It’s True! The P-Shot® Helps Men with Erectile Dysfunction
News provided by
Cellular Medicine Association
June 14, 2021
FAIRHOPE, AL, June 14, 2021 /PRNewswire/ — Sixty men volunteered to have their penis injected with their own blood by eight urologists from Aristotle University in Greece; the results—a double-blind, randomized, placebo-controlled clinical trial published in the May 2021 issue of the Journal of Sexual Medicine—showed that “Platelet-Rich Plasma (PRP) Improves Erectile Function.” More than two-thirds of the men who had their penis injected were pleased with the improvement in their erection and there were zero complications from the procedure. During the study, the sixty men who participated were not allowed to use any other treatments to improve erections.
Dr. Charles Runels (the inventor of the procedure, which is called the Priapus Shot® or P-Shot®) said, “It’s been a long decade with much resistance, but I’m hoping this new study helps more physicians recognize the potential benefits of the P-Shot® procedure.”
On September 12, 2010, Dr. Charles Runels registered his Priapus Shot® (P-Shot®) with the US Patent and Trademark office—announcing that he had found a way to inject platelet rich plasma into the penis to improve the health and function. Since then, multiple studies have been conducted and have shown benefit; but, adoption by urologists has been slow.
“We needed this study.
We needed this study. I’m a community physician with a small office who just happened to be blessed with the discovery of this therapy more than a decade ago. We have amazing and brilliant providers in multiple universities; but, even they have trouble securing financing for research since the procedure involves the patient’s own blood—there’s no drug, and so there’s no pharmaceutical company to finance the research. If this were a drug, you would see commercials about it on every televised football game—it’s that effective. Until now, surgery and prescription medicines have been the first choice of most urologists and family practitioners; with this procedure, there is not a drug to buy or sell and there’s no surgery. I’m grateful these brilliant physicians from Greece have strengthened the evidence that the P-Shot® should be considered along with the current therapies. Nothing goes away, but this important option should no longer be ignored” said Dr. Runels.
Dr. Runels also invented the Vampire Facelift® in 2010 and used his observations from that procedure to design the P-Shot® procedure and the O-Shot® procedure—all of which use PRP: which is known to improve the circulation, nerve conduction, and collagen production and so to improve the health of tissue in over thirteen thousand research papers in multiple tissue types.
“Though these brilliant researchers helped prove the concept of the P-Shot®, their research protocol had to be kept simple to improve the clarity of the conclusions; their published protocol does not include all of the components of the P-Shot® procedure,” said Dr. Runels
All of those physicians and nurse practitioners who are licensed to perform the P-Shot® procedure (in 55 countries) will be found at PriapusShot.com. Providers not listed there may be performing an inferior procedure or doing the procedure illegally. Dr. Runels and his colleagues of the Cellular Medicine Association, conduct and consult regarding research in the areas of esthetics, erectile dysfunction, urinary incontinence, orgasmic dysfunction, lichen sclerosus, & the treatment of scaring using blood-derived growth factors.
“Please beware, serious problems have happened when patients have undergone what was advertised as one of our procedures (Vampire Facelift®, Vampire Facial®, O-Shot®, or P-Shot®) from unlicensed providers who did not follow the protocols of the CMA,” said Dr. Runels.
Charles Runels, MD
Cellular Medicine Association
251-650-1251 fax DrRunels@Runels.com https://PraipusShot.com
SOURCE Cellular Medicine Association
*Penile Rehabilitation post prostate surgery
*Shock Wave Therapy
*Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout *Peyronie’s disease treatments *Radiofrequency *Priapus Shot® (P-Shot®) *Safety in the Office with COVID *O-Shot® for Urinary Incontinence
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
About two years ago, I was teaching a workshop at my class and a urologist was there, who was head of the department at a prominent hospital/university. And in the process of talking about some of the procedures and some of the ideas in the group, I mentioned Dr. George Ibrahim. And when I did, the response I got was like I was talking about, I don’t know, St. Peter or [inaudible 00:00:51] or something.
So, our guest today, Dr. Ibrahim, has a lot of respect. He was teaching urologist at Duke for quite a time and then opened a private practice. Like all of us, he was in the fire, paid his dues, and then none of us want to stop. And so he’s built up multiple located … I think he has two locations now where he does our procedures and continues to teach for us. But it’s really been interesting to learn from him because the combination of his ideas about urology and combined with his ideas about our procedures have been unique and helpful. So I think without any further delay, let me just pull him onto the call so he can answer some of the questions that have come up and talk about some of the ideas that have occurred to him during his work. So let me just get him on the call right now.
Fine. Hello Charles.
There you are. Yes. Thank you again for being on our call today. Lots of people are on the call. I put out a sort of a teaser, let people know that you would be here. So, quite a crowd today. And a backlog of questions from people about things that I want your opinion about. Just so you guys know, Dr. Ibrahim and I spoke briefly yesterday, but most of the stuff that I’ll be asking, I’ll be as curious as anybody about what his thinking is. We haven’t had an in-depth discussion for a while. So, why don’t we just start off with the list I have here of topics that occurred to you that might be helpful. George teaches for us. And so he’s alert to the problems and the challenges that come when you introduce these procedures to your practice as well as to the science and the discussion that’s going on in the medical literature and among our group.
So, I have this list of potential topics. You can just start wherever you want, and I know everyone will be interested in your ideas. I can list them all for you if you want. The first thing I had here was dyspareunia, if you want to start with that one, because it’s such a hard problem. To me, that’s the worst of the sexual dysfunctions for women because they can fake arousal or even accommodate lovingly without a high sex drive. And an orgasm sometimes is not necessary. Women with pain will start to avoid their lovers. So let’s start with that one since that’s such a tough one
Well, Charles, thank you too so much for your introduction. I do appreciate you give me a chance to be here with you. This is an honor, and I hope we can make everybody’s time worthwhile. So to get straight to your topic, I really think that without addressing a female’s hormonal balance at that time of her age, you’re not going to make much headway. Borrowing a history of breast cancer that’s ER positive, there’s really no reason to not optimize the female’s hormones, everything from the lubrication that it brings to bring it back, the vaginal walls and helping with the tissue paper aspect that you see once a woman goes through menopause. These are the kinds of things that I really think, unless you’re going to be able to do that, you’re going to have a hard time.
I do think that the O-Shot can help, but unless she’s got some [ } on board, and that can be done topically and regionally. It doesn’t have to be done systemically, but I think that’s one of the first thing that at least that’s what I always tell one of these kinds of women that have suffered from this problem.
Yeah. I like to stress to people that so far in spite of several years of campaigning for it, I like to stress to people that it’s really all we’re doing, these [PRP/cellular] procedures, is just making that local tissue healthier, but there’s so many other parts involved in the sexual response from the spinal cord, to the psychology of our thoughts, to the hormonal [inaudible 00:05:24] you that has to do. Without hormones, we can’t even make collagen or have blood flow. Hormones make our heart pump. So, there’s this system, and I’ve been campaigning that we talk in systems analysis the way we talk about a neurological system and a cardiovascular system. And the reproductive system is not the same as the orgasm system or the sexual response system. So, stressing that to our patients so we’re not over promising them a magic shot, but helping them, although it can be like magic sometimes, but helping them understand there’s this whole system we have to think about.
Absolutely. And with testosterone going to zero in almost every one of the menopausal women I see are almost undetectable. There’s no way that there’s going to be any desire or lost. And while you might be able to help with the lubrication, without that mental stimulation or desire, it’s not going to be a fun experience. It might not be painful anymore, but it’s hardly enjoyable from what I hear from my patients.
So talk to us about how you think about, so you first start with optimizing their hormonal status. And there’s so many … The diagnosis, I’m almost regretting now starting with this because the diagnosis of dyspareunia is so complicated. But, maybe a fairly quick overview of how you think about that diagnosis, everything from dryness with breast cancer to surgical problems, so that maybe at least give an outline for the people on the call.
