This sample of our weekly journal club is posted as an example of part of the benefits our joining our provider groups. We do these meetings weekly...every week and feature physicians and their amazing research from around the world.
Topics Discussed Include the Following…
*Documenting the Penis
*Documenting the Penis by text (in a private way)
*How long to wait after the O-Shot® before getting a Vaginal Laser treatment?
*Treating the Bell’s Palsy with the Vampire Facelift®
*Where to park your podcast
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Documenting the Penis
Charles Runels: Welcome everybody. Looks like we have a great turnout today. Let’s start with this question just it’s about where to find the questionnaire for men. It’s a good reminder that we should be doing something to document an objective measure of what’s happening. Moving to the O-Shot® and the Priapus Shot®, so I’ll show you where to find it for both. When you log into the Priapus Shot® membership site, and you click on the how to do procedure button, and then you scroll down. There’s an erectile scale, so it’s objective measurement of erectile function. It’s commonly used by the urologist and there it is right there. Erectile dysfunction intensity scale.
Then when you open that, it gives you a scale of from one to five, for five questions. So the lowest you can get is one on every one– times five, the most you could get is 25, so that’s where you would download that. Now, if you don’t want to, well let me take this back.
Online, Text, Documenting the Penis
If you want to continue to survey them, old school way would be to do this the day you visit with them, and then on follow up visits, but if you wanted to have it done automatically, then you’d go back over here and we have, so you go back to the dashboard and then you click on patient survey.
We will administer that for you. I recommend you do both. Do something on paper the day you visit them, and do the procedure and then follow up, but then also all you have to do is put in their name and cell phone number, and then they’re surveyed in a HIPAA compliant way with some open ended questions, also you can see we have a drop down menu so we look to see which kit you used, and other things like are they on testosterone. If someone put something really strange in here, then we have a way I can use birthdays, and the day they saw you, and you could reconstruct it and contact them, but the good thing is I can give you your data. What your patients are doing, and this will help us design future studies.
Even though it’s not double-blind placebo, there’s a fair number of data points being collected, so we can publish this in a prospective survey kind of thing, and that same erectile dysfunction scale was part of this, so questions one through five questions where they’re graded one through five. That’s where you find it, on the how to do page, and then scroll to the bottom and you can download it. Then on the same thing for the female side, there’s female sexual distress and female sexual function index, which takes a few minutes. Female sexual distress is the quickest. Female sexual function index probably takes, if they’re thoughtful about it, five minutes or so, but we can administer those also by survey. Then give you that data. So that was a good question.
How long to wait after the O-Shot® before getting a Vaginal Laser treatment?
Let’s see. This was a good, oh, well I’ll come back to that. Let’s go ahead and do this question. How long does a patient need to wait after the O shot for getting a Mona Lisa vaginal laser treatment for vaginal atrophy? By the way, you guys, you can type into the question box if you want to contribute, you can just raise your hand and I’ll unmute your mic, or you can type into the question box if you have a question or a comment, and I’ll either read it or unmute you so you can talk. This is a great question. As part of the answer to this, someone asked me for a detailed video recording that they could show their patients after they had a procedure done.
The O-Shot® procedure, so I’ll show you where I put it and I’ll recommend that you guys do your version of it. I’ll show you where it lives. Right here. If you go to the O-Shot webpage, the main site, and then recent posts, I put a podcast blog right there. So you can just click on it there, and actually the transcription is done, I’ll have that posted by tomorrow morning, but I recommend you take my transcript, and read it, and do it your own video or your own podcast, and put it on your website, and modify it based on your observations and philosophies. You’ll see I go into what to expect whether you’re doing it for like necrosis, and I go into some of the ideas about using other methods like radio frequency, the Emsella with the electromagnetic contraction of the pelvic floor.
If you are interested in Emsella, send message to the company to get a discount for being a member of the O-Shot® provider group…
if you purchase, then let us know and we will put an icon by your name on the O-Shot® directory so that women know that you offer a combination therapy of the O-Shot® procedure combined with the Emsella treatment…
here’s where to let us know…
So back to this question, if you do the O-Shot® the day of the procedure, you could do the O-Shot® immediately after any sort of inner treatment, so you do vaginal laser, or radio frequency, and the same visit, same day, immediately afterwards you could use PRP. Same thing if you were an Olympic athlete, you’d use PRP to help recover the muscle function immediately afterwards. If you go to PubMed and just read about PRP, one time it was outlawed by the Olympic committee because it does seem to help recovery with muscle function, but then they decided to allow it.
You could make the argument that it may even help the day of using an Emsella or the electromagnetic treatment, but if you do the PRP first, then the energy’s going to denature the amino acid proteins, just like if you took insulin and shook it, or you cooked it, you denature the amino acid chain and uncode that chain so it no longer, it just becomes another protein. It no longer is a chemical messenger like the amino acid peptide or hormones like growth hormone and insulin are, which is of course why you cannot take them by mouth because the digestive system, as you guys know, breaks amino acids apart so now it just becomes like you ate a hamburger, so you can’t take insulin as a pill or growth hormone as a pill because it denatures or scrambles the message.
