think that’s all the questions on that one.
Let’s see, we may about to wind this down.We went through that one last time.We answered that one last time. Okay, I think that’s it let’s go through and see if you guys have question then we’ll shut this down. Let’s see Doctor [inaudible 00:38:33]has some prior questions.[inaudible 00:38:40]I’ll just let you have at it. Are you there?
An Orthopedist Talks About PRP
David: I’m here.
Charles Runels: Beautiful so, thank you for[inaudible 00:38:54]the interesting questions, tell us what you’re thinking and let’s just[inaudible 00:38:59] what is on your mind if that’s okay.
David: [inaudible 00:39:06]I wanted to tell you that[inaudible 00:39:18] my son with whom I’ve done PRP, came home with[inaudible 00:39:23]surgery for twelve years longer going through more [inaudible 00:39:29]
Charles Runels: Hey David, I’m hearing some really interesting stuff just breaking up a little bit and it sounds like a lot of experience to share with us,there anyway you can get closer to the mic or fix it where we can hear you a little better because it sounds like [crosstalk 00:39:49] this could be very valuable.
David: Let me open the[inaudible 00:39:52]in my computer and maybe that’s better. Can you hear me now-
Charles Runels: That’s better, whatever you just did made it way better. Maybe you could start over if you don’t mind.
David: Yes I had replaced my laptop so was using my other screen.So as I said, I’ve used my son and my wife as guinea pigs for PRP and stem cells recently, but I’ve had 12 years of orthopedic experience. Is that coming through over the email?
Charles Runels: It’s perfect now, and it’s very valuable. We’re interested in those 12 years of experience.
David: So I’ve got 12 years of experience of using bone marrow concentrate amniotic material, PRP in all forms and fashion from every vendor, and as you know, I recently converted from being a cutting surgeon to being a non-cutting surgeon and moved into the alternative realm. I recently got back to Tucson from the AMG meeting, so we kind of focused a lot on the cosmetic side as well as peptides.
Results of my son’s tennis elbow, he’s had five years of tennis elbow after Hurricane Rita and using a chain saw to cut down two trees in his backyard, and came to me and said, “Dad, can’t you possibly un-retire enough to operate on my elbows?” I said, “No [inaudible 00:41:09].” I said to Austin, “I’m gonna inject ya in my clinic with this new PRP I’ve got. We’ll see what happens.” Well, in five months, he called me, and I won’t use the profanity, but he says, “You got a blanking cure for this. You need to advertise it. [inaudible 00:41:22].” I used your technique and just used it on his elbows.
One thing he did tell me, he says, “That hurt like hell.” He said, “I can’t recommend it to anybody unless you find a way to make it not hurt so bad.” We’re looking into nitrous oxide, we’re looking into topicals a little bit more, and whatever. I just don’t want to interfere with the [inaudible 00:41:45] of the platelets, so any suggestion you might have on that, that you can publish for us it can help us be humane would be good, his orthopedist worked on a [inaudible 00:41:55] and we don’t care too much, but I think it’s better for the cosmetic world for us not to hurt people.
Charles Runels: Yeah, sure. Well that’s a lot of … keeping going because in 12 years you’ve got more to share than that, keep going.
David: I don’t want to burn up the hour, but the …
Charles Runels: No, no it’s good. I’m through with all the questions, I want to learn from you.
David: Well, I also reported on my wife’s recent O-Shot and that she did unbelievably well for ten days and no leakage whatsoever, we’re married 46 years, two kids, a 45-year-old, a 34-year-old and we’re physiologically young, but she’s had some incompetence, she’s got a [inaudible 00:42:36] some other things, that I said, “Look we need to try this, this isn’t so much for orgasm and libido, it’s for your … whatever, I wanna find out what happens.
She was dry for ten days, with no problem with jogging and trampoline and everything else, which was a big change. And then she kind of had a regression back. She says, “You know I think I may be actually leaking more now after ten days.” So I kind of just [inaudible 00:43:03], sometime I don’t much, whenever I get it back a little bit, just wait. And I ask her finally and I said, “So are you still leaking?” And she says, “You know I’m not.” And so I think as you said before you got to look other places for problems sometimes [inaudible 00:43:24] we’re so used to in medicine, the most critical people around for our own selves.
Charles Runels: Let me see if I can explain, again we need the ultrasound studies to prove this. We have two … excuse me, we have three now [inaudible 00:43:38] radiologists in our group and hopefully they’ll do these studies for us, but here’s what I think you just described. So if you think about it when you do the procedure, you obviously, there’s no time for cell growth you get those [inaudible 00:43:56] and all that. My best explantation for what I have … resolution of confidence immediately, which doesn’t happen to everybody, but happens a lot is that we are forming that [inaudible 00:44:10] matrix and it’s acting like liquid sling and stopping the [inaudible 00:44:15] immediately.
