Marketing Medicine During COVID

Marketing Medicine During COVID


This course is offered only in-person; it is not offered virtually/online so that participants will be able to focus without distraction in a true workshop setting.

Here are some of the things you’ll learn in this full day devoted to emails…

*Not just learning but practicing in this WORKshop, and then going home with emails already written and ready to send.
*How to write informative, compelling, inspiring emails in 10 minutes or less.
*The best software to use to send your emails and a cram course on how to use it.
*How to combat the fear of saying the “wr0ng thing.”
*Write an email that displays your knowledge instead of one that turns you into a discount store.

*How to stack emails that go out automatically so that you have emails going out every day to just the right person at the right time.
*How to decrease your chances of landing in the spam folder.
*How to use the software so that it’s not much different than writing a word document for you to write a web page and an email.
*Easy templates where you can almost fill in the blanks with what’s already in your head (the things you’re tired of saying all day long in the office) and convert those things into compelling and motivating emails.
*Exactly how to convert your daily reading into ideas for writing emails.
*How to unblock your brain so that for you to write an email is as easy as doing your routine medical care.
*How to avoid being robbed and hire the right people to help you (and do most of the work yourself for almost no money or time).


Complete Money-Back Guarantee
Come to this course, bring a pencil and paper, pour yourself a cup of coffee, take notes, then write an email in 10 minutes, during the workshop, before lunchtime. If you do not think that just ONE email (distributed the way I teach you) will more than pay for this course, if you do not think that my methods will make you smarter and your patients healthier, then you can walk out and collect a complete and cheerful refund.


2021 January 30 from 9 am until 6 pm cst

Reserve 1 Seat for $1,897<–
Reserve 2 Seats $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

 


Venue for “E-Mail Secrets Workshop”

No Mask Needed On Your Breaks at the Grand Marriott–The Bay Wind Keeps You Safe. Inside, we follow guidelines.
  • The venue for the workshop will be the Grand Hotel where you will have access to a spa, golf, harbor, and resort pool. Rates are usually around $200 to $300 per night. This hotel has a shuttle from the airport to the hotel but it’s about $75 (almost as much as renting a car).
  • The closest airport to fly into is Mobile Alabama. The taxi ride from Mobile to the coastal village of Fairhope) is about 45 minutes. Here’s an article from Smithsonian Magazine about the town of Fairhope.
  • The airport at Pensacola Florida is about the same distance by time (and my favorite local airport) but will probably require renting a car since it’s further in distance than the Mobile Airport.
  • One alternative place to stay in Fairhope is The Hampton Inn (23 North Section Street, Fairhope, Alabama 36532), which is about 3 miles from the venue (Grand Hotel Marriott). The room for 2 people at the Hampton is around $140–will be discounted to $99 if you use the code “Studio Medicine when you make a reservation. If they must upgrade to a larger room due to availability, you still will get a nice discount with that code (which is only for my patients and workshop attendees).
  • In Fairhope, you can shop antiques and clothing and quaint places to eat, or stroll the Mobile Bay.

If you have difficulty making arrangements, please contact me at DrRunels@Runels.com or call 251-648-7704

I’ll be glad to see you.

Peace & health,
Charles Runels, MD

Reserve 1 for $1,897<–
Reserve 2 Seats $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

JCPM2020.12.30. Premature Ejaculation. P-Shot®. Chronic Prostatitis

Topics Discussed Include the Following…

*Premature Ejaculation
*Chronic Prostatitis
*Shock Wave
*P-Shot®

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Premature Ejaculation Helped by HA injections<–

Apply for On-Line Training for the P-Shot® (Priapus Shot®) procedure<–

SHOCK WAVE TX FOR CHRONIC PROSTATITIS<–

Behavioral Therapy for Premature Ejaculation<–

Tool for Assessing Premature Ejaculation<–

 

Next Workshops with Live Models<---

OShotWomen.com<– (you can now buy this at wholesale if you are an O-Shot® provider. Call 1-888-920-5311 for more information)

The Priapus Shot in India<–

Cellular Medicine Association
1-888-920-5311

First Paragraph of Lady Chatterley’s Lover
Ours is essentially a tragic age, so we refuse to take it tragically. The cataclysm has happened, we are among the ruins, we start to build up new little habitats, to have new little hopes. It is rather hard work: there is now no smooth road into the future: but we go round, or scramble over the obstacles. We’ve got to live, no matter how many skies have fallen

JCPM2020.12.16.Peptology.ImmuneBoosting.

Topics Discussed Include the Following…

  • Peptides
  • Peptology®
  • Apomorphine
  • Thymosine
  • PRP

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Peptology® Training With Dr. Heather<–

Relevant Links

Strengthen Immunity (NEJM)<–

Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis

Next Workshops with Live Models<---

Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020

More ways to possibly boost immunity<–

Apomorphine<–

O-Shot® Women<–


Cellular Medicine Association
1-888-920-5311

E Mail Secrets that Make You Smarter & Your Patients Healthier

Email Secrets…
How to Write 10-Minute Emails that Make You Smarter,
Your Patients Healthier,

& Your Practice More Profitable


This course is offered only in-person; it is not offered virtually/online so that participants will be able to focus without distraction in a true workshop setting.

Here are some of the things you’ll learn in this full day devoted to emails…

*Not just learning but practicing in this WORKshop, and then going home with emails already written and ready to send.
*How to write informative, compelling, inspiring emails in 10 minutes or less.
*The best software to use to send your emails and a cram course on how to use it.
*How to combat the fear of saying the “wr0ng thing.”
*Write an email that displays your knowledge instead of one that turns you into a discount store.