In the same way, if you did an O-Shot®, so the question is how long does a patient need to wait after the O-Shot® before you do the Mona Lisa, but what you can assume is whenever you do the Mona Lisa, you’re going to undo first of all the amino acid messenger chain, that are the small peptides, that are released from the platelets. Then second of all, of course the laser is going to cause damage, which is the intention of fractal sort of puncture wound as if it were doing a laser version of micro-needling. And then you have recovery or healing of that. So if you’re doing heat and you have pluripotent stem cells that have migrated there because of your plasma it appears to me that you would probably undo that as well, that growth.
I would say you would do the Mona Lisa whenever you thought the effects of the O-Shot had taken place. If you flip the order, you go Mona Lisa and O-Shot immediately afterwards on the first day, but if you do Mona Lisa first I would want to wait at least six weeks, preferably eight weeks so that you have most of the benefit of the O-Shot before you did the laser. If you look at the wound care studies that Sclafani did with PRP most of the effects were there at eight weeks with full effect at 12 weeks post treatment with PRP. I would want to give it eight weeks or else I’m attenuating the results of the O-Shot.
Using the Vampire Facelift® help Bell’s Palsy
Okay so, we covered this one with the short vagina last meeting, let’s see if anybody has, nobody has a question yet. There was a really interesting question someone had about, yeah. So Catherine Stone (check her out here) is one of our [amazing] providers in New Zealand and she also keeps an office in London, one of our teachers, she teaches a beautiful class there in New Zealand.
She teaches along with Dr. Kirshni Appanna.
She says, if you, well she talks about Botox [as a treatment for Bell’s Palsy], but she comes up to Bell’s Palsy, “I treat a lot of residual Bell Palsy and facial asymmetry patients this way using Botox. Once their Palsy is established how about PRP for Bell’s Palsy? Would you only use it the first six months or you think is long term?”
Where to inject, so this is a great question. One of us needs to publish this because so far three people have told me that they saw benefit years after the Bell’s Palsy.
I’ll pull this up just so you can see. The only reference I saw to it in the literature was someone who put this out where they used mononuclear cells and platelet plasma which there’s two variables–after 26 YEARS of being plagued with this condition.
But, we’ve had three different people tell me, and I’ve actually seen this as well, a Bell’s Palsy improved years afterwards. One of the people works in my office as a matter of fact had, not a Bell’s Palsy but facial surgery that left her with numbness that’d been done over ten years before she came to work for me.
I did the Vampire Facelift® for a cosmetic result and then anecdotally she noticed that the sensation had returned to her face. So, I don’t know when the time limit is for this to happen, but it appears to be that it can happen after, not just the acute phase, but months or years after the Bell’s Palsy has occurred. If you actually just look at the research, what’s been published, there’s a fair number of studies showing plate rich plasma helping regenerate nerve tissue. I think it’s because we know it’s affect on attenuating all the immune response, it’d be nice to get to these people immediately when the Bell’s Palsy occurs and see what would happen and someone needs to do that study.
There’s so much research that needs to be done based on our observations but there’s no downside and a huge upside so I would say try it and of course it’s in the distribution of the facial nerve, I would just, but there’s no downside of just putting it everywhere. I would just put subdermally everywhere. We actually used to do this eight years ago when I first started doing the Vampire and using PRP cosmetically. I would use more of it, I’d basically tried to fill every part of the face subdermally but most people found that, or some people found it a little much so I became more selective and strategic about where I place it.
But I think in the case where you’re trying to regenerate nerve, I would just consider it, putting it everywhere. Or, if you want to be more specific you put it in the distribution of the facial nerve. Okay, let’s see, we didn’t have as many questions this time, i think that pretty much covered the questions that showed up on the website. See if anybody else has any questions. We may shut this down early. The, let’s see I don’t see any other questions.
I’d like to cover when we do these journal clubs, I like to cover research that we’ve done and hopefully somebody will build on that and something about marketing. As far as marketing goes this time, I think that there was one question that came up about building out a link to sell the Altar or whatever you might want to sell, creating a link that goes on your website. I actually covered that a few workshops or journal clubs ago, it might help if I just show you how easy it is to find things that are actually on one of our pages. If you go, I’ll go in and I’ll show you. There’s a search box and if you just type that, whatever it is you’re looking for, so let’s say that we’re on this page, and by the way our Altar shipped this week so hopefully you guys are seeing that.
Where to park your podcast<–
Get to the page. Yeah. There, so whenever you’re here, you just put in the search box whatever it is you’re looking for so it’ll pull it up on any of the posts. We have many pages on these websites. Let’s see if there’s any other questions. Not many questions this week so we may just shut this down. Okay so I think that’s it. My big marketing tip, well big but I don’t know about that, but the marketing tip I have for you this time is record an aftercare, either podcast or video. For podcast I use Libsyn.com L-i-b-s-y-n.com. You can record a podcast or a video for the actor here. What to expect before your procedures, you can put that on your websites because a lot of people look at that before they have a procedure done and you’ll find that people come to you and have the procedure done because they saw your aftercare instructions. So tonight was a quick one, I don’t see any other questions so we’ll just shut this down. You guys have a wonderful week.
