JCPM2022.07.26

Topics Discussed Include the Following...

*Botox for bruxism-the central effect
*PRP for peptic ulcer disease
*Botox for erectile dysfunction

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

Relevant Research, Relevant Links

BotoxClass.com<--

Research Review

The central nervous system effects of Botox and how those effects may benefit in the treatments of Bruxism and erectile dysfunction with Botox

  1. Mazzocchio R, Caleo M. More than at the Neuromuscular Synapse: Actions of Botulinum Neurotoxin A in the Central Nervous System. Neuroscientist. 2015;21(1):44-61. doi:10.1177/1073858414524633
  2. Caleo M, Restani L. Direct central nervous system effects of botulinum neurotoxin. Toxicon. 2018;147:68-72. doi:10.1016/j.toxicon.2017.10.027

ED

1.Abdelrahman IFS, Raheem AA, Elkhiat Y, Aburahma AA, Abdel-Raheem T, Ghanem H. Safety and efficacy of botulinum neurotoxin in the treatment of erectile dysfunction refractory to phosphodiesterase inhibitors: Results of a randomized controlled trial. Andrology. 2022;10(2):254-261. doi:10.1111/andr.13104
2. El-Shaer W, Ghanem H, Diab T, Abo-Taleb A, Kandeel W. Intra-cavernous injection of BOTOX® (50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial. Andrology. 2021;9(4):1166-1175. doi:10.1111/andr.13010

Bruxism

1.
Ågren M, Sahin C, Pettersson M. The effect of botulinum toxin injections on bruxism: A systematic review. Journal of Oral Rehabilitation. 2020;47(3):395-402. doi:10.1111/joor.12914

2.
Fernández-Núñez T, Amghar-Maach S, Gay-Escoda C. Efficacy of botulinum toxin in the treatment of bruxism: Systematic review. Med Oral Patol Oral Cir Bucal. 2019;24(4):e416-e424. doi:10.4317/medoral.22923

3.
Caleo M, Restani L. Direct central nervous system effects of botulinum neurotoxin. Toxicon. 2018;147:68-72. doi:10.1016/j.toxicon.2017.10.027

Renshaw cells (affected by BOTOX)<--

Research regarding the P-Shot® for ED<==

Treating peptic ulcer disease with PRP

  1. Xu T, Tian Y, Wang Y, et al. Effects of Autologous Platelet-Rich Plasma on Healing of Peptic Ulcers: A Randomized Controlled Trial. M’Koma A, ed. Gastroenterology Research and Practice. 2022;2022:1-9. doi:10.1155/2022/7944849
Next Hands-On Workshops with Live Models<---

Question from Members

The current question I have is concerning a P-Shot, I administered on an 80 yr old male. He wanted to try it not necessarily for ED. But more for relief of urinary frequency. He has no history Of Prostate Cancer, his PSA levels are low, and < a week after the P-Shot®, he reported improvement in his frequency symptoms (2-3hrs versus q15 minutes). However, he now states his frequency has worsened (q30 minutes).

It has been 3 weeks since the procedure, and I told him we would continue to monitor.

Have you ever seen the P-Shot® relieve urinary frequency in men?

Relevant Links

-->Next class to learn to inject the major joints (knees, elbows, shoulders, Achilles) with PRP<--
-->Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<--
-->Next Hands-on Workshops with Live Models, worldwide <--

--> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

O-Shot® CBD Arousal Oil. O-Shot® providers order wholesale by logging into the O-Shot® membership site, or by calling CMA Headquarters.

Altar™--A Vampire Skin Therapy™. All CMA members can order wholesale by logging into the membership sites and going to Dashboard-->Supplies

 

 

 

 

 

 

 

 

 

 

Charles Runels, MD

 

 

 

 

 

Cellular Medicine Association
1-888-920-5311

Urinary Incontinence in Women: A New Way to Avoid Surgery—Why & How it Works

The Overlying Most Important Principle in This Report

What diseases could you treat If you had a treatment that could propagate new blood flow, grow nerves, calm the autoimmune response, fight infection, regrow collagen, and enhance glandular function? The answer to that question gives you an idea about the possibilities with platelet-rich plasma (PRP). That idea (together with the current research and the experience of more than three thousand doctors over a decade) is the theme behind the strategies discussed in this report.

Thinking about how antibiotics work helps you consider what conditions may be helped by antibiotics; this consideration of which conditions my be helped and which may not be helped by antibiotics happens so automatically that we may not consciously acknowledge the process.

For example, we would not think about antibiotics for the primary treatment of uterine fibroids because fibroids are not primarily caused by infection; antibiotics only treat infection. But, with a new therapy that is not as well known or understood, we may not be clear about the mechanism of the treatment; therefore, there can be confusion regarding which disease processes the new therapy may be of benefit—leading to inappropriate use and less than expected results.

But, if a new treatment is considered (as with old standards of care) only when the pathology of disease makes the use of the new therapy appropriate, results will be optimal and we can avoid the proverbial throwing out the baby with the bathwater when the new therapy “doesn’t work” when we use the new therapy for a problem for which it would not be likely to help.

With this general idea about the relation of mechanism of therapy and pathology of disease in mind, consider that (except for secondary results which we will discuss in later sections) the only conditions that PRP may help are those in which strategic injection into tissue will improve the disease by improving the health of the tissue: neovascularization, neurogenesis, collagen production, improvement of glandular function, attenuation of autoimmune processes, fighting infection (all of which PRP has been documented to do).

