Topics Discussed Include the Following…
*Vampire Facial® techniques reviewed in Facial Plastic Surgery Clinics of North America, August 2019
*When to activate PRP with Calcium (chloride or gluconate)
*Tear Troughs & Bags Under the Eyes
*PRP with or without Amnion in the Neck
*Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
*Selecting the Best Patients for the O-Shot® Procedure
*Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
*2 Guiding Principles That Bring More Patients and Provide Better Care
*Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
*Pelvic Floor Spasm
*A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Vampire Facial® Procedure in Facial Plastic Surgery Clinics of North America
Dr. Runels: This should be a really wonderful meeting tonight. We’ve got new research, and we have the amazing Dr. Edward Tangchitnob who is out in California, award winning for his practice, and brilliant gynecologist, and surgeon, and teacher of our procedure. This should be an interesting call. We have some new research I want to just bring up very quickly. First, let me bring Dr. Edward onto the call. Let’s see, hold on just a second. I’m going to unmute you here. There’s a couple of research things that are out that I think are really nice. Hold on just a second. Let’s see.
Edward, I’m not sure what’s going on with your mic. I don’t know if you will need to call. It looks like your audio might be turned off or something. Let me go ahead and bring up the research and as soon as I see your mic light up I’ll unmute you. Let’s see if there is something here. Anyway, so I’ll be watching for that. I can see Dr. Tangchitnob on the call but I don’t … Okay, there it is. There’s your microphone. Here we go. Beautiful. There you are. Can you hear me.
Dr. Edward T: I can.
Dr. Runels: Beautiful. Look at this. Just a review article but it came out in here it is, in Facial Plastic Surgery Clinics of North America, August 2019. I don’t think you could see a better endorsement. I mean, there’s the abstract. “Platelet rich plasma has gained popularity in facial plastic surgery because of it’s healing and growth factors.” But then this is the part I love, “One of the most popular uses facial skin rejuvenation in the form of injections and topical application during microneedling …” That would be in for a facelift and facial, “… and the promising nature makes using it for injection or conjunction with microneedling a good addition.” Beautiful. That sounds like a pretty strong endorsement in that journal, or in that periodical. This is the article I wanted you, and I put a link to that. Actually, I didn’t yet, but let me put a link to that into the chat box, you guys.
Using Scientific Research to Educate and Market To Your Patients
That’s a good one to take … If you just take this link ( https://www.sciencedirect.com/science/article/abs/pii/S1064740619300331?via%3Dihub) and you put it in an email or a Facebook post and you shoot that out to your people and say, “Hey, here’s some research that came out this month.” Here’s a little trick about … It’s just commonsense, actually, for how to talk with your patients, is make, when you have this this counts as news. We’ve all heard on CNN or whatever news channel you listen to where they talk about something, they usually report it out of the New England Journal, because the guy on the street knows that’s a reputable journal. But, often it’s the news reporting on the news. This is news, and you could call up your news channel and say, “This is what I do.” You could also just post this to your social media, or an email to your people and say, “Hey, look what came out this month, more nod of approval from the the powers that be, that this is something that’s useful, and this is what I do.”
I want to shoot over … Any comments about how you’ve been doing that, Edward? I know you’ve had some success with your marketing. Talk to us about how you’ve done things like this.
Dr. Edward T: I think that there’s a lot of information out there at the fingertips of all the patients. They’re getting bombarded constantly from their Twitter feeds, their Instagrams, their Facebook. I think everyone, and anyone, really can be the so-called expert on a particular topic. When I’m emailing my patients, and I make a habit of it every two weeks using Ontraport email client,
I think that we have a very captive audience, because the patients already know and trust us, and the open or the click rate is a lot higher, especially when it comes from us. I’ve also played around a few times with the subject line. I’ve done split testing to kind of see what kind of topics and what kind of tone of the subject, or the copy, can resonate with my patients. I’ve been actually surprised a few times in the split testing. That was something I kind of picked up along the way.
Just to kind of give you an idea, a year ago I didn’t even know what Ontraport was, or an email client was, let alone what split AB testing was. But, as I’ve come along on this journey I’m finding that my ability to communicate to my patients in sophisticated ways is being appreciated. The way I’m measuring it is that I’m able to see that the number of conversations, booked appointments, and paid procedures is going up. Just as you’ve said before, the more we seem to email and communicate the more the patients are aware of the procedures that we’re performing, and the more that they’re aware that their procedures are available from the physician, or the practice they’ve trusted all these years, the conversion rate, I think, is a lot higher.
Dr. Runels: Yeah, let me expand on a couple of important points you made that I failed to make. One is that people are bombarded, but for your patients, you being whomever is on this call, and for my patients, and Edward for his patients, they are more interested in … Because they’re bombarded it’s confusing to them. As you just said, Edward, they want us to curate that and point out to them what’s important and occasionally, I think the ratio should be mostly what’s good, but occasionally point out to them something that may be popular that you don’t think is as useful. As a general rule that’s more of a waste of our energy to talk about what’s not good, but being the curator I think we tend to think, “Why do they care about what we think since they’ve got CNN, and the Mayo Clinic Newsletter, and the Cleveland Clinic Newsletter?” I actually talked to a man today that helped the Cleveland Clinic start their newsletter. They’re doing exactly what you just said, for people who wind up going to the Cleveland Clinic they want to know what the Cleveland Clinic thinks.
My patients, and Edward’s patients, and everybody else on this call, they’re more interested in what we think than what the Cleveland Clinic thinks. So, sending that out every couple of weeks, and making it something that reports, this is your perfect … This is what you wait for, and you don’t have to wait long on their procedures because we’re in the news so much. But, you shoot this out and now you’re not spamming people, you’re reporting on the news just like CNN does.
The second thing you said is that just the general idea that when I said expand on this, the idea that email still is the powerful way. Even when you post to Facebook it doesn’t get shown to all of your friends, and they’re so bombarded, and it’s limiting the conversation. Sometimes it gets banned if it’s some picture about, or something about, sex. The old email to your patients is still, in my opinion, the most powerful way to get things done.
When to activate PRP with Calcium (chloride or gluconate)
Okay, let me pull up this other … You know, I think I’ll hold off on the other research. There’s something here about … I just wanted, since you’re an expert surgeon I wanted to talk some about how PRP’s been used in surgery. Let’s skip over that and maybe do a question. This one comes up occasionally about calcium chloride. “I used to use calcium chloride. I started with Selphyl,” so the short answer to this is if you Selphyl it comes with a kit. With the others you can either order it as, it’s the same calcium chloride that’s in your crash cart or, and here’s … I’m on the O-Shot website. The reason I’m not pointing it out to the Vampire Facelift website is I quit using calcium in the face. It makes it hurt more. If I have a Selphyl kit I just leave it out.
But, you can use the same calcium that comes in a crash cart and mix it in with … So, I took it off the Facelift site, but you can mix it with the PRP. This is a video showing you how to do it, so you can take that ampule, mix it in to just a 10 cc syringe and then use that syringe as a dispensing vial into an empty syringe and then put your PRP into that, obviously not cross-contaminating that. You can make this into a multi-dose vial.
There’s a source of it at mrcrashcart.com. It’s where you get your calcium chloride. That’s 10% calcium chloride. Also, you can get it at McGuff, which is the same place where we get our syringes, and it’s on this supply list that sits up here. There’s your supplies in the PDF file right there, and where I get some of it. There’s the phone number, there’s the email for McGuff, and that’s basically if you order everything on that you can do pretty much all of our procedures if you have a PRP kit.
What’s your … Edward, I know I really stress using calcium chloride for the O-Shot® and the P-Shot®, and if you’re trying to grow nerves. Say you lost the sensation in the breast. I’ve quit stressing it. I don’t see people talking about it much with hair anymore, or with the face. Is that still what you’re doing, or have you altered that in any way? What are you doing when it comes to calcium chloride, or calcium?
Dr. Edward T: No. I still follow the teaching that I was given originally, which is exactly what you had mentioned. I’m finding, particularly, with the Vampire Facelift®, for example, the ability to kind of spread over the cheeks and in the nasolabial folds, as well as run down very finely in the tear trough, I don’t use calcium chloride to activate. It would be a little bit to viscous, in my opinion.
Tear Troughs & Bags Under the Eyes
Dr. Runels: And there is that idea that, which you just mentioned, is that with the O-Shot® you want it to gel quickly and stay in a pretty small area, relatively speaking, where with the scalp and the face you want a more diffuse spread. This right here, I think, is a really important point. Dr. Hamilton has someone who has some bags under the eyes after injecting. I recommend, and the question is, “What do you do?” Absolutely I’ve treated a lot of people who came in with … The tear troughs, not so much in the lower lid, but in the tear trough area if it is convex I can almost guarantee you there’s filler in there. I’m seeing people say, “No, it’s not filler,” and then I put a hyaluronic base in it, just a little dot, and it goes away. When I say a dot I mean one unit on a 30-unit insulin syringe is what I do with a 31 gauge insulin syringe and just put 0.01 mL in there, or one unit on that insulin syringe, and it goes away.
But, if you don’t have a lot of experience with using fillers I just wouldn’t use. I would use PRP as a stand-alone in the tear troughs, or do a mixture of one part JUVÉDERM® and nine parts PRP, so 0.1 of JUVÉDERM® and 0.9 of PRP in a 1 cc syringe, swished around, and use that and this is less likely to happen. But, it is fixable. I know you sent me some amazing pictures, Edward. Do you have any of those handy that you could show us? And, you can talk about what you’re doing, because I know you’ve developed some pearls around the face. Do you have any of those handy that I could just hand you the screen and you could talk to us about what you’re doing?
Dr. Edward T: Sure. Give me one second here.
PRP with or without Amnion in the Neck
Dr. Runels: Yeah, that’s cool. I’ll talk about this next question while you’re pulling that up. “Any protocol for injecting PRP with or without Amnion into the neck?” I think we covered this, actually, on the last call, but just to review. I think if you’re working with the neck I’d do three things. Again, if it’s a turkey neck they need a surgeon. I send lots of people for blephs, and for neck lifts, and facelifts. If it’s just necklace lines, or if there’s some platysma looseness that I can fix with Botox® then I go for it, and people love it. I charge for the PRP part of it 600 bucks. What I’ll do is … I treat it like a scar, basically. So, in the necklace lines I’ll put 27 gauge needle into the necklace line and inject intradermally and subdermally with PRP, and then microneedle PRP on top of that.
Then, if you’re going to mix Amnion with it, I just use one of those half cc Vampire Amnion. You know we have our own brand now that’s about one-fifth the price of what most people charge and it’s good stuff. You put a 0.5 cc of that, or a half a cc of that to 5 cc of PRP and mix it up and then inject it. Then, Botox® 2 units along the line about every inch or so apart, and then put them on a good cream, put them on our Altar® Cream. If you want to go all out, put them on Retin-A 0.1% cream at night and our Altar® Cream in the morning and they get amazing results. You found some pictures for us, Edward?
Dr. Edward T: I did.
Dr. Runels: Okay.
Dr. Edward T: Let me see if they-
Dr. Runels: Yeah, I’m going to hand you the … By the way, you guys, Edward teaches a great class where … Actually, let me just give you the screen. I want you to show us your pictures and then we can talk about your class. Let’s see.
Dr. Edward T: I’ve got a great story about this first case, if I have control of the screen here.
Dr. Runels: All right. It should be offering it to you right now.
Dr. Edward T: Do you see what I see here?
Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
Dr. Runels: Yep? I got you. She’s 55-60 year old woman treated with Vampire Facelift®.
Dr. Edward T: Originally, to take us back, this patient found me. She had actually moved, her and her husband from Tennessee and found me for an O-Shot®.
Dr. Runels: Beautiful.
Dr. Edward T: We ended up doing an O-Shot® on her and there’s so much crossover with the PRP procedures that she asked about the Vampire Facelift®. Naturally, we ended up doing a facelift on her. Now, this was one of my great kind of before and afters, because she had such a great result both from kind of the textural component as well as the shape. Staying with the classic form here I ended up … I just used one syringe. I used [inaudible 00:16:07]. I did some [inaudible 00:16:08] around her PRP, and that’s the result she got. My pearl is with this particular case I remember … I think that I was able to achieve the lift I did really by pulling, doing a pulling technique. When I first started doing these injections I would go right on the periosteum, right where the zygomatic arch is.
I still do that, but now I pull up very aggressively, and I draw Dr. Hinderer’s lines, which you can see here kind of mid [inaudible 00:16:41] down to the lateral aspect of the nose, and the lateral canthus down to the mouth. See where my finger is, this pointing arrow what I do is I lift and pull up really, really high on the skin and you can actually see where that line used to be, the one I drew when you kind of pull the skin up taut. I inject where the line used to be. What I mean by that is that for patients who are over the age of 40 who have a little bit more heaviness and need more lift I’m really kind of pulling up and I’m using the filler as a tack.
Dr. Runels: Interesting.