Treatment of Bell’s Palsy with PRP (why the Vampire Facelift® could help this condition after 26 YEARS)<–
Cellular Medicine Association
Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
Dr. Runels: Thank you for having me.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.
I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.
Let’s see what else is going on. I want to let you guys that we’ve put out some … We’ve put out a press release about some of Dr. Posey’s research about the O-Shot® (Orgasm Shot®) procedure and treating lichen sclerosus …so you may get some questions [from your patients] about that. I thought you might want to know more about what you should treat and what you shouldn’t treat if you’re doing lichens sclerosus. She’s actually on the call so I think I may undo her mic so she can tell you some of her thoughts about this research and how to know when to treat this and when not. She does a class and you might qualify to begin that class and that’s classroom … That’s a good thing. I’m going to unmute your mic, Kathleen.
Here we go. You there Kathleen? Hello?
Treating Lichen Sclerosus with the O-Shot® Procedure
Kathleen Posey MD, FACOG: How are you doing? Yeah, I’m here. Can you hear me?
Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.
Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …
The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.
More of Our Research .. O-Shot® P-Shot® Vampire Facelift® Vampire Facial®
With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.
About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.
Charles Runels: This one?
Kathleen: No, go to the last picture. Keep going. Another one.
Charles Runels: That one?
Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?
Charles Runels: Yes.
Kathleen: You see that, Charles? That band?
Charles Runels: Yes.
Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.
I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.
Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-
Charles Runels: Yeah.
Kathleen: That to that, to that.
Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.
I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.
I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.
The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …
Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.
Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?
Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?
Charles Runels: Yes.
Charles Runels: I can. I can hear you.
Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.
Charles Runels: That don’t need the retreatment?
Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.
Charles Runels: Yeah. Okay.
Kathleen: There’s another picture, a previous picture.
Charles Runels: This one? This one?
Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.
Charles Runels: This one?
Kathleen: Yes. Yes. Can you hear me?
Charles Runels: What point do you want to make about this one?
Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.
Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.
Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.
If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.
Kathleen: Charles, I’d like to-
Charles Runels: The other thing while I was on the subject. Go ahead.
Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.
Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.
Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.
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.
Cellular Medicine Association<–
See Transcript Below…
Schedule a Marketing Consult & Orientation “Sure Start”
Platelet Rich Plasma for the Treatment of Scars<–
Research about Platelet Rich Plasma
Platelet Rich Plasma Hair Protocol 1
Platelet Rich Plasma Hair Protocol 2
Platelet Rich Plasma Hair Protocol 3
Cellular Medicine Association
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.
Section 5 of 5 [00:40:00 – 00:58:16]
Cellular Medicine Association
Relevant Links (listen to the end for a do list that brings new patients who need you)…
- The new Vampire Wing Lift™ website. VampireWingLift.com
- Where Vampire Wing Lift™ providers may be found. VampireWingLift.com/members/directory
- Where providers can login. http://vampirewinglift.com/members/wp-login.php
- New research by our providers…
Lichen Sclerosus. Kathleen Posey.
O-Shot® for incontinence and sexual function. João Brito Jaenisch Neto
- Post reviews to Priapus Shot® click
- Post reviews to O-Shot® click
- More marketing tools<–
- Pre-written emails and web page<–
Hope this is helpful.
Charles Runels, MD
Cellular Medicine Association
Transcript of Video/Webinar
Charles Runels: Okay, let’s get started. The first question, we’re on the Vampire Breast Lift website, is actually a comment from Wendy Hurn.
Vampire Breast Lift® Questions…
She says, “I have performed several of these procedures to date and have amazing results around six weeks. My own, which is performed nine weeks ago, was amazing. Fullness and firmness with cleavage area many have commented upon. After breastfeeding in the past, I am delighted, so can pass this on to my patients with confidence.”
Thank you very much for writing Wendy.
This is one of those things where it almost seems too good to be true. I’m always grateful when our providers encourage each other. One thing about this when you do these procedures, just be sure you realize there’s a correlation and there’s causation and if you hand out 1,000 Tootsie Rolls to women who walk down the sidewalk, there will be some of them who get breast cancer. If you called it a Breast Lift Tootsie Roll, they might blame it on your Tootsie Roll. I think you can make a very strong argument that PRP is perhaps protective against cancer. We also have the strong research that if you look at the research part of the vampirebreastlift.com.
If you look at the Research tab, you’ll see there’s very good, very strong, research showing that when you mix PRP with fat and transfer it to the breast, there is a trend towards less cancer and there has been two really strong studies showing no increased risk of biopsy or recurrence rate in people who have had breast cancer and then being reconstructed, so it appears to be a very safe thing, but I would still do the same things that you would do for documentation if you were transferring fat to the breast. Most people know you transfer fat to mix it with PRP, so do those same protocols, just make sure the woman has been two things. Make sure seems been recently screened and that whoever keeps track of her breasts says that she’s good to go and number two, make sure you get a good consent form.
Second thing, but hopefully one of you guys will eventually do the research. I think that if you did, if you look at this trend towards less cancer, I think if you did a study where you injected the left breast of a thousand women, you would see a higher rate of breast cancer in the right breast. We don’t know that yet, but that’s what I suspect.