I think that the biggest part of the pain that a woman [inaudible 00:07:06] has and comes to fear when it comes to sex after menopause, is that the vaginal epithelium has become so atrophic. And without a nice beefy, robust, lubricated, thicker vaginal wall, so the vaginal walls, any kind of sex is going to be painful. And that’s where I’m going with it all.
Okay. So when you do your procedure with the O-Shot, because you know you can have the dryness for breast cancer or you can have a pelvic floor tenderness, you can have an episiotomy that’s tearing, not mentioning the things like ovarian cyst and uterine fibroids, but the things that we can address with an O-Shot, can you talk how you might vary the how you do the procedure with a woman who has tenderness that it’s in a particular spot versus just overall dyspareunia from say dryness?
What I’ll typically do, if she is in menopause and she has been away from any kind of estrogen production for a few years, I’ll try to see if she’s against doing systemic hormones to see if she would do around about three to four weeks of topical extra dial. A lot of folks like to use a combination of estriol and estradial. I think estradiol is much more powerful, but I try to get them to do about three to four weeks prior to doing an O-Shot, telling them that it’s going to make, the O-Shot’s ability to repair tissue and strength the things and all the magic that the O-Shot does, a lot more [inaudible 00:08:49] better blood flow in the face of the O-Shot if she can do some estrogen for a while ahead of time. So I’ll try to get you to do that for about a month. And then I’ll go ahead and do the O-Shot.
And oftentimes, especially in women that have been in menopause without being on estrogen, I will oftentimes warn them ahead of time, “Look, we’re going to see some results from one. It might be phenomenal, but don’t hold off on doing a second one within two to three months after the first one to augment the effect of the first one.” Especially, again, if she’s not been doing estrogen.
Okay. So, I know you have an upcoming class and I want to put this in the chat box so you guys will have access to it before I forget to do this. And Dr. Ibrahim, as I mentioned, was a highly respected teacher of surgical procedures. And I’ve seen him teach there in his office. And he’s patient and articulate and cordial and inspiring. So I highly recommend his class if you’re looking for some hands-on work. And he’s squeezed it into one day by leaving out the aesthetics part and focusing really heavily on the sexual medicine for both men and women.
I know this, in your course, you’ll talk some about radio-frequency and laser technologies. And I actually got a question today about Emsella. Maybe just expand upon your ideas about things to do along with when it comes to the machines. Because I know people are either have them or contemplating them. So radio-frequency, laser and magnets, could you talk about how you work those into your protocols?
Absolutely. And before I do that, I’m going to put the plug in for the workshop. It’s going to be March the fourth. We’ll just squeeze everything into one day. Fortunately, I’ve had COVID and my first vaccine, so has my physician’s assistant, and the majority of my staff. But, we’re going to do what we have to do. That all being said, I do use enhancement. Patients are given the option. Some patients only want to get another shot or a Priapus Shot®. Some have heard about some of these other methods. I’m not here to do a commercial for any particular device.
Combining Shock Wave with the P-Shot® Procedure (timing)
I chose a laser over radio-frequency but I’ve seen both of them were great. I just chose not to have two devices that accomplish basically the same thing. So, I use a laser, but I’ve no … It’s done essentially the exact same way as radio frequency. And I use that often when I’m doing my O-Shots. And then with men, even if they don’t want to sign up for an acoustic wave treatment series, are pretty much always we’ll do some acoustic wave treatment just prior to injecting them for their P-Shot because I think that the [inaudible 00:12:04] trauma that we’re producing and increasing the blood flow from that acoustic wave treatment absolutely helps keep the PRP in place and excite the growth factors to do the jobs that we’re hoping that they’re going to do.
That all being said, my staff loves doing these workshops. And we’ve missed it for all the travel restrictions this past year. And so we’re itching to get back in it because they have fun doing it. They love seeing me teach because I know that’s where I used to do it. You may say I’m always my most excited and happiest when I get to teach. And so it’s always a fun event.
Beautiful. Yeah. So if you guys are interested in that, click the link now because the link goes away when the webinar’s over and then you’ll have that page open. So, you will sometimes do a shockwave therapy at least briefly, even if they haven’t asked for it, just prior to a P-Shot. Let’s say that they go for it and they say, “Money’s not an object, I live down the street, Tom’s not a problem,” what would be your Cadillac treatment for a man with, let’s start with Peyronie’s disease, what would be your protocol?
Because here’s the thing, I get the questions all the time. We’re still working on getting enough research out there. We have some. People act like we have none, sometimes our critics. We actually have a pretty good list of papers now over the past five or 10 years, talking about our stuff. I’ll just give you the list for the Priapus Shot. And it’s not a thousand papers, but that’s a pretty impressive, I don’t know, it’s probably 20 papers out there talking about PRP in the penis now. But there isn’t this goal [inaudible 00:13:52]. It’s like if you run a 100 yard dash, you know when the race is over. But the effort to convince our colleagues that PRP is a viable option where it becomes standard of care for every urologist and every family practitioners treating Peyronie’s erectile dysfunction, there’s no discreet line that’s, okay, now we all start to do this.
Combination Therapies for Peyronie’s Disease
So, even more so if you start combining, okay, what’s the best algorithm if you’re going to combine it with shockwave. And there isn’t no published study that says, “This is the best, and this is what the recipe should be.” So when I get those questions, I’m always curious to what your protocol would be for someone with unlimited funds, unlimited time, how would you treat Peyronie’s?
That’s a great question. And I’m thrilled that you told people we all have different recipes for cooking a pound cake, basically. Because the science isn’t out there and I’ll give you my rationale reasoning for doing it. They’re offered the choice off easily. Again, just the Priapus Shot® or the acoustic wave treatment combined with a Priapus Shot®, when they choose the combination, which the vast majority do. Part of that, the reason is we make it much more attractive for them to do it as a package financially. But more importantly, I know that we’re going to see a better end result, have a happier patient. And I’ve said this, especially in my aesthetics practice, nobody is ever upset by spending more than they plan to spend if they get a better result than they thought they were going to get.
And so with that in mind, and just assuming they’re planning on doing both acoustic wave and the Priapus Shot® at the same time, for Peyronie’s, right off the bat, tell them this is not going to be a one and done situation. “Peyronie’s, Mr. Jones, that’s going to be something that we’re looking at. I want you to be scheduled for at least two of the Priapus Shot®.” Again, there’s the financial incentive that it’s not two times one cost. And I will typically start by doing the acoustic wave treatment. And I identified the plaque for our medical assistants who are the ones who deliver the acoustic wave treatments. And they’ve been very, very well-trained because my grasp of the penile anatomy and everything. But I have them concentrate a lot of the acoustic energy on the plaque itself.
And typically, we’ll have them do three acoustic wave treatments in a row. Mostly depending on how far away they live, typically a week apart. And when they come back to their third or their fourth acoustic wave treatment, right after they’ve had the acoustic wave treatment, I’ll do the Priapus Shot®.And just if people are taking notes, men who have acoustic wave treatments do not need to be numbed, but if I’m going to be doing a Priapus Shot®, I’ll go ahead and place my penile block before they do the acoustic wave for one reason, impatient. This guarantees that the guy sat around for at least 20 minutes letting the block sink. Number two, if I missed one of the nerves, they’re able to tell the medical assistant, “My right side of my penis is completely numb but I can still feel it on the left, and she lets me know when I come back in there and augment it.”
So I’ll do the first Priapus Shot® in the middle of the acoustic wave treatment. And then I’ll do the last or the second Priapus Shot® following the same day of the final acoustic wave treatment and then see how they go from there, telling them ahead of time, we’re probably going to have to do some kind of maintenance afterwards, meaning maybe one acoustic wave treatment a month and maybe a Priapus Shot® once or twice a year, depending on how they are or what kind of results that they get from their Peyronie’s. And one more thing before I go much further. This is one of the times where I’m very insistent on the penile pump or the vacuum erection device.
[crosstalk 00:18:10]. That was my question.