Striated Urogenital Sphincter Grows Weaker

In considering where improved tissue health might improve stress urinary incontinence in women, first consider the striated component of the urogenital sphincter—it accounts for one-third of the resting urethral closing pressure Delancey2017

Here's my sketch of the striated muscle component—taken from diagrams published by Delancey and others:

Striated Urogenital Sphincter
Striated Urogenital Sphincter

The striated urogenital sphincter completely encompasses the urethra at level one; while, at level three, it encompasses both the urethra and the vagina.

Beneath the striated urogenital sphincter lies smooth muscle that runs longitudinally which also contributes to the closing pressure.

Just like the striated muscle of the bicep or the thigh, the number of muscle fibers in the urogenital sphincter decreases with age. Also, the number of nerves innervating the sphincter decreases with age.

To complicated matters even more, the function of the urogenital sphincter is known to be damaged by childbirth.

Does the decrease in innervation lead to the decrease in muscle fibers; or is the decrease in muscle and the decrease in nerves two independently evolving conditions? And does blood flow play a role? I could find no clear answer to these questions. But, whatever your answer to those questions, they prompt corollary ideas such as that the effect of voluntary Kegels may be attenuated by the decreased innervation of the striated muscle (explaining the lack of effectiveness of Kegels in some women).

Treatment Strategies Based on the Functional Anatomy of the Sphincter

Activation of the striated muscle of the sphincter independently of the patient’s volition or the innervation of the muscle (for example with an Emsella® magnet) would possibly create more contraction than would be possible even with heroic efforts by the woman. This super activation would cause a strengthening of the striated sphincter and an increase in closing pressure.

Also, the sports-medicine literature offers robust support for the idea of using PRP to restore damaged or atrophic muscle. And, multiple papers demonstrate neurogenesis propagated by the injection of PRP.

If we propagated neurogenesis and muscle fiber restoration with PRP, then that might be synergistic with Kegels or with magnet therapy or with surgery (if needed).

The Urethral Wall Acts Like a Penis

The urethra wall (not the surrounding tissue, the urethra its self) carries a vascular plexus with AV anastomoses; blood flow can be directed into or away from these venues to inflate or deflate them; so, it demonstrates tumescence similar to that of the penis. But in the female urethra tumescence contributes to the closing pressure of the urethra (not erectile function, as in the man).

Hormones are known to affect this tumescence-like function of the urethra. But, what are hormones but messengers to tell cells what to do? Messages-to-the-cells is exactly what happens when the cells of the urethral wall are exposed to the small peptide chains released from platelets.

PRP was shown in a recent double blind placebo controlled study to improve the erectile function of the penis. Since PRP helps with neovascularization in general, and has been shown to improve erectile function, it seems logical that PRP may also, when injected into the urethral wall, improve the tumescent function of the urethral wall and the closing pressure of the urethra—resulting in a decrease or resolution of urinary incontinence.

Longitudinal Smooth Muscle of the Urethra

The longitudinal smooth muscle of the urethra also contributes to the closing pressure. The smooth muscle cannot be contracted by either volition or by a magnet, so neither would help strengthen the smooth muscle component of the female urinary sphincter. But, as we have documented with the studies in our bibliography, PRP has been shown to revive muscle fibers. So, injection of the urethral smooth muscle may also account for some of the benefits of PRP seen when it is injected into the periurethral area.

And of course, such benefits of PRP may also be of help post op from a mid-urethral sling placement. One study documented that the nerves and blood vessels between the anterior vaginal wall and the urethra are damaged by the surgical placement of a midurethral sling; and, we have just discussed how PRP can repair nerves and blood vessels.

Urge Incontinence

Urge incontinence, multifactorial and often seen in combination with stress incontinence, can be partly secondary to peripheral nerve involvement as previously mentioned. And, research supports the idea that PRP may improve the function of those nerves resulting in an improvement in urge incontinence—if the PRP should be deposited in the proper place.

PRP Injection Strategies for the Treatment of Urinary Incontinence

So, it makes sense that all of the above mentioned ideas, if applied to the urinary sphincter in a female, might show synergistic benefit. Indeed, multiple papers do show that injection of PRP into the periurethral area or into the urethral wall improves stress urinary incontinence.

In these published papers showing benefit for stress urinary incontinence with the injection of PRP, multiple techniques have been used; so, let’s think about some of those techniques while keeping the functional anatomy in mind—looking for a best possible strategy (at least with our present knowledge).

The O-Shot® Procedure for Urinary Incontinence

With our O-Shot® procedure, we usually do two injections, one of which goes into the vaginal wall, hydro-dissecting the entire area.

Four CCs is enough to fill the whole space between the urethra and the vaginal wall and include the urethral wall—if you put the needle where it to needs to go.

Just like with an IV, there's variability, both in technique and with the skill of person doing the procedure; but if you can put the needle where it belongs, you should be able to put PRP in the areas we’ve described.

The following is a snapshot from one of our instructional videos showing one of the two injections the way we teach the O-Shot® procedure for SUI. By injecting the actual anterior vaginal wall, within a few millimeters of the hymenal remnant, you avoid the pain fibers within heart's line, and you're able to fill both the space between urethra and vagina and affect muscle, blood flow, and nerves. This can be done pain free or near pain free using the proper technique and only a topical cream for anesthesia.

This method, when done properly, is called the O-Shot® procedure. The procedure can be done in the office using the person’s own blood and without pain in most cases.

I trademarked the term “O-Shot” to prevent a variability of techniques with the associated variability of results being pushed upon women. All of the licensed providers of the O-Shot® procedure agree to follow a standard protocol with variations based upon diseases process. All licensed providers also agree to only use devices to prepare the PRP that have been approved by the FDA for the preparation of PRP to go back into the body. Our licensees are tested and are subject to losing the license to use the name “O-Shot®” in advertising if they fail to follow our standards.