Next one is a question from Dr. Climikoski.
He says, “I have a patient who’s had breast implants and has loss of nipple sensitivity. Her primary concern is to regain the sensitivity back. She asked me, ‘What percentage of people that receive the Vampire Breast Lift do in fact have significant improvement in the sensitivity and are pleased with the results?’ If you provide me with an idea of this percentage, that would be helpful, as I’m a new provider for this procedure and don’t have my experience to draw from. Thank you.”
The answer to this one, I think, is … Again, we don’t have the research. In my practice, it is very near 100%. I’ve actually never had a failure when I was treated someone for loss of sensitivity after implants, but if they had extensive reconstruction, then all bets are off. When I talked to our providers, I hear everything from 50% are improved up to near 100%. I just wouldn’t promise this benefit if it’s for someone for extensive reconstruction, and with everything you do, I highly, highly, highly recommend that you offer a money back guarantee. When I treat this, usually it’s a woman who’s coming for improvement appearance and this is something she wants in addition to that. And so, she’s still happy if her sensitivity isn’t back like she thought it was, maybe, when she was 17. I’ve yet to have a woman tell me it did not make things better than before the procedure.
PRP Science-Techniques (what if the needle clogs?)
Next question is a woman who had … She just wrote this in to me. She says, “I had a 30-year-old,” this came an email but I thought we’d cover it here, she says, “I had a 30-year-old for her O-Shot. We used the Eclipse to spin the blood. My patients PRP was irregular in consistency and had clumps of what I thought had to be platelets. The 27 gauge needle and the syringe, for that matter, clogged a few times. I tried to force out the clumps from the syringe, but I’m wondering why this could’ve happened. Any comments appreciated in advance.”
There’s two things that could be causing clogging. I’ll tell you what they are and I’ll tell you how to deal with this because it can happen to everyone. First, it could be actually the platelet-rich fibrin matrix. I have seen clod up as quickly as two minutes out. This is why when I do this procedure, so in other words when the platelets are in the syringe, just sitting there, they can wait for about six hours in theory and still be okay to use, but once they’re activated; thereby, exposure to thrombin, calcium chloride, calcium gluconate, hyaluronic acid filler, or being excreted from the syringe back into the body exposed to collagen. All those things can cause the platelets to now degranulate, release the growth factors, and then the fluid of the plasma becomes congealed to hold the growth factors in place.
This is called platelet-rich fibrin matrix. It looks like goo inside your syringe. You may want to spend a syringe, activate it, and then just let it sit there and not use it so you can see what this looks like. It looks like little string or a little rubber band or something with a precipitate that forms in the syringe. It’s only probably 10%, 20% of the volume of the syringe will be clotted, but it makes a nice little linear precipitate in the syringe if you just let it sit and congeal. That’s what you’re making.
Now, if there’s turbulence and you’ve activated it can look clotted up in little clumps and that is what you’re seeing if there’s a delay. If you immediately take it out of the centrifuge and you see some little stringy things, maybe that’s platelet-rich fibrin matrix, but I’m not so convinced that sometimes it’s not some of the actual gel itself. I’m told that that’s not the case, but I’m not so clear that what that is and it could be the gel. In any case, I’ve never had it clog the syringe unless I’m slow about getting into the person’s body. When you’re drawing it out, use a … I use a 18-gauge needle to pull it out of the tube and then I have 25-gauge needles, literally within reach, so if I’m sitting there doing the O-Shot or whatever procedure have 25-gauge needles close by. If it starts to gel up and I can’t get it through the needle, then i just grab one of those and swap it out or sometimes you can just swap it before another 27 and whatever matrix is clogged the needle will be stuck in the needle, so when you get a new one, you can keep going. That’s the way to deal with that.
Try to have your patient all the way ready before you ever activate the platelet plasma when you do the O-Shot. Have 25-gauge needles within reach and fresh 27s and you should be okay. Oh, one other thing about the gel. We’ve had a few cases of urticaria. I’ve seen about, well, I’ve seen one myself in the face and I had another man who had some urticaria after Priapus Shot. In both cases, it went away with a Medrol Dose Pack. I’ve had two cases of urticaria reported to me by our providers. One after the face and one after an O-Shot where the woman got some urticaria of the inner thighs. All resolved without sequela using a Medrol Dose Pack.
If you look at the medical literature in some of the orthopedic literature, they talk about this happening and postulate that perhaps there’s a urticaria reaction that some people have to their platelets, but perhaps it’s from the gel itself. I just bring this up as a possibility. I don’t know why it happens, I just know it happens and that’s how you treat it. Maybe some of you guys can help us do that research.
Anything you would add to that Kathleen?
Kathleen Posey: No, but I actually think … I agree with the 25-gauge needle. I actually think I’ve used the 25-gauge needle more so than the 27 because the gel does really get thick and it makes it harder to push.
Charles Runels: So you use the … just routinely use the 25 for the anterior vaginal wall?
Kathleen Posey: Yes.