Dr. Edward T: I think before I was, basically, just filling down to the level of the bone hoping that it would just raise the skin. But with this technique when I’m drawing Dr. Hinderer’s lines I’m pulling the skin as high as I can. I inject with my right hand, so I pull with my left hand, and then I kind of see where that line used to be and I inject there. Obviously, when you pull the skin up with your left hand here, the line you drew goes up. So, the line you can imagine that used to be there is where I inject. That’s kind of the after that I get here. There’s a lot more kind of superolateral projection doing this pull and lift technique. I started developing this because as I’m getting into the more longer-lasting fillers such as Voluma®, that’s actually how Allergan teaches it. Now, I’m combining this lift and pull technique with the Vampire Facelift®, which was my introduction to facial aesthetics when I first learned this from you, Charles.
Dr. Runels: Beautiful. So, can we go through that again? So, you draw the lines and then you pull-
Dr. Edward T: What I do is … Right. So, I draw the lines and then I pull up on the lateral aspect of the cheek just as high as I can with my non-injection hand. Where the line used to be, now that it’s been moved up, that’s where I inject.
Dr. Runels: While you’re holding it up?
Dr. Edward T: While I’m holding it up.
Dr. Runels: Okay, beautiful. You’re directing all along the lateral zygomatic arch there. Is that what you’re … Okay.
Dr. Edward T: I’m doing the 0.15 and the 0.5 is classically descried by the Vampire Facelift®. I think I’m getting more bang for my buck when I’m thinking about using it as a tack rather than as a fill, and then I put the PRP over it and it seems to work really well with that lateral superolateral projection.
Dr. Runels: That’s some beautiful photographs. What are you doing around the tear trough area? I hear lots of different techniques for the tear trough. I like that technique where you’ve taken the best of Allergan’s teachings and then one upped it with your Vampire ideas. Talk to me about … By the way, if I were defining the Vampire Facelift® it would be like this. Take a syringe of filler, do your best work with it, polish it off and think of that as reshaping the mattress, keeping in mind the ideas that you just mentioned about shaping the, restoring the youthful shape of around the eye and the mid cheek area especially, because that’s where research shows that we first get an idea about our perception of how old someone is. So, that’s where you start and then you think about the other things that are described on the website based on your understanding of the face and your understanding of your best technique.
I never expect everybody to do it exactly the same way. We all have different eyes on different days and with different people. As long as those techniques are used then they’re going to have the best result possible. It’s just what’s going to happen. So, that’s the Vampire Facelift®. Around the tear trough, and we all have a different way of seeing it, but we’re all following that basic principle, using HA, make your best useful shape, polish it off with PRP, and then if you need more HA that’s fine go for it, but let that be additional cost to the patient since it’s additional cost to us, and that way we’re all going about the same guidelines as far as our pricing, as well. The tear trough, though, is where I see the most variability, so talk to us about what you’re doing since that was one of the questions tonight.
Dr. Edward T: Absolutely. I get very, very medial all the way up almost to the nose, and then I inject and I’d watch the PRP fall backwards. I don’t activate, by the way. One of the risks that I … Actually, one of the side effects of this particular technique is I almost always get a little bit of bruising, and so they get kind of that darkened shadowing after I do a Vampire Facelift®. It goes away and I assure them of that, but I’ve been getting really great outcomes with it. I also get better outcomes I’m finding when they come back four to six weeks later, and I only inject their tear trough with PRP. I think sometimes the first PRP injection might not be enough, particularly if they are almost on that borderline of needing a lower bleph. I also finish it with Lytera®, which is a skin cream made by SkinMedica® that helps with pigment. I learned that one from an oculoplastic colleague of mine who gave me that pro tip.
Dr. Runels: Beautiful. Thanks for the pearl. That’s why we do this at night. Let me ask you for a little bit more clarification, though. You started that explanation by talking about doing something more medially. Can you talk more about what you meant by that.
Dr. Edward T: Absolutely. If I may use my … If you can still see my screen here, I’ll use this picture. My needle originates or goes in here and goes all the way to the most medial aspect of the eye near the nose here. I’m going to zoom in here slightly. To me I see this triangular shape here that I want to fill, because when I go through this crepey, or there’s almost always kind of crepeness here of the skin. The bag, or the space here, is so thin here it fills so well with that unactivated PRP that it filled all the way up to here and comes back. I don’t know if that was by design or not. I suppose to try to get rid of your tears as you kind of tear, but it’s natures way of very efficiently kind of whisking away excess fluid there. I’m just kind of leveraging that shape.
Dr. Runels: Interesting. Would you say the name of that cream again that you’re using, and you’re using it for the crepe papering in the lower eye area? Is that right?
Dr. Edward T: Correct. It’s actually Lytera® 2.0. It works great because it works well for the color. In those patients who have an ethnic predisposition to bags under their eyes this alone works fantastic. That’s where I got the idea to begin pairing this with that part of the Vampire Facelift® that involves injection of PRP under the bags of the eyes.
Dr. Runels: Just so you guys know. You may have picked up already, Edward has a strong background in mathematics as an engineer and then is a world-class and award-winning robotic surgeon and gynecologist there in Southern California, and does a really beautiful job of teaching combination therapies, teaches BioTE®, so he teaches hormones and he teaches lots of ways of thinking about how these procedures can be combined with energy sources and surgical techniques. With that introduction, can you pull us up some pictures and talk to us some about your ideas about the O-Shot®, starting with maybe, if it’s handy, maybe that picture you have of the urethra, which I think is amazing. But, talk to us more … I want to get back to marketing, because you’ve been really successful with the marketing.
Selecting the Best Patients for the O-Shot® Procedure
First, talk to us some about your ideas about patient selection. I never want to get away from the idea that the better we are about patient selection, that’s the first step to having great results. All of us want to have wonderful results and be paid appropriately for doing, basically, miracles with our patients. Can you first start with explaining this picture and then some patient selection pearls?
Dr. Edward T: Absolutely. To kind of go a step back, as an engineer I think that it’s very important to define and measure all the activities we do. As a physician I try to look for those tools in our clinical toolbox to measure these outcomes. When I had done my fellowship in robotic and urogynecologic surgery at Scripps Clinic in San Diego, one of the kind of key aspects of my training, even before I started doing pelvic surgery, was urodynamics. Urodynamics to me is the gold standard for actually assessing the different kinds of urinary incontinence. Does the patient come with a pure stress urinary incontinence? Do they come with a overactive bladder picture? Or, is it more commonly the most common kind, which is mixed, which is actually the most difficult to treat. So, when I do my assessment of the patients for their candidacy I think it’s ideal when you do the full work up, although it doesn’t happen every single time, to have some kind of urodynamic evaluation.
The area that I look at, and I’m most interested in … Actually, I’m going to scroll down here, is the intrinsic sphincter deficiency assessment, or the urethral closing pressure, because I really want to know at the urethra what the degree of damage or the degree of strength that resides. To me at one end of the spectrum you have a very healthy urethra that upon closure can actually withstand the increased pressures that are created when the patient laughs, coughs, or is a little bit heavier. That’s a young patient, maybe they’ve not had kids before. They cough real hard they’re not going to leak, because the urethral pressures and that intrinsic urethral strength is quite strong.
On the very other end of the spectrum, you have a patient who has intrinsic sphincter deficiency in which the urethra takes on more of a complete pipe shape and function. In the case of the patient with intrinsic sphincter deficiency, when you perform urodynamics on them you will see that their urethral closing pressures are way less than 50 mmHg. They’re actually quite low. In my opinion, the patient who is healthy, who can be continent when they cough really hard, versus the patient who has intrinsic sphincter deficiency, somewhere lies in between the ideal patient for doing an O-Shot® for urinary incontinence.
I’m thinking, in my mind, Charles, that the patient who doesn’t have a lot of tone to begin with … You could probably do four or five O-Shots® on them, several lasers, even putting a sling on them, and it may not work. Why? Well, I think by nature that urethra it’s too damaged or it’s not functional. Many of our procedures that are noninvasive, such as doing an O-Shot®, or doing two, or even giving them testosterone in the form of a pellet that causes hypertrophy of the muscles that surround the urethra, may not work. In fact, when you kind of do the literature search, one of the gold standards for performing a treatment on someone with intrinsic sphincter deficiency is to do a TVT, or perform a TVT, a transvaginal tape, in which it’s a lot of back support against that urethra does not work that well.
If you look at … I’m a big fan of the mini-sling, the Solyx. For those of you who are on the call right now, mini-sling is a very small sling that’s usually called the minimally-invasive sling, because it’s so small and doesn’t pierce through any of the spaces, may or may not give as much of that backstop support for someone with ISD.
What does that mean for all of us performing and looking for the ideal O-Shot® patient. Well, I would actually really use the history to try to guide us. How long has the incontinence been going on? Are there things that you can do, or things that you’ve tried? Some patients have been very good about doing Kegel’s muscles and Kegel training. They get some improvement upon doing these Kegel muscles. They just can’t get to it every day. I mean, we have such busy days. To do Kegel muscles with intent it’s just so difficult. That patient is a good O-Shot® patient, because they can demonstrate that with some exercising they could bring back that tone.
Someone who has had … I actually saw a patient today. She had had two C-sections. I’m about to do an O-Shot® on her next week. I think she’s a good candidate. We just did her urodynamics. We’ve proven that her urethral closing pressures are well above 50 mmHg. It makes sense in her history that probably with time, age, and the decrease of hormones that that tone or incontinence is changed. I think she’s going to be a fantastic candidate for an O-Shot®. These very soft findings in the history, not all of us have urodynamics ready to do in the office, I think really guide our ability to find that O-Shot® patient. Sometimes it might take another O-Shot®, for example.
Dr. Runels: Can I ask you two quick questions? First, for the person who doesn’t have the ability to make those measurements could you elaborate more on what clinical history or physical findings they might use that you’re correlating with those measurements? Second, do you have the beginnings of a data bank measurements before and after an O-Shot® that we could publish somewhere?
Dr. Edward T: I’m beginning to collect that score, because very early on, which is why I’m referencing this picture, I wanted to find a way to measure, if not visually, at least quantify the difference in the closing pressures after doing an O-Shot®. Now, this particular publication, or this article submission, was a case report of a 48-year-old gravida 5 para 2 … Actually, wow, last year. Almost by design a year ago that I had published, and this was after we did an O-Shot® in the operating room for a patient we did robotic surgery on. You can see here before the O-Shot® I put the cystoscope in. This was a 30-degree Stryker cystoscope, and you can see what the urethra looks like before the O-Shot®, and this is immediately after. I can imagine with time that the O-Shot®, the effects of the O-Shot® platelet rich plasma probably would just improve the tone of the urethra.
I actually don’t have, and I wish I did, pictures in a series of what happens at 30, 60, and 90 days, because I don’t know how I would consent a patient to do cystoscopy just to see how the O-Shot® is doing. More rather, bringing the patient in and just kind of asking what their incontinence level is.
The second part I think you were asking is, looking at a questionnaire, which is what we did, I’d be happy to share with the group, too. There’s a great one developed by LABORIE who makes my urodynamics equipment. It’s a checklist of about ten questions that, basically, look to see, Do you feel like you have to pee as soon as you put the key in the door? We call latch-key urinary incontinence, which really speaks more towards overactive bladder. Or, Do you leak when you cough? How many pads are you using a day? You could almost get a gestalt on whether they have stress urinary incontinence or overactive bladder, for which the two treatments are different. I am seeing almost in colloquial, or kind of informally, that the patients with overactive bladder are needing to use less Detrol, something about their O-Shot® and rejuvenating some of the vaginal mucosa immediately underneath the bladder helps with overactive bladder.
Dr. Runels: Anecdotally we’ve had some people with very severe cases that have made remarkable changes, so hopefully you can get us some objective numbers that we can publish somewhere. Can you give us your pearls about actually doing the procedure, and thank you for showing those pictures and, yes, we would like to see that survey you’re using for measurements.
Dr. Edward T: I’ll get that to you and maybe you could distribute it out to-
Dr. Runels: I’ll just post it on the web … Is it copyrighted? Is it something we can post?
Dr. Edward T: It’s pretty general.
Dr. Runels: Okay, I’ll post it to the membership site for people to download. Would you talk to us about your pearls about how you think, what you’re thinking, when you actually do an O-Shot®?
Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
Dr. Edward T: Absolutely. So, when I talk about … I’ve experienced in two realms and I’m very fortunate because, I think I’ve told you this before, my hospital system has been extremely supportive with regenerative medical techniques that I’m doing in the OR. My story in terms of the OR, versus doing it in the office, which I’ll talk about in a second, really stem from a product made by Stryker. Stryker made a product called Vetigel® and Vetigel® is a combination of autologous PRP in which the scrub tech or the nurse that would have to draw the patient’s blood and then mix it human thrombin and that’s what our GYN oncologists and I were using to put on the vaginal cuff before I even took your class, Charles. This is …
Dr. Runels: Interesting.
