JCPM 2018March14.FDA.Altar™.AllergicGranulomatous.Profit.VolumaVsJuvederm.CaCl

Topics Discussed Include the Following...

-FDA Talks about PRP & Stem Cells in the NEJM "Balancing Safety & Innovation for Cell-Based Regenerative Medicine.
-Altar™. Vampire Skin Therapy™.- Protocol for Vampire Facial™ Combination.-How it Works
-Facial Allergic Granulomatous Reaction and Systemic Hypersensitivity Associated With Microneedle Therapy for Skin Rejuvenation
-Installed Base Profit Model & How the Pharmacist Makes Off with the Booty
-Can you use Voluma® instead of Juvederm® when doing the Vampire Facelift® procedure?
-Calcium Chloride Sources and Mixing

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

Transcript
FDA--PRP & Stem Cell Guideline Summary

Charles Runels: So, if you look ... So, we're talking offshore havens, polar extremes, medicines wild west, unlicensed stem cell clinics ... When I saw this article come out, this is when I started becoming extremely careful, or ... I'd already been careful, but more careful in warning those in our group to be careful [00:00:30] about the words used. These articles, by the way, are often written, including the one we'll cover today, by people who work for the FDA, basically telling you how they think, how to play by the rules, and what's not playing by the rules. In other words, "We're coming after you if you don't play sweet."

Balancing Safety and Innovation for Cell-Based Regenerative Medicine (click)<--

So, this one is extremely important. Let's go ahead and open it up and get to it because [00:01:00] it lays down the rules, and if you want to go deeper, it tells you where to find it. So, both of these guys ... By the way, if you scroll to the bottom, you can see they are from the FDA. So, that's where they're affiliated from. So, this is great. You're getting it straight from the people who are making the rules.

I just want to point out a couple things. Most of you guys know this already and you're looking at it, but those who aren't, [00:01:30] just a few things to notice. If you look down here somewhere in here, they say that the definition of stem cells are obviously ... Depends on who you're speaking with. And they make a big point in here, but they make a big point out of the fact ... I'll just quote it. It says, "Even in the absence of serious, adverse events, the use of therapies that are of unproven efficacy is a disservice to patients in public health. [00:02:00] An increasing number of safe ..." I'm reading from somewhere in here. I don't know where it ... One of these paragraphs. It says, "An increasing number of safe and effective therapies," I'm back to quoting this, "are becoming available on the basis of the findings of well-designed clinical trials."

But then, if you pop above that, it says, "Two explanations [inaudible 00:02:20] should be safe and effective for so many different conditions, and [inaudible 00:02:28], and that they can [00:02:30] differentiate appropriately based on the environment to which they're introduced, but we now know with reasonable certainty," I'm still quoting this, "from the scientific literature that this is not always the case." And if you search through the New England Journal alone, you'll find a few scattered articles where they talk about the wrong tissue growing in the wrong place.

FDA Guidelines About HCT/Ps<--

So, this article is part warning, but thankfully, mostly explanatory about how [00:03:00] to know when you're safe and how to play by the rules. And I'll just go ahead and say, the punchline is down here in the fine print. In this, they give you where the rule books are: four guidance documents, and here's where to find them. Right there. Okay?

So, by the way, this is a free ... You don't even have to be a subscriber to read this article in the New England journal. They make it available to you.

So, two other quick points, and then we'll come off of this. Definitions ... [00:03:30] So, pull this up. Right here. Okay? And all these section numbers and everything ... I'm gonna try to simplify this. I don't claim to be an FDA expert, but I want to make sure I know the rules well enough to play and keep them from knocking on my door. So, section 351, there's two basic things that make ... Where the FDA gets to govern how we talk [00:04:00] about human tissue. Right? They don't have any rights obviously on your hair, your urine. That belongs to you. So, when does it become FDA business?

It becomes business, and this is the paragraph that outlines it for you, when it becomes "a biological product," which is sort of nebulous to me. That's 351. And 361 is "when there may be risk of infectious disease." And so, [00:04:30] then they define this HCTP right here. So, regulatory human cells, tissues, cellular tissue-based products, that's the acronym for that.

So, the fun thing is that they make a big point of telling you in this chart what doesn't even ... In other words, we don't look at it. It's not even on our radar. Human milk is not even ... Because it's not even considered HCTP, [00:05:00] so those two regulations, 351, 361, that have to do with biological products and transmission of infectious disease do not apply to anything on this list.

And the last on the list, whole blood or blood components including platelet-rich plasma. So, if you're looking for something in writing that lets you know the FDA's not going to be knocking on your door when you're using platelet-rich plasma, there it is. The other thing that sometimes comes up, "Well, do I need the [inaudible 00:05:30] [00:05:30] waiver or something that says that I have a laboratory clearance to be able to do this?" You do not because you're not analyzing it, so you do not need that. So, here's your in-writing thing. This comes up sometimes from IRBs who are replying for research. Sometimes the institution review boards are still not sure exactly what has to be done to be able to do this. There it is in writing.

Now, when you get up to this area, this gets divided based [00:06:00] on what you're doing. If it's a biological product, then it has to be approved or regulated, I should say, to make sure it's been manufactured in an acceptable way, but it does not have to be approved like a drug. If you start manipulating it, then it becomes a drug, and they can rough you up about it.

So, it's a really nice article. Most of you guys ... That's all you need [00:06:30] to know or all you want to know, but if you start to do any research or your attorney, or whoever's doing your keeping you out of trouble person in your office, needs to read the definitive article, that's it. And I'm happy to put ... I'll just go ahead ... I'll put a link in the replay of this on the page where this video will sit inside our website. And I think that's all I want to say about it.

Next thing I wanted to talk about that might be helpful [00:07:00] has to do with a really deep dive into what it means to be having stall-based profit model, and how that helps your practice, and how the pharmacies are sort of ... They're walking away with the booty because they've got an interesting set-up which I'll dive into in a minute and tell you better how you can take advantage of it. [00:07:30] But let's ... In a way that helps your patients, and helps you keep the lights turned on, and puts your kids through college ... But let's answer a question quickly, and we'll come back to that.

So, not so many questions this week, which is good because it gives us time to dive deeper into how the profit gets made, and our most profitable members of our group, and what I think is going on in some of the groups that struggle. And I've learned this from being [00:08:00] beaten up, you really understand, as you guys know if you get hit by a left hook, you start to watch for the left hook, so I don't ... Anyway, we'll get to that. Let's answer a question.

Can You Use Voluma® Instead of Juvederm Ultra Plus® When Doing the Vampire Facelift® Procedure?

This is a good one. So, "Have you used Voluma ..." Let's open this up where we can see it better. Here we go. "Have you used Voluma instead of Juvederm Ultra Plus during the Vampire Face Lift, particularly in the cheek region of the procedure? I thought I saw this question, but I can't seem to find it. [00:08:30]

Further, any suggestions for a micro-needling device for the Vampire Facial?" Two very good questions.

Recommended device for the Vampire Facial® procedure

First of all, the device question is simple and easy because as of literally a week or two ago, there's only one device that has become FDA-approved for micro-needling in the way that we're using it for scarring, and not tattoo removal. Now, that doesn't mean you can't have another one out there, but if you want the only, at this present moment, FDA- [00:09:00] approved device, it's the SkinPen. And they don't pay me to say that. No device company gives me one penny. I keep it that way even though lots of pennies are offered to me.

But as of two weeks ago, that's it. And the reason that's important is because they had to prove to the FDA that the blood is not being pulled up into the handle, and is therefore contaminating the device and cross-contaminating, of course, with other patients, which some of the old devices did. Not good. So, [00:09:30] if the FDA was ever going to come in and look at a device, in my opinion, it should be the one that knocks holes in your face and has the possibility of transmitting disease from one patient to the other. Horror of all horrors. So, I'm not pushing hard for that. If you've got one that you trust is not cross-contaminating, go for it, but I'm highly recommending ... If you're ready to buy a new pen, they're the only ones that are FDA-approved at [00:10:00] the present moment. Others may be coming.

Voluma vs. Juvederm Ultra Plus

Now, back to the first part of the question, Voluma versus Juvederm Ultra Plus ... And any of you guys that have done hands-on training with me know that I tend to be more of a minimalist. Even if someone wants to have an exotic look, I like to achieve that with minimal amounts of material, and product, and puncture wounds, and such. And I think when you combine Juvederm Ultra Plus with [00:10:30] PRP, you get the effects of Voluma. I was lucky enough to train with [Mark Bailey 00:10:35] before Juvederm was approved in the US. We only had Restylane, and we started ... This was up in Canada, where I trained with him, and at the time, he was the top [inaudible 00:10:47] at least in North America, maybe the world. I'm not sure.

And we were using Juvederm Ultra Plus, like many of you, the way Voluma is taught now. [00:11:00] Of course, Voluma lasts longer, but I think that Juvederm lasts, at least a similar amount when you're combining the platelet plasma with it. I haven't proven that, but that's what I think. I also feel more comfortable using Juvederm all around the face, in tuning up the mouth and such. So it's just more versatile, but it can definitely be used, many of our people do use it and I really think it's very similar to internists [00:11:30] who has 200, maybe not that, let's say 50 different beta blocker, blood pressure medicines and hypertension use. But only has to become expert with one or two out of each class and the rest just be good with whatever it is you're using.