Physicians can apply to receive more detailed instructions and to be licensed to perform the O-Shot® procedure here—>: OShot.com/physicians<—

Example of Another Technique for Curing Urinary Incontinence with PRP

Another group demonstrated (I think in a very brilliant and useful study) the resolution of urinary incontinence with the injection of PRP directly into the urethral wall—in women with objectively-demonstrated severe incontinence.

But, in their method, they report that the procedure was so painful that the subjects had to receive the urethral sphincter injection under intravenous general anesthesia in the operating room.

The following photograph illustrates the injection points:

This is NOT the O-Shot® procedure; the O-Shot® procedure is a method of choosing the proper patient, preparing the PRP in the proper way, and injecting the PRP with the agreed-upon technique after using local anesthesia the gives the best chance of an in-office, pain free procedure.

But, though these investigators did something other than an O-Shot® procedure, they did help the mission of finding a way to cure or improve female urinary incontinence by their demonstration of the possibility of improving the health and function of the urinary sphincter by using a functional-anatomy-based, strategic injection of PRP.

Another third technique (not pictured here) showed benefit for SUI but described injecting 4 cc of PRP spread out in 0.1 ml aliquots for FORTY separate injection points.

Please Help

I have no study showing which of the three separate techniques described above gives the best result. There is no question about which causes the least amount of pain: (1) 40 separate injections, vs. (2) five injections into the urethral wall requiring general anesthesia in the operating room vs (3) the O-Shot® which can be done usually completely pain free and only requires topical anesthesia and a pain-free lidocaine block in the office.

Though we still do not have a study documenting which works the best of these three techniques (or which of other techniques that you might imagine), hopefully, I have given you a quick version of why I think our method (which we have been doing for a decade with over 100,000 women treated) may be best.

More importantly, what I hope I’ve shown is that there is a need for us to carefully think about and study which might be the best technique because we think technique matters. One of the dangers of having taught and provided the O-Shot® procedure for 11 years is that I may start to believe everything I say...first you show something is feasible, then you have the herculean effort of looking at the infinite number of variables to find the best way.

Please help us study and think about this categorically new way to improve the health and function of the female genitourinary tract.

Summary

  • PRP improves the health of tissue by collagen production, neovascularization, neurogenesis, attenuation of the autoimmune response, anti-bacterial effects, improving glandular function, and muscle repair.
  • The strategic injection of PRP into areas of damaged tissue with the resultant improvement of health and function of tissue has been demonstrated in thousands of studies over the past two decades.
  • An increasing number of studies are showing that this principle of injection of PRP into the damaged or aging tissue of the urinary sphincter may be helpful in restoring urinary continence in some women resistant to other therapies.
  • Injection technique matters since only tissue exposed to the PRP will primarily benefit.
  • Only those licensed by the Cellular Medicine Association (after testing) can legally advertise using the name “O-Shot®.” This is done so that a greater degree of predictability of safety and results can be offered to women who may choose PRP injections as a mode of treatment.
  • The O-Shot® procedure has and will continue to evolve as the research accumulates from the members of the Cellular Medicine Association and others.
  • The O-Shot® procedure is varied based on the functional anatomy and upon the pathophysiology of the disease process in any individual woman.
  • This report gives an overview of the principles behind the O-Shot® procedure and Emsella therapy but does not constitute training or license to do the procedures.
  • I hope if you are not yet a member of the Cellular Medicine Association (CMA) that you will consider joining our organization and studying our training materials, we need more help thinking about and researching these ideas:
  • If you already a member of the CMA, I hope you will continue to support our mission by participating in our weekly journal club and sharing your observations with your patients and your thoughts about the current research.

My goal is to be a pipe for the movement of ideas. I continue to be grateful every day, to the members of the CMA who have shared ideas that make this report possible. And, most of all, I am grateful for the women who have been patients who have trusted me to teach me; with old ideas and new, the best book is observing and listening to the one woman in front of you who will teach you about her disease and how to make her well—if you listen.

References

Selection of Papers Demonstrating Neurogenesis with PRP

Chung, Eric. “Regenerative Technology to Restore and Preserve Erectile Function in Men Following Prostate Cancer Treatment: Evidence for Penile Rehabilitation in the Context of Prostate Cancer Survivorship.” Therapeutic Advances in Urology 13 (January 1, 2021): 17562872211026420. https://doi.org/10.1177/17562872211026421.

Foy, Christian A., William F. Micheo, and Damien P. Kuffler. “Functional Recovery Following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma.” Plastic and Reconstructive Surgery. Global Open 9, no. 9 (September 2021): e3831. https://doi.org/10.1097/GOX.0000000000003831.

Kuffler, Damien P. “Platelet-Rich Plasma and the Elimination of Neuropathic Pain.” Molecular Neurobiology 48, no. 2 (October 2013): 315–32. https://doi.org/10.1007/s12035-013-8494-7.

Sánchez, Mikel, Eduardo Anitua, Diego Delgado, Peio Sanchez, Roberto Prado, Gorka Orive, and Sabino Padilla. “Platelet-Rich Plasma, a Source of Autologous Growth Factors and Biomimetic Scaffold for Peripheral Nerve Regeneration.” Expert Opinion on Biological Therapy 17, no. 2 (February 1, 2017): 197–212. https://doi.org/10.1080/14712598.2017.1259409.