Dr. Edward T: … before I took your class. We were finding that the rate of vaginal cuff dehiscence and post-robotic hysterectomy spotting went to nil. One of the most frequent calls that we get as a gyne robotic, or any kind of gyne surgeon, is post-hysterectomy spotting, because the cuff has little pores through it. We were just plugging the Stryker Vetigel®, which is really just PRP plus thrombin, over the cuff and the patients had less pain. They were not spotting. We had less calls. We were happy.
Then about three months later it made me so sad because Stryker pulled the product off the shelf. In my very engineer mind I said, “You know what, this is just too good of a product to not have on the shelf,” so I started looking at other companies. We use Regen. We were able to replace a pre-existing product in our hospital OR with a similar product. I think I found a very pleasant loophole, right, because I had to have something to replace it, so we found something to replace it that ended up being a lot cheaper.
Dr. Runels: You’re referring to Regen when you say there’s something to replace it? Regen Therapy?
Dr. Edward T: Yeah.
Dr. Runels: Okay. I’m going to put a link … I don’t want to stop your flow and I’m not changing the subject. I’m just going to put a link into the chat box, guys, with a few … to just a PubMed page that shows a few, four papers, about using PRP in surgical situations, one with mesh, one with rectal-vaginal fistula, along those similar lines. So, when you’re using this as part of a hysterectomy are you making a gel with your Regin kit, or how are you processing it to make it do the same thing that the previous Vetigel® was doing?
Dr. Edward T: When I do it with my hysterectomy, I do make it with a gel, and I [inaudible 00:36:47] calcium chloride, and I add about 0.1 of thrombin, that is autologous thrombin.
Dr. Runels: Yes, and Regen, just so you guys know, Regen has a kit that comes with thrombin …
Dr. Edward T: Exactly.
Dr. Runels: … or a way to make thrombin, and they also have a setting on their centrifuge to make a gel. Am I understanding properly? Is that what you’re doing? Are you using that thrombin kit?
Dr. Edward T: That’s exactly what I’m doing, but I’m doing that above the vaginal cuff. When I undock the robot and I’m done with the … Actually, I did the same exact same for a stage IV endometriosis patient today. She’s on the floor. She’s doing great, and after I undocked the robot then I used my PRP kit, and I do a classic O-Shot®, and that’s it.
Dr. Runels: Interesting. Beautiful. That’s pretty amazing combination therapy. Do the people that are getting hysterectomies from you, do they realize what a higher standard that you’re taking this procedure to? I guess they do. Tell it to me more about, do they find that out when they show up for surgery? Are you advertising this combination or way of doing hysterectomy, because it sounds like what I would want my loved one to have?
Dr. Edward T: I think that at the end of the day I’m guided by the same principle that my father, who I operate with still today, actually we just did the case together, has always taught me, which is be very patient centric. I just want to take care of my patients. The money part, and the finances, and the marketing sometimes, as you know, Charles, can get in the way of that.
Dr. Runels: Yes.
2 Guiding Principles That Bring More Patients and Provide Better Care
Dr. Edward T: It’s kind of a very means to an end, I suppose. But, when I start counseling the patients about what we do I start out by saying that we want you to recover as quickly as possible. So, when I lead with that, and I also followup with the fact that we utilize the newest and latest technology in regenerative medicine, the patients begin to understand that their body actually does have a natural mechanism to heal itself. If not using parts of their own body, why would I reach for something on the shelf if I didn’t have to, if I could use their own PRP, and their own thrombin, autologous, to help them heal? I think when it’s set up like that it’s an easy sell.
Dr. Runels: Well, and part of the reason I brought it up was that I feel like, as your father said, Part A is that the want to be patient centric and make sure that we’re always doing the best with the least amount of risk. Then, Part B is that, I think, it’s our responsibility to make sure that our patients know what we’re capable of doing. I think that’s a different way of thinking about it than the way, and I know that’s the way you think, as well, but some people think, “Oh I just want to do it but I don’t want to have to sell it,” but if you use a different way, and it has to be sincere, of course, but if your way is not trying to get people to do things, but your way is taking responsibility for educating people in what you’re able to offer them as an option, and then they decide what they want based on a fully-informed description of the possibilities.
That, I think, is really what we’re supposed to be doing anyway, whether we’re taking insurance or not. If it happens to be something that somebody could pay you for, well that’s wonderful, but it’s kind of what we’re supposed to do anyway, and that is the best way to “sell stuff.” As you know, I never script these conversations with our teachers, because I like the serendipity of discovering along with the people on the call what might be possible. Have you had any of the gynecologists reach out to you, or do they even know it’s a possibility the ones who come to your class for you showing them this way that you’re doing a hysterectomy, or is your description you just gave enough for them to take it and run with it?
Dr. Edward T: Well, I think that they understand it. I always get a very academic nod to what I’m doing but to your point, Charles, some of the GYNs that I train, they’re my colleagues, they’re a little bit slower to adopt, because we’ve been kind of put into a corner with our Board certifications, and you’re supposed to do it this way. I’ll be honest with you, if that’s how we did hormones then we wouldn’t have any progress.
Dr. Runels: Yes.
Dr. Edward T: If all we did was treat to the exact specifications of what [inaudible 00:41:25] put in brackets, none of our patients would feel better. We would still have all these issues.
Dr. Runels: Is there something you can measure, for example, that postop spotting that you were talking about? Is there something you could measure where you could do the next 40 patients, 20 with and 20 without that? It would the great to have some sort of paper where we could let people know what you’re doing. You know, I just put a link in PubMed where there is some discussion already. I couldn’t find the one … There’s one out there somewhere about using PRP as part of the hysterectomy process. I guess it came out of the people who did the research for the last product you mentioned, but I can’t find that paper right now. Anyway, I won’t dwell on it too much, just to let you know it’s something else that would help the whole group, because there’s lots of GYNs and urologists in our group.
Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
Okay, we’ve got a couple of questions, and I’m going to unmute Stephen Carp who has a question for you. Let’s see if I can unmute him here. Let’s see. I’m just going to let you ask him instead of me trying to slow down the mail. All right. Dr. Carp, you’re unmuted. Go for it.
Dr. Stephen C.: How are you? Good evening.
Dr. Edward T: Hi.
Dr. Stephen C.: I’ve got a patient that came in, been a long-time patient, who came in just looking for a potential solution. Had endometrial cancer. Had a hysterectomy with radiation and has some scarring that’s tender, and discomfort, a few cm proximal to the introitus that’s probably from about 5 to 8 o’clock or so. She came in because she’s actually a physician and wondering if PRP might be something that could help soften that, might help with that area. Have you had any experience with any PRP in post-radiation in the pelvis?
Dr. Edward T: I have not, but when I think about the three or four cases of patients who have had traumatic vaginal deliveries, they create quite a bit of scar tissue in that fourchette. The success cases I’ve had for those particular ones required more than one O-Shot®, and by O-Shot® I mean doing the classic O-Shot®, but then also doing focal 1-2 cc of activated PRP right into that area of the scar tissue to soften it up. I would also go so far as to maybe use vaginal dilators and, depending on the comfort level of the oncologist, there’s a great product that has compounded DHEA that could definitely soften that fourchette. DHEA with history of gynecologic malignancy is still kind of up in the air, but I have a lot of breast cancer survivors. We’re right next to City of Hope, my practice, and we were using a lot of these nontraditional therapies to help these patients out. I can imagine the irradiated tissue is very similar.
Dr. Stephen C.: Yeah, I would think so.
Dr. Runels: Let me add to that in that my position that I am grateful every day is now becoming described in the Earpiece for lots of brilliant people like you guys. I’ve had quite a number of people, probably a dozen different providers, call me and tell me about similar cases, several cases of dyspareunia post radiation. One case in particular comes to mind where a woman had repeated tearing and pain in an old episiotomy scar, and just like you just said, Edward, it took three treatments with injecting, basically infiltrating the areas if you’re getting ready to suture it intra and subdermally with PRP, and then waiting four to six weeks and doing it again, and doing that three times, and then the woman was without pain and without bleeding. It was something that was a nuisance for quite a number of years. Another case of radiation that had some scarring and pain around the anus, as well. Yeah, so it’s been done and it’s been helpful, and hopefully some of you guys will publish a case report.
I had a case ... While we are talking about dyspareunia, I had a case of scleroderma that got well, but just one. These are … No one person has enough to do a series, but maybe we should some case reports, or try to pool it. What else? Anything else, Dr. Carp?
Pelvic Floor Spasm
Dr. Stephen C.: I’ll just as an addition to that, have you had any experience, especially with urogynecologic, with Botox® for the spasms that they get in the pelvic floor?
Dr. Edward T: I have not done that, although many of my colleagues have. One of the risks of doing that is if you do it too much they go into retention. I have not done that particular method. I have used CO2 fractionated laser. I’m a big FemiLift physician. I use FemiLift quite a bit for overactive bladder, as well as the compounded vaginal estrogens work very well. I think there is a great deal of dysfunction at the level of the vaginal epithelium, that thin layer that separates the bladder from the vaginal canal that needs to be addressed. It gets irritated in these patients with overactive bladder.
It’s really interesting, because one of the gold standards that the insurance covers is the administration of Detrol, or an anticholinergic, which many of my patients within about 30-60 days will self-discontinue due to the side effects, the dry mouth, the dry eyes. They might have less overactive bladder but [crosstalk 00:47:28]. There’s some brain slowing, especially in the older population.
Dr. Runels: Yeah, there was actually a paper out about six months ago that was pretty compelling that there really is an increased risk of dementia long term, as well.
Dr. Edward T: I can see why. You, basically, create that parasympathetic overabundance or push the parasympathetic system to try to dry everything out, well it’s probably going to slow your brain function down, as well. The patients are getting forget. I think it’s very high risk in the older population due to polypharmacy.
Dr. Runels: Anything else, Dr. Carp?
Dr. Stephen C.: No. Thank you.
Dr. Runels: Thank you for the excellent question. There was quick question from Dr. Vora about Emsella, and the answer is, “yes,” some of us are combining Emsella with results. Some are using the intensity vibrator that has contraction component to it. Are you doing any of that, Edward?
Dr. Edward T: So, I was using the [Visa 00:48:30] Plus for a while. I don’t know if you’ve seen that as a at-home device.
Dr. Runels: Yes, talk to us about it.
Dr. Edward T: So the Visa Plus is something that the patients were using. They would take home, use as a light therapy that helps with collagen generation and urovascularization. There’s two versions of it. There’s a version that’s available in the United States, and then a stronger version which I think is only available in Canada, is one of the examples of, I think, an at-home treatment that the patients can use.
Patients always want one and done. From the very beginning I try to tell them, especially when it comes to some of the dyspareunia associated with the menopause state, once estrogen runs out and the vaginal epithelium begins to change it takes a variety of different approaches that begins in the office and really continues with the patient at home. I might do an O-Shot® on them and have them go home with something called … There’s a commercially available medication called Intrarosa®, which is compounded DHEA, or I would use vaginal estrogen. They’re going to work on that at home for the next 30 days. They may come back. I do another pelvic exam. Maybe the grade of the atrophy changes, or improves, or they could have one more sexual encounter that month. To me that’s a win. Then we will add a vaginal laser.
The in between treatments, whether it’s a device such as the Visa Plus or these creams are very, very important, whether you’re talking about vaginal health or you’re talking about aesthetics in the face. I think really beginning to set that as a proposition to the patient, “You’re going to be doing things at home, that are going to help.” Certainly having multi-modality.
I have colleagues of mine in Southern California having great success with the Emsella®, to strengthen the pelvic floor, as well as doing an O-Shot®, looking back at our … We have about 300 patients on pellet treatment right now. Many patients will cite that their urinary continence has gotten better within the first treatment of testosterone. How do I know that? It’s because they won’t show up to their urodynamics test, and so I know something is there. Having that multi-modality approach for urinary incontinence, intimacy, even aesthetics I think is going to be key.
A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Dr. Runels: Beautiful. We’re going to talk … We have about nine minutes left and Edward has some interesting ideas about when it comes to marketing with trademarking and not just our procedures but you as a provider and expanding upon that idea. So, we have about eight minutes left, Edward. Before you do that, though, I just want to tell you guys that Edward is, obviously, brilliant and excellent teacher, and excellent as a provider for our procedure, so highly recommend his classes. He’s got one coming up July 27, which is pretty close, but I don’t know if he’s got slots left, but I’ve put a link to that. If he doesn’t have slots in that one I’m sure he has another one coming up soon. With that, Edward, if you don’t mind, talk to us some about, I know you’ve thought a lot about that idea. Can you expand on that some and then we’ll close it down for the night?