To expand upon that I don't think the research backs up as well combining plate rich plasma with Ray DS because just the structure of the gel, of the [00:12:00] liquid gel that's in an HA, I think provides a better substrate on which the pluripotency stem cells to migrate and mature verses the calcium hydroxide [inaudible 00:12:11] crystals that are in ADS. Not saying Radius is a bad product, I'm just saying when you're doing this, the fame part face lift where you are creating a sculpture that you have to augment and improved with plate rich plasma. I think using your favorite HA, whatever it is, and combining that with plate rich plasma works. So the answer to that question is, yes, is [00:12:30] the short answer.

Installed Base Profit Model

So let's go back to a little bit about profit, since we don't have as many questions this time. So we covered an update about the research. One question, let's talk about what install based profit is. So, some of you guys may have bought computers where they give you the printer. And course the reason they give you the printer is that now, you have [00:13:00] to buy the ink from them. And that know that they're going to make enough profit on the ink, that they can afford to give you the printer. So that's install base. So you put a base in and then people have to buy something to substitute. Something works with the razor, you buy the razor, that the Gillette razor, that cost you only 15 or 20 Bucks. But the next time you buy about refills it's $40 to get four little razors. [00:13:30] The thing is that people are more sensitive, this is an important point about this, I'm diving deeper than I've ever done with this model even in our hands on classes where we talk about this. But you are very sensitive to price point when you buy that initial thing.

Let's say you're buying printers, it costs more, they all have lots of different options. And so [00:14:00] because of that, you shop around to save $50 on the printer and look at all those options. This is very important, here. This is how people have made fortunes outside the medical world. So you shop like crazy, but now once you have the printer, you don't shop at all because there's one kind of in that fits it. And it's a lower priced item, maybe some of the more frugal people find some way to refill it or get a knock off version on Amazon, [00:14:30] but then it clogs your printer and go back to the brand name. You're just not as sensitive because you've already made the decision for the printer and now you need what fits it. Alright so hold that thought, you have the more sensitive higher priced item that you purchase and now you have a less expensive item that fits the thing you purchased. That's important, it fits the thing you purchased, so it's the thing you want. It's called [00:15:00] installed base. Here's where we get ripped off.

Another quick example is, you don't need another example you guys have got it. I will give you. Another one is you buy the Lamborghini and you have to buy the insurance. Now that one's interesting because two separate people sell it. You've got the Lamborghini guy who is flashy and good looking, or the woman who's good looking and [00:15:30] you buy the fricking car that costs more than a house. At least in some parts of Alabama. Then you gotta have insurance, and the person who sells the insurance to you is not so flashy. But selling insurance on a bunch on Lamborghini's and now he's getting, or she's getting money every month. Not so flashy, the insurance guy maybe he's flashy but he's probably going to have a big streak [00:16:00] of sort of accountant nerd in him and look straight laced and more secure and less flashy because he's selling security on that $150 000 investment. SO you have two people, one sells you the installation installed base, and the other one is you the thing that makes possibly more profit than selling the car, because its recurrent monthly.

Next Workshops with Live Models<---

Now here's doctors have been duped. It's so bad when you think [00:16:30] about this, imagine if you did this. I almost used the F word, because it makes me angry, because it happens every day. What if you sold the Lamborghini but you got paid $130 and then they walked down the street and gave the $150 000 to another person. How would that go? See [00:17:00] that's us. So you're riding and that other person gets to sell the insurance too. You just got to sell, you made 130 with one zero dollars to sell the Lamborghini, but then they go down the street to pick up the Lamborghini. You guys know where I'm going with this right? They go pick up the Lamborghini down the street, and that guy who didn't have anything to do with the sale, makes [00:17:30] the cash. And then gets recurrent payments on the same Lamborghini every month. Right? You know where I'm going?

I'll tell you exactly how it's happening. You go drive about a mile from here and a one quarter on a four lane highway, you'll see four pharmacies. All of those buildings much bigger than the local family practitioner, who's getting paid $130 to figure out what medicines grandmother needs with [00:18:00] three organs failing. And she goes down there and you better believe refilling those prescriptions, is like the Lamborghini literally, in price. And the pharmacies getting the money. So you have a big B, Walgreens, Win Dixie Pharmacy and Walmart Pharmacy literally all within a stone's throw. So that's installed base only we don't get it. Now I worked around that, in Alabama you can have a pharmacy and for awhile I did. And [00:18:30] you better believe, it put me right in cross hairs. So even though it's so called legal, you try doing it and if you think your colleagues are jealous of their turf, you better believe the pharmacies are jealous of your turf. Even though they can go do fricking free shots all day long, and put their toe on your turf. Control the money, you control power. And so when it's time to make the the laws. [00:19:00] Now I'm getting more off on the politics, but you guys know the physicians get their pay cut more than the pharmacies do. Okay. Anyway.

That's installed base, you get it? Now to understand it, and you understood it before, but now you see sort of how I'm diving into it. How do you do that with these procedures? You want a base and they're going to shop and kick the tires and "Do I want a Vampire facelift or I just need to get a facial [00:19:30] down the street from the whatever." And so they're price sensitive, "Do I get this light therapy or what do I get?" That's equivalent, of course, to shopping for the printer. The lost opportunity for us has been that once they do the thing, some of you guys are selling lots of aftercare products or the residuals, like the Lamborghini insurance. You're already doing that and you're making something match. [00:20:00] I'm not saying you quit doing that, but for eight years I have wanted a residual that match the base. So, we finally have it. And some of you guys already know it. You've seen it on my emails, but we have vampire skin therapy now, that is the after care products that fits our procedures. The first one we're rolling out, is altar, A-L-T-A-R. Play [00:20:30] on words. So this would be the aftercare product for the vampire facial.

 

I have a word of warning, though. One of our providers, I think it was Sylvia, sent me a picture where someone had some sort of something put on their face and then micro-needled and had a reaction [Facial Allergic Granulomatous Reaction and Systemic Hypersensitivity Associated With Microneedle Therapy]. I haven't seen the person, so I wasn't sure if it was urticaria [or something else].

 

 

 

 

 

There are two cases we've had in our group and there's a couple [00:21:00] of mentions in the research about urticaria happening from your PRP. We're not sure why that happens, but you just Medrol Dose pack, it goes away.

We've had it in one one face and one [inaudible 00:21:10] in the inner. But this look like it could be actually some sort of granulomatous thing and there's an article in the research showing that, that happens. And it's treated with antibiotics & steroids. And it's because your micro-needling actual particles into the face.

So, the protocol [00:21:30] for this would be doing your micro-needling. If you have an HA that you're using, that's fine micro-needling that, but nothing particulate, including this cream. Even though I think you could probably micro-needle it in on the foot side, I do not recommend it. We have not checked that out. The research that goes with this, if you go to our, let me see if he's on the call. He [00:22:00] didn't make it today, but we had him, Dr Glassman. I'll get him on one of the future calls. He brought these to me, and we have a ... Thanks to our collaboration with Dr. Glassman, we have the exclusive on the patent to the material that's an extract that has been proven in clinical trials, and a $2 million NIH study looking at wound healing to decrease the numbers of senescent cells and increase [inaudible 00:22:27] activity and such.

So if [00:22:30] you want to see the details on that, here's some of the research. I actually found some before and after pictures from the research which I'll post on the recording here.

 

 

 

This is the guy who invented it. He's got a pedigree that can with anybody, multiple research studies, and we have the exclusive on this. So now you have many blades that match the razor and you can offer, alter, a Vampire Skincare [00:23:00] therapy as an aftercare product after the facial or the face lift.

So the protocol would be you usual way of cleansing the skin, I vote for hydrochlorous, which you get on Amazon. It's very cheap, and I think it's easier to use, it doesn't irritate the eyes.

Hydrochlorous Acid

Vampire Facial® Protocol that Includes Altar™

Whatever you do to cleanse the skin. You apply your PRP micro ... And the plus, minus HA micro needle it in, and then your PRP after that, and then alter [00:23:30] on top of that, and then they use that, could use it, perpetually. If they're prone to acne, they should not, cause it has ... We're not sure what it does with acne, but if you have oily skin you'll find it has a heavier feel to it. The before and after pictures on people have who have been radiated, or have dry, cracky skin from either age or exposure to the cold and heat and such, or even some psoriasis and [00:24:00] with diabetic wounds, are absolutely amazing. So, anyway, that's the protocol and this is now install based.

1. Cleanse the skin (after topical anesthetic cream).
2. Apply PRP
3. Microneedle
4. Apply PRP
5. Apply Altar™ twice a day for 3 weeks then every night perpetually (suggested retail is $147 per 1.7 ounces).

Where to buy Altar™ (click)<--

 

 

 

 

 

 

We'll be making install based products for the O Shot, for hair, for other things. So stay tuned, we'll probably have a peptide cream and the, my ... The reason it's taken me eight years is because, in my opinion, nothing really was new under the sun that I thought was up to par. [00:24:30] I've owned the name Vampire Skin Therapy for at least five years, and ... But I just didn't think anything was up to par.

So to buy this, I'm going to put a link in here. The suggested retail price, which you know what you do in your privacy, if you want to give it to your mother-in-law or sell it occasionally to a special person for less, or give it as a bonus, that's fine. But that should be the one off, and the only advertised retail price should be $147 [00:25:00] or more. That's for the 1.7 ounces, and that gives you over doubling of your ... You'll see, you could do the math on it. But it gives you more profit than you get on any of your other products. Not saying throw everything else out, but there you have it. That's our new thing and ...