Penis Pump Tips
Yes. Okay. We have templates that every patient gets, and it has a video and it has their instructions because they’re going to forget 90% of what you tell them in the office. But the first line of the penile pump instruction is, this is frustrating. You’re going to feel like you need a third hand to hold down your scrotum while you hold the cylinder and the other hand holds the pump. You’re going to figure it out. But I always try to teach them how to use the pump. At the initial conversation, set the time that they show up for their [inaudible 00:18:46] wave treatment and a P-Shot, they have already used the pump. The last thing I want them to do is to go home after a Priapus Shot®, I’m not going to let them do it while they’re still numb. So then the next day they try to do it and if it’s the first time they’ve done it, they’re going to be a little sore. And so it’s much better to teach the guy how to use the pump and become proficient in it before you start your other treatments.
Let me just jump in with a couple of amens here. First of all, I want those of you who haven’t seen this, I want you to see that there is a study from the British Journal of Urology that’s been out now for a decade that shows that people who had scheduled surgery for Peyronie’s disease, 51% of them canceled it with a pump alone. And so you’ve got some science to back that up, but there is some frustration with the pump. And George is the first that I’ve heard come up with a great idea that’s like a lot of great ideas, simple after someone thinks of it, is that oftentimes the complaints people have as side effects from the Priapus Shot, they’re really blaming the side effects of the Priapus Shot on their misunderstanding of the pump. So having them do that for a week or two or some amount of time before they get the shot helps them sort that out and less likely to think that the procedure went wrong. And that’s how you’ve done it for a while, right?
Absolutely. And ever since we started doing this way, the number of callbacks, I don’t like using the word complaints, concerns has dropped dramatically. Because there’s rarely a concern after a Priapus Shot®, but the pump, if they don’t use it correctly, they over … I literally take a black sharpie and mark out a good portion of the dial and say, “There’s no reason to ever go past this line.” You don’t even have to go all the way to this line, but don’t ever go pass it because some guys would think, “Well, if one’s better, then four must be even much better.” And they would overpump and then it would not be good.
Yep. So, another, Dr. Ibrahim, on the call. I’m going to unmute him. He has a question. Actually, I’ve got a pretty good line of questions here. So, let me see, where do you get … Here we go. Dr. Ibrahim, you’re unmuted. If you want to go ahead and just ask your question. I can read it if you don’t have your mic on.
Okay. The only questions I see are links. So I don’t know what kind of question [inaudible 00:21:41].
Well, I can read it to you. I’ll just read it out. It looks like maybe his mic is not working. He just wants to know the ideal candidate for the P-Shot, what medicines are you giving after the shot like you putting on daily Cialis or something, any over-the-counter things you’re doing? I think that’s it. So medicines afterward, over-the-counter things, and what’s your ideal candidate for the procedure?
I don’t mean this flippantly, but I think all of us, we all know if you start with a really good canvas, you’re going to be able to get a nice painting. The ideal candidate is the guy who barely needs half [inaudible 00:22:21], I’m assuming, the P-Shot. Somebody who’s got great vasculature, good blood flow, great neurologic issues going on, they’re not smoking, they’re not overweight. But that’s not reality really, but that’s the ideal candidate, is the one that he’s not up to the performance he was at 22 but he’s still doing a good job. That’s the kind of guy I love seeing walk in the door because that’s going to be the home run.
The much older guy, the 78, six, year old man with history of renal problems, terrible Batchelor disease, diabetes, [inaudible 00:23:01] and all that. As far as over-the-counter stuff, and that is not what I give them, it’s what I tell them not to do. We have another handout telling them no [inaudible 00:23:15] and we list as many as we can because people don’t know that Excedrin is aspirin. And telling them, none of those for a week ahead of time. And for at least a week, if not more, after we do the procedure.
As far as a low dose daily Cialis … Now that the PD5 drugs are generic basically, it’s a lot easier to tell somebody to do it. I typically ask them right off the bat, have they ever tried one of the other or any of them? And a good many will say, “Yeah, I tried Viagra and I couldn’t stand the headache, but Cialis tended to not work as well, but I didn’t have the … I was [inaudible 00:24:02],” or vice versa. And I will write for some [trockies 00:24:08] just because that’s what I got used to back when these drugs were not completely generic and you couldn’t really write for pill form and get away with it. So I do have trockies that have either and/or Cialis or sildenafil in them, that I will tell them, “This could help you with everything that’s going on here.” And the biggest part of that is helping to increase blood flow. And I do tell them, especially in the beginning, it’s not a homework assignment they have to do, or they can tell their wives, “Yeah, it’s a homework [inaudible 00:24:40].” They must do but I wanted to have as many erections as possible after a Priapus Shot® as they can have to stimulate the blood flow.
Yeah. That’s my aftercare instructions too, go home and have sex. Let me just quickly rattle off what I tell people the easy and hard cases and you expand on it, correct it, a different opinion, whatever. This is not a place for everybody just to try to agree. We’re swapping ideas. I tell people, “Avoid the person that a thousand or a million times zero is still zero.” So I tell people, “Avoid treating or at least make it a small percentage of your treatment, so you don’t get to discourage, the person who can they do Viagra or they do TriMix and just nothing happens. They never get in the morning erection, they’ve had diabetes for 20 years because they probably have vascular disease all the way, iliacs to the heart, aorta, whatever. So, and all we’re doing is treating the penis.
Who NOT to Treat with the Priapus Shot® Procedure
Although I have heard people say they get great results with some of these patients, keep them to a minimum so you don’t get discouraged. And if that’s your first three patients with a P-Shot, you’re going to be discouraged. I try to avoid the person whose main goal in life is to grow their penis to some significant amount more than what GOD gave them, because it’s hard to make that person happy. I want the person who has Peyronie’s … The thing is our easy list is still everybody else’s hard list. I want the person who has Peyronie’s because I have a high success rate. I want the guy who had prostate surgery, who’s now been dismissed by the surgeon. Here’s where I really want you to help refine my ideas or correct them or expand them.
I want the guy who’s had prostate surgery, who had erections before the surgery, who’s now been dismissed by the surgeon and he’s not happy with what’s going on. And then add in the P-Shot to the usual penile rehabilitation of a pump and daily Cialis. And I want the guy who’s got an erection, but it ain’t what they used to be, but he’s got something. He takes Viagra. He takes TriMix or he’s trying to avoid getting started on it. And then with that person, I’m going to be able to maybe cut the dose in half. He’s okay if his penis gets a little bigger, but it’s not his main primary goal in life. Expand on that, especially the penile rehabilitation, where would you correct me or expand upon what I just said?
[inaudible 00:27:12] I’m going to start with the first thing you said about … The example I used with my staff, and not necessarily in front of the patient, but they get the idea of why I don’t take that patient home. The patient that walks in and they’re so excited to see me, “I’ve heard so much about you Dr. Ibrahim, nobody’s ever been able to help me with this. I’ve been to so many different dah, dah, dah, and nothing’s ever worked.” And I’m thinking to myself, “And you just met the next doctor that’s probably not going to work [inaudible 00:27:39].” And I’ll listen, but nine times out of 10, it might be somebody I choose not to take or I start from the very beginning with all the, I can give you no guarantees, dah, dah, dah, kind of deal.
The thing about size, I do feel that there’s too many folks that, I don’t want to say members of our club, but I’ve seen too many other providers that offer the Priapus Shot®. And the biggest thing on their website is how we’re going to magically increase the size of your penis instantly. And I let patients know when they’re coming to see me, I go, “You’ll notice I don’t make any mention on my website about increase in size whatsoever.” I go, “We might see an increase in flaccid size. We both know that there can be an increase in both erection and flaccid sizes, but I never use that, is, “That’s why I’m glad you came to see me. I want to help you gain more size.” [crosstalk 00:28:46] If it happens, I tell him, “We’re both going to be excited, but that’s not how I’m going to measure your success. We’re going to the prostate surgery.”