Dr. Edward T: Absolutely. So, as I’m going through the mental exercise and thinking about how to combine all the different procedures and finding that a combination of different approaches that hit different aspects of what I’m doing is the best, I really did a deep dive and found that my main focus is intimacy, how to restore it, how to improve it, how to educate patients on it. I was very happy when my trademark, actually I have a copy of it here, by the U.S. Patent Attorney Office was accepted now with for the second year in a row. I’m ready to defend it, because I came up with this idea of Timeless Intimacy. You can see here, this was actually from my-
Dr. Runels: One second. I took the screen back. I’m going to give it back to you. Now you can show us. Go for it.
Dr. Edward T: I applied for a Trademark. It was actually more of an activity than anything else, and it was successfully accepted by the U.S. Patent Attorney Office. This was a recent email, actually July, by my attorney and I was able to submit it again for the second year in a row. The Timeless Intimacy trademark basically encapsulates performing a minimally invasive vaginoplasty, performing an O-Shot® and followed by a laser, in this case a CO2 FemiLift at a particular setting to help heal and to help reconfigure the vaginal vault to take on a more youthful function. I would always tell the patients, if you want a certain tightness or a certain kind of friction coefficient in terms of the sexual intimacy that you were at 21 we’re not going to go past that, right. We want you to be in a place I would say, ideally, between 20 and 30, in a place before you had children, in a place before you entered menopause, such that you could resume intimacy again comfortably and pleasurably with your partner.
As a part of that I then went on to develop Timeless Health Solutions, Inc, which is my Med-Spa or my functional wellness practice. That’s now being developed as its own entity. It has its own collateral. There’s a voice that’s being developed in which the girls in my office are trained to pick up and talk to the patients with a particular voice.
I’m finding who I am as I’m going along in this journey, that originally I started as an engineer. I think I have a very compelling story to use technology and, basically, give that technology and distribute it in such a way to help patients. I’ve become a surgeon in the last few years, a robotic surgeon in the community, helping women have surgery in a minimally invasive way and get back to life sooner, and putting it all together. I think that’s really what the Timeless Experience is. I think it’s really garnered a lot of attention in our community. I know it’s being recognized at the level of [inaudible 00:54:48] hospital systems. I’ve been recently kind of given this idea, this honor, of being a social media expert in women’s health. Now I have this wonderful platform to get all these ideas of regenerative medicine, minimally-invasive surgery, and to be able to talk about intimacy in a way that’s never been done before in my community.
I’ve been very kind of passionate. This was actually what I was going to talk to you about tonight, and I’m going to highly the second point here. I would say, Charles, right now in the last few minutes that I’m in lean startup mode, and I looked at my colleagues, my engineer friends up in Silicon Valley, and there’s this wonderful book by Eric Reese called The Lean Startup. What that means is creating these very small … Let’s see if I have a picture of it. … MVP, that is a minimum viable product, and really getting it out there to see if the population, or the market, is interested in it. What that means for us as busy physicians is before we buy that next laser, or before we buy that next cool sculpting machine, can we create these minimum viable products and test our market, and how convenient is it that our market are the patients who have been following us all this time.
Dr. Runels: Yes. Yes, we already have an audience.
Dr. Edward T: We have a captive audience. In this world of marketing you actually have to pay for these focus groups.
Dr. Runels: Yes, and let me emphasize that real quick. I don’t want to slow down your momentum, but everyone needs to remember, you are marketing to your people. If you [want to 00:56:27] market to the whole world that’s fine, but you need to start with your people. If you don’t have a group of people that you call your people, in my opinion, it’s difficult to have a steady flow. You start by building a fan base of people who love you, because you’ve done good things for you. Now you can do what you’re talking about. Okay, keep going.
Dr. Edward T: I think every once in a while when I get stuck, Charles, I put my engineering hat on and I think about what an engineer would do, because if I think about what a doctor would do, I would probably take on another [inaudible 00:56:58] contract and working harder and I’d probably be- [crosstalk 00:56:59] Just being honest with you. I’ve already seen this. I saw what happened to my father, right? I think desperate times call for desperate innovative measures, and I put my engineering hat on and I found this, and I’m just sharing this with our group, lean startup. In the last minute here I encourage …
Dr. Runels: You know what. Keep going, go a little over. That’s fine. I think this is good stuff.
Dr. Edward T: … and want all of us in the call, the physicians, to really become lean again. I think that all of us as physicians need to find a way that we retract because the environment right not conducive to us expanding aggressively. We must all come together and retract and regroup, much in the way that Sun Tzu says in The Art of War about looking at our enemy and knowing that we are not ready, and we are not powerful enough to be out there and fight. So, we have to retract, and in this very lean startup manner regroup and see what anchors us.
Dr. Runels: Yes.
Dr. Edward T: It’s very easy because all of us in quarter four … I know I’m speaking to everyone on the call right now when the tax comes all of us who are on the call most of us are in private practice, and we are lured by the laser companies, and by a big company to do that capital investment just to decrease our taxable income. Really understand what it is that our market is demanding. We can do that by creating these very small value propositions and testing it. That’s why doing a class on injectables, or learning how to do an O-Shot® is so valuable, because it may be caused that initial fee, the tuition, and that’s it. That fee is the minimal [crosstalk 00:58:47]
Dr. Runels: Then you take the money from that and do the next thing, yes.
Dr. Edward T: You got it, because what makes you think, and forgive me for saying this, that you’re going to be able to make a vaginal laser which can cost up to $100,000 work if the patients in your group don’t even want an O-Shot®? To that same degree, what makes you think buying the newest fractional CO2 facial laser is going to be appropriate when the patients don’t even want you to do a Vampire Facelift® on them?
Dr. Runels: That’s right. The guy who taught me Botox® was doing … He was the top Allergan account in the world, we talked about this before, and he always said, “Get your Botox® practice going then buy the facial laser.” So, exactly that’s the right strategy. When you get to where you’re one or two O-Shots® a week now you can take the money and take the flow, and you know that your laser’s not going to gather dust, or you’re radiofrequency. I’m loving this. Tell us about the next thing on that list.
Dr. Edward T: I guess the next thing, …. Forgive if I’m going over here but-
Dr. Runels: No go for it. We like it.
Dr. Edward T: In addition to retracting … This is what I’ve been doing. I’ve been retracting, rebuilding, regrouping, and creating my brand. The brand tells a strong story that I’m infusing technology with medicine. I actually had a doctor friend of mine, Charles, reach out to me, and she asked me how I’m seven places at once? I said, “What do you mean?” She’s like, “I’m watching your Instagram, man, and you’re like seven places at once. I’m like, “Thank you, I’m not.” I have virtual assistants. I try to automate and eliminate, and I’m doing this because I have a virtual architecture and I check in with this lovely girl in the Philippines. I give her a list of things to do and in the morning it’s all done because of the time zone difference. It could be something as simple as arranging for my dry cleaning, or figuring out a logistical issue for a seminar that I’m going to be teaching out.
But, when I’m able to do that and create that virtual architecture she learns from me. We talk about, as engineers, machine learning, and we talk about artificial intelligence. You don’t really need that when you could actually have bonafide intelligence. These virtual assistants, it’s a skill and I’ll be honest with you, coming out of fellowship I didn’t really know how to manage people that well. I’ve learned more about managing people, and learning how to lead working with these virtual assistants than I have in all the time I’ve graduated, because you learn about time management, because now I know what the value of time is in a quantifiable way. I’ll give you an example.
I found out that it’s actually a lot easier to click with my thumb Expedia and book a flight, and look for a flight than it is to go in almost two hours back and forth in different time zones to get my virtual assistant to book it. That’s a great example, right? But, for something that takes a lot of different steps, like research, I’m trying to find a cheaper way to bring in needles or syringes to my office. That’s an hour affair. I’m putting that to my virtual assistant, so now she does my supply chain and I’m like, “Oh, there’s something called supply chain. Let me learn about how to do supply chain management.” It didn’t cost me that much, and so that becomes part of my virtual architecture. It becomes part of my virtual corporation, my virtual timeless structure, and that’s the virtual architecture that’s rising me, or raising me, to make me look like I’m in seven different places at once. It’s because my virtual architecture is raising me, it’s giving me more time.
Dr. Runels: Beautiful. Both the virtual assistant and someone in the office who functions like an executive assistant, not just doing the nursing work, but they are willing, and expecting to do things like drive your car, or go buy your groceries, that sort of thing, I think when you value your time at at least $1000 an hour, which everyone on this call should be doing, then that person if they save you an hour a day, you can pay them a reasonable rate and still do well. What’s next on that list?
Dr. Edward T: I suppose the last thing … Let me give you the website that I use, and I explore …
Dr. Runels: You can just throw it in chat box and everybody will have it.
Dr. Edward T: It’s onlinejobs.ph. You actually see it.
Dr. Runels: Okay, there you go. Onlinejobs.ph. I concur with you in that the people in the Philippines they like Americans and unless they’re having a typhoon where they lose their internet they are as a rule usually reliable, and they are grateful. You can pay them what for her is not so much, and you can be helping someone have a whole different lifestyle in the Philippines. I highly recommend what you’re doing.
Dr. Edward T: The last part of my pitfall, so I will try to wrap all this up, because between becoming lean, creating a virtual architecture, becoming proficient with all of these advanced regenerative medical procedures, and learning how to do aesthetics with an artful aye, I’ve also learned along the way. A lot of the pitfalls, I think, stem from paid advertising. I think in the group whoever is still listening left, all of us, I think, have all tried to pay-
Dr. Runels: By the way, it’s everybody. Nobody’s dropped off. They’re listening.
Dr. Edward T: Anyone who’s tried to pay for advertising finds it very difficult to measure a return on investment, because in my mind as a physician if I pay for advertising it means that there will a measurable return for a booked and paid patient. However, with marketers and paid advertisers out there, their metric is leads, or …
Dr. Runels: Yes.
Dr. Edward T: … clicker rate. Things that are not as relevant clinically to us and to our bottom line. I think there’s a big discord.
Dr. Runels: They don’t pay the groceries. Clicks don’t pay the groceries do they?
Dr. Edward T: It took me a long time to learn that at the very visceral level, that we have a disconnect here. That disconnect is what’s actually preventing, in my mind, marketers and physicians from really aligning together. I think that if there was a better, more kind of physician-centric way to create paid advertising … You know it’s good that all of us on the call know the basics of marketing and advertising, but the the end of the day we are doing all this to try to get back to what we signed up for, which is to help patients and do medicine.
Dr. Runels: Yes.
Dr. Edward T: As a pitfall I think what I’ve been guilty of is going down too far and kind of veering off course, and there’s so many tools, and so many virtual assistants, and so many Ontraports, and mail … I mean, there’s so many digital pools out there that I think every once in a while I have to pull myself back, not as an engineer now, because that’s all we do is create tools, right, for better solutions, but pull myself back to the medium, which is the physician in me and go back to doing medicine. I would say that’s a pitfall that I’ve realized that it’s very easy to go down that rabbit hole and find that next digital tool, that next widget, that next app, and forget what we kind of signed up for.
Dr. Runels: Just let me expand on that just a little bit and then let’s call it an night. All wonderful stuff, Edward, by the way. There are so many tools, and I’m literally at a class now in Cleveland that cost me 30 grand. I’m in a class today, earlier today, with a guy that made $900,000 in two weeks online. These are high-end people, high-end in that they know how to make money online. It’s interesting, what I’ve noticed is the people who are making 10 million or more on the internet, they’re still doing the basics, and it’s not just online. The other thing that these guys with real businesses with tell you is that you bring it offline as soon as you can. It’s handing out the brochures to your patients, or your just physical card and saying, “Hey, if you know somebody else I can help, would you give this to someone.”
Using the tools, just the basic tools of a video so you don’t have to keep explaining it, emails that you send to your patients every couple weeks so they know that you’re there, that are not fancy, that are messages that give them the things you would say to them if they were in your office anyway about what you want them to do to be healthy, and what you’re able to do for them with explanations and clicks to show them the research. So, a video, a web page that’s helping you let them know what you’re able to do, and then instead of doing all your time marketing you’re doing something, it’s a practice, and so you’re practicing it. But, here’s the fun part, you’re practice of marketing is actually making you a better physician, because you’re teaching your people how to be well leveraging digital tools.
I know if people are on the call that have done it on Instagram and Facebook and all the other tools, and I’m not saying you don’t do those things, but for these procedures what you just said is the formula that works, an email, a video, a web page. Deliver good messages and then while that’s doing you have more time and more money to go take care of your people, sometimes for free because the money’s flowing.
Edward, always a pleasure. I know people, I’m telling you the stick rate was amazing tonight. Everybody was listening, so I know they loved it. One last thing, guys. Edward does a mean class and you can tell he’s on top of all dimensions of this. So, have a great night, and I’m honored always to have your attention. Bye-bye.
Dr. Edward T: Thank you, everyone. Goodnight.
Watch (13 Minutes) the 3 Steps to Practicing Better Medicine Without Insurance…
WARNING: If you follow the ideas presented in this seminar you will dramatically increase the quality of your medical care AND increase your cash flow. But, if you will not devote 1 hour per week to implementing what you will learn in this seminar, then you will be wasting your time to attend.