*How to stack emails that go out automatically so that you have emails going out every day to just the right person at the right time.
*How to decrease your chances of landing in the spam folder.
*How to use the software so that it’s not much different than writing a word document for you to write a web page and an email.
*Easy templates where you can almost fill in the blanks with what’s already in your head (the things you’re tired of saying all day long in the office) and convert those things into compelling and motivating emails.
*Exactly how to convert your daily reading into ideas for writing emails.
*How to unblock your brain so that for you to write an email is as easy as doing your routine medical care.
*How to avoid being robbed and hire the right people to help you (and do most of the work yourself for almost no money or time).


Complete Money-Back Guarantee
Come to this course, bring a pencil and paper, pour yourself a cup of coffee, take notes, then write an email in 10 minutes, during the workshop, before lunchtime. If you do not think that just ONE email (distributed the way I teach you) will more than pay for this course, if you do not think that my methods will make you smarter and your patients healthier, then you can walk out and collect a complete and cheerful refund.


2021 January 30 from 9 am until 6 pm cst

Reserve 1 Seat for $1,897<–
Reserve 2 Seats  $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

 


Venue for “E-Mail Secrets Workshop”

No Mask Needed On Your Breaks at the Grand Marriott–The Bay Wind Keeps You Safe. Inside, we follow guidelines.
  • The venue for the workshop will be the Grand Hotel where you will have access to a spa, golf, harbor, and resort pool. Rates are usually around $200 to $300 per night. This hotel has a shuttle from the airport to the hotel but it’s about $75 (almost as much as renting a car).
  • The closest airport to fly into is Mobile Alabama. The taxi ride from Mobile to the coastal village of Fairhope) is about 45 minutes. Here’s an article from Smithsonian Magazine about the town of Fairhope.
  • The airport at Pensacola Florida is about the same distance by time (and my favorite local airport) but will probably require renting a car since it’s further in distance than the Mobile Airport.
  • One alternative place to stay in Fairhope is The Hampton Inn (23 North Section Street, Fairhope, Alabama 36532), which is about 3 miles from the venue (Grand Hotel Marriott). The room for 2 people at the Hampton is around $140–will be discounted to $99 if you use the code “Studio Medicine when you make a reservation. If they must upgrade to a larger room due to availability, you still will get a nice discount with that code (which is only for my patients and workshop attendees).
  • In Fairhope, you can shop antiques and clothing and quaint places to eat, or stroll the Mobile Bay.

If you have difficulty making arrangements, please contact me at DrRunels@Runels.com or call 251-648-7704

I’ll be glad to see you.

Peace & health,
Charles Runels, MD

Reserve 1 for $1,897<–
Reserve 2 Seats $4,897 (save $897)<–
Reserve 3 Seats $6,897 (save $1,684)<–

Surviving COVID-19 from a Physician Who Did

Topics Discussed In the Following Video Include…

  • Dr. George Liakeas discusses his recovery from the ventillator during his battle with COVID-19.
  • Dr. George Liakeas gives his best tips for helping your patients fight COVID-19 and win.
  • How the Priapus Shot® procedure may help with some of the damage caused by COVID-19
  • How COVID-19 has caused an increase in erectile dysfunction.

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Dr. Liakeas next classes<–

Transcript

Dr. Charles Runels:
Today, we have an amazing guest with us. Dr. George Liakeas. He is an amazing intellect in New York City, has an office on Billionaires’ Row. But he’s a humble, down to earth, brilliant man. He personally remodeled his office. They are in one of the high rises, so he can hammer a nail, and he can figure out your medical problem.
But the reason I asked him to be on the call, he also displayed the grit that you would expect from a Greek warrior, and both survived the ventilator with COVID-19 as well as kept his business running through COVID. So I’ll put him on the call here shortly, and before I do that, it looks like he hasn’t logged in yet. So I’ll pull him in as soon as he does, but before I pull him into the call, I wanted to bring up a couple of things that I think will help you take care of your patients.

Erectile Dysfunction After COVID

First, this came out about COVID causing erectile dysfunction. Here’s the paper it’s referring to. I’m going to put this into the chatbox. There’s a couple of reasons for noticing these papers, one scientific and one more to do with marketing/medical.

The scientific version, of course, is that people with any illness COVID or the flu, or anything that affects their peak health can affect their sexual function. But there’s also discussion here about the possible, just like you can get a mild carditis from a viral infection, possible orchitis or change in testosterone levels, just from the stress that comes with fighting off an infection.

So that’s the medical thing we should know that should heighten our sensitivity and eagerness and willingness to discuss sexual medicine, even in the middle of a pandemic.

The marketing political version of it is that as an example, I will show you this one where one of our doctors in London, Dr. Shirin, who is just an amazing doctor there who teaches for us as well, has got some press because she noticed that she’s having more people who are locked up with their lover and they’re finding out they can’t use the office as an excuse for not to be having sex. So they are having to face their sexual dysfunction and coming to the office for Priapus shot.

I’ll give you that link as well to Dr. Shirin’s article. And I’ll tell you how you can leverage this with your local press here in a second. It’s very common for us as providers to get a local press on the television or the radio leveraging the national press. It’s hard for newspeople to come up with something new every day. And they’ll often want to bring a national story into the local arena, and I’m giving you a way to give them news.

So this is from the Cleveland Clinic, but it’s made the popular press Cleveland Clinic. I’ll give you this one too. I’m about to tell you how to get on your local TV show for free if you choose. So that I’ve put in the chatbox. By the way, if you click these things in the chatbox, they will be open when I shut down the webinar. If you don’t, they disappear.

So I’ve given you the link to Dr. Shirin’s press piece to the NIH article about erectile dysfunction, and it’s open-source. So you can just see the whole article there. And as well as to the Cleveland Clinic article that references the one about erectile dysfunction. So here’s a couple of ways you could use this to help people in your community.