Wu, Yi-No, Chun-Hou Liao, Kuo-Chiang Chen, and Han-Sun Chiang. “Dual Effect of Chitosan Activated Platelet Rich Plasma (CPRP) Improved Erectile Function after Cavernous Nerve Injury.” Journal of the Formosan Medical Association, March 27, 2021. https://doi.org/10.1016/j.jfma.2021.01.019.

Selection of Papers Demonstrating Muscle Revival from PRP

Bernuzzi, Gino, Federica Petraglia, Martina Francesca Pedrini, Massimo De Filippo, Francesco Pogliacomi, Michele Arcangelo Verdano, and Cosimo Costantino. “Use of Platelet-Rich Plasma in the Care of Sports Injuries: Our Experience with Ultrasound-Guided Injection.” Blood Transfusion 12, no. Suppl 1 (January 2014): s229–34. https://doi.org/10.2450/2013.0293-12.

Bubnov, Rostyslav, Viacheslav Yevseenko, and Igor Semeniv. “Ultrasound Guided Injections of Platelets Rich Plasma for Muscle Injury in Professional Athletes. Comparative Study.,” n.d., 5.

Le, Adrian D.K., Lawrence Enweze, Malcolm R. DeBaun, and Jason L. Dragoo. “Platelet-Rich Plasma.” Clinics in Sports Medicine 38, no. 1 (January 2019): 17–44. https://doi.org/10.1016/j.csm.2018.08.001.

Middleton, Kellie K, Victor Barro, Bart Muller, Satosha Terada, and Freddie H Fu. “Evaluation of the Effects of Platelet-Rich Plasma (PRP) Therapy Involved in the Healing of Sports-Related Soft Tissue Injuries.” The Iowa Orthopaedic Journal 32 (2012): 150–63. http://www.ncbi.nlm.nih.gov/pubmed/23576936.

Moraes, Vinícius Y, Mário Lenza, Marcel Jun Tamaoki, Flávio Faloppa, and João Carlos Belloti. “Platelet-Rich Therapies for Musculoskeletal Soft Tissue Injuries.” The Cochrane Database of Systematic Reviews 12 (January 2013): CD010071. https://doi.org/10.1002/14651858.CD010071.pub2.

Selection of Papers Showing Help from PRP Injections for Stress Urinary Incontinence

Athanasiou, Stavros, Christos Kalantzis, Dimitrios Zacharakis, Nikolaos Kathopoulis, Artemis Pontikaki, and Themistoklis Grigoriadis. “The Use of Platelet-Rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 11 (November 2021): e668–72. https://doi.org/10.1097/SPV.0000000000001100.

Callewaert, Geertje, Marina Monteiro Carvalho Mori Da Cunha, Nikhil Sindhwani, Maurilio Sampaolesi, Maarten Albersen, and Jan Deprest. “Cell-Based Secondary Prevention of Childbirth-Induced Pelvic Floor Trauma.” Nature Reviews Urology 14, no. 6 (June 2017): 373–85. https://doi.org/10.1038/nrurol.2017.42.

Indian Journal of Medical Ethics. “Cosmetic Surgical Procedures on the Vulva and Vagina - an Overview.” Accessed January 18, 2022. https://ijme.in/articles/cosmetic-surgical-procedures-on-the-vulva-and-vagina-an-overview/.

Ford, Abigail A., Lynne Rogerson, June D. Cody, and Joseph Ogah. “Mid‐urethral Sling Operations for Stress Urinary Incontinence in Women.” Cochrane Database of Systematic Reviews, no. 7 (2015). https://doi.org/10.1002/14651858.CD006375.pub3.

Gorton, E, S Stanton, A Monga, A K Wiskind, G M Lentz, and D R Bland. “Periurethral Collagen Injection: A Long-Term Follow-up Study.” BJU International 84, no. 9 (December 1999): 966–71. http://www.ncbi.nlm.nih.gov/pubmed/10571621.

Joseph, Christine, Kosha Srivastava, Olive Ochuba, Sheila W. Ruo, Tasnim Alkayyali, Jasmine K. Sandhu, Ahsan Waqar, Ashish Jain, and Sujan Poudel. “Stress Urinary Incontinence Among Young Nulliparous Female Athletes.” Cureus 13, no. 9 (September 2021). https://doi.org/10.7759/cureus.17986.

Kirchin, Vivienne, Tobias Page, Phil E. Keegan, Kofi OM Atiemo, June D. Cody, Samuel McClinton, Patricia Aluko, and Cochrane Incontinence Group. “Urethral Injection Therapy for Urinary Incontinence in Women.” The Cochrane Database of Systematic Reviews 2017, no. 7 (July 2017). https://doi.org/10.1002/14651858.CD003881.pub4.

Lee, Patricia E., Rose C. Kung, and Harold P. Drutz. “PERIURETHRAL AUTOLOGOUS FAT INJECTION AS TREATMENT FOR FEMALE STRESS URINARY INCONTINENCE: A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL.” Journal of Urology 165, no. 1 (January 2001): 153–58. https://doi.org/10.1097/00005392-200101000-00037.

Long, Cheng-Yu, Kun-Ling Lin, Chin-Ru Shen, Chin-Ru Ker, Yi-Yin Liu, Zi-Xi Loo, Hui-Hua Hsiao, and Yung-Chin Lee. “A Pilot Study: Effectiveness of Local Injection of Autologous Platelet-Rich Plasma in Treating Women with Stress Urinary Incontinence.” Scientific Reports 11, no. 1 (December 2021): 1584. https://doi.org/10.1038/s41598-020-80598-2.

Nikolopoulos, Kostis I., Vasilios Pergialiotis, Despina Perrea, and Stergios K. Doumouchtsis. “Restoration of the Pubourethral Ligament with Platelet Rich Plasma for the Treatment of Stress Urinary Incontinence.” Medical Hypotheses 90 (May 2016): 29–31. https://doi.org/10.1016/j.mehy.2016.02.019.