Oh, last thing, we have some people with pretty nice audiences in the million range of followers. A couple of celebrities that are going to [00:25:30] be talking about this in the next week or two. We've got two press ... Possible press publishing that will happen. We're sending samples to a couple of fairly popular magazines, print and online. So this is not ... It will not ship until April the 12th. So if you order it, they won't bill your credit card until they ship it. It does go throughout Europe if you're listening to this, and you can get ... [00:26:00] If you're not in Afghanistan or something where you're shooting at people, we can get it to you, and I think that's about it.

Let's do another question or two and then we'll shut it down.

Can you do the O-Shot® on  someone with ITP?

I get this a lot. I have a patient with ITP. Her platelet count runs in the 70 to 90,000 and she's interested in having the O Shot. You know, here's the thing, we're still obviously in the early stages of proving how things [00:26:30] work, and I honestly don't know. My feeling is that you have nothing to lose by trying with this woman, and a lot to gain.

My warning is this, if you're starting out, stick to the easy, easier cases. Nothing is 100%, because I highly recommend that if someone is not happy with what you do, you give [00:27:00] them every penny that they've paid to you back. And if you're going to do that, and you're treating only the difficult cases that we're not sure how things are going to go, and you're giving people their money back, you'll be frustrated. Especially if you haven't been doing it long enough to see it's benefits. You don't even know with confidence that it's helpful.

So stick to the easy cases with the O Shot, which is the younger to ... Younger as far as structure goes. Women [00:27:30] who have ... Younger to mean is, you know you could be 70, but you usually it's the 35 to 55 year old woman who her cervix is not falling out of her vagina, and she's got incontinence. She can have an orgasm, but it's not what it used to be. She's got dyspareunia, because we do well with that for some reason, but it's not a surgical cause of dyspareunia, and Lichen Sclerosus. Those are easy wins [00:28:00] for us, and course they're difficult wins for other people so that's why people are going to like our stuff.

Something like this, I would treat it, and I often do treat it just because I want to help people. What you guys do, I don't see a downside for it. But just if you're new to the groove, I would stay away from the harder cases. For example, we've also had some anecdotal reports treacle incontinence women when they've had the big tearing. Things that can go in the grade [00:28:30] four or five, I think, when they a postpartum tear. And we have ... I know of two very definite, excuse me, three very definite anecdotal reports of that improving after one, in one case three different injections to help that. So anyway, stick to the easy cases.

Calcium Chloride Sources and Techniques

So Terry says, "On the calcium chloride question." And there's a video out there where I show to transfer it from the ampules in your crash cart in to a 10 CC syringe. Can you just leave it in the glass ampule instead of transferring it? You could, I think it's just obviously I think a cut testament to how careful our FDA is when it's difficult [00:29:30] to find people to serve you salt water, which is of course what calcium chloride is.

Source of Calcium Chloride <--

But I usually transfer it, of course, to a sterile syringe, cap it, and then I just don't let anything that's not sterile touch that and use it as a multi-dose vial. But I can usually get vials from McGuff and many of the people in the group are telling me they also will get it, so go to our supply list and check out McGuff if you're in the US. Those outside the US probably [00:30:00] don't have as much trouble coming up with that.

Let's see if ... I don't see any other questions, and I want to thank you for being here and posting your comments. It would help, you know I don't want to be the sole source, I want to hopefully do a lot with helping you guys talk to each other, so anything that gets posted here, gets discussed, if not before at least during our conversations. I'll post links to everything we talked about, and you guys have a wonderful week. Thank you very much.

Charles Runels, MD
Charles Runels, MD (photo)

Cellular Medicine Association
1-888-920-5311

Order Altar™ at Wholesale Prices (click)<--

Journal Club & Pearl Swap.

Topics Discussed Include the Following...

*Free Marketing Opportunity for the O-Shot® Procedure
*Kenalog for Peyronie's Combined with the Priapus Shot® Procedure
*A Way to Use a Video to Talk about the O-Shot® for Urinary Incontinence
*More about the combination of kenalog with the Priapus Shot® for Peyronie's Disease
*Using the Priapus Shot® on a man on beta blockers (or other anti-hypertensive drugs)
*Ejaculatory Problems Post nephrostomy, decreased sensation and possible pump over use (and how to let the attending urologist know what you're doing)
*Workshops with Live Models (and specialized training of Teachers)
*What size needle(s) to use with the O-Shot® procedure
*Do you do anything differently when you do the O-Shot® procedure for incontinence than when you do the procedure for sexual dysfunction?
*Vampire Amnion™ Hands
*Consent form for the Various Amnion Procedures
*Our Wholesale source of quality Amnion (from the premier provider in the US)

Video/Recording of CMA Round Table Journal Club & Pearl Exchange

Transcript

Free Marketing Opportunity

Charles Runels: Thank you guys for coming. I wanted to start with bragging about one of our providers got some really amazing publicity that we can use to promote our practice. All of us can use.

As usual, today I'd like to cover free publicity that's available, some research and answer questions.

Again, Shirin (Dr. Shirin Lakhani) in London has this beautiful article where they interviewed her about urinary incontinence. You can see where it talks about non-invasive therapies. She talks about using either a laser or the O-Shot® [procedure].

It's not a huge article about the O-Shot, but in some ways this is better because it's about a huge problem. These stats are usually shocking to people. As a rough guide you can say that somewhere around 20% of women in their 20's, 30% in their 30's and it reaches 50% of women by the time they reach 50, suffer with incontinence.

[This should say 1 in 20 in their 20's (5%) and close 50% by the time in their 50's]

Incontinence is defined as interferes with hygiene or your social life. You're having to do something because it's a hygiene problem. Wearing pads or something like that. Or you're having to limit what you do. You can't sit through a meeting at work. It's interfering with your ability to travel. Those sorts of things.

Just a quick tip, if you want to make something sound like not much, you can call it 5% and that's the number of women that have incontinence in their 20's. The 5% is the same as one in twenty. Actually, it's not 20%, it's one in twenty for women in their 20's. Thirty percent by the time you reach 30 and it reaches close to fifty percent by the time you reach 50.

Anyway, it's a nice article. I can show you it's a very simple thing...

1. if you want to post something like this. You can click here. [or] You can also just take and copy this

http://www.womenshealthmag.co.uk/health/female-health/7867/incontinence/

2. and then you go to your Facebook page [and post the link]

3. and/or you write an email and you paste that link [into the email]. Then just tell people [in the email or on your Facebook page] that you're offering that [the O-Shot® for incontinence] and that you're happy to talk with them.

And the phone will ring.

4. The second thing you can do is (in that same email or facebook post) you can add a (click)->>link to our research. I'll show you where the research lives about incontinence. If you go to the O-Shot page, then you click at the top where it say "research," there's an article here by Dr. [Nato inaudible 00:03:29] down in Brazil, right here, where he talks about incontinence.

Then, here's another one. This one came out of Lake Forest. There's two. This is my study. They mention not just incontinence, they talk about Peyronie's as well.

This one and this one talk about incontinence. We saw it in our original study that we put out back in the day and I'm having trouble finding it now. We didn't report it. We were trying to limit it to just sexual function. But there are two studies.

If you put a link to those two studies and a link to this article in an email to your patients, the phone would ring. You could also put a link to either this whole page, which has the research on it, and a link to this and that would make the phone ring. Make use of that. It's hot.

5. This also would get you [some amazing publicity for free], if you called your local news channel and said, "Hey, this thing that's making the news about treatment of incontinence, we do that here and I'm happy to give you an interview."

It's interesting, the news is so hard up for news. You'll often see... Just watch the news tonight and you'll see reporters interviewing reporters because they're that hard up for someone to interview to create news. If they will interview each other, they will definitely interview you.

If you don't call them because you bought a new machine, but you call them because you have local news that relates to national news. Women's health is huge. This is huge. You have this if you're on this call and you're doing the O-Shot, you have this to talk to.

Just to let you know how huge this is, in the U.K. this is ranked number 8,000 as far as popularity of websites. In the world it's about 100,000. It's a very popular website. Watch the traffic. Other news channels would be eager to talk about this.

If you're not doing the O-Shot and if you're interested, you just call my office and let's get you going if this is something that integrates with your interest.

Let's answer a few questions. Then we'll come back to more ways to create more profit by taking better care of people.

Kenalog for Peyronie's Combined with the Priapus Shot® Procedure

We had a couple more interesting questions for the Priapus shot. Let's do this first one. He said, "I work in a multi-specialty practice and we offer the P-Shot and the vampire facelift. I have a patient with Peyronie's disease and would like to use intralesional Kenalog along with ERP. Do any one of the member have experience using the intralesional Kenalog to break clients caused by Peyronie's. I've treated scars on the skin with steroids with some success. Injected PRP and next week tried the Steward injection. Any contra indications to use both? Will steroids inhibit the PRP function?"

The easiest way to think about this is think in terms of healing from surgery. What we're creating with our PRP is the same thrombin cascade and wound healing that would take place with surgery. I like the idea of combination therapies but just realize that if you follow the PRP with Prednisone of any kind. Whether it's high dose Prednisone because they have small turn immune disease or intralesional, it could in theory undo what's happening with the PRP.