In this coming 1-day seminar, in Houston, Texas, Charles Runels will share details about how as internist from Alabama with ONLY 3 red lights on main street created more than a billion dollars in value for the doctors in his group, funded research, AND innovated in health care bringing new effective treatments to medicine (and creating 2 non-profits)…using a lap top and one exam room. Presentations will be by the inventor, Charles Runels, of the Vampire Facelift®, O-Shot® [Orgasm Shot®], Vampire Breast Lift®, P-Shot® [Priapus Shot®], & author of research and best selling books.
He will draw upon over 2 million dollars invested in his marketing education (and 20 years of doing his own websites)…and give you as much as he can in this 9 to 5 seminar.
For physicians (and other health care providers)
who want to improve health care while having more cash to keep the doors open (and to provide free care to those who need it…without begging the pimp-insurance-for a raise).
Powerful plans for those already accepting cash and strategies for escaping the pimp (insurance) for those who are still on an all insurance practice.
As a result, you’ll be able to support your practice with those who want to pay you, and you will have more money and time to work for free to care for the indigent (without asking insurance to reimburse you).
And you will have more time and $ for your family.
September 15, 2018. 9am-5pm
Price: $197 for One VIP Ticket
Click the Button Above or Call 1-888-920-5311 to Reserve Your Seat
By the Inventor of the Vampire Facelift®, Vampire Breast Lift®, O-Shot®, Priapus Shot®
How this workshop will change the life of you and your patients…
- How to write your first book in one weekend…and have it on Amazon..even if you can’t type.
- How to offer cash procedures that your patients will love and respect you for offering.
- How to leverage a “corner stone” business model to introduce one procedure after another with each financing the other for a snow-ball effect of health benefits for your patients and money for you.
- Enjoy more time reading the medial literature and enhancing your skills as a physician while increasing your income.
- How marketing will make you a better doctor by focusing the way you think toward the most helpful modalities while expanding your ideas into the future.
- The 1-hour, weekly routine that will revolutionize your professional and personal life.
- Why the people who are poor need you to make money so you can take care of them for free…and how to do this on one hour a week.
- How to have your on show on iTunes that your patients will love to hear (for free to you and your patients).
How this Seminar will Work…
From the time you walk into the room, you’re going to start developing your strategy for changing the life of you and your patients while improving the CASH (not insurance) flow of $ into your practice.
You won’t need your computer. You won’t need a pen or a paper (we will supply everything). Just bring your self, and maybe your office manager or marketing person, and be ready to start planning.
The good thing is that much of the DO will involve delegating to others what should be done…taking very little of your time.
But, you will need an hour per week to implement. Most doctors hire someone for 10’s of thousands of dollars…but the person they hire does not understand how to talk to patients. More importantly, if you do not understand how to put YOU into the marketing materials…then you get a worthless but expensive internet presence.
“This is listen, plan, do.”
September 15, 2018. 9am-5pm
So, What’s it Going to Cost?
We routinely see doctors see an extra $20,000 the first month. Many of the doctors whom I have taught, see an extra $400,000 to $1,000,000 per year.
NO MEDICAL PROCEDURES WILL BE TAUGHT AT THIS WORKSHOP. THIS IS FOR TEACHING ETHICAL MARKETING ONLY–NOT FOR LEARNING THE SPECIFICS OF DOING A PARTICULAR PROCEDURE (BUT WHICH PROCEDURES MIGHT BRING THE MOST VALUE TO YOUR PATIENTS AND HELP YOUR PROFITS MOST, WILL BE COVERED).
Price: $197 for One VIP Ticket
“100% Money Back, No Questions, Guarantee”
If at the end of day, if you ABSOLUTELY do not think you will more than pay for this course within ONE MONTH of going home if you only implement 1/2 of what you learn, I will write you a check for the full price that you paid for the course.
–Charles Runels, MD
Apply for Admission<– (If you are not accepted, you will receive a prompt and cheerful refund. Only physicians, nurse practitioners, and PA’s may apply. Attendees may bring his/her marketing person at full price for an extra ticket for the marketing person.) NO MEDICAL PROCEDURES WILL BE TAUGHT AT THIS WORKSHOP. THIS IS FOR MARKETING PURPOSES ONLY.
ALL OF ADMISSIONS WILL BE USED FOR MEDICAL RESEARCH.
Kiss Your Pimp Goodbye
WARNING: This is a WORKshop…you will do and create while here. Do not come to this if you do not intend to work…
Charles Runels will share details how as internist from Alabama with ONLY 3 red lights on main street created more than a billion dollars in value for the doctors in his group, funded research, AND innovated in health care bringing new effective treatments to medicine (and creating 2 non-profits)…using a lap top and one exam room. By the inventor, Charles Runels, of the Vampire Facelift®, O-Shot® [Orgasm Shot®], Vampire Breast Lift®, P-Shot® [Priapus Shot®], & author of research and best selling books.
He will draw upon over 2 million dollars invested in his marketing education (and 20 years of doing his own websites)…and give you as much as he can in these 2 days and 16 hours of work.
For physicians (and other health care providers)
who want to improve health care while having more cash to keep the doors open (and to provide free care to those who need it…without begging the pimp-insurance-for a raise).
Leave the course with your written outline for your book (that you will finish in a month)
and a detailed economical marketing plan for your practice that will boost your effectiveness as a healer & increase your profits with cash procedures.
Powerful plans for those already accepting cash and for those who are still on an all cash practice.
You will have more money and time to work for free to care for the indigent (without asking insurance to reimburse you).
And you will have more time and $ for your family.
August 18-19, 2018. New York City.
Venue to be announced.
Apply for Admission<– (If you are not accepted, you will receive a prompt and cheerful refund. Only physicians, nurse practitioners, and PA’s may apply. A attendees may bring his/her marketing person at full price for an extra ticket for the marketing person.) NO MEDICAL PROCEDURES WILL BE TAUGHT AT THIS WORKSHOP. THIS IS FOR MARKETING PURPOSES ONLY.
1/2 OF ALL PROCEEDS WILL BE USED FOR MEDICAL RESEARCH.
Free white paper and how to get discounted price on Emsella for being an O-Shot® provider…
This sample of our weekly journal club is posted as an example of part of the benefits our joining our provider groups. We do these meetings weekly...every week and feature physicians and their amazing research from around the world.
Topics Discussed Include the Following…
*Documenting the Penis
*Documenting the Penis by text (in a private way)
*How long to wait after the O-Shot® before getting a Vaginal Laser treatment?
*Treating the Bell’s Palsy with the Vampire Facelift®
*Where to park your podcast
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Documenting the Penis
Charles Runels: Welcome everybody. Looks like we have a great turnout today. Let’s start with this question just it’s about where to find the questionnaire for men. It’s a good reminder that we should be doing something to document an objective measure of what’s happening. Moving to the O-Shot® and the Priapus Shot®, so I’ll show you where to find it for both. When you log into the Priapus Shot® membership site, and you click on the how to do procedure button, and then you scroll down. There’s an erectile scale, so it’s objective measurement of erectile function. It’s commonly used by the urologist and there it is right there. Erectile dysfunction intensity scale.
Then when you open that, it gives you a scale of from one to five, for five questions. So the lowest you can get is one on every one– times five, the most you could get is 25, so that’s where you would download that. Now, if you don’t want to, well let me take this back.
Online, Text, Documenting the Penis
If you want to continue to survey them, old school way would be to do this the day you visit with them, and then on follow up visits, but if you wanted to have it done automatically, then you’d go back over here and we have, so you go back to the dashboard and then you click on patient survey.
We will administer that for you. I recommend you do both. Do something on paper the day you visit them, and do the procedure and then follow up, but then also all you have to do is put in their name and cell phone number, and then they’re surveyed in a HIPAA compliant way with some open ended questions, also you can see we have a drop down menu so we look to see which kit you used, and other things like are they on testosterone. If someone put something really strange in here, then we have a way I can use birthdays, and the day they saw you, and you could reconstruct it and contact them, but the good thing is I can give you your data. What your patients are doing, and this will help us design future studies.
Even though it’s not double-blind placebo, there’s a fair number of data points being collected, so we can publish this in a prospective survey kind of thing, and that same erectile dysfunction scale was part of this, so questions one through five questions where they’re graded one through five. That’s where you find it, on the how to do page, and then scroll to the bottom and you can download it. Then on the same thing for the female side, there’s female sexual distress and female sexual function index, which takes a few minutes. Female sexual distress is the quickest. Female sexual function index probably takes, if they’re thoughtful about it, five minutes or so, but we can administer those also by survey. Then give you that data. So that was a good question.
How long to wait after the O-Shot® before getting a Vaginal Laser treatment?
Let’s see. This was a good, oh, well I’ll come back to that. Let’s go ahead and do this question. How long does a patient need to wait after the O shot for getting a Mona Lisa vaginal laser treatment for vaginal atrophy? By the way, you guys, you can type into the question box if you want to contribute, you can just raise your hand and I’ll unmute your mic, or you can type into the question box if you have a question or a comment, and I’ll either read it or unmute you so you can talk. This is a great question. As part of the answer to this, someone asked me for a detailed video recording that they could show their patients after they had a procedure done.
The O-Shot® procedure, so I’ll show you where I put it and I’ll recommend that you guys do your version of it. I’ll show you where it lives. Right here. If you go to the O-Shot webpage, the main site, and then recent posts, I put a podcast blog right there. So you can just click on it there, and actually the transcription is done, I’ll have that posted by tomorrow morning, but I recommend you take my transcript, and read it, and do it your own video or your own podcast, and put it on your website, and modify it based on your observations and philosophies. You’ll see I go into what to expect whether you’re doing it for like necrosis, and I go into some of the ideas about using other methods like radio frequency, the Emsella with the electromagnetic contraction of the pelvic floor.
If you are interested in Emsella, send message to the company to get a discount for being a member of the O-Shot® provider group…
if you purchase, then let us know and we will put an icon by your name on the O-Shot® directory so that women know that you offer a combination therapy of the O-Shot® procedure combined with the Emsella treatment…
here’s where to let us know…
So back to this question, if you do the O-Shot® the day of the procedure, you could do the O-Shot® immediately after any sort of inner treatment, so you do vaginal laser, or radio frequency, and the same visit, same day, immediately afterwards you could use PRP. Same thing if you were an Olympic athlete, you’d use PRP to help recover the muscle function immediately afterwards. If you go to PubMed and just read about PRP, one time it was outlawed by the Olympic committee because it does seem to help recovery with muscle function, but then they decided to allow it.
You could make the argument that it may even help the day of using an Emsella or the electromagnetic treatment, but if you do the PRP first, then the energy’s going to denature the amino acid proteins, just like if you took insulin and shook it, or you cooked it, you denature the amino acid chain and uncode that chain so it no longer, it just becomes another protein. It no longer is a chemical messenger like the amino acid peptide or hormones like growth hormone and insulin are, which is of course why you cannot take them by mouth because the digestive system, as you guys know, breaks amino acids apart so now it just becomes like you ate a hamburger, so you can’t take insulin as a pill or growth hormone as a pill because it denatures or scrambles the message.
In the same way, if you did an O-Shot®, so the question is how long does a patient need to wait after the O-Shot® before you do the Mona Lisa, but what you can assume is whenever you do the Mona Lisa, you’re going to undo first of all the amino acid messenger chain, that are the small peptides, that are released from the platelets. Then second of all, of course the laser is going to cause damage, which is the intention of fractal sort of puncture wound as if it were doing a laser version of micro-needling. And then you have recovery or healing of that. So if you’re doing heat and you have pluripotent stem cells that have migrated there because of your plasma it appears to me that you would probably undo that as well, that growth.
I would say you would do the Mona Lisa whenever you thought the effects of the O-Shot had taken place. If you flip the order, you go Mona Lisa and O-Shot immediately afterwards on the first day, but if you do Mona Lisa first I would want to wait at least six weeks, preferably eight weeks so that you have most of the benefit of the O-Shot before you did the laser. If you look at the wound care studies that Sclafani did with PRP most of the effects were there at eight weeks with full effect at 12 weeks post treatment with PRP. I would want to give it eight weeks or else I’m attenuating the results of the O-Shot.
Using the Vampire Facelift® help Bell’s Palsy
Okay so, we covered this one with the short vagina last meeting, let’s see if anybody has, nobody has a question yet. There was a really interesting question someone had about, yeah. So Catherine Stone (check her out here) is one of our [amazing] providers in New Zealand and she also keeps an office in London, one of our teachers, she teaches a beautiful class there in New Zealand.
She teaches along with Dr. Kirshni Appanna.
She says, if you, well she talks about Botox [as a treatment for Bell’s Palsy], but she comes up to Bell’s Palsy, “I treat a lot of residual Bell Palsy and facial asymmetry patients this way using Botox. Once their Palsy is established how about PRP for Bell’s Palsy? Would you only use it the first six months or you think is long term?”