O’Connor, Eabhann, Aisling Nic an Riogh, Markos Karavitakis, Serenella Monagas, and Arjun Nambiar. “Diagnosis and Non-Surgical Management of Urinary Incontinence &ndash; A Literature Review with Recommendations for Practice.” International Journal of General Medicine 14 (August 16, 2021): 4555–65. https://doi.org/10.2147/IJGM.S289314.

Oshiro, Takuma, Ryu Kimura, Keiichiro Izumi, Asuka Ashikari, Seiichi Saito, and Minoru Miyazato. “Changes in Urethral Smooth Muscle and External Urethral Sphincter Function with Age in Rats.” Physiological Reports 8, no. 24 (2021): e14643. https://doi.org/10.14814/phy2.14643.

PANDIT, MEGHANA, JOHN O. L. DELANCEY, JAMES A. ASHTON-MILLER, JYOTHSNA IYENGAR, MILA BLAIVAS, and DANIELE PERUCCHINI. “Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle.” Obstetrics and Gynecology 95, no. 6 Pt 1 (June 2000): 797–800. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192577/.

Perucchini, Daniele, John O.L. DeLancey, James A. Ashton-Miller, Andrzej Galecki, and Gabriel N. Schaer. “Age Effects on Urethral Striated Muscle II. Anatomic Location of Muscle Loss.” American Journal of Obstetrics and Gynecology 186, no. 3 (March 2002): 356–60. https://doi.org/10.1067/mob.2002.121090.

Perucchini, Daniele, John OL DeLancey, James A. Ashton-Miller, Ursula Peschers, and Tripti Kataria. “Age Effects on Urethral Striated Muscle I. Changes in Number and Diameter of Striated Muscle Fibers in the Ventral Urethra.” American Journal of Obstetrics & Gynecology 186, no. 3 (March 1, 2002): 351–55. https://doi.org/10.1067/mob.2002.121089.

Wiśniewska-Ślepaczuk, Katarzyna, Agnieszka Pieczykolan, Joanna Grzesik-Gąsior, and Artur Wdowiak. “A Review of Aesthetic Gynecologic Procedures for Women.” Plastic Surgical Nursing 41, no. 4 (October 2021): 191–202. https://doi.org/10.1097/PSN.0000000000000400.

Zhou, Shukui, Kaile Zhang, Anthony Atala, Oula Khoury, Sean V Murphy, Weixin Zhao, and Qiang Fu. “Stem Cell Therapy for Treatment of Stress Urinary Incontinence: The Current Status and Challenges,” n.d. https://doi.org/10.1155/2016/7060975.

Zubieta, Maria, Rebecca L. Carr, Marcus J. Drake, and Kari Bø. “Influence of Voluntary Pelvic Floor Muscle Contraction and Pelvic Floor Muscle Training on Urethral Closure Pressures: A Systematic Literature Review.” International Urogynecology Journal 27, no. 5 (May 2016): 687–96. https://doi.org/10.1007/s00192-015-2856-9.

Lee, Ping-Jui, Yuan-Hong Jiang, and Hann-Chorng Kuo. “A Novel Management for Postprostatectomy Urinary Incontinence: Platelet-Rich Plasma Urethral Sphincter Injection.” Scientific Reports | 11 (123AD): 5371. https://doi.org/10.1038/s41598-021-84923-1.

Chiang, Ching-Hsiang, and Hann-Chorng Kuo. “The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.” Frontiers in Pharmacology 13 (February 8, 2022): 847520. https://doi.org/10.3389/fphar.2022.847520.

Selection of Papers Demonstrating Improvement of SUI with Magnet (Emsella®)

Azparren, Javier, and Judson Brandeis. “HIFEM PROCEDURE ENHANCES QUALITY OF LIFE OF ELDERLY MEN WITH POST-PROSTATECTOMY INCONTINENCE,” n.d., 6.

Evans, Kimberly, and Julene B Samuels. “FEMALE URINARY INCONTINENCE AND SEXUAL FUNCTION AFTER THE HIFEM® PROCEDURE,” n.d., 2.

Gözlersüzer, Özlem, Bestami Yalvaç, and Basri Çakıroğlu. “Investigation of the Effectiveness of Magnetic Field Therapy in Women with Urinary Incontinence: Literature Review.” Urologia Journal, January 9, 2022, 03915603211069010. https://doi.org/10.1177/03915603211069010.

He, Qing, Kaiwen Xiao, Liao Peng, Junyu Lai, Hong Li, Deyi Luo, and Kunjie Wang. “An Effective Meta-Analysis of Magnetic Stimulation Therapy for Urinary Incontinence.” Scientific Reports 9 (June 24, 2019): 9077. https://doi.org/10.1038/s41598-019-45330-9.

Samuels, Julene B. “HIFEM TECHNOLOGY – THE NON-INVASIVE TREATMENT OF URINARY INCONTINENCE,” n.d., 7.

Samuels, Julene B., Andrea Pezzella, Joseph Berenholz, and Red Alinsod. “Safety and Efficacy of a Non‐Invasive High‐Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life.” Lasers in Surgery and Medicine 51, no. 9 (November 2019): 760–66. https://doi.org/10.1002/lsm.23106.