Ideally what you would do is maybe do the PRP and give it the full six to eight weeks to do its effect and then the Kenalog. Basically, space those out at least six weeks apart. You can do Kenalog, wait six weeks and do PRP or PRP wait six weeks and do Kenalog.

The reason I pick six weeks is if you look at the soft tissue studies where there's wound healing with PRP, or those of you who are studies say the cell turnover if you use Retin-A, it basically takes two cell turnovers to see the effects of something like Retin-A. Six weeks is the minimum. Twelve is usually where you see full effect.

If I were making up a protocol for this, based on that, I would say use your PRP and then wait 8-12 weeks. Then use your Kenalog and then wait 8-12 weeks and then cycle it like that.

If you want to see... By the way, it's been shown that combination therapies for Peyronie's disease are a very good idea. I'll show you where I put that research, for you guys to find it. By the way, why don't I just put these links in the comment box so you don't have to come find them. When I post, there's a chat box and I'm putting it here if you want to copy/paste them and save them in a Word document or something for later.

That's the link to the amazing article about Peyronie's disease. You should be able to find this, but here's the link to our research page if you want to link to that.

A Way to Use a Video to Talk about the O-Shot® for Urinary Incontinence

Before it slips my mind, let me show you something else. I'll come back to the Peyronie's. If you want to talk about incontinence, I put this here because I think it's a very informative video about incontinence with the O-Shot. It's not hyped up. Let me find it for you and I'll put a link to it.

Link to Video to Model if You Want to Talk about Incontinence...Notice that She Talks about Her Personal Experience. Nothing takes the place of having experienced the procedure yourself. (click to see the video)<--

So, Dr. Boyd out of Mississippi, she has a really nice practice, and she's done very well with the O-Shots. I'm going to share this link with you, and if you do your version of this video and put it on your webpage, you will have good results. So, there's a link to that video. So, a combination push for anything would be a link to research so the science people can read it or the science part of a person's mind can read it. This is an extremely powerful combination. So, a link to the science. A link to something in a popular journal, so people realize this is not something, some weird thing not many people are doing. That's reassurance that it's being done by others. So, you show the science, you show a link to a popular thing, then you have a video preferably with a provider talking about it. So ...

Siri: I'm not sure I understand

Charles Runels: I'm sorry, my computer is interrupting me.

So, you have a video that the provider does, you have a link to the research, and a link to something in a popular journal or news cast. That combination's extremely powerful. So, I just gave you all three links. I gave you a link to the research, I gave you a link to the video, that you could either post that one or preferably do your version of that, and a link to a popular press. Put all that in the email. Put all that in the webpage. And you've got something that will help people decide ... you don't want everyone to come see you. It'll help those who need you make the decision and those who don't decide, might.

If you notice when she does her videos, she talks about the things that she cannot help with the O-Shot. Talks about other things that might be helpful other than the O-Shots. This isn't a sales pitch. It's an educational video about different options and how to know if this might be the right thing for you.

More about the combination of kenalog with the Priapus Shot® for Peyronie's Disease

Let me go back to the Priapus shot. And peyronies and our question about using Kenalog. So, if you go to priapusshot.com/peyronies you will see where I went through a textbook and most of the references in the textbook that were current and relevant. A textbook about peyronies disease. And, I pulled out everything that seemed well documented and ... For example, there's literally a study with vitamin E at that dosage, that shows that it helps peyronies if it's used in combination and ... So anyway I put all that on that one page. For some reason, we don't know why, but those who smoke are more prone to develop peyronies disease. And Cialis has actually a histological effect. It's not just causes erection, it has a histological effect, that could helpful with peyronies.

And if you go to the research page you will see actual links for everything that I'm talking to you about, links to research, links to regenerating nerve, and so there it's all there. And links to using the pump for Peyronie's. Which I recommend that you use at a pressure of seven to ten. It's all right there. Twice a day for about ten minutes. So, whatever ... so I'm all in for combination. I'm not so much into Kenalog because it could interfere with your PRP. But, I don't know. I don't really know.

Now, Xiafles, this ... I spelled it wrong ... Xiapex, we actually have a new study showing that PRP works better with fewer side effects than Xiapex, which is a fifty-thousand dollar series of injections. But, the exact protocol and how to choose who will win and who it will not work for, we are still trying to figure it out. So, those are the options. And back to our original question. I think it's a wonderful idea. And if you are going to do it, just space them out.

Using the Priapus Shot® with a Man on Beta Blockers

Okay, another question from Dominique. Anyone have experience with patients ... by the way, hopefully you guys will go log in if you have other ideas. I'm going to approve these and put, so they will show up on the blog, and put links to this video. But, go in if you have other ideas. That's the idea. That you guys talk with each other and I become more of a facilitator. So, if you have ideas, go in a post it here.

Dominique says, "Does anyone have experience with patients on beta blockers. I have a client that has been on a beta blocker since he was young, from a virus that gave him a heart arrhythmia. Heard he is able to get erections, but they are not predictable, or as strong as he would like. He is able to use Viagra somewhat successfully before the procedure.

So, the way I would answer this is of course beta blockers have an effect on the parasympathetic and sympathetic balance that interferes with erection. But, it has nothing that of course would interfere with the benefits from our Priapus shot. So, if you have a multi component and system and there's limiting step, then it's possible that that limiting step could undo what we are doing. Yet, it is also possible whatever effect that beta blocker is having could be less detrimental to the erectile process perhaps if we could increase blood flow. So, when I have someone who has something that their doing pharmacologically or some disease process, for example, long term type two diabetes that might undo or attenuate the effects of my priapus shot, then I just practice the procedure with that and no matter what I always make sure the person knows that if it's not effective and they are not delighted, they can keep the money. And, I would recommend that the hard cases ... and I would consider this one to be a more difficult case because you have something counteracting the effects of your Priapus shot. But, we honestly don't know with this particular person if it could be made better.

I'll put it this way, if I were on the beta blocker at thirty years old I would want two Priapus shots about six to eight weeks apart to see if I could improve my erectile function, since it's a fairly low risk procedure and potentially high benefit.

The following review article from 2016 gives some very helpful suggestions. Only 3 pages (p. 238-240) will be tremendously helpful to you. Click<--

So, I've been talking too much. Let me see if anyone has anything they want to say. If you want to add to my answers, I'd rather it not be me talking all the time. I prefer that you guys ... you know there's a lot of expertise on this call, I'm seeing names and a lot of expertise. So, if you wanted to contribute, just click the little button. I'm keeping the sound off because a lot of people have noise in the background, you know a dog or child or busy ER, or something. Raise your hand if you want to contribute or have experience with any of these questions.

Ejaculatory Problems Post nephrostomy, decreased sensation and possible pump over use (and how to let the attending urologist know what you're doing)...

So, here's another question. Lots of interesting [inaudible 00:18:06] O-shot, I'm on the Priapus shot website this time. She's says, "I had an interesting conversation with a middle aged male with ejaculation failure. Long story, I'm relating it as he spoke to me that he had a bladder resection in 2012. He had been able to have erections with Viagra and Cialis since then. But becoming more difficult to maintain since 2017. Now he has prostate problems, he has a pouch, but developed stones in the kidney and the pouch. November seventeen a nephrostomy tube was placed and stone removal performed under general anesthesia. Patient thinks that the procedure took one to two hours only and since that time he has inability to ejaculate for ten to fifteen days. States the shaft of the penis is numb, but the head of the penis is not. States he cannot feel anything during sex. The only way he can ejaculate now is with oral sex after two hours.

Woo. Must have either a tag team or a very motivated girlfriend.

Denies numbness inner thigh or pubis. He's blaming the surgeon. The surgeon's unable to correlated the problem with surgery. The patient asked about the P-shot and the surgeon said yes he could try it. That's good.

And this makes a point ... Let me stop here and make a point. When someone is paying you cash for a procedure, it probably means that the thing that is covered by insurance that everyone else is doing did not work or they would not be paying cash. And I've found that most people are receptive to ... Most other providers are receptive to our help. Because, often they ... The person that is in your office is their difficult patient. But, it should be handled in the proper way. So, if this person, and I'm glad to see that Caroline did this, and I know her, she's an amazing provider who's been doing her stuff successfully for a while. And so, I know she would do this, but if this person showed up in my office, I would pick up the phone and I would call the surgeon and say, "Hey, this guy loves you, he's here not because he's trying to swap doctors ... " I always start with that, so they realize I'm not trying to scoop their patient. And I would say, "But he's got this problem, and I have something that could help. I'm not sure, but it could help, and I just wanted you to know what I'm doing." And I'll go ahead describe it to those who don't know our procedures, is I'll say, "I'm using the platelet rich plasma like the dentist or orthopedic surgeons have used to try to regenerate tissue, collagen, nerve tissue, blood flow. And if you want to know more about it, you can see it on the website priapusshot.com, or O-shot®, whatever it is I'm talking about. And then, I do an old school letter to the person that goes back to their provider.

Often, the patient is nervous about me making that call, because they're afraid their primary doctor or surgeon will be upset, like they're cheating on them or something. And I always relieve that fear by saying, "Hey, you know, you get two people's opinion, you get bids, at least two or three people, before you get your house painted. So, any quality physician will be happy to have another doctor think about their patient if they're having difficulty. So, don't worry about it." And then, I call the doctors. So, okay, on with the story.