One is by just, of course, seeing, recognizing, and asking your patients who are coming in.

And second is by going and sending out an email that talks about this. And I’ll add one other thing to include with this in a second. Here, I’ll give you this link as well. There are actually six papers out that show Botox helps with depression. And I think everybody knows now if want to go to look the research is all over the internet about how COVID and locking people up is causing a bump up in depression and suicide and drug abuse, and divorce. And people are feeling locked up, and that makes them sad. So there’s now six papers published about Botox helping depression, even in depression that’s resistant to antidepressants.
So you have here now two reasons that you can actually, for medical purposes, talk about what people want to push into an elective thing. People are so depressed. They’re killing themselves or turning to drug abuse. That’s not cosmetic. And I would argue that cosmetic is not really an optional thing. Looking pretty makes people feel better. How many times have you seen someone who’s on chemotherapy, but they just want to look prettier.
My sweet sister, my baby sister, contracted breast cancer. And then it recurred in her liver.  After, she wanted PRP in her scalp because she wanted her hair to be there as much as possible, even when on chemotherapy. So this is where I would use the F-word if I am tempted because it makes me angry when people want to say something that has to do with just looking pretty is not important.

It is.

So how could you push this out?

You could call your local reporter and say, “Hey, the Cleveland Clinic is talking about how COVID is causing erectile dysfunction. One of the causes is a change in hormones, another cause could be a change in just fatigue or energy level. And another cause may have to do with circulation. I have ways that I’m treating all of that in my office. And so if you want, I will do a story about, and let you interview me about this and just mentioned offhandedly, but the main thing for your listeners or readers or watchers, whatever will be about the news. But of course, I’ll want to mention that I treated it in my clinic.”

And then you send them an email with links to that I just gave you. And I will be shocked if some of you don’t make it onto your local news, then you send out an email to your people about the same thing, where you say, “Hey, if you’re locked down, you’re not feeling so happy these days, and you’re suffering from sexual dysfunction or depression. I have some ways that I might be able to help you.”

So okay, beautiful. I just got a link that… Here let’s see if I got a text that George is on the call and must be signed in under someone else’s name. I don’t see his name. Hey, George, if you could raise your hand or something so I can identify you, I think it must be on someone else’s computer or something. So that I can unmute you because people want to hear your story.

Okay, let’s see if I can find him. He is supposedly on this call. Let’s see if I can find him. George survived, his businesses survived, and he survived the freaking ventilator. Give me a second. Let me figure it out. Let’s see if I can figure out where he is. I’m just going to call him. Sometimes the freaking… I’ll call his wife. He’s got a brilliant wife who runs his office there, and I’ll bet she will answer the cell phone. Here we go. And she will know where he is.
Nicole:
Dr. Charles, [inaudible 00:09:45].
Dr. Charles Runels:
Hey Nicole, I don’t see George on the call. Is he on the call?
Nicole:
Yes [inaudible 00:09:50], just hold on one second, please.
Dr. Charles Runels:
Hey, Nicole, let’s just do this, can you just hand him your… you guys, I have the phone on speaker so you can just hand the phone to him, and we can do it this way-

Dr. George Liakeas’ Tips on Surviving COVID–physically and financially

Dr. George Liakeas:

Can you hear me?
Dr. Charles Runels:
Perfectly well, so much easier than trying to do all the freaking webinar links. So guys, let me introduce you to George and his wife, Nicole. I’m going to pull up where you can see his picture. Here he is. And this is his website where he teaches. But obviously, this is a personal thing. I mean, when you have a near-death experience, that’s a personal thing. But I felt like maybe there are some lessons to be learned. And George is a natural-born teacher. He has residents come through his office there in New York City, and he teaches an amazing class for us. And many of our members have come through his classes, but I thought, how can you go through both making it as a business in New York City and making it off a ventilator from COVID and not learn something.
So I asked him if he’d be kind enough to just share whatever he thought might be helpful to the group. And here he is. So you are up, George if you want.
Dr. George Liakeas:
I’m here.
Dr. Charles Runels:
They should be able to hear every word.
Dr. George Liakeas:
Well, thank you for having me. So I still can’t, I’m still not speaking back to normal, one, this is not my voice, normal voice, and two, you’ll hear me often gasping for breath. I feel fine, but anyone who hears me, it’s a little bit scary, and it is what it is. In fact, the other day, we have a relative who was celebrating her 99th birthday while we, my wife and I were celebrating our anniversary. And this person always includes them in our anniversary celebrations. And there she includes herself because, at 99, I guess you only have a few left, but the comedy was that she couldn’t blow out her candle. I couldn’t blow out my candle. And Nicole had to blow out to all three candled, and it was really… It was like, whoa.
On the one hand, it was obviously comical. And on the other hand, my mother, who was sitting there, was saying, “I can’t believe my eyes.” So believe it, coronavirus is a little bit scary. I don’t know why. I’m only 49 years old. I don’t have high blood pressure or diabetes. I don’t know why I ended up on a ventilator. It is a different world now, that’s true. Forget about the vaccines, which whenever they are available. Thanks very simply some of the things we didn’t know where I’m just stand back in March. I got it at a time when we were telling patients to not wear masks. Not only were we telling them the masks were unhelpful, we were telling them to not wear masks because the CDC and the department of health organizations were telling us that masks you fidget, et cetera.
So that’s when I got it. I think I know a few patients that we were testing and might’ve given it to me. One of them I spoke to not too long ago, and I said, “Paul, did you ever… How sick did you get? Because I think you gave me coronavirus.” He says, “I don’t think so. You probably got it from somebody else.” Maybe, also, maybe not anyway, whatever. I don’t know why I was even bringing it up, but it’s become sort of a comical part of my life. And I can only say this, of course, because I survived.
At the end of the day, people said, “Well, what did you learn?” By the time I got sick, I had tested about 30 people positive. I had tested probably 80 people in total. I mean, I was testing them on the street, and because we didn’t want them to contaminate the office, Paul snuck upstairs and felt he was fine, didn’t want to leave. So he was a good example of how easy it is to contaminate your environment.
But even when we were testing, even when I was testing people on the street and I would say to them, “I’m going to put this in your nose, or even you put it in your nose, don’t cough, they might make you sneeze or cough. Don’t cough in my direction. Don’t cough in that puddle. Don’t cough on that guy’s car.” The city was empty. But I would tell them these things and test them right there on the street. And as they put it in their nose, and of course you see stars a little bit. They would turn to me as if to say, “I’m about to sneeze, get away.” And then they would sneeze in my direction even though I was [inaudible 00:14:27] as if I told them when you sneeze, sneeze on me.
I already know a few people that tested positive that did not follow my directions. I wasn’t wearing a mask. That’s probably how I got it. But what was very strange was that they had all… when I would call them two and a half days, three days later to tell them, “Yep, you’re positive. Now stay home and quarantine, et cetera, et cetera.” They all said, “Well, I’m shocked because I am better already.” So when I proceeded to get fevers, fevers that were shocking because I mean, I don’t remember having a fever of 104, and it’s not going down with Tylenol, but otherwise, I felt fine. No shortness of breath, no cough, no nothing. And I, too, was telling my wife, “I’ll be fine. Give me a few more hours. Give me a few more days. Let me sit here in the corner of our bedroom, I’ll be fine.” And she was very adamant that I should go to the emergency room.
And, of course, she’s not a doctor. Why would she be telling me what to do? But to appease her, I went to the stupid emergency room. And as I get there, of course, I have some patients who are patients in the emergency room. And I’m waving at them through the glass, et cetera. And after being there for an hour, wondering what I’m doing here, because who’s smarter than me, right? I don’t need to be here. All of a sudden, I couldn’t breathe.
And then I told you the comedy about it once before I’ll spare everybody the trouble. But basically, then I had to call the telephone number that I was given by my nurse. And she must’ve gone on break. So now I’m calling the front desk of Cornell University, New York-Presbyterian hospital’s emergency room, trying to tell them that I can’t breathe. And they’re telling me, “Sir, speak up. I can’t hear you.”
Dr. Charles Runels:
And this is where I just want you to pause for a moment because if you did a sitcom and George when he wants to be, or even when he’s not trying, he could be very comical. But I just want to make sure people get the picture. You’re in the ER, but there’s no one near-
Dr. George Liakeas:
People say even come to examine me. You got to get suited up. So they put me in an isolation room, and I’m by myself feeling fine, minding my own business, waving to my friends or patients/nurses, et cetera. And then all of a sudden I can’t breathe, and there’s no one to tell-
Dr. Charles Runels:
Yes.
Dr. George Liakeas:
So then I have to call the front desk. Apparently, instead of what was supposed to be the charge nurse’s phone, it went to the front desk. And I had to explain to them that I’m calling from the emergency room, and she’s telling me, “Sir, I can’t hear you. Where are you calling from, bad connection?” So I called the second time. And just to give you an idea of the seriousness, I really couldn’t breathe, but I wasn’t even thinking about it. I just wanted them to know I couldn’t breathe. And I woke up two weeks later.
But I don’t know if they found me in the corner of that room blue. I don’t know if I was… perhaps obviously, I had passed out and was cyanotic or at least my oxygenation. When I went to the hospital, my oxygenation was 88, but I felt fine. So to give people an idea, when I was telling my wife, I’m fine, this is ridiculous. I don’t have to go to the emergency room. I mean, I felt it, I wasn’t trying to be cavalier, but it turned on me very quickly. And if I had not already been in the emergency room, they would have been bagging me in my apartment. So I just survived-