Silantyeva, Elena, Dragana Zarkovic, Evgeniia Astafeva, Ramina Soldatskaia, Mekan Orazov, Marina Belkovskaya, Mark Kurtser, and Academician of the Russian Academy of Sciences. “A Comparative Study on the Effects of High-Intensity Focused Electromagnetic Technology and Electrostimulation for the Treatment of Pelvic Floor Muscles and Urinary Incontinence in Parous Women: Analysis of Posttreatment Data.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 4 (April 2021): 269–73. https://doi.org/10.1097/SPV.0000000000000807.

Another Selection of Papers Showing Neovacularization from PRP

Araujo-Gutierrez, Raquel, Jeffrey L. Van Eps, Jacob C. Scherba, Albert Thomas Anastasio, Fernando Cabrera, Cory J. Vatsaas, Keith Youker, and Joseph S. Fernandez Moure. “Platelet Rich Plasma Concentration Improves Biologic Mesh Incorporation and Decreases Multinucleated Giant Cells in a Dose Dependent Fashion.” Journal of Tissue Engineering and Regenerative Medicine 15, no. 11 (2021): 1037–46. https://doi.org/10.1002/term.3247.

Bindal, Priyadarshni, Nareshwaran Gnanasegaran, Umesh Bindal, Nazmul Haque, Thamil Selvee Ramasamy, Wen Lin Chai, and Noor Hayaty Abu Kasim. “Angiogenic Effect of Platelet-Rich Concentrates on Dental Pulp Stem Cells in Inflamed Microenvironment.” Clinical Oral Investigations 23, no. 10 (October 2019): 3821–31. https://doi.org/10.1007/s00784-019-02811-5.

Li, Yuan, Shan Mou, Peng Xiao, Guining Li, Jialun Li, Jing Tong, Jiecong Wang, Jie Yang, Jiaming Sun, and Zhenxing Wang. “Delayed Two Steps PRP Injection Strategy for the Improvement of Fat Graft Survival with Superior Angiogenesis.” Scientific Reports 10 (March 23, 2020): 5231. https://doi.org/10.1038/s41598-020-61891-6.

Nolan, Grant Switzer, Oliver John Smith, Susan Heavey, Gavin Jell, and Afshin Mosahebi. “Histological Analysis of Fat Grafting with Platelet‐rich Plasma for Diabetic Foot Ulcers—A Randomised Controlled Trial.” International Wound Journal 19, no. 2 (June 24, 2021): 389–98. https://doi.org/10.1111/iwj.13640.

Norooznezhad, Amir Hossein. “Decreased Pain in Patients Undergoing Pilonidal Sinus Surgery Treated with Platelet-Rich Plasma Therapy: The Role of Angiogenesis.” Advances in Skin & Wound Care 33, no. 1 (January 2020): 8. https://doi.org/10.1097/01.ASW.0000615376.97232.0a.

Saputro, Iswinarno Doso, Sitti Rizaliyana, and Dhitta Aliefia Noverta. “The Effect of Allogenic Freeze-Dried Platelet-Rich Plasma in Increasing the Number of Fibroblasts and Neovascularization in Wound Healing.” Annals of Medicine and Surgery 73 (January 3, 2022): 103217. https://doi.org/10.1016/j.amsu.2021.103217.

Sclafani, Anthony P., and Steven A. McCormick. “Induction of Dermal Collagenesis, Angiogenesis, and Adipogenesis in Human Skin by Injection of Platelet-Rich Fibrin Matrix.” Archives of Facial Plastic Surgery 14, no. 2 (April 2012): 132–36. https://doi.org/10.1001/archfacial.2011.784.

Zhang, X.-L., K.-Q. Shi, P.-T. Jia, L.-H. Jiang, Y.-H. Liu, X. Chen, Z.-Y. Zhou, Y.-X. Li, and L.-S. Wang. “Effects of Platelet-Rich Plasma on Angiogenesis and Osteogenesis-Associated Factors in Rabbits with Avascular Necrosis of the Femoral Head.” European Review for Medical and Pharmacological Sciences 22, no. 7 (April 2018): 2143–52. https://doi.org/10.26355/eurrev20180414748.

An Optional Technique for Injecting PRP for Incontinence

Chiang, Ching-Hsiang, and Hann-Chorng Kuo. “The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.” Frontiers in Pharmacology 13 (February 8, 2022): 847520. https://doi.org/10.3389/fphar.2022.847520

The Effects of Mid-Urethral Sling Placement on the Tissue of the Female Prostate and Female Sexual Function

Gaudet, D., D.G. Clohosey, J.L. Hannan, S.W. Goldstein, N. Szell, B.R. Komisarek, M.A. Harvey, et al. “249 Midurethral Sling Placement Disrupts Periurethral Neurovascular and Glandular Structures near Anterior Vaginal Wall: Potential Role in Female Sexual Dysfunction.” The Journal of Sexual Medicine 15, no. 7 (July 2018): S221–22. https://doi.org/10.1016/j.jsxm.2018.04.214.

 

JCPM2022.03.08.InterstitialCystitis.SUI.RiversOfGold.FxAnatomy

Topics Discussed Include the Following...

*Wordtracker and how I use it (one of my top 5 marketing tools)
*PRF vs PRP
*An alternative, much more painful, way to treat stress urinary incontinence using PRP
*The functional anatomy as it relates to the O-Shot® procedure
*Interstitial Cystitis and the O-Shot® procedure
*The Common Thread that runs through all CMA strategies & The great Sculptor, Rodin
*Two of my favorite ways to use Wordtracker to find rivers of gold.

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

Transcript, Research, Relevant Links

Transcript

Top 5 Marketing Tool

Good evening and welcome to tonight's Journal Club with Pearls & Marketing. This is one of the most important tools I have used called Wordtracker. It's a paid version, I'll show you how it works for me and how it's helped my practice tremendously. And actually in the background, has been helpful in educating our patients about everything that we do and I'll show you a cheap version of it, that's actually free, that's on Google.