"Then he casually mentions that the surgeon has resected the bladder and told him eventually would need a penile implant. Says that part of the pre-implant protocol is to use the penis pump. Had already one, started and knew how to use it. So he said that pumped as high as it would go, four ... " High as it would go is not four, high as it ... I don't know what, but high as it goes is pretty dangerous, you know, not like going to kill you dangerous, but possibly damaging to the penis. And most penis pumps, the scale to around 10, minus 10, is going to be about a fourth of the scale. But who knows? It could have been an odd pump, where that was, you know, 10 was as high as it would go. "10 to 15 minutes, 2-3 times a day. Electric pump. So, I am thinking he's not a surgical complication, but a complication using the penis pump incorrectly. Would a P-shot help this? How many treatments might he need? By the way, he will not be getting ... 'cause Medicaid denied the $63,000 procedure."

Yeah, so, this is a good one for all of us to think about. Let's see, first of all, if someone has numbness, I usually don't use a pump at all. And I've found, just anecdotally, that when someone comes to me for numbness, then the pump seems to interfere. And I've had people come to me quite a few times ... One guy flew down from New York all the way to Pensacola Airport five times, until he recovered all of his numbness, or recovered all of his sensation. And so, yes, I agree that the pump absolutely could be causing the numbness, and we have research ... And I'll go back and show it to you. We have research showing that our procedure could help with, regrow nerve tissue. A lot of it out there actually ... Here's the research that's showing regrowing nerve tissue in rat penises, but if you just go to PubMed and you put in ... I'll show you, just go to PubMed. I want you to see this for yourselves. When you put in "platelet rich plasma" and then you add to it "nerve" and then you sort through this, you'll see there's quite a bit of thinking about regenerating nerve tissue using platelet rich plasma.

So, back to this question. There it is. I agree that this should be ... I would stop the pump. I would give him a series of two to three injections eight weeks apart using at least 10cc of PRP. And then after his sensation is better, then perhaps ... Well, if he's not going to get a penile implant, maybe he never uses the pump again. But if he does, make sure he has a pump and someone goes over it with him in great detail how to use it. Now, if you go into our website, I'll show you this and I'll come back. If you go into our website, so this is me being one of you guys. And you go the dashboard. And then you go to the "How to Do the Procedure," and then scroll down, you'll see I put ... Here. Here's a nice little eight-minute video detailing ideas about how to use the pump. Okay, right, good.

So, let's go back to our questions. Okay, so I think we got that one answered. Bottom line is, stop the pump and do the procedure, the Priapus Shot® procedure two to three times, eight weeks apart.

Okay, we covered that one last ... It's overstimulation is the cystic ... with persistent genital arousal disorder. And so, and I haven't posted that video yet. So, that's my bad, I apologize, but I will have that video up so that answer will be out soon.

What size needle(s) to use with the O-Shot® procedure...

So, we got a question from [Edra 00:27:16] here on the call. Her question is, "Is it possible to use a 25-gauge one-inch needle for the anterior vaginal injection with the O-Shot®? I've had a few patients that it's been difficult to get a 27 to insert due to the patient anatomy, thick rugae, etc." Now, when it comes to the size needle for the anterior vaginal wall, the anterior vaginal wall as far as sensation goes, it is not very sensitive. We still using numbing cream, and without the numbing cream you can sometimes get away with it, but it will sometimes hurt. So, I always use numbing cream. A 25-gauge needle is sometimes necessary, because the platelet rich plasma gets too thick to push through a 27. So, I keep them at hand.

But as far as it entering the tissue, I think there, what could be happening ... Watch and see if you're bowing the needle or if the needle is glancing off the tissue, because I see that having taught now hundreds of people to do this procedure, I see frequently that people for some reason, they get in a hurry. I recommend that you do a couple of things. First of all ... I'm sorry, it's my computer talking to me. First of all, the 27-gauge needle will go into the tissue of the anterior vaginal wall if it's entering at the right angle. If it's not, it's probably glancing off, or the angle's a little bit off. One way to make it easier to see what you're doing is tilt the pelvis up, either put a pillow or ... Many exam beds have something that tilts the pelvis up. So, by tilting it up, the anterior vaginal wall comes better into view. Or a bedpan or a pillow, but if you do that, you'll be able to, I think, to better see what you're doing, and it should easily go in. Let's see. So, that's what I think is happening.

Now, what will frequently happen, almost every time with me, is when you enter the tissue with either a 27 or a 25, because the tissue's not ... it's free floating in that area. It's not, you know, it's stretched over a bony process or something. It goes out of view, and so if you enter the tissue and then you bring the needle back a fraction, very small amount, a few millimeters, the tissue comes back into view, but the needle does not come out of the tissue. It just brings it back to where you can see it. I know it's a lot of talk about just getting a shot. When you get this thing right, your results will be much, much, much more reliable, the pain will go way, way down where you're hardly ever hurting anyone. Think of it like an IV. You learn to do it in five minutes, but you learn to do it very well after you've done it 50, 100 times. Even the gynecologists in our group will tell me, usually with a surprised expression, "You're right, Charles. I started getting much better results after I did this for about a month." Don't be discouraged if it's a little bit awkward. It's hard to see. We're not used to giving injections there.

Sliding into that space between the anterior vaginal wall and the urethra, which is only an eighth of an inch in an 18-year-old and it becomes much less in the post-menopausal woman, is tricky. The good news is if you goof it up, nobody dies. You just get less results and you get to do it again or give them their money back, but nothing horrible happens. Anyway, that's a very good question, and I think that's probably what's happening, just get the angle a little different. Let's see what else.

Workshops with Live Models (and specialized training of Teachers)...

I want to stop here. We'll come back to the questions. I usually forget to do this, but I want to give a shout-out for upcoming workshops, because I advertise these for our providers. Let me add one other thing before I show you guys, because there's a couple really good ones coming up. Before I get to this, let me just say again, don't be discouraged, because it's tricky. Even for the very experienced urologists, gynecologists in our group, it's a tricky little procedure, so just be patient with yourself. The other thing is we don't really know what the perfect dose is for this. For example, there's a sick therapist I treated, he got amazing results, and I'm sure that I spilled about half of the anterior vaginal wall injections by going through one of the [rookay 00:32:21]. I just finished the procedure and I told her, "Let me know how you do, and I'll repeat if I need to." She did amazingly well, never had to repeat it. She's three years out, still doing well.

Let me give a shout-out to our upcoming classes, because we got some superstars. Dr. Ibrahim was faculty at Duke, literally world-renown surgeon with prostate surgery for cancer. Really has a high understanding of our Priapus Shot® procedures. Dr. Gordon is down in Antigua, so if you want a really cool vacation, then it's beautiful down there. It's just like paradise. Where you stay, I've gone and seen this place, where you stay down there is just a little resort that's amazing. Of course, Sylvia's been teaching the longest of all our teachers and does a great job with the face in all the procedures. Our new teacher, not new to teaching but new to teaching for us, Dr. Dormer up in New York City. She is a really world-renown injection injector instructor and has just a luscious place up there in New York to teach. Adrian, these Canadian doctors are amazing. He's been teaching for years and now he's integrating.

I want you guys to know with the upcoming classes, if you want to get some more instruction on one of the procedures, that's their expertise. Urologist, just a beautiful place, brilliant man. Used to be a barber, Dr. Gordon. When I saw him inject, he said, "Yeah." He's just amazing. Said, "Yeah, the first time I started injecting, I was good at it and people asked me why," and he said, "Well, I guess because I was used to shaving people with a razor." Anyway, that's if you're into the face, these two people are amazing right here, and of course Sylvia. If you just want to hang out with a bright man in a beautiful spot, Dr. Gordon is the man for it and he knows all these procedures, and of course Dr. Ibrahim, especially for the P-Shot and the O-Shot, having his expertise as urologist.

Do you do anything differently when you do the O-Shot® procedure for incontinence than when you do the procedure for sexual dysfunction?

Okay, let's go back to our questions. Let's do some O-Shot questions. Oh, this is a very important question here. To treat urinary incontinence in a female with good sexual function, do you do anything different? Please take notes because this is a really important question, and I haven't talked about it a lot on the websites. I do in my classes. I'm so glad for this question. Anything different if you're treating incontinence versus sexual function. All right. Huge, very important question. Think about this for a second. Let me pull up a picture so you can see what I'm talking about. This picture. This is one you see a lot, and this one. This picture of the clitoris, or cartoon really, showing how the corpus cavernosa come down on the pubic rami and the corpus spongiosum and basically surrounds the urethra.

Then if you look at how it looks, just looking at it, we can see clitoris, and it comes down like this. With the corpus spongiosum and the corpus cavernosa, and the clitoris actually becomes like a wick to get to those areas. There's two reasons for injecting the clitoris, even if they're there for incontinence. Here's a better look at the cross-section.

Reason 1 why you inject both clit and ant. vaginal wall for both incontinence and for sexual dysfunction...

Reason number one, corpus spongiosum, bulb of the vestibule, corpus spongiosum, corpus cavernosum. We actually have done ultrasound visualizations with one of our amazing providers, Dave Harshfield, whose an intervention radiologist, so we put a little hockey stick ultrasound probe there, and we can see the [peripe 00:36:50] flowing down here. Back to the question. Two or three reasons. One is that this tissue is a wick down to this area, and if you look at the histology and actual mechanics of how a woman's urethra works, there's no true sphincter. A man has a circular sphincter, muscular sphincter to help hold his bladder. A woman has more like a one-way valve that is partly formed by the tissue of the clitoris.