The P-Shot® after Prostate Surgery
Absolutely. I was a big prostate cancer urologist, but that was my forte. And I didn’t do it at the time. But if I was dropped back where I was teaching prostatectomies, men would go home with a penile pump for no other reason, to continue to get more blood flow because they’ll stop having those nocturnal erections a lot of times because of the damage to the nerves. Even when the nerves are spared, it’s going to take some time for them to fully recover. And a lot of times they’ll never recover because as I was taught way back when, when we didn’t do many nerve sparing, that the nerves are part of the prosthetic capsule and nerve sparing is cancer sparing.
So, today, especially with the robot, many more men are left with their neurological function intact. My biggest question I ask them at the beginning is, how has it been since your surgery? And if it’s anything less than six months, I go, “Okay, well, what I’m going to do for you is not going to hurt anything, but you might want to wait and see how you are at six months because you might get all your recovery back.” But the question is, do you get any kind of blood flow when aroused? And if they’re like, “Yeah, but it’s just [inaudible 00:30:19]. It’s not hard enough.” I go, “Okay. All right, good. I can work with that.”
But if the answer is nothing, then I tell them, “Okay, well, I’m going to be able to help you. There’s no question.” And by that, I’m not telling them yet because they don’t want to hear about injections, but I’m thinking in my head, “All right, I’ve always got TriMix in my bag.” But if the [pitch knob 00:30:40] doesn’t work or depending on what other kinds of [inaudible 00:30:46] they might have going on, I might just say, “Let’s just help you out and get right down to the business. And let me show you how to do these injections.”
Yep. Okay. All right. Let’s see. My thing’s blowing up with questions here. I’m just going to look. Let’s see if Sarah’s microphone will work. She’s got three or four questions. If not, I can read the questions to you. Sarah, are you there? Okay. All right. Let me just read her questions. So do you have the patient pump the same day as the shot or have them wait until the next day?
Hey, [inaudible 00:31:25], can you hear me now?
Yeah. Go for it.
Great. So, one is, how much time-
Where are you Sarah? Just got a hell of a snow a little bit.
I’m in Denver. And Dr. Ibrahim and I were in a shockwave treatment or shockwave treatment together. I don’t know if you remember Dr. Ibrahim. Sat next to you. Anywho, my question was, when you do the P-Shots in the middle of your shockwave therapy, how much time after the P-Shot before resuming shockwave treatments. It seems like the protocol has changed over the years.
And I do remember that workshop. So, nice to hear from you again.
So I heard a couple of different questions. One was, sounded like, when do we resume pumping after the P-Shot and then what was the one about … What did you say about the GAINSWave [inaudible 00:32:24]?
Do you have them take any time off after your first P-Shot prior to resuming your shockwave treatments?
Okay, good. I’m glad you asked that. I don’t. So if they’re set up for their acoustic wave every week and I do their acoustic wave treatment on the Wednesday that they’re coming in normally and I do their Priapus Shot® that same Wednesday that they’re scheduled to get both of them, the following Wednesday, a week later, they go ahead and they get their acoustic wave treatment. If it was two days earlier-
Okay. Thank you. [crosstalk 00:33:02] the function of the P-Shot to have that trauma, that soon after huh?
Well, typically because I’m doing the first of the Priapus Shots during the acoustic wave series of 56. That first one, I typically would do right in the middle of the series at number three or four. And then I don’t do the final one until after their last treatment.
Right. Okay. And do you do your shockwave treatment first and then the P-Shot after that on that third session?
Yes. I do the acoustic wave first with my rationale being that [inaudible 00:33:45] what trauma that we might be causing helps the Priapus Shot and its growth factors stay around the area and focus on the parts of the penis that we want to rehab.
Okay. Completely agree. In that same training that we went to in Florida for GAINSWave, at that time, they were saying, wait four to six weeks after that first P-Shot before resuming treatment. But, you don’t think that’s necessary before resuming shockwave treatment.
Correct. And I don’t have any literature to support what I’m saying. And I can’t imagine they’ve got any literature.
I don’t think they do [crosstalk 00:34:26].
I know that the results that I’ve had doing it the way that I described have been fantastic. And have I done hundreds of these doing the protocol that they showed us, I don’t know, it might’ve been just as good. But, I’m not going to mess around with what’s working for me. But, I’m an open mind. If somebody tells me that they have compared such durations and differences, I’m all ears.
Okay. And then regarding the second question about pumping, I [inaudible 00:35:01] Dr. Runels that you generally recommend, I think you would have them pump perhaps immediately after the P-Shot at the appointment and at that same GAINSWave treatment or training, they recommended differing pumping to the next day because of the potential of having some bleeding and that traumatizing the patient. What is your protocol, Dr. Ibrahim?
Okay. So when I learned it, when I was at Fairhope, we were pumping immediately afterwards. I’m doing a penile block on these guys now, so I don’t want them pumping until they’re not numb. Because, like we said, at the very beginning about the pump, one of its problems is the pump causing pain and bruising and issues. And if they’re totally numb, they don’t know what’s going on. I think, especially when I’ve done the acoustic wave prior to doing the Priapus Shot®, that there’s enough trauma now. And let’s just wait till the next day when they’re not numb to resume pumping.
Yeah. Interesting. I used to do the block and have completely for the last year, just continued that. I use a really good topical and the Pro-Knox and they do amazing. But, just throwing that in there.
In fact, I’d love for you to contact me and let me know the source of your topical, because as we all know, it’s not the lidocane or [inaudible 00:36:33] or benzocaine or whatever. It’s the base that makes the biggest difference in a lot of these pharmacies. That base is a closely guarded secret. I’ve got some great ones that work on the [inaudible 00:36:45] because I haven’t found a good one for the penis in your right. You might not have said it, but I’m thinking in my mind, “I’ve done thousands of penile blocks.” And the goal is to get near the nerve, but I’ve hit the nerve enough times to where I’ve caused some residual discomfort from doing the block.
I have too.
But I actually learned the technique from the block from you from one of your videos. And yeah, I’ve gone through many derivations because I do aesthetics as well for topical numbing. And I’ve just within the last year found one that I feel like is a home run. So I’m happy to share that with you. And then my last question is, are you injecting any exosomes versus PRP in the penis?
I am. And that’s a topic that that Dr. Runels and I left off, especially, some of the agenda. I do.
Great. I do as well. So I’d love to chat with you offline about that.
Wait a minute, I will say this out loud. I am a huge fan. A huge fan.
So, Sarah, just so you get an idea of what we’re thinking. There are things like the exosomes and STEM cells and things that I’m most afraid to pronounce out loud. And it has to be thought about in terms of, of course the way Dr. Ibrahim does in terms of where you are and who’s the person and what’s the powers that be is saying, and is there an IRB and all that. And so it’s the kind of thing that I like to keep those conversations less broadcast so that people don’t get the wrong idea and get in trouble by not following the same kind of guidelines that George is following. So, I think the best way to find out his ideas about that is to show up in his class. But I appreciate your questions very much. I’ve got a long list. I’m going to jump to the next person, but thank you for jumping on the call. Okay. Did I lose you?
Nope. Thank you so much.
How to Vary the Injection of P-Shot® When Treating Peyronie’s Disease
All right. All right. So another, I think his mic isn’t working, but we’ve got another question here from Dr. Eric [Byman 00:39:17] who says that he would like to know how … And this is a frequent question. I’m glad you asked this Eric. How do you vary the way you’re injecting your PRP when you do the P-Shot and how you’re doing, I think you touched on briefly, how you’re doing the shockwave when you’re treating Peyronie’s or do you?
Okay. For me, yes. All right. If I was not treating a plaque specifically, I would deliver almost all the PRP along the … Yeah, I do between three to five max sticks on both sides depending on the endowment. And then a little bit in the glands. I think the glanular part of the Priapus Shot is more for sensitivity because obviously the glands does not play any role whatsoever in erections. It does get a little bit more [inaudible 00:40:20] a little bit bigger, but that’s not where the meat is. When it comes to Peyronie’s, I’m going to take maybe a third of the entire amount of PRP that I have. I’ll split what’s left after that third to do this half injections. And then I will directly inject the plaque two to three to four times, depending on its size, directly with the PRP.