Charles Runels: While I’m here, just for those who may watch this video because this is all will be recorded and I’ll just post this to where people can see it. This gives a really nice simple diagram about where the material goes. I wonder sometimes if people are using enough. If you use the gel tube, I think you should probably spend three for each side of the breast. The price is set to where you can afford to do that. Basically, 15 milliliters of PRP for each side however you make your PRP. Some of the … I don’t know who knows, but I think some of the people who report not seeing much result are not using enough of this stuff. Let’s see. I think that’s all we had on the breast lift. Let’s look at some of the questions. By the way, anybody on the call who wants to ask a question, just click the raise your hand button and I’ll let you just say what it is you want to ask. Now, we’re on the O-Shot. That was the breast lift. Let’s go down the unanswered questions. By the way, if you ever want to ask a question, this is where to post it. Some of these have gone unanswered, but oftentimes our more experienced people will jump in there and answer a question. This is the way you get more than one opinion.
Priapus Shot® Questions…
Okay, so Dr. Ness has two questions. He uses the EPAT for erectile disfunction, along with PRP, after the fifth treatment and before the sixth. Should we inject PRP more often, say after every treatment? Also, has EPAT been used on women to augment the O-Shot? We’ll do this first question. I actually had an email from one of our urologists this morning. I’m seeing several variations, but most of the variations involve using PRP after the first treatment and after the last treatment, whatever your protocol is.
There was another research paper came out this past July in the Journal of Sexual Medicine showing that this works, but there’s no one that has done, okay, this protocol versus that. We’re still trying to figure this out. There’s a research paper for someone. Obviously, there’s two variables there, how you inject the PRP, or where and when, and how you do whatever physical therapy you’re doing.
More O-Shot® Tips…
I don’t know if anybody has anything to add to that, but the bottom line is that do whatever your normal protocol is, and then do your PRP after the first one and after the last one. Same thing with any sort of these physical therapies, lasers. Whether it’s shockwave therapy or it’s … and your frequency. I know you have the Thermi-Va, Kathleen. When are you adding in Thermi-Va when you do O-Shots?
Kathleen Posey: Well, I add it when they want to have improvement in the labia majora or want to decrease the size of their vagina. What I have noticed consistently now, having done enough of them, I really think when you decrease that distance between the clitoris and the vagina and/or urethra, the orgasms get stronger. I think, I’ve done enough now to know. The patients are telling me now, the ones that have had the Thermi-Va with the O-Shot, that the orgasm has gotten even more intense than the O-Shot, so I think that’s an added bonus.
I wish somebody would do the research to prove that it’s that distance because there’s such a problem when somebody has a baby and things get stretched out AP-wise. What you’re really stretching out is that length between the vagina and the clitoris, and then you’re constantly, as a gynecologist, “I used to be able to have orgasms with penis in vagina. Since I’ve had children, I cannot have orgasms with a penis in vagina.”
I’ve even seen C-section patients that haven’t had a vaginal birth, they’re still stretching out. They still have [inaudible 00:13:19]. They’re still having problems. I think, basically, probably gravity, but they do over somebody’s lifetime take away from your ability to have different types of orgasms.
Charles Runels: When it comes to you, do you do Thermi-Va and then O-Shot immediately following on the first visit, or how do you do your series when you’re combining those two therapies?
Kathleen Posey: Most of the time, I do the O-Shot and the Thermi-Va at the first visit, but sometimes it just depends. If they come in there and just say, “I’m here for the O-Shot,” I do that, and then after I do my exam, and I find they’ve had three kids, and I feel like they could benefit from the Thermi-Va, I give them the pamphlet and talk to them about that. So I’ve done it different ways. I’m not real consistent on … because there’s usually three treatments of Thermi-Va, and I’m not real consistent when I do the O-Shot with it. It can be the third treatment.
Charles Runels: I recently talked to Dr. Alinsod about this too [he does something very similar] and I know, Dr. Posey, you’ve done a lot of these. How long have you been doing O-Shots now, three years?
Kathleen Posey: Four.
Charles Runels: Four, yeah, so you’ve had … and I think probably more than anybody on the planet, your experience with lichen sclerosus combined with PRP is you’ve probably seen more patients than anyone. I don’t say this is for gospel because no one’s done the research, but when I speak to other providers, including Dr. Alinsod, they will sometimes do Thermi-Va, then another Thermi-Va, and then the last one of Thermi-Va, they’ll do Thermi-Va followed by O-Shot, or they’ll do ThermiVa and O-Shot on the first one, and then another Thermi-Va, and then, if they’re doing well, on the last one they just do a Thermi-Va. If they’re not as where they want to be, they’ll add an O-Shot to that last Thermi-Va treatment.
As far as the business part of this goes, a lot of our providers, when they come in, they’ll offer the O-Shot at the regular price, and then if they want to add in the Thermi-Va, they’ll cut the price of the Thermi-Va treatments in half, and sell it all as a package. Anyway, that’s become extremely exciting what people are seeing combining those two.
The general principle though that you never break, I think, is that you don’t do a heat, energy type treatment immediately after the O-Shot or the heat denatures those amino acids, small peptide, chemotactic factors, so you can do them both in the same day, but if you do both, you always just do the O-Shot after the heat therapy. I know you know that Dr. Posey but some of the new people may not.