One of our providers who's a surgeon, Elizabeth Owings, has a beautiful lecture. We're trying to get her pictures into a book, where she demonstrates with the histology and a lot of the research that's out exactly how this is working. Part of the valve for the urethra in a woman is formed by the tissue of the clitoris, so that's reason number one is you're actually helping the tissue that forms the valve for the urethra when you inject the clitoris.

Reason 2 for injecting both locations

Number two, these nerves and nerves of micturition surrounding here could possibly be helped by injecting the clitoris and the nerves that innervate the clitoris; there's some cross innervation. That's part of it. It could be that the reason we're seeing benefit with both urge incontinence and stress incontinence is the nerves of [big turition 00:38:24] are being helped in the same way we just talked about the nerves of the penis being helped. That's the other part of it.

Reason 3

Lastly, and this may be more important even though this is not scientific, this is social, I think I can probably best illustrate with a story. I had a woman come to me for an O-Shot. As she was sitting down on the exam table, she said, "Dr. Runels, I just want you to know that I told my husband I was getting this for incontinence. I love him dearly. I would never leave him, but he's dying with prostate cancer and I have a boyfriend, and I'm really getting it for the sex." That was a very courageous thing for her to tell me, and for her to trust me with that secret was huge obviously. But I think we can probably all agree that not everyone tells us everything about their sex, and probably of all the things that are not openly shared, maybe sex is at least in the top three of things that we don't openly tell everything about what we're doing.

The third reason is that the person who tells you they are there for incontinence could be not telling you everything and they're actually hoping for the sexual benefits as well. For all of those reasons, I would say no matter what people come to you for, so if it's for incontinence, you still do the clitoris. The other question, the flip side of that or the reverse of that question is: Would you still do the anterior vaginal wall if they're there for sex? For that, I could talk all day, but I'll keep it short. Let me show you a cross-section. The question would be, the flip side of this question would be: Would you still inject the anterior vaginal wall if they are there for sex? Since we think of the clitoris as being a sexual organ and the urethra being more to do with urination. I'm not seeing the cross-section. Let me Google another picture and let me answer this question very quickly for you. Actually this will probably do it. Yes.

Reason 4...Dr.G!

If you look at this cross-section, you'll see that anterior vaginal wall and urethra. This is maybe five centimeters long, give or take. Dr. Grafenberg, for whom the G-spot is named, his big idea was that the urethra is the most erotic part of a woman's body. Let me show you that something, let's see if I can find this real quick because it's extremely interesting. Dr. Grafenberg. Yes, I did know that. You can actually find his writings where he talks about, let's see if we can find it. Ejaculation. I'll find it and see if I can't post it for you guys.

Ernest_Grafenberg_1950_The_role_of_ureth (reading this could change your life, if you truly understand what he's trying to say<---

But his big idea was that of all parts of the woman's body, the most erotic part is urethra. The G-spot is basically a bastardized version of his idea. He never really talked so much about the spot [though he did mention it some], he talked about the whole pressure on the urethra itself, the whole urethra being arousing, and I really think the spot changes in the same woman from day to day. There's really no magic spot, it's just everything, and figuring out what's going on that day by being in tune with each other and trusting each other. There's really a lot of magic goes on, but this idea of the urethra being more erotic than the clitoris is what Dr. Grafenberg had to say.

Back to this. Of course you would want to inject this area around the urethra, so its sensation and blood flow and function of the Skene's glands, all of that would be enhanced we hope by that procedure. You always inject the clitoris when you're treating incontinence. You always inject the anterior vaginal wall even when you're treating sex. Okay, so let's go back to this and see. I know we answered these other two with last week's webinar, which I haven't posted yet. Let's go to the face, and I think we call it a day. Let's see if there's any new questions here with the face. Post care instructions, Vampire Facelift. Great question.

The way I explain this to patients is that when you do Botox you're tightening a sheet, but if you want a better mattress, that's what PRP does, it's what Juvederm does, and it's what peptides do and Retin-A and other things. I'll just give you guys a clue right now. We're about to roll out a cream that we have for Vampire providers that is going to be amazing. I'll be able to announce that to you guys next week, but we have the rights to a patented ingredient that you could use post Vampire Facelift and post Vampire Facial. Hopefully we'll start taking pre-orders next week, and then we'll ship it hopefully a week or two after that. That's the goal. I've kind of been keeping that under my hat, but just tell you it's coming. For now, I would say the main thing is that you want to encourage them to continue to improve the health of the mattress, mattress being of course the collagen and the blood flow that supports fibroblast and collagen and nerve function or just healthy tissue. Those things would be Retin-A cream, I prefer, 0.1% Retin-A cream and learn how to use it, peptide creams, and very soon the new cream that I'll be announcing as exclusive to us in the next week or two.

Great question. I think that's enough for one day. I'm going to just give you guys a chance, if you have any other questions, then I will field them now. Otherwise we'll call it a day. I'm always honored by you guys paying attention to this and being involved. I think we're literally changing the world. I wasn't able to pull them up, but I saw some hands, just one quick comment.

I saw some hands yesterday actually that I treated about two months ago, three months ago, with a combination of PRP and amnion. I was literally shocked, and I did a Vampire Facelift on her the same day. We see lots of good results. Could be there was just something freaky about this woman, but I'm telling you, I was shocked.

Erin was with me, she was shocked, and this lady says she's having people walking up to her wanting to know what the heck she has done, which we normally see with our Vampire, but I'm telling you this was more dramatic than I have ever seen with a Vampire Facelift. I'll have those pictures for you at least of the hands. For privacy reasons, I'm not going to show the face, but the hand pictures. All I did was I talk the usual, I took a syringe of Juvederm and I took some amnion, one Juvederm syringe, one of our five milligram amnions, mixed it together with some PRP and did her hands, and it was really shocking.

Hands Before PRP with Amnion & Juvederm

Hands before PRP with Amnion & Juvederm

Hands After PRP with amnion & Juvederm

Hands After PRP with amnion & Juvederm

The consent form for all of the combined PRP with Amnion Procedure (Vampire Amnion™, O-Shot Amnion™, and Priapus Shot Amnion™ can be found under the "legal" tab on the respective dashboards.

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All right, so I'll see you guys next week. Thank you very much. Always an honor. Have a good week. Bye-bye.

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Charles Runels, MD (photo)
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PRP. Centrifuges & Definitions

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Transcript...

Lecturer: If you take a tube of blood and you place it on the counter, it settles by weight. The heavier stuff sinks to the bottom first, and the lightest one's up at the top. All you need a centrifuge for is to make it happen faster, and when you're done, it goes red cells, white cells, platelets, in that order, and most of them are stuck right here in this thing called the buffy coat, and then this also has platelets in it, but you can see the color changes. This is my finger. I just spun the yellow top and took a picture of it. The color changes as you get closer to the top and by the time you get here it's mostly water.

Now, what is platelet-rich plasma? Remember the guy called me down at the ortho meeting because what I was calling platelet-rich plasma didn't meet his definition of what platelet-rich plasma is. I think I told him ... Did I tell him my joke about the girl and the high school kid? So my Dad told me there was this girl in his high school that only had sex twice. Once with the football team and once with the basketball team. And so, my point is that you got to, that words can mean whatever you decide they mean and people are going to use the word platelet-rich plasma to mean two different things, and I want ... They're not trying to trick you. It's a true statement, just like the girl just had sex two times. That was true. So they're not trying to trick you. They just have a different meaning for their words, and I want you to understand what those meanings are so that you can make a smart choice.

Okay, so you ready? So, if you take this, let's assume they don't, this person probably has hematocrit of about 40 percent, 45 percent. How do I know that?

Male student: Just estimate by ...

Lecturer: Yeah, exactly. You can look at it.

Male student: ... [inaudible 00:01:41].

Lecturer: Exactly. So if the crit was 50 percent, it would be half plasma and half red cells, right? So let's just to make the math easy, let's assume we're dealing with a man with a crit of 50 percent, and without using a microscope, I'm going to tell you how to know how many platelets you got. So, let me set this down for a second. So, if this were, if I just took a tube of the man that had a crit of 50 and I spun his blood in a centrifuge, I would have ... and this is 10 milliliters, I would have 5 milliliters give or take of red blood cells and I would have five milliliters of plasma with the platelets mostly living right there. You guys still with me?

Some of the platelets would be in this upper layer of red cells. The younger platelets have a weight that's very similar to red cells so they would be right here, but that's a small number. Most of them would be right here with some of them through here. So if I took this and I put that into a syringe, I would have platelet-rich plasma if my definition of rich means compared to whole blood. Right? And what would be the concentration of platelets in this compared to whole blood? Two time, three times, four times. Which one?

Male student: Two times.

Lecturer: Two times, right? Because you took the platelets that were in ten and you put it in five, so you doubled the concentration of platelets, and you didn't need a microscope. So, the gel kits are engineered to do that. When you're through spinning them ... oops, went backwards ... We should probably talk a little bit about what's in the platelets. So these are seven or so of the over 20 growth factors that we know are there. The way I describe this to the patients, and I'll say "You're making what was in that scab ... " because they always remember scraping their knee as a child, I said "You're making that yellow goo that was in the scab, and that's what prompted your body to grow the skin back." When I go to Antigua next week and teach this class, they're going to have me on the news. I always use that analogy when I talk to lay people about what it is I'm doing.