Before we get to that, I want to jump to the articles that I found this past week that I think you will find very helpful. Remember for every article that we talk about, that's a potential message to your patients because they don't know what you know. And so if you let them know about it, then either they or someone they know might benefit from it. So let's pull up what I've found most helpful.

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Usually, I go through several 100 items to find what I think is most useful, that's something esoteric that may be interesting as far as general education, but I try to find the things that can change the way you take care of your patients the very next day, and of course, be rewarded with it with more profitability to take care of your family. And I'll put the links to all these. These we skipped last time because we happened to fall on the same time the president was giving his State of the Union Address and so we skipped that. But apparently Tuesday night at 9:00 PM Eastern Time is a good time because I'm sure they thought about that a lot when they tried to figure out when the president should talk. So we'll keep this time.

And let's start by, I want to give you this link, even though we talked about this in our last meeting. This is such a useful... I want to bring it up again. I'm not going to go over it again because we've already discussed it. But in case you missed the last time, I just put a link to this in the chatbox. I like it because it reviewed so many things, from micro-needling, for acne, for hair loss, talked about all these different ways to use platelet-rich plasma. And I think with a reference list that's very helpful. So that's a good one to keep in mind. This classification, and again, something that's useful if you're going to be doing research, and I'll throw this one in the chatbox as well because many of you are doing research and as you read the research, one of the things that we get criticized about, those of us who do cellular therapies, is that there's not a good apples to apples way to talk about it. And looking over this gives you ways to think about that.

PRF vs PRP

So let's get to this week's articles. So here's an article where they use platelet-rich fibrin or PRF, which I haven't talked about much. I think it's useful to note that one of the authors is paid by one of the manufacturers of the kits for this, but still, I haven't talked about PRF much. And they talk about here, drawing 40 cc's of blood, getting the platelet clot, and then using a blade between a luer lock connector, passing the clot back and forth to micronize it. And that gets it small enough to pass through a 20-gauge needle. So there are several things that I don't like about it. The good thing I like is, grew some hair back. Of course, we're able to do it through a 30-gauge needle with PRP and you don't have to draw as much blood, you can do our hair treatments and most of what's in the literature withdrawing 10 cc's of blood and using the five cc's of one and a half to two times concentration that comes from a simple gel kit.

So it's nice to know that PRF works. It's also interesting to note that in this case report, it seems to me that there's a lot more trouble to be had and more pain to be had since you need a larger gauge needle, even after do you micronize the clot by passing it back and forth. So even if you're not doing PRF, it might be useful to look at this, I'll put the link in the chatbox. And all these links go away after the webinar is over so it's useful, even if you don't read them now, just click on them so they're open and you have it when the webinar is done.

I know some of your colleagues will talk about PRF and they get good results, I'm not knocking it. I'm just offering this as a reason why I don't use it in my practice.

An alternative, much more painful way, to treat SUI with PRP

This article is also instructional, you can see they actually helped us out because they inject it around the urethra with PRP for female stress incontinence. And I'll come back to the details, but I want to go ahead and give you the conclusion. It demonstrated the efficacy and safety of repeated urethral sphincter injections of PRP. And by the way, they went once a month for four injections. And they showed that they had a high success rate and it lasted up to 12 months after the treatment with no serious sequelae. Here's where I wish these guys would've given us a call before they did the study because the way they did it was so painful the people had to be put under general anesthesia. In my opinion, they took what was a pretty simple way to do our O-Shot® and complicated it.

Grateful they did it and grateful they showed benefit, but they complicated it and they made it a lot more painful.

Functional Anatomy as it relates to the O-Shot® procedure

So let me show you a picture of what they did. First, they put a sterile Q-tip in the urethra to see the orientation (ready to sign up yet?).

Then they injected at five separate injection points around the urethra. You realize that's the external meatus so they're within hearts line. So this is extremely, extremely painful if done on an awake patient. Guys, as you know, this is innervated in the same way that the urethra within your penis. So this would be like taking a needle or a fishhook and going through the meatus and injecting the urethra as it passes through the penis five times. Obviously not something you want to do on an awake patient, but I think the idea behind what they're trying to do of course is to duplicate what we've been talking about now for a decade. And the idea behind it is good.

I'll show you some anatomy so you'll know more about what I'm visualizing when I make that statement. But I wish they would've given us a call so they wouldn't have tormented these poor ladies.

Let me show you a picture and I'll come back to the next study. Let's see. Here. So this is a sketch that I made from DeLancey's chapter in the Urogynecology Textbook and it came from research he did on functional anatomy about the urogenital sphincter in a female. There's this striated muscle portion and there's a smooth muscle portion. So you can see the striated muscle portion at level one up here near the uretero-vesicular junction goes just around the urethra.

Then at the mid urethra, it goes around the urethra and around the vagina, this is the collapsed vagina. This is the urethra.

And by the time you get to the distal urethra, the striated sphincter goes completely around the vagina and urethra.

But there's also a smooth muscle component that is not illustrated here that surrounds the urethra.

And then of course the urethra wall itself has a plexus of arteries and veins with venules. So there are venules that can collect blood or collapse so it's tumescent just like in the penis and that tumescent also contributes to the closing pressure, the resting closure pressure to the incontinence mechanism.

So one way to make this painful would be just to inject five times around the urethra. If you have injected the face though, you know how that PRP, not PRF, but PRP is so aqueous it just hydrodissects throughout the tissue, wherever it is.