Kathleen Posey: I have one thing. Can I add one thing
Charles Runels: Yeah, sure. Please do.
HUGE TIP (Small Vagina & Thermi-Va)…
Kathleen Posey: I just treated a patient this week that the Thermi-Va people sent me: Had seen a plastic surgeon in New Orleans, decreased lubrication after chemotherapy for colon cancer. She was in her 40s. No exam. So she gets here, and she’d gone from having intercourse three times a week to barely being even one. It was very, very painful.
Her vagina was so small, and they had done the Thermi-Va, so they were making it smaller, so all her symptoms got worse after the Thermi-Va. Actually, a lot of her pain was in the posterior fourchette. I just treated her this week, but I gave her another shot because I said, “Look, I’m going to see,” but you really have to select the patients and do the exams. If the three of us says, “Okay, I’m going to increase lubrication and decrease pain,” well, if the problem is your vagina’s too small, you’re going to make her worse.
She was worse, so the plastic surgeon complained to Thermi-Va. Thermi-Va says, “Well, where’s her exam?” They go, “Well, I didn’t do one.” They lived in New Orleans, so the plastics doctor called me and said, “Well, will you see her?”
You just really have to take each case individually because she was crippled because of a really small vagina. I don’t know if the O-Shot helped her. I did the traditional O-Shot, and I treated her with pain. I just wanted to throw out all these pain symptoms. I did another one today, which was episiotomy pain, and it’s helped her. She’s a year out and this is her second time. I do do the O-Shot, as well as treat where the pain is.
Charles Runels: Yes, all those are good tips, excellent tips, actually. I’ll just add to that that there probably should be, and maybe you can help us think about this, a … What’s the right word? Sort of a chart where you can picture down the one side is all the therapies, and then across the top are all the different problems, and you pick which do you do? Do you do radiofrequency or laser or PRP or dilators or hormones or whatever? And you can picture a pretty extensive chart.
I agree, not everybody … I don’t even use the word “tight” or “loose” vagina. To me, it’s all about matching your lover, and not everybody needs a smaller vagina, and when it comes to pain, for some reason our O-Shot just seems to be amazing, even when the etiology isn’t always known. But I want to emphasize what you said, if they can put their finger where it hurts, always put a cc of PRP there, and then do the regular O-Shot in addition to that. For example, your lady that had the episiotomy scar. My experience has been that, after an episiotomy, they’re usually good to go. So she lasted a year, and now it’s come back and hurting her again?
Kathleen Posey: Yes, it lasted a year. What she had was an episiotomy scar, and then some scarring around her posterior fourchette as well. It hadn’t come back as bad, but she just said, “I don’t want to have painful intercourse. It worked so well before, just repeat it.” I looked, it was a year ago. That was her second shot.
Charles Runels: Beautiful. That’s encouraging. So it wasn’t all the way like it was, but it wasn’t-
Kathleen Posey: No.
Charles Runels: … it had started to come back. There’s that negative feedback loop that can just make anybody avoid sex, especially, I think, women who have pain, and so breaking that feedback loop is so important. Just anecdotally, another patient I heard about from one of our providers, who’s-
Charles Runels: Just anecdotally, another patient I heard about from one of our providers who stays here with, usually with O-shots, she said she had a lady who had an episiotomy scar that had, not only hurt, but would bleed and tear ’cause the skin was so thin. The tissue was so thin, for years. And, no creams and all sorts of things had been tried with no result. And in this case, it took three injections 8 weeks apart, before the bleeding and the pain was gone. So, 8 weeks, pain’s a little better but not gone. Another one. So a series of three O-shots. So, I’m thinking in some cases the tissue may need more than one procedure.
And then lastly, I know we don’t have it here yet, but I know in Europe they have HA that’s made for the vagina. And then I’m wondering in those cases, it might be helpful to do both. So, like we do with our vampire user HA posteriorly with pure AP on top of it to help build that tissue posteriorly when we have an episiotomy scar. All thought they should not be used anteriorly unless it’s under an IRB protocol because of the risk of granulomas. Okay, let’s do the next question. Anything else you could add to that, Kathleen?
Kathleen Posey: No, that’s fine, thank you.
Charles Runels: Okay, let’s see. So, Cindy Crosby says, “My first question is piggy-backing of a question I read in the previous post. If there are there any post-op instruction pamphlets for vampire clients, please email. Second, I had an O-shot and the client had two large babies with two episiotomies. The anatomies very difficult to maneuver. The urethra’s approximately four centimeters long, it’s in the middle of what appeared to be a build-up of scar tissue. Has anyone experienced this and what was the solution?”
I’m gonna turn this one to you Dr. Posey.
Episiotomy Scars & Pain…
Kathleen Posey: Well, I agree, these can be tough. I would put a red rubber catheter in there and find out exactly where her urethra is. And therefore you would know where to put the PRP. Those are hard because, she probably had a cystocele and if you’re not used to looking at them, you’re not gonna know your anatomy because, it gets very distorted. That’s-
Charles Runels: Mm-hmm (affirmative). So, I think you told me once about a lady who did not get benefit for incontinence and then you brought her back and put in a catheter and then things. Describe for them what you do.