Okay. Thank you. So we have another question that I’ve never had before. A lot of these questions … By the way, I’m putting into the chat box the address of someone, let’s see, who is … Dr. Peter Metropolis just gave us the address and phone number for a pharmacy. Thank you, Peter. For someone who has a cream that he’s found to be helpful doing the Priapus Shots. So you guys might want to try that one. The question is, someone got a TriMix … Let me just see if I can unmute the person who asked this, because this is complicated. You may have follow-up questions. Okay. Dr. Lydia Dennis, let me unmute you because this is one I’ve never heard before. Dr. Dennis, there you go. You should be able to speak if your mic is turned on. If not, I can read this.
Okay. I’ll just read the question. Six year old guy with erectile dysfunction, previously on TriMix. I’m not sure what that means. But, was he on it when he came to your office or he stopped when he came to the office, but he was previously got a P-Shot on January the seventh. And two weeks later, says the TriMix no longer works. The penile pain, no pain or bruising after the P-Shot still having spontaneous morning erections. I don’t know how to explain that. My first guess is that maybe he’s overusing the pump and he’s waking up with an erection, but his TriMix isn’t working. I don’t know. Can you think of a way to explain that one?
Okay. I pulled my TriMix out of my refrigerator and I know it was fresh. And I ask him how many units he’s doing at home. If it’s an inordinate amount, I might not start with that. But I’ll then inject it myself [crosstalk 00:43:03]. Because they say they inject and gosh knows, are they doing it right, where are they doing it, and has that TriMix been sitting out for how long, how old is it? Always, that’s part of another handout that we have, letting people know that TriMix begins to lose its power both with time and temperature. So you might’ve kept it cold but if it’s four months old, it’s not going to be nearly as potent as it was today. You opened the bottle the first time. If it lays out on the counter for three hours, same thing. It’s not going to be nearly as potent as when you pull it straight out of the refrigerator. So, before I believe that it’s not working, I’m going to try it myself. [inaudible 00:43:48]
All right. So, I’m not sure Dr. Dennis’ mic is not working. So, hopefully that’s helpful and seems to make sense to me. When someone tells me for example that PRP cause damage, it’s like saying you suffocated on oxygen because PRP causes tissue to become healthier. So it doesn’t mean it’s not happening, it just means there’s something else going on that has to be figured out. It’s not likely the PRP has actually damaged something.
Yeah. It’s like the people who tell you they’re allergic to Benadryl or epinephrin. Okay. Well, we all know what’s happening there. You’re getting sleepy. Benadryl or epinephrin, your heart’s racing, but they’re not allergic to it. If somebody is blaming the P-Shot, well, it’s also the person that was having problems to begin with, but now you get to be the crutch and he can blame you for it rather than himself for his inability. And I’ll tell the person, “I’m doing the best I can. I know where I’m putting things. I get to teach other physicians. I’ve been doing this as urologist for forever, but I’ll be glad to give you a list of folks that do a similar procedure that I do. And they may be able to help because I don’t know if I can.” Because at the end of the day, we all know you can’t help everybody, especially if they’re looking for a reason for something not to work.
So, I have enough left on your outline to keep us busy for many hours. I’m going to try to get through as much of it as it can. And again, I’m always grateful to pick your brain on the ratio of knowledge and experience to cordial and easygoing with you is out the roof than nobody else maybe that I’ve worked with. So I always enjoy picking your brain. All right. So next on our list is … But, if there’s something you feel like you want to jump in, go for it because I don’t want to structure it so much. You don’t have a chance to just run. We have experienced people on the call, but we also have quite a number that are new.
So if you have any quick tips, maybe we could jump to that now. With the COVID things going on, your ability to continue to make a living, it’s really interesting. I’ll get some people that are in the group that are just prospering like crazy, more than ever, truly. And then others that are dropping out. Literally, it breaks my heart going broke and closing their office. And it just breaks my heart because think about the irony of that; a doctor closing their office because people are getting sick. That’s something wrong when that happens, but it’s happening. And so help us talk to that person. How can you continue to do business and prosper, even though people were getting sick? What an ironic question, but help us out with that.
That’s great. And this should be brought up for folks who aren’t doing some of these things. Part one, when patients start to cancel an appointment or want to reschedule because they’re worried about COVID, staff, they have been very well trained by my office manager on, “Mrs. Jones, please, this is going to be one of the safest places you can be.” First of all, everybody in the office is used to washing their hands before they see anybody. Wearing masks and gloves is part of what we do day in and day out. That’s before COVID ever hit and we had to worry about PPE. We already had it all.
Number two, you’re not going to be in a waiting room with other folks. In fact, you won’t wait at all. And you’re going to pull up into the parking lot. You’re going to give us a phone call. And then one of my staff will check them in over the phone, make sure that we have a current payment, credit card, usually. They will actually even run the credit card for the anticipated, what the visit is going to be for telling them that there might be an adjustment depending on what we end up doing up there so that they’re not going to have to sit around. Their followup is going to be scheduled either before they’re ever seen, or once they go back to their car. They’re on the phone, again, with the MA. So the contact that they’re having with us face to face …
Because there was a time in North Carolina when I was limited to, I can’t remember if it was six minutes or something that I could be in the room at one time. And patients began to love it. They would walk in. They walk straight back to the room. They’d get on the table. I’d say hello to them. This was not for brand new patients. Brand new patients is a different story, but these are people who we’ve already had a relationship with. And we just get right down to business. And I’d apologize for not being able to spend more time with them, but the new rules made it. So I had a bit of time I could be in the room.
Now things are relaxed and we can spend a lot more time, but a lot of patients began to love it. So, we continue now to check our patients in and out before they ever get either up in the office or they come in, they’ve already been checked in and then they go back to their car and we finished the checkout without them sitting in a room, without other people hearing about their business. The privacy aspect’s been a lot better. So, we’ve done very well. We had two months. It was horrible and I was worried about who’s going to … I’d have to let go. And I’m happy to say nobody was let go. The new method has been a phenomenal forced change that we’ve had to do and it’s come over very well amongst our patients.
Thank you for that detailed explanation, because it really breaks my heart to see doctors going out of business because we have more sick people. And I’ve put up here something that makes sense, but I want people to know there have research to back up what makes sense. So here we have published. You can see this was in the January 1st issue of what you would expect. People who are stuck at home are getting depressed and there’s been multiple research papers out about that. They’re getting depressed, there’s more abuse, there’s more substance abuse and physical abuse and child abuse, but the people that are having sex are doing better.
And I’ll put this up here because, especially in the beginning of COVID, but it continues to this day, people are almost embarrassed about talking about the fact that we take care of sexual problems as if somehow that become unneeded because people are sick with a virus. It seems to me it’s more needed than ever. We need comfort. We need love when things are tough and we’re the people that help make that happen. So can you expandable, have you seen some of that or what’s your idea about … My point is nobody needs to make an excuse about going to work and talking about sex, even though people are dying.
You know what, I’d never would’ve thought to bring that up, but you’re absolutely right. Just to carry out that in, on the aesthetic side, now that everybody’s doing Zoom meetings and they’ve got 4k and high-def cameras looking at their face from two feet away, anything and everything above the nose, people who are doing that have never done it. Because the other is what you just said about the sex part, with so many families that have both spouses working, but now they’re both working from home and they found themselves in an environment where sex is okay at two o’clock in the afternoon, they want to do it. And a lot of couples coming in together. In fact, I’ve never had more couples at one time. Usually it’s one of the partners, almost always the female, that gets started and then the other one comes in after the fact. But I’m seeing more and more new patients enter as couples to optimize their sexual intimacy together because they’re spending so much more time together. And yeah, that is something that I would not have thought to bring up, but I see it a lot now.
So we only have seven minutes left. Thank you for hanging with us for the whole hour. I got two questions that have been sent to me. Well, first of all, this is something I know that you’ve had a lot of experience with surgically before there was ever an O-Shot. So talk to us about in seven minutes, your ideas about the O-Shot, where it comes into the treatment for stress and urgent continents. And then last, have you had any thoughts about the new magnet Emsella treatment?