But we didn't invent a drug, we're just taking what the body normally does every time you are cut, scraped or had surgery. This is nothing hokey. If this wasn't there you couldn't heal when you scraped your knee as a kid on your bicycle. All were doing is getting those same platelets that started the thrombin cascade and we're putting it in a syringe. And we don't even care about the platelets. We care what's in the platelets. So when the platelets are exposed to collagen or calcium or thrombin, they break open and they release all these growth factors. And people say "Well, how does it stay in place?" It stays in place because it gels, and that's why you had that yellow stuff, and becomes platelet-rich fibrin matrix. Everybody say that. Platelet-rich fibrin matrix. Because when, I'll see our doctors on the news and they'll get tongue-tied and say "Rich platelet plasma" or all sorts of crazy combinations. It's platelet-rich plasma and platelet-rich fibrin matrix.

Now the Selphyl people have a great kit. It comes with calcium. They finally lowered their price a little bit. It used to, they tried to sell it for 400 bucks for those three drops of calcium, but now what they're doing, they're using a little bit of a game on our doctors, and they'll say "Well, we're the only ones that are selling platelet-rich fibrin matrix." And all they're doing is they're selling you one kit that makes the PRP and another little tube that has calcium in it. Well, heck, all of us are making platelet-rich fibrin matrix every time we inject it or add calcium to it. Okay? So don't fall for that.

All of us are making platelet-rich fibrin matrix. When you take the platelet-rich plasma and you inject it, it turns to this matrix when it's exposed to the collagen in your body. Yes, sir.

Male student: The calcium, what's the ...

Lecturer: Okay, yeah. So I haven't introduced that yet. So calcium chloride is ... I usually use 10 percent, this is in the research a lot, and again, a lot of this came from our orthopedic friends trying to think how can you ... Let's just stop and think. Why do we even need to do this? Why can't you just take whole blood and shoot it in the face? It's got platelets in it?

Female student: [inaudible 00:06:18].

Lecturer: Well, that's basically, I mean ... It's got platelets, though. Right?

Male student: Well, you're not going to get the matrix ... It's going to be diluted.

Lecturer: It'll be diluted, but you still have platelets.

Male student: So you're not going ... It's going to be too diluted to get the effect for the small area that you're working.

Lecturer: Maybe. Maybe. It's a good point and that's what our orthopedist friends would tell us, is that you don't have a high enough concentration. So the game they were playing was, they have a little, tiny space like a knee, and they need a lot of growth factors to heal something that doesn't have good flow, like collagen in a knee, so that's where the technology came from and the reason the plastic surgeons and the derms and gynecologists have to think about is you've got a lot of blood flow in a vagina and a face. I've sutured up hundreds of faces like you guys have. You hardly ever see it get infected. They can go through a windshield, get drug on the street and get urinated on and cut with a beer bottle and you wash it with a little saline, sew it up, they're fine. Not so with a knee.

And so, the game they've had to play, and same thing with the dentists at Wound Care Center in the hospital over here with the hyperbaric chamber, and the oral surgeon would send people over that had been radiated for throat cancer. Now they have to do surgery on radiated tissue, so we'd do hyperbaric medicine, then they would do their surgery and do PRP afterwards to try to make it heal better. So, what the technology, what the research shows out of that is that if you activate those platelets before you inject them, you get a more complete activation than if you depend on the collagen itself to activate the platelets. And one guy, when I lectured in Serbia, there was a guy there who had just published a paper he had worked on for 20 years. I was definitely not the smartest man in that room, and he was big on that. He said if you don't activate, the tissue itself is only going to activate about 65 percent of your platelets.

And so the orthopods have been activating with calcium and thrombin and they've been looking for what's the sweet spot for concentration, and what they have found is for a knee, the best healing takes place at about five times the concentration of whole blood, for a knee. But we don't know that that's the case for an easy to heal tissue like a vagina or the face, and what I can tell you as a clinician is that for three years, I spun gel kits. I used Eclipse, I used Regen, I used Selphyl during those three years, and a gel kit, all it does is it starts with a little goo at the bottom. You got one in your kit, C?

Male student: Yeah.

Lecturer: So want to show them one that hasn't been used. Just hold it up where they can see what it looks like. Can you pull it out of that package? And you'll see it looks like a little goo at the bottom, and what happens is that goo is stuck here and you add blood. Then the good pops up like a cork to the top of the blood. Yeah, hold it where they can see the goo at the bottom. Yeah, you see that white stuff at the bottom. Yeah, Vanna White, there you go. So, that goo pops to the top and then while it's spinning in the centrifuge, it winds up stopping somewhere in the middle so that ideally you've got nothing but red cells there and platelet-rich plasma right there. Compared to whole blood it's just this with the goo stuck between the red cells and the plasma.

So it winds up looking like this. We'll come back to all this. Like that. So platelets here, red cells there, goo right there and your buffy coat ideally should be there. If you try a different speed or a different length of time you're spinning, the goo's going to be at a different place. If you use a centrifuge with a different diameter, you're going to get a different g-force, so their intellectual property is that they know that, the people who sell these kits, that this goo put in a centrifuge with this diameter and circumference, spun at this many RPMs for this many minutes is going to put your plasma right there.

And it sterilized in such a fashion, again, nobody gives me kickbacks on any kit. Nobody. I don't get a penny. I don't get something put into my son's bank account. I don't get a blowjob. I don't get nothing. Okay? And so, that's why you see kits from eight different manufacturers back there, right? But what I'm telling you is there are people out there who don't use these kits. That's why I'm prefacing this remark. You can get a yellow top for seven dollars. You don't even have to pay for it. You can probably have Lab Corps bringing you yellow tops to your office. You all need something? You guys okay? Do you need something? I'm just making sure you're good because we got fed and breakfast and juice and you guys just came in off of a plane, so I want to make sure you're comfortable. Do you all need some juice or food or something? Because we got beignets. I hate being on airplanes. I freaking hate it. And so you're probably feeling beat up and dried up right now. You got some Perrier or something? Give them some Perrier.

So, anyway. So that's a long way of saying that don't do that because that is second rate medicine and when someone asks you is this a FDA approved procedure, what is your answer going to be? Is this o-shot FDA approved? How do you answer that?

Class: No.

Lecturer: No. Why? Can you elaborate?

Male student: Because one, it's not a drug.

Lecturer: He's right. Blood's not a drug, and so the analogy I give people is I'll say "You know, if I sell a needle and thread to a doctor ... " I'm getting back to the kits. "If I sell a needle and thread to a doctor, I can't go get a needle and thread that's made to suture up clothes and sell that to a doctor to suture up people." So, I have to prove to the FDA ... it should be called Food Drug and Device ... so the FDA has to approve a device to be used in the human body, but then once that suture material's in a doctor's hands, it's approved, now it's doctor's business. FDA's got nothing to do with how you sew up a wound. Nothing.

So in that same manner, you're using ... and you need that analogy to explain to patients ... you should be using a device that's FDA approved to prepare blood, not to examine in the laboratory but to go back into a human body, and that's a different game than preparing it to look at under a microscope. It's a different level of approval. So if the patient says that, you say "I have a device that's FDA approved to prepare plasma to go back into the human body, and I know the concentration of platelets that I have in there, but the procedure is not needful of approval because it's your blood." That's the way you explain that.

Okay, so back to this thing. So, you do this with a gel kit, you got two times concentration of whole blood, and I can tell you I've literally treated hundreds of people with two times concentration of whole blood with a very, very high success rate on the o-shot, the face, and the priapus shot. The two times concentration. In my opinion, I don't think you need more than that to do those procedures like you do with the knee, okay? On the other hand, I don't think you're hurting anything going to five times concentration, and it could be that our research eventually shows that you get a higher percentage of ... Not all my procedures work.

Maybe you get a higher percentage of success rate when you go to five times, then you do a two, just like you do with the bone. We just don't know that yet. But my suspicion is you'd get a pretty high success rate with these procedures if you used whole blood. I'm not going to do that, but my suspicion is that you might because there may be enough platelets in just whole blood to make it work for a face or an o-shot. I don't know.

But activation, whether it's by calcium chloride or by the body's own collagen, makes PRP turn into platelet-rich fibrin matrix, and that's why it stays in your penis or around the urethra or in your face because of that matrix gel holds it there. Now, here's what I've decided ss a clinician, I'm open to be taught. I'm going to send you home with more questions than answers. It's just like when you get a new drug, suddenly there's hundreds of research papers come about how to use it. Part of the danger of me teaching this is I start to believe everything I'm saying. I want you guys to go research it and figure out a better way, okay? But here's the way I'm thinking about it.

If I'm treating something like a face or the scalp, I want that PRP to spread, and if I'm treating the breast I want it to spread, and if I get a little bit less activation and it still works, I don't really care. But if I'm treating around the urethra where I want it to stay in a space that's only a few millimeters in diameter or in a penis where I want it to kind of stay in a, you know, relative to my whole scalp, it's a lot more area than here, than my penis, so I want it to spread. So what I'm doing is I'm using calcium to activate when I do the o-shot and the p-shot and when I do loss of sensation for the breast. Everything else I'm not activating it.