Kathleen Posey: Right, I mean that lady had, I mean you don’t want to say a looser … We have a large vagina had cystocele rectocele I put it where I thought it should be the first time. And she just said it didn’t work and she got on the O-shot website, said my name … This is a long time ago.
Charles Runels: (laughs).
Kathleen Posey: Trust me, okay. She got on and said, “This is horrible.” And I think they gave her a discounted rate. So I brought her in, and I said, “Look, but it didn’t work, you’re going back on.” And she did.
Charles Runels: So you brought her back and repeated it, and she went, and she got better. And so, what you did was put in the catheter? Tell me exactly what you did.
Kathleen Posey: Yeah, I took a small red rubber catheter, you put the other end up on the abdomen, so you don’t get pee everywhere, and then you see exactly how distorted that urethra is, because the urethra is distorted in that patient. And it takes the vagina with it, okay. And so you have to see where to put it. And sometimes it can go off to the left or the right, it isn’t straight in the middle. And that was her problem, it had gone off to the side, and so I just put it in never never land.
Charles Runels: So, in the second procedure, your intention is to put the lumen of the needle in between where the catheter was and the outer service of the vaginal wall? Is that what you did?
Kathleen Posey: Yes, which was probably part of the cystocele and it’s gonna look like it’s scarring, it may not have a normal look by itself.
Charles Runels: Beautiful, very helpful.
Okay, let’s see. Dr. Tuttle, “Dear Dr. Runels I have a new person who wants an O-shot, so a daily load dose of methotrexate. Will O-shots still work? Will we get enough PRP, will it work in the presence of this suppressant drug?” She’s using the Emcyte machine.
Okay, so. The general rule I follow is: Would this person recover from surgery? Could you do surgery on them? And if the answer is yes, so can you do it with HIV? Yes. Could you do it with a profound thrombocytopenia? No, not a good idea. So, I don’t know … What’s your thoughts on this one, Kathleen?
Kathleen Posey: I don’t know, but the only P-shot that didn’t work at all was on an 82-year-old with a platelet count of 75,000, and I did two. But I don’t really, I don’t know. I would try it, it’s worth a try. I’d give them money back if it didn’t work.
Charles Runels: Yes, see that’s how I do it. And if you’re new to this, you’re listening to this talk, the first two months, I would just do the easy cases. And of course nothing’s 100% but you have a really high success rate. If not the first shot, the second shot, you’re gonna get it at least 80, 90% of your people well. If you’re treating incontinence with good pelvic floor integrity, dyspareunia, lichen sclerosis, those people are going to get better- people who can have an orgasm but it’s not as strong as it used to be.
If you’re treating someone who’s never had an orgasm in their life, that’s a hard case. Or something like this, where you’re not sure what’s going to happen. I agree, you’re not going to hurt her with this. She would heal, you could operate on her, but is it going to affect this procedure? I don’t know. So this would be a more uncertain case. I would be more hesitant to take these cases until I’ve been doing them. Otherwise, if you do something that’s hard and your first two don’t work, you lose confidence in what you’re doing.
But, on the other hand, I will often take someone who I don’t see any logical reason why I’m doing harm, and then I take them, exactly what you just heard Dr. Posey say, under the condition … I just tell them right off the bat that, “You know, I hope I can get you better. And I’m willing to try this. And if I don’t get you better, I won’t keep your money.” And worst case scenario, you lose a little money but you’ve learned, and you haven’t hurt them, and you’ve helped them find a solution, and you’re still profitable in the next procedure.
Let’s see, I think we just had a question typed in. Okay, yeah, so … Okay, here we go, thank you. So, Dr. Carp I’m gonna unmute your mic, Dr. Carp, so that you can talk with us. Hold on just a second.
Go for it, you there?
Dr. Carp: Yeah, can you hear me?
Charles Runels: Yes sir, perfectly.
Dr. Carp: Yeah, I do all kinds of surgeries on patients with methotrexate, you know, the significance. So I wouldn’t be concerned in the terms of a complication with injecting it. I don’t see how it should have any impact on the expected results with the PRP.
Charles Runels: Beautiful. Thank you for that. When you do your surgery, you don’t anticipate it affecting them healing. So I’m not doing operations every day, so I don’t know that. So, you wouldn’t expect it to have an effect on wound healing. So therefore, we’re both thinking that one variable should not change what the effect of the O-shot would be.
Anything else? Because I know you’ve been doing this awhile, too. Any comments on any of the other questions that we’ve fielded that you want to add to?
Dr. Carp: Not really. I think that, certainly as was pointed out, if they’ve had some uvula-related issues in the rectoceles, et cetera, it does make it more difficult anatomically.
Charles Runels: Mm-hmm (affirmative) yeah. I think it’s never an embarrassment to turf … I love that we have a gynecologists and a urologists as part of our group. And to those in our group who are not, if they see someone where the anatomy is not what you’re used to seeing, I would feel free to … You know, I’ve referred people to Dr. Posey, she’s about two and a half hours from me. And people that … For example, when the clitoris is phymosed down, that’s not something I should be tackling. And so, I send them her to a gynecologists.
And so I encourage those in our group to look at the others in the group that are close to you, so that we can work together.