Where to inject, so this is a great question. One of us needs to publish this because so far three people have told me that they saw benefit years after the Bell’s Palsy.
I’ll pull this up just so you can see. The only reference I saw to it in the literature was someone who put this out where they used mononuclear cells and platelet plasma which there’s two variables–after 26 YEARS of being plagued with this condition.
But, we’ve had three different people tell me, and I’ve actually seen this as well, a Bell’s Palsy improved years afterwards. One of the people works in my office as a matter of fact had, not a Bell’s Palsy but facial surgery that left her with numbness that’d been done over ten years before she came to work for me.
I did the Vampire Facelift® for a cosmetic result and then anecdotally she noticed that the sensation had returned to her face. So, I don’t know when the time limit is for this to happen, but it appears to be that it can happen after, not just the acute phase, but months or years after the Bell’s Palsy has occurred. If you actually just look at the research, what’s been published, there’s a fair number of studies showing plate rich plasma helping regenerate nerve tissue. I think it’s because we know it’s affect on attenuating all the immune response, it’d be nice to get to these people immediately when the Bell’s Palsy occurs and see what would happen and someone needs to do that study.
There’s so much research that needs to be done based on our observations but there’s no downside and a huge upside so I would say try it and of course it’s in the distribution of the facial nerve, I would just, but there’s no downside of just putting it everywhere. I would just put subdermally everywhere. We actually used to do this eight years ago when I first started doing the Vampire and using PRP cosmetically. I would use more of it, I’d basically tried to fill every part of the face subdermally but most people found that, or some people found it a little much so I became more selective and strategic about where I place it.
But I think in the case where you’re trying to regenerate nerve, I would just consider it, putting it everywhere. Or, if you want to be more specific you put it in the distribution of the facial nerve. Okay, let’s see, we didn’t have as many questions this time, i think that pretty much covered the questions that showed up on the website. See if anybody else has any questions. We may shut this down early. The, let’s see I don’t see any other questions.
I’d like to cover when we do these journal clubs, I like to cover research that we’ve done and hopefully somebody will build on that and something about marketing. As far as marketing goes this time, I think that there was one question that came up about building out a link to sell the Altar or whatever you might want to sell, creating a link that goes on your website. I actually covered that a few workshops or journal clubs ago, it might help if I just show you how easy it is to find things that are actually on one of our pages. If you go, I’ll go in and I’ll show you. There’s a search box and if you just type that, whatever it is you’re looking for, so let’s say that we’re on this page, and by the way our Altar shipped this week so hopefully you guys are seeing that.
Where to park your podcast<–
Get to the page. Yeah. There, so whenever you’re here, you just put in the search box whatever it is you’re looking for so it’ll pull it up on any of the posts. We have many pages on these websites. Let’s see if there’s any other questions. Not many questions this week so we may just shut this down. Okay so I think that’s it. My big marketing tip, well big but I don’t know about that, but the marketing tip I have for you this time is record an aftercare, either podcast or video. For podcast I use Libsyn.com L-i-b-s-y-n.com. You can record a podcast or a video for the actor here. What to expect before your procedures, you can put that on your websites because a lot of people look at that before they have a procedure done and you’ll find that people come to you and have the procedure done because they saw your aftercare instructions. So tonight was a quick one, I don’t see any other questions so we’ll just shut this down. You guys have a wonderful week.
Treatment of Bell’s Palsy with PRP (why the Vampire Facelift® could help this condition after 26 YEARS)<–
Cellular Medicine Association
Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.
Dr. Runels: Thank you for having me.
I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.
I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.
My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.
Platelet Rich Plasma.
Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.
There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.
We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].
Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.
We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.
We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.
One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.
That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.
Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.
Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.
Wound Healing/Scar Resolution
Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.
If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.
Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.
Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.
Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.
If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.
Penile Rehabilitation and Erectile Dysfunction
I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.
In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.
The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.
Improved Orgasm & Libido in Women
That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.
I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.
Dr. Marco Pelosi III: Thank you Charles. Beautiful
The following is a video and transcript of the weekly “Round Table Journal Club” of the Cellular Medicine Association.
Charles Runels: We’ll start with some research that I think is worth paying attention to and then we’ll answer what questions might have appeared in the past week or so and then a quick marketing tip about how to use our poster. So that’s what I have planned for today but as always, we’ll take any questions that you guys have on the call.
If you’re not a subscriber to the Journal of Sexual Medicine, oh, by the way, we also have some really crazy good press that came out this month on the current Men’s Health magazine.
The one that is on the stands now. It’s the issue that has Mark Wahlberg on the cover. So it’s in every Wal-Mart, every bookstore right now and we have an article in there. It’s titled, “New Year,” excuse my French but that’s the title of it. “New Year, New Dick,” that’s the name of the title and the guy talks about our priapus shot.
As often happens, he doesn’t get the legal part right and he spells Priapus incorrectly, but he puts shot with a lower case “s” and leaves off the registered mark (®) so there really is some pretty sloppy journalism going on (since a little research shows that Priapus Shot® is intellectual property intended to mean a particular way of using PRP injections in the penis and post op and pre op protocols).
But, Andy Warhol said, “I don’t read the reviews, I just measure them in inches.” But this is a really good time to talk about the Priapus Shot®. I’ll send out an email to the group to let people know, but the Priapus Shot® porcedure is really in the news. To put an ad in that magazine costs you quarter million dollars and we have an eight page article now about the Priapus Shot® procedure in Men’s Health, so it’s a good time to talk about that.
So back to this research, it’s pretty easy to summarize and this has been out for a few months and I’ve been wanting to bring it up. It talks about this thing that we all know that women who are put on Serotonin Reuptake Inhibitors often have a drop in their sex drive.
This is the paper that came out... Click to Read Abstract<--
But what isn’t talked about a lot is that even after you stop the medication, often times they keep the low sex drive. So I have a little formula that I use before there was an “O” shot that I’m happy to share with you and then I think combining it with the “O” shot, we should get even better results. But I wouldn’t pretend like only rejuvenating the tissue of the vagina could take care of all the problems that might be going on metabolically in the brain secondary to months on an SSRI.
What I have found works the best is this. I make sure that, I’ll just bring this up where I can kind of type it out. I’m going to put this where I can make it where you can see it. This would be my of handling this and I’ve found that just one thing often doesn’t work. The first thing I put on is I like Depo-testosterone, Depo-testosterone. This is one of those drugs unlike some, where generic is fine, I don’t or I’ll compound it, can even be better in some cases. I don’t like to start a woman with creams because she may forget them, she may sweat them off down here in the south where it gets hot. Lots of things can happen.
Maybe she’s not absorbing it well and if a month later, her libido isn’t up, I have to do blood tests to know whether or not she’s even using it or absorbing it properly. But if I start off with Depo-testosterone 50 mg IM every 21 days, which is a pretty whopping dose and so you have to obviously, you don’t just put her on that and forget her. You have to bring her back about a week to two weeks after the second dose at the latest and you redo blood tests and see how she’s doing. They’ll often say their libido pops up towards the end of that 21 days and then pops back down and then comes up after the second shot and stays there. Then I’ll adjust it and then swap her over to creams or pellets after you get her libido back. But otherwise I’ve found I fiddled too long where that I know it’s in there and I know if testosterone’s going to help, that dose will help her.
1. Depo-testosterone 50mg im every 21 days. 2. Wellbutrin 3. O-Shot® 4. Family &/or Sex Therapy
Then if she needs an antidepressant, which often times she will not after you have her on testosterone, but I like Wellbutrin. It seems to, I’m spelling that wrong Wellbutrin. Anyway, you guys know what I’m trying to write, Wellbutrin. The slow release at 150 mg somewhere in that range. That will help the depression and also help with sex drive. Then of course, the “O” shot can go in that formula now and I like to make sure of course, that someone’s thinking about whatever else might be going on at home socially, or emotionally with the woman. It’s just sexuality and orgasm is such a complicated thing. I have done some of this, talking and counseling and trying to get husbands and wives in. But, it’s time consuming and I don’t attempt it anymore. A marriage counselor or a sex therapist or both. And that combination I think, well I know, that combination has pulled without even using the “O” shot before there was an “O” shot, has pulled my people out of that.
But the reason I wanted to bring up this research, is that most people realize there’s an SSRI syndrome that causes decreased libido, but it’s not often talked about that it persists in many women for unclear causes, even after you drop the off the medicines. I’ll copy this link into the chat box so it you guys want to check that out, you’ll know where to find it.
This is the paper that came out... Click to Read Abstract<--
Okay, so that’s the research for the day and let’s get to some of the questions. If you guys have any questions, just type them in there and while I’m getting to this other research, if you want to contribute to that cause I see some gynecologists on the call, just let me know and I’ll unmute your mike because I know that many of you have experience with this and may want to add to what we just said. And I would love to hear from you. So, there should be a little thing to raise your hand if you have your mike. Some of you don’t even have a mike turned on, but if you do and you want to contribute your ideas to that, let me know because I’d love to hear from you. Let me pull up the next question.
How long can you wait after phlebotomy before doing preparation of the PRP?
So this is a good question I think. It says, “What’s the longest we can wait after drawing the blood and before spinning and injecting? We’re performing “O” shots intraoperatively at the end of the case, who have a longer case. We like to draw blood prior to surgery. Any thoughts?” In the thoracic suite where people are doing heart bypass surgery, this is one of the places where this has been used PRP, to help healing of the sternal wound postop. The number I’ve been quoted is up to six hours, even after you centrifuge it, it can sit there. I think it’s certainly okay to let it sit there for three to four hours as you’ve indicated here in this question and then throw it in the centrifuge and inject it. That’s the answer to that question.
Now of course, after you push it through the needle or you add calcium chloride to it, all bets are off and I like it to begin the person’s body, preferably in less than a minute or two and I’m always trying to put it once I activate it with calcium. Which I hope you’re doing if you’re doing the “O” shot, activating it either with thrombin, which some of the kits have, calcium chloride or calcium gluconate. After that activation happens, it should be in the person’s body in less than three minutes.
I see Kathleen, if you don’t mind I’m going to have you pull up this next question, talk about how you deal with the ladies in your practice who have been on SSRI’s. Are you there Kathleen?
Kathleen Posey: Yeah, can you hear me?
Charles Runels: So for those of you who don’t know, Dr. Posey has seen thousands of women in her practice, is a gynecologist down in the New Orleans area. So talk to me about how you deal with the women either who are on SSRI’s or who have been on SSRI’s while I pull up the next questions. If you don’t mind.
Kathleen Posey: Very similar to you, that’s why I didn’t say anything except I agree. I mean if they come in on an SSRI and they have diminished orgasm ability, which most of them do I don’t stop their SSRI right away, I just add Wellbutrin and usually the combo is fine. Before I do the O-shot though, I really want the O-shot to work and I really try to ween them off the SSRI on to the Wellbutrin and a lot of the times I’ll do the same thing, I’ll give a shot of testosterone in it at the same time I’m doing a pellet, or I’ll give a shot of testosterone when I’m doing the O-shot because I just want them to get started and pretty much do the same, I use the pellets more than I do the injection but that’s just my preference.
Charles Runels: Okay so when you do, let me catch up with you. So when you do, someone comes in and they’re on an SSRI, you might start Wellbutrin and give them a testosterone injection or a pellet and then either do that O-shot then or bring them back and do the O-shot later is that correct?
Kathleen Posey: Yes but I keep them on SSRI because a lot of times, you know most of them have been on the SSRI so long I find if you just stop it and then just try to get them to go to a [inaudible 00:11:18] it doesn’t work that well. Wellbutrin makes them a little bit more nervous, it’s not as sedating and if you just give it, that’s why even the therapeutic does at 150 the therapeutic dose is 300. So if you just give them 150 it seems to work with the SSRI and then I’ll let them go a month or two talking about the O-shot, talking about testosterone and I usually try to ween them, eventually [inaudible 00:11:56].
Charles Runels: Okay. Alright.
Kathleen Posey: I know a lot of the psychiatrists do it that way too, they’ll just add …
Where do you get your supplies?
Charles Runels: Add the Wellbutrin, okay beautiful. Alright so here’s another question, it says where do you get your 30 gauge needles and your 1/16th syringes? So if you go on to the, hopefully it’s on here, if it’s not I need to fix it. If you go on to our website what I’ve tried to do is on the how to do page, so you’ll be coming from a different direction but … There should be a link to everything. Maybe there’s not. Nope. I’ll just put, I know it’s on the O-shot so let me pull it up there and I’ll add it to the vampire facelift. If you go to … by the way I just added to, let me pull this up, [inaudible 00:13:08].info … okay.