Treating Stress Incontinence and How the O-Shot® Procedure Integrates with Mid-Urethral Slings
So let’s talk about the incontinence. First of all, you see the literature that talks about 51% of women over the age of, just making up, 40 something report incontinence. And whenever I give talks, I go, “That’s the biggest wrong number in the world.” If a woman has gone through menopause or she’s ever, let’s say 50, and she’s had one or more vaginal deliveries, they’re incontinent. But they’re all used to it. Their mother wear her pants when she caught the sneeze. Their best friend wears her pants when she’s jumping rope. And so, so many women don’t even complain about, “I have this today.” Healthy as hell, thin, fit, 50 year old woman, three vaginal deliveries. It’s on our form. I don’t care if you’re coming in for Botox. It’s one of the questions on the form. Do you leak when you cough, sneeze, laugh, job, et cetera, then in parentheses stress, urinary incontinence?
And she didn’t even think to mark it, but I looked at her history and her age and I just couldn’t conceive up. And sure enough, she says, “Oh yeah, whenever I do jump rope, which is like three to four times a week, I’m always leaking.” And I go, “Well, let’s talk about what we can do.” And so it’s far more common and I advise everybody to make sure it’s on your list of questions, because if you’re going to be part of your club and you’ve learned how to do the O-Shot, then I will address their incontinence at every single visit until they tell me either, I don’t want to hear you talk to me about my incontinence again, Dr. Ibrahim, or they go ahead and [crosstalk 00:54:34].
And [inaudible 00:54:34] is, is I have done enough slings, enough mesh, enough tax in my career. And [inaudible 00:54:42]. They were horrendous and they had brought with issues. If I had had the O-Shot when I was in residency, I would have done a third of the female vaginal incontinence procedures that I did as a resident. One-third. It would have knocked out probably at least half, if not two thirds, of the cases that I had done. Because so many women are completely dry after one or two O-Shots. Every one so far has been dramatically improved if not, parentheses, cured. And again, I thought of how long is that going to last? I don’t know. I don’t have that crystal ball. Some, they’ve never had to come back and some come back once a year and some in between. So-
The other surgeons in our group will tell me that even if the woman chooses to go straight to a sling, they’re usually still almost always grateful that they were offered a non-surgical solution first. Because there’s this urban feeling that surgeons want to cut, but actually surgeons want to get people well. And sometimes that means surgery, but there seems to be an appreciation for a surgeon that has something other than a scalpel in their bag. And then if they choose to go straight to the swing, they’re happy that they were offered something else. And so I’m glad to hear you supporting that idea. And you’ve seen it even work with urgent continence. I’ve heard that, but it’s interesting that you’ve seen it as well.
So when somebody comes in, they might stress incontinence stress, even though we’d give them the examples. And I find out that it’s urge. You’re itching to go. You’re back of the cold section of the grocery store, and you’re looking for the bathroom and, “I got to go, I got to go.” And you wait yourself before you can get there. That’s urge incontinence. I’ve had some women say, “Look, I’ve had a friend. She had urge incontinence. You told her ahead of time. Look, I can’t promise you anything for urge.” I go, “But it’s not going to hurt it. And if anything, it might make sex better.” And if it helps her incontinence, both of us are going to be thrilled to pieces and damned if it didn’t help her incontinence. And so I can give you the anatomic reasons why stress incontinence is held by the other shot, but I have no idea how urge it is. And I’m not talking about the incontinence. I’m talking about the urgency, the neurologic feeling in the head and the bladder that have to go. It helps with that. And I have no idea how come.
Yeah. I’ve got some, as I’m sure you do, some theories about that, but we’ll save that for the … I’m telling you guys, every time I’m in the room or on the phone with this man, I learn a lot. He’s innovative, but he knows the science as well as anybody on the planet. So if you’re looking for a hands-on class, I can’t tell you, you just need to go see him. So last thing and then we’ll close it down. What’s your ideas about the magnet that’s being used to help incontinence?
To be very quick and short about it, of course I download it and I do not own one.
Okay. All right. So guys, I think that we better shut it down. And lots of people are busy and I’m always honored. Everybody’s busy. So I’m honored that you made the call, honored that Dr. Ibrahim made time for us, and I’ll make sure this recording is posted somewhere soon. You should get an email automatically, but if you don’t just look forward on the membership site soon for the video and the transcript. Thank you for being on the call Dr. Ibrahim. I’m always grateful to you.
Thank you so much, Charles. I do appreciate your kind words and I appreciate your comments on the workshop.
Dr. Ibrahim is Western North Carolina’s only physician certified by the American Academy of Anti-Aging Medicine. He has been specifically trained in the use of bio-identical hormones, having passed both written and oral exams. A former Duke University Clinical Professor of Urology, Dr. Ibrahim’s experience with hormonal balancing goes back decades.
George Ibrahim, MD is a well known, board-certified urologist who has been professor at Duke University.
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… Support@CellularMedicineAssociation.org
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.
Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
Charles Runels: I’m doing this broadcast from Las Vegas today. There’s an [A4M 00:00:12] meeting and I was trying to make sure I’m up to date on a few things. I bumped into one of the authors of this textbook.
I’ll try to let you guys know what I’m doing to try to keep up with our area of interest. I found … One of the authors who’s a Pharm D [Angela Pressman, PhD], wrote a chapter of this book and she alerted me to it. I haven’t read it yet, but I bought it and I’ll let you know, but it looks like it could be relevant to what we do.
Charles Runels: Yeah, so I just want to brag on you a little bit. I know this … I’m getting a lot of inquiries about lichen and some of it, non-surgeons are qualified to treat and some you refer instances like this. Maybe you can address what to look for, and how to take care of people, and not get into trouble. Your latest … I know that where you’ve been working for this protocol now for … Of course, you working on the surgical side and me taking notes on the PRP side, and doing the … Well, we published two papers with Andrew Goldstein and we published this so you talk about what you’re seeing and what your latest thoughts are of treating lichen if you don’t mind.
Kathleen: Okay, what I see a lot or hear a lot is the patients come in and tell me they are having painful intercourse, and they either bleed, or they tear, and or their ability to have an orgasm has really decreased. Usually, by that time, they have pretty advanced lichen. I do my exam, but they haven’t had a biopsy. I do biopsy everybody. Then I give them the offer. I offer them the option of doing the O-shot along with other PRP after I release the adhesion at the …
The main adhesions that are stopping them from having intercourse are down at the [inaudible 00:03:27]. It’s a band that forms there and there’s a lot of hesions between the vagina and the rectum. The clit, the formosis of the clitoris, I find, decreases the sensitivity and some have pain, but some have no pain. It’s more that they want to look normal and feel like a woman again, and they think their clitoris has gone away, which, of course, it hasn’t. It’s just covered over by scar tissue.
With these patients, I start off releasing the various adhesions. Especially like this lady in the picture, you couldn’t even get … You couldn’t even do an O-shot right from the start because her vagina’s about the size of a pinball and you can get in there, and you can’t really get too much by her clitoris. I will release all the adhesions. By the time she left, I was able to do an O-shot, but where I also put the PRP is anywhere I’ve done surgery. Then I really infiltrate about 3 cc’s down to the post [inaudible 00:04:29]. I’ve also taken a 15 blade knife many times and gone up and down making slits and then spreading it so that they’re wider in the posterior part of the vagina, and the put the PRP on top of that.
About half the time it takes two applications. The second one I do six or eight weeks later. I’ve been doing this now for four years. This lady’s pretty bad, but I saw her about a month ago and she’s got more adhesions about the clitoris. I just … At first, this one, she couldn’t even urinate correctly. I had to release some more … She’s still able to have intercourse not hurting and not … I treat her about once a year, now, that lady. There are some ladies … Go to the last picture.
Charles Runels: This one?
Kathleen: No, go to the last picture. Keep going. Another one.
Charles Runels: That one?