Dr. Charles Runels:
That’s a very sobering thought, isn’t it? So sobering. That it can sneak up on a physician who obviously knows the signs to look for, but this idea of being hypoxic without experiencing dyspnea is unusual. Isn’t it?
Dr. George Liakeas:
But it just seems to be a common thread in COVID for some reason. For some reason, people can be hypoxic and not short of breath is what many people are saying, and that’s deceiving. So when now patients of mine tell me they tested positive, I tell them, “Do me a favor by a pulse oximeter. And if it gets below 92, I’m curious if it gets below 90, that’s not normal. And if it’s below 88, make your way over to the hospital as soon as possible.”
Dr. Charles Runels:
Yeah. Smart advice. So-
Dr. George Liakeas:
It’s has been an interesting time. We are in a different place. There’s no question about that. And since then I woke up two weeks later comedy ensued, even though I was a doctor, of course, you’re by yourself in these rooms. And I had to sort of learn how to walk again. I was completely not cachectic, but I had lost a lot of weight, my muscles had atrophied, and it was a mess. And to this day, I still am quite fatigued or easily fatigued. And this speech problem is probably from the tubing rather than coronavirus. It’s probably from a ventilator, and they tell me it could last a month for every day that you’re on a ventilator, and I was on for two weeks, but I otherwise feel fine, and I’m happy to be here. And I still go to the office to pat everybody on the back and do the things that only I can do.
I haven’t been seeing the general patients. We have half the office does the cosmetic side that my wife runs, and as estheticians and half the office does the medical, strictly medical, and for the medical, I just can’t. This is a good day, but normally I just can’t keep the level of speech going without losing my voice, et cetera.
We also have a friend who’s a plastic surgeon that came on board to help me out with some of the cosmetic things so that I’m not overly doing it because I can’t handle it. And we’ve been managing.
Dr. Charles Runels:
Good. So a couple of questions that I frequently get from our providers and from patients that I’m sure you’ve thought about in-depth. I want to come back to a near-death experience because I think there may be other things to say about that. Probably a day’s worth of things to say about that, but talk to me about what can people do? I think there should be more discussion about… I know there’s some randomness to it, but yet there’s also some science to it.
What can people do if they are just under the assumption I’m going to be exposed to COVID? What in your mind can people do to make it such that they can survive it? And here I’m thinking along the lines of, let’s say that yours as an analogy, if you’re the mother of a child with cystic fibrosis, every pathogen is a potential life-threatening thing, and you know your child’s eventually going to be on the ventilator in an ICU. And 20 years ago, I think the lifespan was 25. And now I don’t know. Maybe it’s 45 or 50, and you know it’s coming.
So my discussions, I don’t know about you, but when I talk with mothers of children with cystic fibrosis, they’re basically living with a child that’s in equivalent of a COVID pandemic all the time. But they do things to make their children extremely hardy so that when they’re on a ventilator or when they get attacked by some pathogen immune system, VO2 max, everything is optimized so that they can survive it.
So now, having come through it, by your understanding of the literature, what would you advise your patients and for us to pass on to our patients best way if you just know you’re going to rub up against COVID? What’s the best way to come out on the other side?
Dr. George Liakeas:
That’s a good question. I’m sure that there is no shortage of anecdotal information, et cetera. But most of what is said is that we would tell people that get diagnosed, and now is the time to perhaps tank yourself up, and it mostly revolves around your immunity. So I would say to other doctors, and even to patients, especially elderly patients, of course, now’s the time to sleep well, diet, exercise, try to be as healthy as you can, try not to be so stressed out if that’s possible or whatever that means, but for sure, tanking yourself up on vitamin C, vitamin D, maybe even vitamin B, those are all things that are good for your immunity.
The other things specifically for COVID is zinc and Pepcid, and Pepcid does appear to have some sort of prophylaxis or-
Dr. Charles Runels:
I haven’t heard that.
Dr. George Liakeas:
Yes, know that. So it doesn’t hurt to take a Pepcid. So why not? And then if you do get exposed or if you want to start sooner at definitely, and perhaps the most important thing is baby aspirin. So if you get exposed, when I first came out of the ICU, I was given blood thinners, Rivarox, or ultimately Eliquist, but after three to six months, it starts becoming perhaps more of a risk. So switch to baby aspirin. If there’s no contra-indication, perhaps taking baby aspirin for that person who might be positive and not know it for a week or from botic events, microemboli things like that.
Dr. Charles Runels:
So, let me make sure I catch up with you. So vitamin C, vitamin B, vitamin D, all the things grandmother said about sleeping, a baby aspirin if you’re exposed, and one Pepcid per day. Interesting. I didn’t know that Pepcid works.
Dr. George Liakeas:
And zinc.
Dr. Charles Runels:
And zinc, yes. Zinc. So we’ve got quite a lot of people on the call that are interested in what you have to say. And many of them have put in things about zinc. What sort of dosages are you telling your patients to take of the various things you just mentioned?
Dr. George Liakeas:
The vitamins C in water-soluble, and the B. So that’ll go through you, but 1000 or 2000 to start taking four or mega doses it might be excessive if you have not been exposed. So I usually tell people 1000 or 2000, they don’t have to go crazy. And if they’re exposed, then they could do as much as they want. And it may not matter the scientist Watson believed in taking 4,000 a day, but anything with vitamin B, I almost tell my patients take a multi… Sorry, take a B complex and do what a bottle says.
To zinc that I’ve been given is 400 milligrams. 200 is fine as well. Again, baby aspirin, but vitamin D because it’s winter, there’s very little chance you will overdose. You’re probably already vitamin D deficient. So instead of one or 2000, I would easily take 5,000 a day, or there’s a 50,000 once a week dosage.
Dr. Charles Runels:
All right, very helpful. And like you said-
Dr. George Liakeas:
If you do have COVID and it affects your lungs, obviously, N-acetyl cysteine seems to be very lung helpful.
Dr. Charles Runels:
Okay, beautiful.
Dr. George Liakeas:
And I believe that’s 50 a day, but NAC, which you can find at any GNC or life extensions, is a very popular vitamin link website.
Dr. Charles Runels:
Beautiful. So while you’ve been speaking, Dr. Byman has been sending me links. So thank you, Eric, that backup much of what you’re talking about. And so that’s nice. So if you guys are listening or if you go to the chatbox, you’ll see some research backing of what you hear George speaking about. Anything, I want to get to what you’ve done. I know Nicole is a critical player there and keeping your clinic running. And so if she wants to jump in, feel free, but I’m interested in how with the combination of illness. And I mean, it’s just to me, you and your bride demonstrate the epitome of grip. When you can go through a life-threatening illness in the city that’s locked down probably more than any other city and still be financially solid throughout it all and continue.
To me, this is what doctors do, right? I mean, how many physicians have died taking in the middle of the COVID pandemic, physicians and nurses and EMTs, and if nothing else out of this, it seems to be maybe the meter of respect for physicians might have come back a little bit more high on the gauge than it was a year ago because people are realizing, “Oh, wait a second. People are actually risking their lives.”
As we do with the flu epidemic every year and HIV and hepatitis C, all those things are potential pathogens to healthcare workers, but it seems like people are noticing more. And now I’m speaking to a man who almost died from what he was doing as a healthcare provider. So anyway, let’s swap from… Go ahead.
Dr. George Liakeas:
Let me say ironically. So, first of all, when I was sick, there’s no question that my wife not only saved my life by telling this fool to go to, in fact, the hospital. But had I gone two days earlier, they would have sent me home. So you have to be very cognizant of things can change, but maybe most of all, you need an advocate.
Nicole was essential to probably saving my life because she served as an advocate reminding them that not only I’m a doctor, he’s a VIP. Take care of him at a time when I can tell you from colleagues that admitted, look, we didn’t even know what to do. And maybe people died because we didn’t know what to do with them. So whether it’s somebody to advocate for you, to advocate for somebody else that is extremely important. During my time, they weren’t allowing visitors. I was in the medically induced coma.
So somebody needed to be communicating to remind people that he’s a person, do what you can, and otherwise, again, colleagues will admit that at least in the crazy times in March and April, people fell through the cracks. So having an advocate was very important, but I will say it’s the reverse, or the opposite perhaps of what you’re saying is that even now, maybe it’s me, it does feel a little bit like, “Well, that’s not a vote of confidence that the good doctor gets sick, obviously not washing his hands, touching his mouth.”
So, although people will acknowledge that it’s very contagious, the ones that don’t get it pat themselves on the back and how good a job they’re doing protecting themselves, perhaps, and the ones that do get it are a little bit in the scrutiny of, “Well, you must not have been safe,” which is not unfair, but its sort of like the doctor that smokes is a good advocate to other smokers that look, I know how difficult it is, but it’s a very bad advocate for people who don’t have smoking as advice and don’t see why it’s such a big deal.
So I think definitely again, in my case, we didn’t have masks. It is what it is, but I think definitely if you do get it, you want to reinforce that you are a clean person who is conscious and aware of the risks, and you still got it. Because similarly, I think patients need to hear that you’re taking this pandemic very seriously and that you are doing things to protect them.
Dr. Charles Runels:
Let me just, I want to go a little bit rogue on-
Dr. George Liakeas:
And I feel confidence that I got it.
Dr. Charles Runels:
Yeah. I’m going to go a little bit rogue here and just out of bounds for just one minute. There’s this in general when it comes to sickness. There’s this general idea of not just COVID among some sets of people that anytime someone is suffering. They must have done something wrong. And no matter what the suffering, if you go back to C.S Lewis writes about pain, and if there’s God, then why is there pain? And I think he puts it best when he says, “You’re going to have pain or use disease in this case, because you can do something wrong because you did something wrong would say cirrhosis, because you drank a fifth of Jack Daniels every night, you can also have pain because you did something, right like stand on the fucking sidewalk of New York and let your patients sneeze on you all day long.”
And you can also suffer. Let me put, so you can suffer for doing wrong. You can suffer for doing right. And you can also suffer because we don’t know the fuck why? Like, why does a young Jewish man get Lesch-Nyhan syndrome? And she was tongued, why does the baby get born with cystic fibrosis or sickle-cell? I don’t know. Maybe there’s something that I can’t see about that, but it seems to me they didn’t do anything wrong.
And so it’s shocking to me, although it shouldn’t be that that attitude might appear. And it’s cool that you brought it up because I know a number. I know one of our providers, and Tron was hospitalized. She would make it on the vent, but others in our group have had COVID, and I should have expected that reaction from some people, but I hadn’t.
So anyway, just in general, that’s the way I like to think about pain, and here, I think it’s the reverse. You have a man who’s suffering because he put himself in harm’s way to take care of his patients. Talk to us more about what you and Nicole did to make and what you’re still doing to help patient flow at a time when people are afraid to go outside.
Dr. George Liakeas:
Right So in the office and patients want to hear this, and many groups have done it from churches to schools, et cetera. We’ve been communicating with our patients from the beginning that we have established COVID protocols from things like social distancing stickers to handless pumps of soap in the bathroom, to remind the patients what we are doing in between patients to sanitize the room, keeping windows open, including guns that spray alcohol, even into the air.
We have an ozone machine. Some of the things I don’t even know exactly how good they are, but I know patients like to hear it. The problem is, how do you stay viable and profitable when, in the past, part of the ability to do that was to have a full waiting room and keep the patients turning. Now, I’ve never seen an empty waiting room in 17 years, and now, even if I’m not at the office, if I look in the cameras, it’s shocking to see an empty waiting room.
Now we’re not at quarter capacity, half capacity, but we’re moving them into the rooms much more quickly. And the waiting room is empty. Maybe that’s a good thing in general, but you have to tell them that you’re going to be doing that. And the one time that two people come off the elevator at the same time, somebody might even inform us, “Hey this person’s here at the same time I am.” All right, “Well, you’re 10 minutes early that person’s 10 minutes late, but what do you want me to tell you?” But they consider it bad planning on your part. So you communicate that you are doing everything you can and remind them. And if nothing else, it’s a way to stay in their minds.
Dr. Charles Runels:
Interesting. So how are you communicating? By emails, social media, how?
Dr. George Liakeas:
By email.
Dr. Charles Runels:
Email.
Dr. George Liakeas:
Yes. When we see patients, we are following up with them a little bit more afterwards and always sort of reminding them stay safe. Don’t forget to wash your hands, social distance, things that remind them we are the doctors, the healthcare professionals, and make them feel like we care and that we are on top of things. And that we are not only calling to see how did their procedure goes. You might have some swelling, et cetera, but also, we are the go-to people for all of questions.
Nicole:
Hi guys, can I chime in?
Dr. Charles Runels:
Yes.
Nicole:
Hi, everybody. So you can see our website right there. My website, I think it’s very important to have protocols on the website. People are looking for it. Even show cleaning while the clients or my clients are here. I have my spot coordinators with Clorox in hand and spraying down everything very carefully using the right words. Like we want to keep you safe. We want to keep ourselves safe, showing on social media that we’re cleaning the rooms, that we’re wearing our masks, and that we’re cocooning them here. That we’re very safe, and we’re very mindful of that. And I think sending emails constantly to remind the clients of that is very important so that they feel safe.
Dr. Charles Runels:
What’s constantly for you, Nicole? How often are you sending emails?
Nicole:
I send emails about twice a week. Or if I’m not, I send-
Dr. Charles Runels:
Yes, I do believe it. So I want to pause there and make sure everybody gets that because most doctors are afraid to send an email every two weeks or have some horror of being put in somebody’s spam folder. But what I think you’re saying is-
Nicole:
I thought that in the past, but I have come to realize more and more. I am sending them the past year. Now I’ve been sending them twice a week.
Dr. Charles Runels:
Yes, and a thing I want you to correct me if I’m wrong, what happens if you’re their person, if you’re their doctor or healthcare provider, if you’re the person they look up to, they might not read everything you send out, but if you’re sending them the kind of information you’re talking about, they won’t put you in the spam, and they’ll actually be grateful that you’re taking enough time to communicate with them, what’s new in your brain, about current events, and what’s new at your office.
Nicole:
Correct.
Dr. George Liakeas:
So we’ve spoken about this in our masterminds. Whether or not you think two emails a week is a lot or whatever. One thing that’s always important is to not just make the emails a selling as you want to sell your practice by giving them something, and what we can do very easily is educated. So the type of email is, “Hey, just a reminder, aspirin is good for the microemboli that can happen after coronavirus, keep doing that. If you feed them something and then throw in your selling pitch, they are less likely to think you’re bombarding them with spam.
Dr. Charles Runels:
Now, talk to us some about… because I’m still old school email, we talked about this a few weeks ago, the Wall Street Journal did an article about how industry is rediscovering that email. You don’t have big brother unless you’re using Mailchimp, kill Mailchimp. They’ve started censoring email of all things, but so far, except for Mailchimp, no carriers censoring emails and websites. So we’re able to talk about sexual matters and not get banned like what can happen on Facebook and other venues.
And to me, it feels like a more in-depth discussion, but I don’t know, expand upon that. Tell me your thinking about why it’s email versus social media and how are you doing it, what mechanism you’re using to send it out.
Nicole:
We’re using MyEmma. I don’t know if you guys have heard of MyEmma. I’ve been using that since I’ve been around since 2002. So that’s just something I work with, and I continue to use it. We use it for medical Sets in Smooth Synergy. It seems to be pretty good. And I just find that if you train your clients to read your emails, I send them out on Tuesdays and Thursdays. I send out educational things on Tuesday, and I also have my product line. So I sent out my products on Thursday. And that’s kind of how I’ve divided the week from Sets Smooth Synergy.
Dr. Charles Runels:
Beautiful.
Nicole:
Yeah. And for social media, we try to use social media. I really would love to have more following on social media, but I find that it’s hard to get someone who really can engage with my clients. I mean, with my client-based in my spa, I have locked down. My ideal client doesn’t really go on social media all that much. So for me, I find that the emails are working the best.
Dr. Charles Runels:
Yeah. So maybe just one more comment about that. Let’s say you were going to deliver a message about the best way. What you just mentioned about how you don’t forget to use aspirin if you are exposed to COVID, and you’re going to send that to someone you love, your family member, you wouldn’t tweet it to them. You’d write an email, or you may be pick up the phone, but if you’re not going to call them, you would send it in an email or a text message. You wouldn’t tweet it or Facebook it.
And so along those same lines, I think what you’re saying is that because you have relationship with your patients, email is more like a communication between two people who have something to say who were in a relationship, which for me, the best way to get lots of followers on social media is do outlandish things like, I don’t know, take a picture in your phone by the swimming pool, or you balance a champagne glass on your booty like Kardashian did. I’m not saying that people in our group haven’t been successful marketing with social media, but I think most of them are not paying enough attention to the depth and the quality that can happen with an email.
And if you just listen to what you’re saying, we’re hearing two concerned people who’ve experienced near death, and you’re actually delivering your heartfelt message about how to stay well to the people who love you that you care about. And you’re choosing email to do it. I should talk less and listen more. So tell me more about what’s in your brain that you’d want the group to know. And then I think we’ll shut it down. We’re coming to the end of the hour. Thank you so much, both of you, for taking time to do this.
Dr. George Liakeas:
Oh, I would probably say one thing that I think is important in terms of what can I do to generate revenue? Is, this is an opportunity to do things COVID-related. When I had coronavirus, and if you read about it, you’ll see a lot of people lose their hair. And I can attest to that. I mean, it was like, “Whoa,” it was amazing. The hair would fall behind me as I would walk, and then it stopped, and they say it’s a stressor that a number of viruses can do. And it’s, telogen effluvium, but it was impressive.
So this has been an opportunity to push, for example, the Vampire Hair Therapy for before you get coronavirus or after you get coronavirus. This is something that might be able to mitigate the strength of your hair loss. And that has been good. There’s been a good response to that.
Dr. Charles Runels:
Beautiful.
Nicole:
So I ran a little special on Smooth Synergy through the Email Blast that for the Vampire Hair Therapy, and that seemed to work. And people agreed. They said, “Oh yes I’m losing my hair,” whether it’s from them being sick from COVID or the stress from COVID. We had a real big up in the Vampire hair treatments.
Dr. Charles Runels:
Interesting.
Dr. George Liakeas:
Also, because it’s holiday season, you can start preparing for a new world and vaccine is here 2021 and start throwing out the specials for them for people that want to pre-purchase or purchase and give as a gift or whatever. It’s also that time of year. People are probably looking for a way to get rid of the negative and see some positives.
So it’s a good time for businesses to advertise. I know in Nicole’s case, she also has been very good at with some of the local businesses that have complained when they needed to shut down or when people don’t want to come. For example, collaborating with some of the hair places nearby that deal with beauty come to us.
Nicole:
Drybar. Just did a collaboration this week with Drybar. So if they come this week to Smooth Synergy, then they get a complimentary dry style at Drybar, which is right around the corner from here.
Dr. Charles Runels:
That is brilliant. And I haven’t heard people talk about that much. I forgot that I actually used to be something I would do. If you have local businesses that share clients, high-end clothing stores, high-end beauty salons, and personal trainers across promotions like that, it works wonderfully well. What about, I’ve never had that much success selling gift cards and always felt like I was doing something wrong. Are you selling gift cards? And if so, tell me how you’re doing it because I see it on your website.
Nicole:
We don’t sell that many gift cards. However, we did. We were very successful every year. I’m not a big promotion person because, in the way past, I’ve learned a lot. I mean, I’ve been in business for now since 2002. In the beginning, I used to do a lot of promotions. Right now, my brand, I’ve kind of changed my tune a little bit in the past since I’ve moved to the new location. So it’s a very high location you can see from the pictures. We put a lot of money, a lot of work into this space. We’re very proud of that.
Dr. Charles Runels:
It’s amazing, by the way, guys, if you go there, you’ll want to move in and live there it’s beautiful.
Nicole:
Thank you. So I really have moved away from promotions, and I really have moved more towards being in touch with our clients. Really giving more for their value, really going back to the gift cards. So now it’s just, I do 25% off on gift cards for Black Friday. That’s really the only time I do like a super promo and that 25 Black Friday that weekend, and then Cyber Monday, I do a 15% off. So I will give 15% off, 20% max here and there very strategically.
I don’t believe in giving away everything like I used to. No, it’s really not good for my brand. And people start understanding that there’s a lot of costs to this. There’s my expertise. There’s my knowledge. And really, it’s about the fact that I built a brand, and it’s not about giving everything for free.
Dr. Charles Runels:
Yeah. And just to add to that, everyone on this call, your brand, your most important brand, of course, is your name. And if you treat the people who come to you like they’re members of an exclusive club, because they’re able to see you and you make that a real thing by taking outstanding care of them, then that translates into what you hear Nicole talking about, which is now you don’t have to attract people by doing Groupons. They become grateful that you’re letting them walk through the door.
Nicole:
So the only thing is sometimes I am embarrassed to say, “Oh gosh, I’m done. People will Google me. And there is a Groupons that pops up.” So for people who might hang up and Google me, Smooth Synergy, I do it very strategically. I only used Groupon for facial, so way back when Groupon started and I would see all my colleagues or my competitors giving away everything for free. I was like, “What are they doing? They’re going to commoditize this industry. This is horrible. They’re going to go out of business.” And as right now, those people have closed. They made a quick buck, and they closed.
So what I did recently about a few years ago, when I decided Groupon was kind of hounding me, and I said, “Fine, I’ll do it very strategically. I’m only going to give away facials or I will stage one of microdermabrasion.” So again, I get them through the door, and believe me, I could not even believe this, but I was so surprised a lot of the Groupon, I have converted into old fellas to really very loyal clients.
Dr. Charles Runels:
I like it.
Nicole:
And I have not believed it.
Dr. Charles Runels:
I like it. So you’re pulling in, well, of course, you guys you have billionaires in your neighborhood, even billionaires, like good deals, but the idea of-
Nicole:
And they also don’t know where to go. They also don’t know where to go sometimes?
Dr. Charles Runels:
So pulling them in through your lowest price or one of your lower-priced services to help you find each other is different than just generally, that’s your main strategy for getting people in the office and keeping them there.
Guys is at the end of the hour. I’m really am grateful on notes. Crazy busy there, and lots of things going on. But quite a number of people on the call, and I’ll make this available to our group to listen to and the replay. And I know there’ll be grateful for you having the courage and making time to come talk to them. You guys have a great day. Thank you. Thank you, George. Thank you, Nicole.
Dr. George Liakeas:
Thank you, everybody. Happy holidays.
Nicole:
Thank you. Happy-
Dr. George Liakeas:
We’ll get through this; this too shall pass.
Dr. Charles Runels:
That’s right. Bye-bye, thank you.
Nicole:
Bye-bye.
Dr. George Liakeas:
Bye-bye.

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From Vampire to Orgasm & Priapus–How and why I invented the Vampire Facelift®, O-Shot®, & Priapus Shot® procedures

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JCPM2020.03.11.SexConversationsMadeEasy.AshermansSyndrome.ThrivingDuringDisaster

Topics Discussed Include the Following…

*Starting the conversation about sex with your patients–in order to grow your sexual medicine practice
*How to choose between radiofrequency and lasers for vaginal therapies
*Research about using PRP to help post-menopausal women to conceive
*Research about using PRP to help with Asherman’s syndrome
*How and why your aesthetic practice can thrive and grow in times of disaster
*C.S. Lewis on Functioning During Times of Disaster

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

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Transcript (coming)

Dr. Peter Castillo, MD

 

 


C.S. Lews on Thriving During Times of Disaster
In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”

In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.

This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.

— “On Living in an Atomic Age” (1948) in Present Concerns: Journalistic Essays


 

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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
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*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

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Transcript

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. Edward Tangchitnob, MD, ACOG

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.

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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 Tangchitnob's Next Classes<--

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.

Gyn Surgery with PRP as Adjunct<--(click)

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.

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