Of course, that’s like what happens to the scab on someones knee, this is what I explain to patients, you know it could go away immediately but it may not, which is making the hematoma, and [inaudible 00:44:28] resolves though, the actual tissue growth doesn’t really start until at least when you’re doing cosmetic work, you can’t see that much until around the third week with like at 12 week.
So what could’ve been is that the matrix was there, stopped it, which is great and I love when that happens even though it sometimes [inaudible 00:44:48] it tells you, you put it in the right place. But then it could go away and when it came back that’s the true cell growth. Now the other thing that just to add to your story and again, I’m making this up, I think this is probably the right thing based on what I’m seeing and about the science of it, I could be wrong and I’m the last person to say everything I’m telling you is right. We need to do the research to figure it out, but your story you just told is very common.
The other thing that’s common is that sometimes it will go away, but sometimes it’s just better, but it’s not all the way gone in that [inaudible 00:45:27] and when that happens just repeat it, it’s so common for it to be better after the second shot even the sex part, sometimes the urine gets better and the sex isn’t better after shot two or three. It’s so common I’ve even thought about just making it a standard protocol that everybody gets two shots because, that to me seems unfair since many women would be improved or as well as they need to be and are, most of them actually around 60 percent last time I surveyed, 60 to 70, depending on the problem.
And then it jumps to 80 to 90 plus after the second one. So it kind of seems unfair those people, the 60 to 70 percent to require a second shot or make them pay for a second shot and may not need it. So having said all that I think that’s my best bet about what happened with your wife, I just wanted to throw it in, but keep going with your experience … we want you to teach us, because here’s the thing the [inaudible 00:46:23] were ahead of us with the PRP and if you’ve been doing it that long you have other things to teach us, so go for it.
David: Well I can tell ya I probably started doing these alternative methods with [inaudible 00:46:33] this and I still … up till February last year [inaudible 00:46:37] this trauma. I mainly, sports, but a lot of trauma. I never had another non union [inaudible 00:46:46] fracture after putting PRP or [inaudible 00:46:49] or bone marrow concentrate in those fractures. It was very, very helpful also with skin cut bridge [inaudible 00:47:00] skin loss and muscle loss, that helped tremendously. What got me to that comment was if you do, do a second one, do you fully or do you charge a reduced price? Or do you give it to them, how do you handle it?
Charles Runels: Okay, so that’s a good business question. I don’t like to tell people, well this is the standard thing that everyone should do, because you’re the one looking at your patients. But I’ll tell you what works for me with most of my patients, if they have a nice result, their [inaudible 00:47:41] is mostly gone and they’re happy with it, but they think, I think it would, I may want another one, most of those people want to pay you again, they realize that it worked, they just want to see if it works better. They want to pay you and so they should, let them. If you want more, you should pay me again. But, I would insist on it if they’re attitude or their, if my feeling about them, their communication to me … it’s not [inaudible 00:48:16] that they feel like they go their value for their money, then I’ll do the next one for free.
[inaudible 00:48:24] it’s not a four hour procedure, it’s fairly quick and our cost of goods are reasonable enough that you’re still profitable, so that’s where I am on a case by case basis. [crosstalk 00:48:38]
Don’t make that decision until it’s been at least eight weeks. And really chances are that they may get better at 12 to 16 weeks if they’re not better at eight, still kind of pushing it. To me it feels kinds of, maybe not so far to them to make, 16 weeks that four months. So do I really want to make them wait for a third of a year before I decide if I’m going to retreat it when they’re leaking down their leg, knowing if I retreat it, it may go away and so it’s sort of judgment call, but one things for sure I would make them wait at least eight weeks because I might need to subject them to another procedure or draw their blood and all the things that go with it and whether their paying me or not there’s some cost of goods and some time involved, break times valuable too. So I would tend to wait at least eight weeks before [inaudible 00:49:34] did work.
David: Excellent, with respect to, to my bias coming from orthopedics and coming from PRP and moving into bone marrow and [inaudible 00:49:44] back into [inaudible 00:49:46] and PRP I think I consider I can say pretty … opinionated that stem cells in some form of fashion, I call it stem cell signaling, just so we don’t get [inaudible 00:50:04] with our big brother but the signaling factors and growth factors that come out of stem cell in my opinion are probably big brother and PRP his little brother and we know that there could be 600 drug factors in the stem cells, PRP or bone marrow and there’s probably 300 drug factors in PRP so maybe it’s not that big of deal, pretty even. In somebody that’s a little bit more aggressive, for example my wife had Hallus Rigidus, which is loss of the cartilage in the metatarsophalangeal above the big toes and ready for either fusion osteotomy to remove the cartilage around or arthoplasty and she was on the surgery this time last year, I chose to go forward [inaudible 00:50:55] as a guinea pig my first case after getting back to California and studying lipogenic stem cells and I injected both of her big toes.