Chapter 15 (O-Shot®) Chapters 16 & 17 about radiofrequency and laser
Kathleen: Okay, this one. Yeah. Okay, that is the same one. This lady is not so complicated, but it still is hard. That clitoris is really bound down. When I first saw this lady, I was really afraid I’m going to have to take her to surgery, I’m not going to be able to do this, but this lady, I was able to unroof her [inaudible 00:06:04] and then you see what I’m talking about in the post [inaudible 00:06:08] is that band there?
Charles Runels: Yes.
Kathleen: You see that, Charles? That band?
Charles Runels: Yes.
Kathleen: You’ve got to release the band. Show that previous picture. Yeah, no the next picture where she’s treated. Where she looks normal, that’s it. See, she’s pretty … She came back … Can’t remember this, but I’m thinking one of the worse … I think it was six months later, I only treated her one time. Yeah, it was treated one time and she said, “I just put a white … Walk around where my index finger is, will you please retreat me?” She was having no pain, you’re unable to have intercourse where that first picture she was having a lot of pain.
I think that I’d be willing to train anybody who has some surgical procedure. This one, probably anybody that could do surgery, some surgery, can do. Those other ones, I don’t know. I think you’d probably have to be a gynecologist or urologist to really feel comfortable because you can get into some bleeding.
Then there’s the other patients that really … I had patients that have no scarring about the clitoris and just have that little band. I think you could treat that too. This lady-
Charles Runels: Yeah.
Kathleen: That to that, to that.
Charles Runels: Let me catch up with you in a bit. Let me just come in on a couple things that you say. I have seen now probably a half a dozen women and some of them in the classes I was teaching had a complaint was decreased ability to orgasm. No one had diagnosed the fact that you couldn’t get to their clitoris. They weren’t this to this degree, or just basically all scar tissue, but still there was enough phimosis … It couldn’t really get to the clitoris.
I saw a study presented at one of the meeting where someone actually documented … We say it doesn’t effect the clitoris, but there’s actually a study documenting that, that with lichen sclerosis it effects the hood and the clitoris is spared so as you said, I think the clitoris is gone if they’re lucky enough to be diagnosed which they often are not. If you have someone who complains of decreased ability to orgasm and you cannot expose the clitoris, even if it’s not lichen they probably should see someone whose … There are other causes for that and someone should look at them.
I think … Because you said, I think probably most people could learn to lis that, but they don’t want to because there’s something wrong. In my opinion, you would be a … You would have trouble explaining yourself unless you’re in some sort of surgical specialty. I think it’s better sent to one of our people.
The other thing I wanted to emphasize about what you said was that … As far as the biopsy goes, I don’t think that everyone in our group needs to be doing a biopsy, but not, like I said, difficult, but they may not want to do it. They just need to make sure someone’s had it done recently and actually treating the person. They should be sent back for follow up with whoever’s doing the biopsy. There’s a 10% chance [inaudible 00:09:36] carcinoma. We think …
Andrew Goldstein, I talked about this recently. We’re hopeful that because we’re showing decreased inflammation, that the chance of cancer is being decreased, but, which it is not using clobetasol. The cancer rate does not go down, but we’re hoping that our PRP decreases that rate.
Charles Runels: Anyway, I just wanted to kind of emphasize those things. Any other pearls about lichen? You’re bringing them back at six weeks and retreating, right? Is that what you’re still doing?
Kathleen: Most of the time, the last patient it’s about 50 50. Can you hear me? Can you hear me?
Charles Runels: Yes.
Charles Runels: I can. I can hear you.
Kathleen: The last patient, yeah I had only treated once and I thought that was a six month later picture. They’re running about 50 50. Let me go, there’s another picture, a couple other pictures in a camera of the one more.
Kathleen: Yeah, there are some people that don’t need a retreatment or they don’t need a retreatment at six weeks. They may need another one at six to 12 months. They’ll call you and say, “I’m having itching.” I’m from out of town. She’ll call up I’m having itching. When I went there, she had found a loner. You just got to exam and look and see what’s going on.
Charles Runels: Yeah. Okay.
Kathleen: There’s another picture, a previous picture.
Charles Runels: This one? This one?
Kathleen: No. No. Yes. It was that. No, you passed it. The one that had all the white on it.
Charles Runels: This one?
Kathleen: Yes. Yes. Can you hear me?
Charles Runels: What point do you want to make about this one?
Kathleen: What I wanted to say about this one is this lady, with a friend of mine had actually had a [inaudible 00:12:03], had posterior [inaudible 00:12:05] removed, painful intercourse. This is what I want to keep pointing out, that the pain is there. It didn’t help it. She comes in, and I was able to unroof her clit in the second picture, do the O-Shot, do PRP and got her. Then, three weeks later she had pain free intercourse. That after picture is three weeks later.
Charles Runels: Yeah, I think we should emphasize because we haven’t said it already, this lady had seven years without sexual intercourse, seven years since her husband had been able to have a penis and vagina intercourse when you treated her.
Charles Runels: Oh was it 12 years. Yeah, even though she was being seen by a dermatologist. These are extremely dramatic, life changing things that are going on in your office. I think part of the take home message is just knowing what to look for, whether you’re going to treat it or not, and if you see [inaudible 00:13:16] like this, to send it to one of the gynecologists in our group who knows how to do this, and I want to reshow everybody what you can do to let people know that you’re treating, willing to look at people with lichen because they’re eager to be treated.
If you click on buyer and provider, I have icons set up and so there’s a legend at the top, and there’s an icon for if you’re using radio frequency. There’s an icon for laser, an icon for if you treat lichen, and an icon for if you’re participating in our research. I’m not sure why it’s so slow to load. Hospital, excuse me, I’m on this hotel internet, so it’s moving kind of slow. Anyway, if you want to treat lichen, then please send me an email or just call our office and let us know, and we’ll put that little icon by your name. Let’s see what else.
Kathleen: Charles, I’d like to-
Charles Runels: The other thing while I was on the subject. Go ahead.
Kathleen: Oh okay. I’d like to add one thing. I see a lot of people from out of town, and I’m having a lady, I can’t remember where she’s coming from. I think she’s somewhere in Florida, but I would like to treat her the first time and get rid of all her Adhesions, treat her, and then probably send her to somebody closer to home that can do it. I know I’ve seen her pictures. I know she’s going to have to be treated at six and eight weeks, six or eight weeks, and then if I find the people that are interested, I’ll send those people back to people that can handle them after the Adhesions have been taken care of.
Charles Runels: Yeah, that’s a good thought. I hadn’t thought about how it goes both ways. Yes, there’s actually one of our providers, I think in Oklahoma that sent some one down to New Orleans to see you. She was bragging about how much better she got but then the provider in Oklahoma was following it with a repeat treatment.
Here’s the little legend I have. We put this cartoon of a red labia and so if you want that by your name, just let me know so there it is. Any client, there’s yours. People are looking for that. Let us know and I’ll stick that by your name.
Easy Vs. Difficult Cases to Treat with the O-Shot® Procedure
I wanted to just list out while I’m at it and talking about the O-Shot, what I would consider to be the easy things that we treat versus the more difficult. I get a lot of questions about follow up and when do you retreat or not retreat and that sort of thing, so just wanted to recover that. Here’s our easy one. Nothing is 100% but these are the ones I think where over 80% of the time either after the first shot or the second one, you’re going to have an extremely happy patient. Maybe over 90% of the time in some cases, would be [inaudible 00:16:47], decrease orgasm, and someone who’s already able to have an orgasm. This would be the lady, she can have one but it’s not like what it used to be. Decreased orgasm but can have orgasm.
Then, it would be urinary incontinence and someone where things are intact, where bladder’s not falling out into the room. Even urgent continence, we’re seeing some great results. It’s usually a mixed bag for both, but then [inaudible 00:17:43]. I know that’s a basket diagnosis, but I mean even in the ones where it’s uncertain ideology, that doesn’t mean we don’t try to work it up. The person who’s had a work up and no one’s really sure what’s causing it and they’re still hurting, that for some reason that person seems to do well with us often. The one with pelvic floor tenderness, trying [inaudible 00:18:19] injection, you inject a trigger point with PRP so pelvic floor tenderness for mesh pain. I know you’ve got some ideas about that. I’ll let you talk about that in a second.