Let’s see, there’s another. We’ve covered breast lift, the O-shot, there’s some questions that have accumulated about the priapus shot. Let’s go through some of these. Let’s see, okay.
“I was just wondering, can you freeze PRP and then thaw it later before activator procedure? We did a P-shot today, we used pure spin, which do about 20 CCs, and we used 10 of it, so we had some left over and didn’t want to throw it away.”
I know some of the ophthalmologists are putting in the fridge and using it for eyedrops for dry eyes, and using it for a couple weeks at a time. Maybe the answer to this is yes, but I wouldn’t want PRP that had been frozen … You know there’s enough profit built into our procedure that you could afford to spend a kit later. If you wanted, what I would say instead of this is that, there are those in our group that, when they use a priapus shot are using more material.
The only reason these volumes came about is back when I started doing these procedures, back in early 2010, so eight years ago, a one tube of Selphyl, which is what I was using at the time… so, my cost of goods was pretty high. So it was based on what I could find, the amount that could spread through a penis, and I found 10 was what it took to actually infiltrate the entire corpus cavernosoum of an average-sized man.
But others in our groups are using more, so I would say instead of wasting it, just double the volumes and use the whole 20 CCs if he’s average size or larger, and you should get a result. The only place I would say not do that, between the O-shot and the P-shot, is absolutely do not do that with the anterior vaginal wall because, I know of three cases now where our providers got a little overzealous and had an overflow obstruction. It went away and the person winded up doing well, and good results for their stress incontinence, but they went from stress incontinence to an overflow obstruction to wear a diaper for three or four days because of too much volume.
I think anything more than 4 or 5 CCs in the anterior vaginal wall is probably too much. But in the penis, go for it.
Anybody want to add something to that?
Lichen Sclerosus in the Penis…
Okay, so Dr. Leonardo says, “How do you treat lichen sclerosis on the glands? The video does not address this. Do you perform the same injections with the P-shot or would you micro-needle it?”
You know, Kathleen you’re treating a lot of lichen in the labia and around the clitoris, what’s your … This is just a larger clitoris, right? Or you could say clitoris is a smaller penis. What would you say? How would you answer this?
Kathleen Posey: I would inject it right in the areas of the lichen sclerosis, wherever they may be.
Charles Runels: Yep. I would too. I would feel … In a normal priapus shot, you would just kind of … I imagine the glands of the penis, literally like a sponge, and of course the underside of it that’s connected to it is the corpus spongiosum, so it does behave like a sponge.
But I agree with you, if there’s a sclerotic area that you can see or the patient can feel subjectively and put their finger on. I would go intradermally, as best you can, into the sclerotic area and treat it like you would sclerosis anywhere else.
I think, again, we just put out the first paper, I guess it was a couple years ago, and this last paper in the American Academy of Dermatology in January of this year. It’s not like we have some huge body of literature about the best way to do this. It’s part of the reason I like these calls because there’s smart people in this call, and you guys can help us figure out what the best way is. But that’s my best idea for now.
Anybody have anything else? Okay.
“I have a patient who has IPP. What is the injection recommendations, techniques, for lidocaine? PRP amounts of each … Locations along the shaft and the depth … In addition, has cold syndrome, for numerous reasons …” whatever.
Okay, so there’s a link here that takes you to a recording when it comes to the penile implants. That, when I interviewed Dr. Joe Banno, who’s one of the urologists in our group … And the biggest thing that I would say here is two things.
I would not use the vacuum pump, and I would not try to inject the shaft at all. And I would consider long and hard whether to even do it at all. Because if their implant fractures that night when they have sex, you could be blamed for it.
But if you do this, and Dr. Banno and I would do this, and most of our providers would do this … I would keep it just to the glands, and come in laterally like you do with the regular P-shot with just the bevel going into the carona of the glands. And just infiltrate the glands, and let that be it. Nothing else, or I think it’s too risky.
Anybody want to add anything to that?
Anyway, watch this video for more details. It’s only five minutes but you’ll get it straight from one of the urologists in our group who teaches. By the way, Dr. Banno teaches urologists how to do implants. It is his specialty. And he has told me that he started making the priapus shot as part of his pre-op before he does the implant because he’s getting more rapid healing and better results, as far as that sensation, and not having that cold feeling.
Any other questions? I think that might be the last one that was turned in. I know we’re only 38 minutes in, but I didn’t come here to try to teach anybody anything. I’m just trying to give us a forum. And our intention is to do this every week because the questions accumulate. And that way, someone other than myself can help think about them.
Anybody on the call have anything else to say or question to ask? Because now is the time and I’ll unmute you and we’ll have it out here for people to comment on.
And I’ll post this video, so who knows? Maybe some other people in our group … We’re pushing 2,000 members now in 40-something countries. We’ve got so many specialties and multiple medical schools, lot of smart people just like you guys are. So, maybe we can get other questions or other ideas.
But anybody have any other questions?
Okay, well I’m on stand-by and I hope this was helpful. And I’ll post the video, and we’ll try to do this every week. So if there’s something that comes in between, this will be the place to get it answered.
Honored to help out, and you guys have a good week. Bye-bye.
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