And what I found is a lot of our people that have told me their o-shots are not working, they've not been activating it. So I think you need the complete activation and I think it's helping it stay in place. You should be activating it when you do an o-shot. Activating it and adding something to that syringe before you inject it, so you're getting a more complete release of all of your platelets, dumping those growth factors. Is that making sense? If not calcium chloride it can be calcium gluconate, it can be thrombin. Some of the kits come with thrombin, some with calcium chloride, and Cell-Fill includes the calcium chloride, but you pay extra when you can buy a vial of calcium chloride and treat a hundred people for a ten dollar vial. Okay?

Now, what's a double centrifuge kit? What a double centrifuge kit does is it takes this and you spin it and you wind up with your red blood cells. This is Harvest, Insight, Magellan, True PRP, that's the double centrifuge. So what they do is they get, you get red blood cells here. You got plasma up here. I'm just going to call it plasma for now. And then they do a second centrifuge that pulls off the richest part here, so then you have ... If you had 60, you would get 30 of red blood cells, 30 of this total, and then you could pull off ten of this richest part and 20 of this, so this would have fewer platelets, this top two-thirds. This lower one-third would have most of the platelets, and so in this case you would call this platelet-poor plasma and this richest part would be called platelet-rich plasma.

And now this is rich compared to plasma. You see the two different definitions now?

Class: Yeah.

Lecturer: So this is rich compared to your plasma. The other, when you take all of this, this is still platelet-rich compared to the whole thing. Two different definitions using the same name. Now, what you can do, you'll see Z has a kit that spins 22-CCs and if you want you can spin that 22-CCs, have a gel kit, and then if this is your gel, you can pipette off this top part and use that part and you'd still have rich compared to ... So that's how you can alter your gel kit. So that's the two, that's kind of the idea behind that.

Password Recovery/Reset. Edit Directory Information

The following video shows how to login to membership sites, change password, & edit information on the provider listings. Click to play (shows up much better if you expand it to full screen)...

The login works for those with an active memberships. Would not be fair for us to allow access to non-paying physicians when others are providing money used for patient education, marketing, research, and lawyering to keep unqualified physicians from using our name.

If not sure if your membership is active, we are here 9am -5pm (Chicago Time) Mon-Thursday and 9-noon on Friday. We can tell you if your card expired and renew it if necessary...
1-888-920-5311.

TIP= Here's the best software for creating and remembering strong passwords (click)<--

Also, members can schedule a free marketing consult here (click).<--

If your provider membership is currently active...

1. Please click below to access the membership of choice...

http://VampireFacelift.com/members/wp-login.php

http://VampireBreastlift.com/memers/wp-login.php

http://VampireFacial.com/members/wp-login.php

http://OShot.info/members/wp-login.php

http://PriapusShot.com/members/wp-login.php

2. Once on that page, click on “Lost your password?”

...then enter your username or the email address associated with your account and the computer will email to you a new password.

If you cannot remember either your username or password, then you can look at the Provider Directory to find your listing & see which email address you used for your membership account and have the password sent to you. You can see your listing on the directories here...

http://vampirefacelift.com/members/directory/

http://VampireBreastlift.com/members/wp-login.php

http://VampireFacial.com/members/wp-login.php

http://oshot.info/members/directory/

http://www.priapusshot.com/members/directory/

3. To change your listed information or password...

To update your Provider Listing Contact information, once you are logged in, look at the very top right of the screen. There will be a black bar across the top and it will say your name. Scroll over your name and choose edit my profile. Fill in all the blanks with the information you want listed on the Provider directory.

Hope this helps!

Charles Runels, MD
Charles Runels, MD (photo)

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Workshop. AES Meeting. Miami

Hands-On Workshop...

Vampire Facelift®, Vampire Breast Lift®, O-Shot®, Priapus Shot®, Hair Treatment, & Vampire Facial®--with Marketing

Combine the principles of Leonardo with the latest science to produce the most beautiful results with Botox, Fillers, and blood-derived growth factors.
Even though the techniques and ideas behind this workshop involve concentration and focus, the teaching is done in a relaxed and casual way using some of my best friends and patients as models. You will be treated with respect and honor and courtesy while learning from me.
Here's what you get with this workshop:
  • Gives you the skills to do the Vampire Facelift® Procedure.
  • Gives you the skills to do the Vampire Breast Lift® procedure.
  • How to become the least painful Botox injector in your town.
  • How to do the O-Shot® [assumes able to do a comfortable pelvic exam] which is rapidly growing in popularity (presently getting more internet traffic than the Vampire Facelift®)
  • Priapus Shot® taught.
  • 8 Strategies for doubling the number of injections you do per day for about $30 per month (and then doubling again and again until you easily make more then $100,000 per year with your injection practice). This alone will bring you more profit (in addition to better service to your patients) than any course you've ever seen. I do my own website, my own search engine optimization, my own YouTube videos, and email newsletter. I'll show you how you can do the same with little time and simply a phone and a lap-top computer and make back the money you paid for this course within 2 weeks.
  • The Key to all of this is that YOU WILL BE TAKING BETTER CARE OF YOUR PATIENTS--the reward becomes a more profitable practice.
  • How to look at the face and identify the most beautiful and the most distracting parts of the face and then talk comfortably with the patient about what can be done.
  • How to inject the lower face with botox with confidence (to treat gummy smile, soften periorbital lines and marionette's lines, and orange peel chins).
  • How to do the Vampire Facelift®, how injecting platelet rich fibrin matrix you must use a different technique than Juvederm and how to explain this to your patients (the Vampire Facelift®). This training gives you the skills to be on VampireFacelift.com
  • How to create beautiful mouths (and never make duck mouths or bird beaks). Here you learn to apply the proportions as described by Leonardo da Vinci--how to translate art into medical practice.
  • A review of basic injection techniques and how to choose the best filler for the job.
  • How to use the various fillers to sculpt the face not only back to a more youthful appearance but also to a more aesthetically pleasing state: includes the brow, the nose, the jaw, the ear lobes, under the eyes.
  • How to use your iPhone and your computer to best document and market your results.
  • Hands on and didactic from 9am-9 pm on Day 1 and from 9 am until 5 pm on Day


Before Before After After

Notice that you see injection marks in the cheek and not in the naso-labial folds. By augmenting the cheeks, I was able to pull out the nasolabial folds while creating a higher, more glamorous "cheek bone."

Also, notice that she has a gull shaped brow (in the after photo) from the filler before the botox I gave her even had time to work.
This woman only asked me to treat the naso-labial folds by injecting those and did not even notice or know that I could treat all the rest:
1) straighten and narrow the nose,
2) augment the cheeks,
3) augment the brow,
4) straighten her mouth,
5) take the tired out of her eyes by filling the tear troughs, and
6) finally, as a side-effect of all the rest, make her naso-labial folds disappear.

When you leave my course, you will have the knowledge to do all of the above, and to become the best injector in your town.

Guarantee: If you do not feel like you will more than pay for this course within 30 days of your arrival home, you can walk out at the end of the first day and get a full refund.

Hands on and didactic from 9am-8 pm on October 11 and from 9 am until 4 pm on October 12

All attendees must be registered...the marketing portion of these workshops is VERY valuable. The marketing person may also be a model for the workshop (at no extra charge) so that he/she can speak first hand on arrival back at the office.

IMPORTANT: I only accept a small number of people to these courses so that I will be able to give as much attention as possible to each person and carefully coach them. The computer will automatically shut down registration after the quota is reached.
Membership at the American Cosmetic Cellular Medicine Association and attendance at this course qualifies you for listing at VampireFacelift.com and gives you access to review videos in the members-only section of the ACCMA. If you continue to use the trademarked names (Vampire Facelift®, O-Shot®, etc.)--there's a monthly licensing fee for each procedure...this fee can be cancelled at anytime.
No video or audio recording is allowed during these events. This is cosmetic work, not the healing of horrific disease, so I have no ethical reasons to facilitate the easy broadcasting of these ideas and techniques. These are very valuable and closely guarded techniques.
I'd be honored to meet you soon and to help you serve your patients better and find more joy and art and financial reward in your cosmetic practice.
Peace & health,
Charles Runels, MD (signature)
Charles Runels, MD
Charles Runels, MD (photo)
251-648-7704 (voice or text)
_______________________________________________________________________________________________________

Guarantee: If you do not feel like you will more than pay for this course within 30 days of your arrival home, you can walk out at the end of the first day and get a full refund.

  • All attendees must be registered...the marketing portion of these workshops is VERY valuable. This non-injector attendee may also be a model for the workshop (at no extra charge) so she/he can speak first hand about the procedures.

Dr Runels is also available for private, one-on-one teaching and for on-site teaching at your clinic...

Call 888-920-5311 to inquire.

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Miami-AES Meeting. Travel Info.

Thank you very much!

I'll do my best to make this workshop more than pay for your investment of time and money and am very grateful for your trust.

If you're on this page, then you probably just registered...thank you very much! If you're on this page and not registered, then this is where to go to register now (click)<--

I'm very honored and excited about offering this workshop as a pre-AES Meeting workshop.
Here's the info on the AES meeting (highly recommended for physicians and for physician extenders) click<--

Useful info...

Travel/Venue (click)<==

 

 

Schedule (click)<--

Questions?
1-888-920-5311

Looking forward to seeing you soon!

Best regards,

Charles Runels, MD
DrRunels@Runels.com
Charles Runels, MD (photo)

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