Mesh pain and the more difficult ones, the ones where if you’re new, I wouldn’t even try these people for the first two or three months, you don’t get discouraged, I treat these people but I think in these cases our success rate is maybe closer to 50% and maybe even less, 40% depending on the person’s age and other factors. It would be never had an orgasm in their life. I think those ladies are a little more difficult to treat. A person who wants to have penis and vagina orgasm. They can have one from a vibrator, but they can’t have one with sexual intercourse. Of course, we don’t have control of the penis of that equation. Both of these two ladies, we have successes, quite a few successes, but I think that our success rate on these ladies is probably less than 80%.
Can you comment some on this mesh pain? Are you still there Kathleen?
Kathleen: Just, yeah I’m still here. Can you hear me? Hello?
Charles Runels: Yes, very well. I can hear you.
Kathleen: I’ve done it when they had perianal pain from the nerve endings around the rectum, and I’ve just injected it all around the rectum. I’ve just injected it all around the rectum and it seems to work real well. Isn’t the doctor in Europe – [crosstalk 00:20:12] yeah, isn’t she putting PRP around the pudendal nerve to ultra sound for mesh people. The lady from Spain.
Charles Runels: I heard a couple people talking about doing an old school pudendal nerve block. There was one study where the mesh was taken out and then infiltrated the field with PRP, but no one has done the study yet, showing our procedure helps it. Although, we’re seeing that even injecting the anterior vaginal wall where the mesh is. You’ve has some experience with how the mesh becomes wrapped around the pudendal nerve or something; can you talk about that? [crosstalk 00:21:00] Or something you read in –
Kathleen: One of my patients is a general surgeon at [inaudible 00:21:13] and there was an autopsy on a mesh patient, and the mesh was all entrapped with the pudendal nerve when they did the autopsy. But, even taking it out, it just has to come out in pieces. It’s so difficult. From my understanding, from that pain, injecting PRP around the … I wouldn’t do it. There are some people, that I think, do it. In Europe.
Charles Runels: [crosstalk 00:21:45] When you do it, is there some worry about injecting?
Kathleen: Yeah, just the anatomy. There’s too much you can screw up. I just don’t have the experience with ultrasound and looking around the vessels where the pudendal nerve is there.
Charles Runels: When we do pudendal nerve blocks … We did those in labor and delivery years ago. I’m hearing that just that will calm it down. Is there something about that that makes you nervous? I would have thought that was a pretty safe thing to do.
Kathleen: I think that’s safe. I’ve just done most of my deliveries with epidurals and not pudendal nerve blocks. No, I think that would be safe.
Charles Runels: Okay.
Kathleen: I would like to see what they’re doing [crosstalk 00:22:40].
Charles Runels: While I’m at it, I’ll make the list for the P-Shot® … What? I’m sorry what did you say?
Kathleen: I didn’t say anything. Nothing. I didn’t say anything.
Charles Runels: Oh, okay.
Easy vs. Difficult Problems to Treat with the P-Shot® Procedure
So, while I’m at it, I thought I’d do a list to the easy wins for the P-Shot®. So that would be decreased erection … And a reason for making this list, again, is all of us want to take care of people and not just take their money and make them well. When I don’t get someone well I give them their money back. I try to mostly take care of people I think I can get well. If you’re mostly taking care of the hard cases, I’m losing money. I recommend that you mostly take care of the easy wins, especially in the beginning, so that you don’t become discouraged.
I’ve seen a couple of our providers, just right out of the box, try the really hard cases. If the first two O-Shot®s you do are in women who’ve never had an orgasm in their life, and they don’t work, you lose confidence in the procedure. So stick to the ones that we know have a high percentage of success.
For the Priapus shot, we have decreased erection, but can still get an erection. In other words, on that erection scale from 5 to 25, they’re above 10, at least somewhere in that neighborhood. They’ll bump up about seven on that scale from your shot.
Peyronie’s disease. The interesting thing is, our easy win is most other physician’s hard win, so you still can be a hero and do wonderful things for people if you stick to the easy stuff.
[inaudible 00:24:35] Closed prostate surgery to help with recovery, but it’s in the person who could get an erection prior to surgery, of course. You do the whole protocol, and that’s on our Priapus shot website. Where you include both for Peyronie’s and the prostate surgery, including the pump and maybe even low dose Cialis as part of the protocol.
Again, lichen, we’re going to get lichen too. Lichen sclerosus, not planus … Although, I think you treated some lichen planus didn’t you? Kathleen?
Kathleen: Yes. Yes.
Charles Runels: [crosstalk 00:25:26] We had that anecdotal initially; I should put this up here. I treated a woman with extremely severe scleroderma, and they can have horrible problems with intercourse. It was a life changing thing for her with one procedure. Lichen sclerosis in men is an easy win.
The hard wins for men, I think, if their main reason for getting the shot is for penis growth … Although, sometimes that can be very rewarding. It can be frustrating, often times, in the men who has the most urgency about growing. So the men who has the three inch erection responds, in my experience, less dramatically than the guy with the six or seven inch erection or a five inch erection.
It’s a percentage of growth than the absolute. So if there is 10% growth on the smaller penis, it’s less noticeable results. Then the person who has long standing diabetes or whatever cause of erectile dysfunction, basically he has no response at all. [inaudible 00:26:55] There’s no response at all to Viagra or TriMix, and that person who probably has some vascular disease proximal to the penis is not likely to get well.
Those are my easy wins and hard wins for the Priapus shot and want to stick to these easy wins in the beginning.
Anything you’d add to that, Kathleen?
Kathleen: Nope. I think you got it.
Charles Runels: Okay.
How to do your own webinars to educate your patients…
I always like to cover something with marketing too. Let’s see if I have any new questions from the [inaudible 00:27:32]. There weren’t that many on the websites on this time around. Let’s see. I don’t see any coming through.
I think there is something meant to be noticed about, as far as the marketing goes, what I’m doing right now. This is a wonderful way to create interest before I was part of this amazing group of physicians. I would do webinars, just like this, for patients.
Back in the day, before I started doing the internet, it wasn’t webinars. It was a conference call. I would record the call and put that on the website. So, if you, as a marketing idea, the best marketing is to teach people how to be well. If you put out an email to your patient, whatever it is you want to talk about … Maybe it is dyspareunia or erectile dysfunction, or urinary incontinence, or something that we’re not even talking about here; maybe it’s something to do with the way you do Botox. If you want to do a webinar like this, the software is very simple to do both setting this up, as well as recording it. Then you have something that can go on your website and play, and play, and play.
I thought I would show you guys where I do this. I know you have to log in to go webinar.com to get here. This is the software … GoToMeeting.com or GoToWebinar.com and they have plans that are not that expensive. Then, you send out an email to your people, you schedule it … and what you’ll find is, that even if just one person shows up, that the content you deliver is on a different level than if you sat down and just said “okay, I’m just going to record an audio or a video about urinary incontinence.”
Then when you’re done, you have the video and you can tell your webmaster to put that on your webpage somewhere. It looks like this. Most of you guys have seen this, but when I do these webinars, I put the recording either on the membership site or I put on our Cellular Medicine Association website. It just sits there to play.
This is probably the best advice I can give you about marketing to your patients. If you teach people about the disease and how to get well, then they will trust you to take care of their disease. If you go through the trouble to teach them how to be well, then they’re much more likely to trust you to take care of them.
So, the short version: teach people about the disease and they will trust you to take care of their disease.
It’s really an amazing time that we live in that we can just, almost no money, wherever you are on the planet, you can just sit down and have a conversation like this with your patients. Then when you’re done, you have a video that you can play for them perpetually on your website.
I think that’s all I have for today, unless you guys have other questions. I’ll put the transcript for this up within the next 24-hours and a link to the book that I recommended, and I’m always honored that you’re here.
Thank you for the help, Kathleen.
Kathleen: Thank you too.
Charles Runels: Alright, you guys have a good day. Bye.
Charles Runels: 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.