So in all the others, which I haven’t done yet on the facelift but I need to, all the others there’s a dashboard and when you go to the dashboard there’s a place where it says supplies and sources, also on the how-to-do procedure and when you click on that I just didn’t realize it didn’t have it there, maybe I overlooked it. But I know where it is on this one and right there is where I get most of my stuff from McGuff pharmacy. They have lure lock connectors, they’ve got the needles, they have the 1/16th syringes with the lure lock connection to it and I buy these by the box full for not much, there’s the part number and I’ll put this link in the little chat box and add it to the webpage where we put the answer to these questions.
O-Shot Provider Member's site P-Shot Provider Member's site Vampire Facelift Provider Member's site Vampire Facial Provider Member's site
So actually most of the questions this week were on the vampire facial website and if you guys aren’t yet doing micro needling or offering it for postpartum stretch marks it’s something to think about because I’m hearing more and more that, that’s working. Sign them up for two to three treatments and it’s really working well from what I here, I haven’t treated enough to tell you first hand but I have people in the group who have treated a lot of people with that. So, but there were quite a few questions in the vampire facial and then after these questions I’ll give you guys some marketing tips on how to use those posters. Oh by the way so here, before I get to these four good questions here I just added a new dashboard and a lot of extra content to the facial. So if you go to the vampire facial dashboard I uploaded some new videos, taken from our workshops and so this is the new facial dashboard and if you go to the how to do page you’ll see some really detailed videos where some of the stars in our group, like this one. Of course Dr. Bowen’s published some stuff about this, there’s some really nice videos, especially this one where some people who do a lot of micro needling talk about it.
Vampire Hair Growth™
So, let’s see back to our questions on this page and then we’ll talk about the posters. Four good questions here. Okay first one, where’s the quiz. I’m not sure why that’s not showing up but I’ll put that, make sure it says well there’s a little quiz there to take from some people but if you’ve already had a hands on course then it’s not going to show up. You’re not doing the hands on course you’re certified. But if you’re learning this as part of an online course then there should be a quiz that shows up. Let’s see this one, good morning I have a patient who’s [inaudible 00:16:44] hair PRP after a transplant, he’s been using Minoxidil, it’s on a low dose Finasteride. The hair is now thinning considerably, what about using the PRP after a hair transplant, any noticeable difference back on Finasteride or not?
So I’m going to approve this so it’ll show up and see if some of our hair people will help answer it but what I know is some of the people have told me that they are using PRP. Of course we know it’s being used as part of the hair transplant procedure with improved results, so most of the hair transplant surgeons are doing that now but the idea of repeating the PRP every six months or so is also becoming a thing that’s done standardly to help maintain it. So the short answer to that is yes, there’s evidence that it will help as far as putting people back on Finasteride it makes sense that it would help. There’s this talk of the occasional person who gets depressed from that and I don’t have an answer for that part of it but I know repeating the PRP every six months or so has been talked about among our group as being something that’s helping. Let’s see so how many treatments are recommended for the hair restoration?
So this again there’s not one standard, I will tell you from the things I’ve seen at the meetings, what I’ve seen that’s been published and there’s been a growing number of papers published and some of this there is not a known this is the answer but I’ll tell you what I think is the consensus for now. So how many treatments? Most people go three treatments at four to six weeks apart. How long until they’re visible? It can be up to six months, they have to be patient. But most of us are stopping if we don’t see any results a month after the second treatment, which would be two to three months in and results, as in documenting with photographs, if you see new hair growth and you keep going, most of us are stopping if you’re not seeing anything after the second month. But to be actually happy with what they’re seeing it can take six months to a year.
How long until the peek effect? Just answered that. How long do the effects last? Most people are redoing it every six months or so, just one treatment not the whole serious of three. What’s the recommended fee for each treatment? Anytime I spin blood it should be at least $600 because you have cost of good and your time. Most people are charging and that’s really almost losing money because you have to pay, not only the cost of good for these kits, which can be expensive but your time, the office time, there’s this engine running every minute in your office, you should calculate what that’s costing you by the time all the people are getting paid and the lights and the taxes and everything. Every minute that engine turn cost you money. So to really come out on this, really most people are charging a series of three for somewhere between 2500 to three grand and obviously that’s worth it if you get good results and we’re not keeping the money if we don’t get results. What type of anesthesia do you use? I put on the facelift … I need to put it on the facial side. That’s why this guys probably hasn’t seen it. But on the facelift side, I just put up a new video about hair. Actually, two new videos. So, here’s one of them. 20 minutes from one of our providers up in Canada. And then, this one. This Dr. Mario is been doing hair for a long time. I think it was 20-plus years he’s been doing hair. We filmed his technique for both doing hair, and blocking the scalp. I was somewhere down in Florida when we filmed this. So, those are two new videos that I recommend you watch to answer both the blocking part, and the technique part.
When do you add in the Botox when using PRP?
Okay. So, I think that answered all those questions. Next questions, if a patient has Botox recently, how long do you recommend waiting before scheduling a Vampire Facial? So if you think about it, the Botox binds to the nerve blocker about … it takes about four hours, so we tell our people, if you get treated with Botox, wait four hours before you lie down, stand on your head, all that stuff, so that it doesn’t migrate and cause atosis. Now, if you reversed it, and you did the Vampire Facial, you could immediately do Botox. If you did the facial first though … excuse me.
So if you did the facial, you could immediately do the Botox same visit. No big deal. If you did Botox, you could do the facial and probably get away with it anywhere other than the more exacting spots, like the lower face or the corner of the eye, where migration would cause a problem. If you were microneedling under the eye or the forehead, it wouldn’t really matter. Ideally it’s either same visit, go facial then Botox immediately afterwards, and I do that quite a bit with the facial and the facelift. Or, if they’ve had the facial, just give it four hours, so it could be the next day, or later that day if you just forgot and did one in the wrong orders, if you did the Botox first. And I think that’s all the questions on this.
Dana Kirk just put in something that is interesting. Okay. So she says, “At the last International Society of Hair Restoration Surgery … ” You know what? I may just unmute you if that’s okay, Dana, and let you tell us what you … sounds like you were at a cool meeting recently. Let you educate us. Hold on a second. If you’d rather not, that’s okay, but I’d rather you just tell them instead of me having to rehash what you said. Are you there, Dana?
Dana Kirk: Hi. Yeah, I’m here.
Next Workshops with Live Models<-- Find O-Shot® provider Find Priapus Shot® provider Find Vampire Facelift® provider Find Vampire Facial® provider Find Vampire Wing Lift™ provider The Cellular Medicine Association (who we are)<-- Charles Runels: Beautiful. Talk to us. So, you were just at a big meeting. Tell us about the meeting.
Dana Kirk: Well, it’s every other year, and it’s internationally, so they talk about the different protocols. And PRP, probably six years ago, was something that they kind of dismissed as being a standard protocol, and now it’s part of the mainstream.
Charles Runels: Beautiful.
Dana Kirk: Yeah. The recommendation is to … In the perfect scenario, you’re doing two treatments one month apart before the actual transplantation.
Charles Runels: Okay. Beautiful.
Dana Kirk: The jury’s still out as to if they do any A cell or anything during the transplant itself, but during the procedure part, they will go ahead and inject PRP at the same time.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: We do not discontinue the Finasteride. That’s continued at one milligram, and that just stays constant.
Charles Runels: Okay.
Dana Kirk: The Minoxidil is just temporarily for about two weeks, withheld.
Charles Runels: Uh-huh (affirmative).
Dana Kirk: And then, you resume every six to nine months with the maintenance, so that they don’t lose the remaining hair. These treatments won’t affect the transplanted hair, but it’s in preservation of the existing hair.
Charles Runels: Beautiful. Very smart. Thank you for adding that. And then, you mentioned something in your note to me just a moment ago, about low-level laser. Have they started making that part of their standard protocol?
Dana Kirk: Yes.
Charles Runels: Interesting.
Dana Kirk: Yeah.
Charles Runels: Do they have a particular brand that they are mostly recommending, or is it pretty much whatever you round up?
Dana Kirk: I mean, it’s across the board. It’s more about the diodes or the [diudes 00:24:45], depending on what part of the country you’re from how you say it.
Charles Runels: Yeah.
Dana Kirk: How many basic lasers are within that. But for the most part, the device needs to have a minimum of 30, and they need to wear the device anywhere from two to three times a week.
Charles Runels: Beautiful. You got this down. Thank you for all the help. So, stay on the line and have … you and Kathleen both have your mics unmuted right now. There’s another question here from … let’s see. Who’s this? It’s from David. I’m gonna unmute you, David, so you can ask us your question. Hold on a second.
When do you repeat the O-Shot® (Orgasm Shot®) procedure?
Okay. So maybe the mic’s not working. So David asked, “What’s your current protocol for the O-Shot? One? Or plan on repetitive series?” So, here’s the deal with that. When I survey our patients and when I survey our providers and I ask, “What happens first and second and third shot?” What I hear is that the first time around, across the board, the hard cases and the easy cases, this isn’t merely incontinence where we get closer to 90% or more depending on whose hand it’s in with one treatment for stress urinary incontinence. Not for that, but just averaging them all together. So, this is including hard cases. A woman who’s never had an orgasm in her life and she’s trying to learn how to have an … you know, trying to get her body to respond.
We have 65% of women are delighted after the first treatment. It jumps to 85 after the second one. And so, I had the idea of maybe just making it standard protocol that everybody gets two treatments, sort of like we do with the hair. You know, you sign up, you get two to three treatments everybody. But to me, that somehow didn’t feel fair to those women, which is more than half, who are perfectly happy after the first. Now the other thing is, a lot of people are happy after the first, but if you repeat it at eight weeks, they then love it. So, after the first treatment, her pain went away, Dyspareunia resolved. But after the second treatment, she was unchained, was the word she used. Whatever that means.
So, it does seem to be additive in some people. But again, I didn’t want to make it necessary if it isn’t necessary. So the short of it is, [inaudible 00:27:20] are happy, and they seem to be still wanting to cooperate with you as a patient, do it again about eight weeks later. I wouldn’t do it any sooner, because otherwise you don’t know the results of the first one. So, do it again. And then, if they don’t respond after the second treatment by eight weeks, now you’re into 16 weeks. Eight weeks after the first one, you can repeat it. Eight weeks after that one, you can repeat it again. Then, I would give them their money back. So, that’s kinda how I go by it. If they come back after the first one and they are better, but they still haven’t seen all the results they want, most people want to pay you again. But, if they just saw zero results, I’ll usually repeat the second one without charging them, and then give them back their money if they’re not better after the second one. So, I think that’s probably the answer to that question.
Anybody else have a question?
David: Can you hear me now?
Charles Runels: Now I can. Yes. Now I can. Beautiful.
David: All right. Sorry.
Charles Runels: Any follow-up question to that? It’s good?
David: Okay. The reason I asked that, and I think I asked it once before about three or four weeks ago, is that, you know, I did an O-Shot on Diane. She had absolutely incredible results on her bladder concerns for about 10 days.
Charles Runels: Okay.
David: She was just exquisitely pleased.
Charles Runels: Yeah.
David: And then, she saw that start wearing off, as I’ve said in past conferences. Now, I’ve teamed up with someone. You know Debra Parker, I presume?
Charles Runels: Uh-huh (affirmative).
David: She’s an RN. She said that she has found that some of the practitioners she works with … she’s an RN in Tennessee or Kentucky. I can’t remember. She has said that the protocol that they’ve used in the clinics that she’s working with now, it’s pretty much go to standard three injections and charge $2100 bucks for a combination of three, and that their success has been 95-plus.
Charles Runels: Yeah. I couldn’t argue with that. You know, you may find that some people are well after the first one or two, and are not really wanting to go further, but I couldn’t argue with that at all. It’s what we do with them. Any other PRP procedures, you know, the Vampire Facial’s a series of three. So, absolutely. I think it’s worth considering.
Charles Runels: I wouldn’t consider it bad medicine considering it’s a fairly safe thing to do. In everything we’ve seen, it seems to be cumulative. The other thing that helps if you have … ’cause some people, it doesn’t wear off until a year out, and so do you really? That’s the question I have, do you really want to have everybody go through a series of three if maybe whatever percentage of them would have been fine with just one? I don’t know the answer to that. I could argue with making it a series of three and having a higher success rate. I’m just kind of deciding on a case by case, after each shot, deciding if they need another one.
The other thing that would add to it I think is combining it with some sort of energy source. So when I talk to the people who do energy followed by PRP whether it’s laser or ThermiVa, they do energy then PRP same visit. Their success rate of the first round seems higher and it seems to hold maybe a little longer. Again, do you want to make it the standard for everybody? It’s probably not needed since many people get better with just one O-Shot®, that’s it, that’s all it takes.
But when I talk … and we don’t have the numbers, that’s part, I want to just put in another plug for this. If you go and do our patient survey, which hopefully you guys are still putting people in, we’re trying to get a feel for that because part of the questionnaire asks people, it’s sent to them by text message, all HIPPA compliant, costs you guys nothing, I can give your data back to you. But the person who puts the person in the study puts in, did you do a laser device? Did you do a radio frequency device? Then we can follow survey data about why they were treated and maybe get an idea if it’s truly what I’m hearing, which is close to 100% if you do energy followed by O-Shot® on the same visit first time around.