The chronology of that is that four and a half months of bated breath she got me and says, “I think my right toe is better, and if I’m not.” She says, “My right toe is definitely better and my left toe is better.” I know exactly when I did this, because I did it a week before the election a year ago and she is now admittedly, somewhere around 75 to 85 percent better in the bad toe and 95 percent better in the good toe and she is extremely happy, I don’t have any claims about regrowing cartilage or anything like that. All I know is symptomatically she can wear high heels and boots and she can jog the hills in Austin, Texas and she can go into yoga where as she could not pull forward, she was putting [inaudible 00:51:52] and everything else on her big toe four times a day and she was miserable. She grabbed me by the throat she said, “Look you’re supposed to be smart, do something.”[crosstalk 00:52:01]
Charles Runels: Obviously that’s anecdotal, but it’s traumatic. It’s not just anecdotal, because you know better than I having been in the ortho world. There’s hundreds of papers, probably thousands of papers in the orthopedic literature backing up exactly what you just said, so it’s not like you’re just pulling that one out of your hat.
David: [crosstalk 00:52:31]It’s really about [inaudible 00:52:32] fractures.
Charles Runels: Along those same lines, I know that most of the people on this call, many of them do treat orthopedic cases, most do not but what you’re saying is very relevant because it all has to do with tissue healing and thinking [inaudible 00:52:47] timeframes and what’s possible and what isn’t and that’s why I’m bringing up this picture that many of you guys have seen before. This from that, which is fairly extensive hypertrophic scar from Cortisone that had been there for a year to this a year later and it still looks like that seven years later, this was six years later, I did this in 2011.
This Juvederm with PRP with no stem cell transfer just recruitment of stem cells from PRP, from the Juvederm as a matrix on which to build the new growth. So if this is going on when we do O-Shots and P-Shots and faces then obviously … and it should be. There’s some intelligence about the process that’s beyond our skillset as far as what we’re actually doing with that needle.
And the other thing you brought up about the malunion … horrific thing that happens sometimes. I had to cases that came to me when I used to do clinical trials with [inaudible 00:53:58] from one woman who had been operated on six times they were considering an amputation, operate six times on her shoulder. They just couldn’t get her humerus to heal and she had an IGF-1 that was less than 60, it was almost in the dirt. She literally out of desperation, because someone told her to come see me and then I had another case with a woman who had an external fixator that had been operated on three times and in the process of doing that research [inaudible 00:54:38] stem testing for growth hormone deficiency, which you know is measured by a [inaudible 00:54:43] which is one of the well factors in PRP. That’s released by the [inaudible 00:54:48]. In both of those cases I put them on six weeks of growth hormone replacement, got their [inaudible 00:54:56] back to normal sent them back to the surgeon. And it’s anecdotal, but in both of these cases the next surgery went well.
David: That’s awesome. My last little caveat and then we’ll stop, which has to do with the recent, it’s recent in the U.S. but not recent worldwide is peptides and we’re dealing with peptides in our PRP and in our stem cells but there are peptides now that can be used in conjunction with what we’re doing to target specific formalities that we’re treating generically with our PRP, which is good but there might even be better results we can send a messenger, via a 15 amino acid of peptide that’s in conjunction with some of these cells and [inaudible 00:55:49], because I am pursuing this like a mad dog right now academically to learn more about it. I’ve got about 25 or 30 years between my masters degree and all that stuff is old and there’s a big gap in my knowledge. But I’m gathering as much as I can, as quickly as I can so I can see where this fits.
Charles Runels: Let me add to that as well because when you [inaudible 00:56:13] it other people think that, not the people on this call, but the people we speak to, our patients think, oh peptides this sounds like something you put in their cream. Well insulins a peptide, [inaudible 00:56:25] a peptide, it’s why we have to have an injection, we can’t take it by mouth, because we would digest it. Where we can take estrogen by mouth, because it’s a [inaudible 00:56:35] hormone and it’s not broken apart by the acid in the stomach. Of course everybody on this call knows that, I just want to point out as you did. There are hundreds of peptide proteins made by the pituitary glands, so when we say peptides it’s not some second rate little “hokie” thing. We’re talking about powerful, hormone like messengers that attach to cells and tell them to do remarkable things and the idea that you can have that [inaudible 00:57:05] already there, packaged up for you in the perfect combination in those platelets is pretty remarkable. We don’t have, it’d be nice to know, which ones do what and understand it the way we do things like growth hormone and [inaudible 00:57:24] and insulin, but if we can make it work why are we trying to figure out which ones are doing what.
I just want to put in my hooray for peptides and we emphasize this is not second rate stuff, this is powerful stuff and it’s what we’re doing when we’re using PRP. The hours up, thank you very much Dr. [inaudible 00:57:48] I’m gonna see if anyone else has a question, if not we’re going to shut this down. I don’t see anything else, so. Thank you guys for showing up, I’ll post this video with a transcript, it will be up in a couple of days, well may be Monday with the Thanksgiving holiday. Thank you for [inaudible 00:58:05] and I think we’re really doing some good things for the planet. You guys have a Happy Thanksgiving.