David: That’s interesting. Okay, well that, thanks for that. I just want to give you an upgrade and to the point …
Charles Runels: Thank you.
David: … Diana said she wants to go ahead and repeat it once or twice, because she had such good results, she wants to have a repeat …
Charles Runels: Beautiful.
David: … and she’d have no problem in doing so.
Charles Runels: Beautiful. Well, thank you for the feedback.
Hey, just hang on the line, let’s see if you have anybody … no other questions. Any other feedback that anybody has, raise your hands, otherwise, I’m just gonna do a quick like five minute, “How to Use our Poster to Get Patients,” tips.
How to use an office O-Shot® or P-Shot® poster to help patients who need you to find you…
Okay, don’t see any other hands.
While you’re on the line David, have you used our poster to recruit patients? If so, how have you used it?
David: I haven’t really, because I deal with someone who has an existing cosmetic practice, who just has some concerns about artwork and style and things like that, so I don’t want to push it.
Charles Runels: Okay.
David: I have no problem. I have not done it, I have no problem with it, she does, so I’ve kind of backed off.
Charles Runels: Yeah, interesting. She doesn’t think it matches the office, that’s okay.
David: Yeah. I’ve used the brochures and she has no problem with handing the brochures. She has no problem with my talking about it on Facebook Live, etc., etc. I don’t know, I haven’t revisited since the first time I tried, so I’ll do it again.
Charles Runels: It does bring up a good point in that some people … and I’ll meet you here in a second Kathleen, ’cause I know Kathleen’s used her poster some. But it does bring up a huge point in that some people are embarrassed to have it, because they realize you now have a sign in your office that’s talking about sex. It could be that’s she’s saying it doesn’t match with the décor, but what she’s really saying is I don’t want a sex sign in the office and that’s okay. It’s her office, she can decide whatever she wants. Then you’ll go to an office and you’ll see, they got a Cosmo on the table and the front cover is about 16 ways to give a freakin blow job.
Charles Runels: Here’s my thing about offices, my number one rule is, if you’re not taking control of the environment of your office, in my opinion, you’re losing one of the main effects of an office. I have had people occasionally come to my office and I’ll come out to bring them back to the exam room and they are sobbing because they’ll say, “I feel like this is a healing place.” What they’re feeling is that I have taken control of their environment, there is not poison in the air, there’s no TV blaring, if somebody donates magazines to my office, they go in the garbage can, because everything that you can see, read or hear in my office is good for you. I’m controlling it and if a magazine comes in, I’m gonna be advertising Botox and they’ve got an add for some stupid cream that’s supposed to work like Botox in Cosmo, so all that stuff goes out the door.
Then as far as what we put in there, everything that I’ve done, I’m trying to take the John Grisham approach. John Grisham has a rule that he never writes a book that he would be embarrassed that his mother read it. If you look at our stuff, I try to keep that in mind. These posters by the way, sit in India, they sit in Maine, one of my providers sits within a short drive of the LL Bean store, places where … I’m in Alabama in the Bible Belt, so it could be that, and I’ve heard people say, “Oh, I can’t put a poster, because it has about sex.” Again, I don’t know the situation in your office, it may not even relate to what I’m saying, but your comment triggered some stuff that probably needs to be said, which is most people find that they’re patients are so needing something to break the ice. They’re so needing anything to break the ice, because they’re afraid and they’re embarrassed to bring up the subject. Anything that you can do to break the ice, they love it.
They also have on the O-Shot® website a little five questionnaire that says something like, “Do you have pain? Are you able to have arousal?” The last question is, “Do you want to the doctor?” Adding that to the intake form gives you an icebreaker to let you know if they want talk or not.
Having said that, I’m gonna open your mic Kathleen and then I’m gonna give my steps on how to use the poster.
Okay, let’s see, you’re on mute.
Kathleen Posey: Okay.
Charles Runels: Are you using poster?
Kathleen Posey: Yes. I’ve used my poster for years, it fits in my waiting room along with the books that are in the waiting room. All my books are in all my exam rooms.
You’re talking about the patients are saying it’s easier to talk about sex. They’ll come in and say to me, “I can’t believe that you’re gonna let me talk about sex now?” What’s also interesting in what you were just talking, what I’ve also realized, I’ve gotten a lot easier to talk about sex.
Charles Runels: Interesting.
Kathleen Posey: I’ve been doing this goin on five years now and I would probably say six years ago, I either didn’t have the time, I wasn’t comfortable or I didn’t know really how to help them to say, “You know, do you have orgasms?” Now, I have no trouble asking a person about their sex life.
Charles Runels: Interesting.
Kathleen Posey: Six years ago I did and I think most gynecologists do even though we are who we are. My poster has helped, because I’m just a routine gynecologist, it’s helped my practice knowing that I’m doing something different, and if they don’t an email or whatever and having the books. A lot of times the books disappear, but I could care less, because if they disappeared in the waiting room or the exam room, they’re reading it or they’re going to give it to somebody else. I actually give out a lot of books. If they’re a hairdresser and I find out they’re a hairdresser and they an O-Shot®, I give them about 10 books, because they’re talking to everybody.
Charles Runels: Beautiful.
Kathleen Posey: The posters really help me get more comfortable about talking about sex and it’s also, I think, gotten the patients more comfortable that they can ask me.
Charles Runels: Beautiful.
Kathleen Posey: When I was doing surgery, I’d just wanted, you want to put that hand on the door when they start asking about sex, you want to run through it, I don’t feel that way anymore.
Charles Runels: Beautiful. Well, you bring up several good tips. One of them is, which before a lot of things that have happened over that last few years, not just with the O-Shot®, but other things. Why bring up the subject if you don’t have lots of options or at least some number of good options as a solution? You don’t want to bring up world hunger in part of your visit, you can’t fix it. Obviously sex isn’t world hunger, but we didn’t have as many options even five – 10 yeas ago. Now that we do, it’s more easy to bring it up. By the way, I think …
Charles Runels: Yes sir.
Charles Runels: Yes.
David: Dave again.
Charles Runels: Oh, yeah.
David: One of the things I’ve used as a … I don’t have as many stories as you do, so I use your stories.
Charles Runels: I mean good.
David: I strongly suggest people do until they have their own. I had a woman in the office today who came to me for orthopedic issues. As you know I’m an orthopedic surgeon and I do a lot of orthopedic BLP and stem cells and peptides and whatever. In the process there of, she said, well you know she knew my associate very well, said, “I’ve known her forever, she’s done all my facial stuff and everything else. What else do you guys do?” Man that was just a perfect opening to be able to discuss. I didn’t have a poster in the room, but I turned on my verbal poster and I started telling Charles stories about your urologist friend and taking off the market by the FDA of the product for urinary incontinence, how horrible slings were except in the cases that had to have them and it when on to the girlfriend and the banker and to this that and the Sunday afternoon when you tried it on yourself. She was just like, “Oh my God, this is incredible. I had no idea that this existed.”
I encourage people to use you until they have their own stories.
Charles Runels: Beautiful and that also brings up another thing, the people that have done well with us, like super well, like Kathleen where they’ve had really really good results as far as the marketing piece, they are out there telling stories. They’ll do a YouTube video, they’ll interview a patient, patients tell their story. Stories are the best way, that’s really how a lot of people learn.
This is where the shot lives, if someone wants to pick one up and I’ll try to expand it where you can see it a little better. That didn’t expand it, just made me try to order one. But anyway, it’s written in a … Here’s the quick way to how to use it and we’ll shut down the call.
If you guys don’t mind I’m gonna mute this a little bit, I’m gonna mute some of the microphones, but I’m happy to unmute them if somebody needs that done.
Here’s my quick version of how to use the poster.
You have it sitting at a place they will be staring at it if there’s any moments waiting in your office. Not just this poster, any poster, something you want to you sell. If you notice, the bottom of the poster has a website on it. You would like for them to go to that website on their iPhone or their iPad while their waiting and find out something about it. If they ask you what the O-Shot® is and they haven’t done that, it’s a very difficult thing to explain in the office. Especially for your staff, whose phones ringing and they’re busy, they don’t want to explain it. They’ll tell them just enough to scare them off.
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When they inquire about it, the best thing to do is do what you heard Dr. Posey do, which is hand them a book or a brochure. Something that they’ll have with them physical to look and think about so that they teach themselves about it. I wouldn’t even really try to push it to a conclusion while they’re in the office, it’s too much for them to figure out what PRP is and whether they want something. You just let them know that it’s available. You don’t want to push it on someone who hasn’t thought about it and is pretty certain that’s what they want anyway. You hand them a book or brochure. I have mine in a little stack, with a little not by it that says, “Free, take two or three.” Otherwise, they feel guilty about taking one.
I have a standing challenge, so far no one’s ever called me out on it. If they do I’m happy to keep my promise, which is that if you give away 10 O-Shot® books in your office, I don’t mean throwing them out like at one of our Mardi Gras parades or stacking them up at the gym, but I mean someone taking it from your office or you handing to someone and saying, “Here, this tells you more about what’s on the poster.” Or, “Here, I think this may help you.” If you don’t get at least one patient for those 10 books, I will send you 10 more books. That’s a standing invitation, because if you don’t get one after 10 or 20 books, then I need to talk with you more about how you’re talking about it. You should be having at least one or two, often times you’ll get two or three people for those 10 books. You’re not just obviously doing a procedure, you’re changing their life. You’re changing their relationship many times.
That’s the quick version of how to use these posters. You don’t want it in the hallway where they’re passing it. One of our providers actually has it in the bathroom, so when they’re urinating, they’re staring at the poster. It could be anywhere where they have to sit for more than a couple of minutes.
I see Kathleen’s hand back up. Let me undo your mic and then I think we’re gonna call it a day.
Kathleen, you’re back live.
Kathleen Posey: Actually, that was an old. My hand was …
Charles Runels: Oh alright.
Kathleen Posey: … a while ago.
Charles Runels: Okay, so you guys have a wonderful week.
Kathleen Posey: I was actually gonna ask you a question about …
Charles Runels: Okay, go for it, I’m in no hurry. Go.
What’s the best way to measure and adjust testosterone levels in women?
Kathleen Posey: It was back with the testosterone. Before I give testosterone or pellets or even an O-Shot®, just personally, I get their pre and total testosterone levels.
Charles Runels: Yes.
Kathleen Posey: What do you think the normal levels in a female should be? What is the limit of high that you will let it go to? I do the thing because again, it’s so conservative I want it for the boards to show that it was frankly non-existent and that’s why I gave them the testosterone. What do you do?
Charles Runels: Okay, so …
Kathleen Posey: What do you think?
Charles Runels: We’ve sat through these lectures before, as you know listening to Erwin Goldstein speak who edited the Journal of Sexual Medicine for seven years. He’s high on this website, which I’m gonna through into, post into here, which is using pre and total testosterone and sex finding globulin to calculate the pre testosterone level. If they’re having symptoms, then I like for … this is showing you all the calculations that computer’s doing for you … I like for their pre-testosterone level to be in the upper 25% of normal, that’s what I calculate for. If it’s in the lower 50th percentile, then I’ll add to it. If check it and if it’s high, and it’s above what’s normal for free, I will drop the level. I think if you don’t do that then you are sort of opening yourselves up for problems. If you’re looking at problems, not I don’t think medically, but politically it’s interesting how testosterone because of the athletes abusing it, it’s become a target for all the things with three letters, the DEA and all that.
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Even though there’s lots of evidence and I know there are physicians and women out there who feel better with the pre-testosterone that’s higher than what’s normal for a female, and I don’t think there’s anything medically wrong with it if you’re following them clinically. I’ll tell you one scenario. I had a poor little lady in her 80s who fell and broke her humerus and was teetering ongoing to a nursing home. I make no apologies, she was still bright minded and just a beautiful hearted woman who lived down the street from me. I put her on a man dose of testosterone, sent her to my favorite physical therapist and we got almost 10 more years of her living independent at home. She got a little hair on her lip, but we’d go have tea every day and she loved me and she was independent for another almost 10 years. Was that bad medicine? I don’t think so. I’m not giving her prostate cancer, she didn’t care about the facial hair so much and we had a good time. But, as far as politically goes, I think pre-testosterone that’s what you follow and there’s the calculator for it, which I’m told is more accurate than letting the lab calculate it for you using those two. You get a sex hormone bonding globulin along with the testosterone level and that’s how you get it.
Again, I start them on that 50mg IM and they get the feeling of it and they kind of blast them off and then I can drop it if I need to.
Okay, you guys have a lot of good information. A crazy good call and happy with all the participation.
Okay, I think that’s it. You guys have a great day. Good-bye.
Charles Runels, MD
Inventor of the Priapus Shot®, O-Shot®, & Vampire Procedures® (facelift, facial, breast lift, wing lift)