So when we inject the body of the clitoris, we actually have some ultrasound studies showing that our presumption was right. We have some visualization by one of the radiologists in our group, Dave Harshfield, who showed actual physical injection just in the body, this truly acts like a wick and the PRP takes, as all water does, takes the path of least resistance. And that would be staying within the tissue of the Corpus Cavernosum.

In the same way, injecting around the urethra, this is from the study I just showed you, so injecting in these separate points like this, it would take the path of least resistance which would be down the wall of the urethra.

But even one cc, five cc's into this is a humongous amount of fluid. The next time you do a Vampire Facelift®, put one cc of fluid in the cheek and watch, it covers the entire anterior portion of the cheek, just one cc. So five cc's balloon this thing up like crazy, would've hurt beyond belief had it been done on an awake patient. And was more than necessary, just one side of this would've been enough to uncover the entire urethra. Think about the volume. What's the volume, what's the size of a cylinder that's five cc's? It's much larger than this urethra wall.

And if you think about the volume, so where we do our injection here with the O-Shot®, by just coming around hearts line, that simple move and coming around hearts line and coming just the other side of the Hymenal Ring. Now you're in an area where it's innovated almost no pain, and you can slide that needle into that space. And if you calculate the volume of the space, well here it's basically nothing because the tissue is up against each other, the urethral wall and the vaginal wall are touching. And here you still have a very small space so that even four cc's is enough to hydrodissect this whole area.

Now what I just told you, I could be wrong about all of it, and I could be proven to be wrong but if you go back to the study we're looking at, and at the results they had, it's actually less than what we normally see with our O-Shot®, but, it was significant enough that they helped our cause by demonstrating that even with a procedure that's more painful than what we do, that there's still benefit.

But if you look at the results, they did 26 women, the study two years, and they showed that benefit, but it was a lesser percentage than what we see with our O-Shot® procedure.

Interstitial Cystitis Research

Okay. Next one. And by the way, jump in anytime we've got a good turnout tonight and so just punch the little button and I'll unmute your mic if you have something to contribute, because I definitely want to hear it. This one is just, is one of many. It surprised me, I just recently reviewed the literature that's coming out about interstitial cystitis and I'll put the link to this while I'm thinking about it. Because, anecdotally I keep hearing no one's done the study yet and we have two we're paying for right now and so that's all our budget allows, but we spend unfortunately much more on lawyering than we do on protecting our name and running off people who pretend to be us than we do on research. But we do what we have to do, we don't want people using our name to trick people into doing things that are not good for them.

So there's the DOI number for this study and I'll just... Also, it's an editorial about another study, but I thought the author of this editorial summed things up very succinctly and very convincingly. So I'm just going to quickly read this. Platelets play a fundamental role... By the way, if you go through the research, all the research is reporting intravesicular injections of the platelet-rich plasma. And one of our providers actually does that, he's an anesthesiologist and he does it that way and he gets great results. But then we have at least 10 urologists slash gynecologists, some of each, that have told me they're getting great results, just doing with our usual O-Shot® procedure.

So I don't know if that means they're inadvertently injecting the bladder, which is right there of course. And you get a little cystic seal, it could be pretty simple to inject the bladder right there. Or, if there's something about what I'm about to read to you that makes our regular O-Shot® work. So just bear with me and you'll understand the reasoning why this should work. And then I want to get to some marketing stuff that could change the way you think about your marketing that saves you money and makes it more effective.

Okay. Platelets play a fundamental role in tissue regeneration, actively participating in the process of mitosis, chemotaxis, listen, this is the list that should give you an erection if you're a man. Process of mitosis, chemotaxis, all this from platelets, differentiation and growth of pluripotent mesenchymal cells. So that pluripotent cell is really what it's all about. That's of course what causes wound healing when you have surgery. And that's really the main thing we're doing with our platelets. And it's really what people are doing when they do stem cells to my understanding because the stem cells die and in the end, it's the chemotaxis factors and all the other things that happen that actually bring the pluripotent cells to the area or activate those that may lie there locally, like in muscle.

In addition to inducing extracellular matrix production to hold it all in place. The proteins are contained... Okay, then I'll skip all these because you guys already know what's in the platelets, that'll bore you. But this part is really profound. Recent evidence confirms the great potential of using, look at this list, confirms the potential of using PRP in Plastic, Vascular Surgery, Orthopedics Trauma, Ophthalmology, Dermatology, Gynecology, Sports Medicine, and Female Urology. PRP was previously proposed as a polypropylene mesh coating.

If we assume that one of the most relevant pathophysiological mechanisms of interstitial cystitis is the increase in urothelial permeability related to proteoglycan deficiency, the use of PRP has a consistent rationale and may be clinically useful mainly if other researchers are able to reproduce these results. And they have, they've reproduced it, and reproduced it, and reproduced it.

The Common Thread that runs through all CMA strategies & The great Sculptor, Rodin

So it's not voodoo, it has a clinical strategy based on the hardcore cell biology, which is what we're about. That's really the thread that we're into. I was thinking today that there are lots of houses going up, people are moving to Alabama, like crazy. Nobody wears a mask here and we have hardly any, we just don't have much crime here. So people are discovering that and we have a nice climate and low taxes. So maybe I shouldn't say that, more people know about it, but watching construction and these artisans are in high demand, the brick layers, the plumbers, we'll just stick with the brick layers. But if you had brick that was fragile, it was fryable it wasn't good brick, it broke apart. You could be the best brick layer in the world and you're still not going to make a very useful house.

So the surgeons, you guys are the surgeons, you can be an artist, you can be Rodin, the great French sculptor, but if you don't have good marble and you're trying to sculpt with sand, you can't do it. And so really, the common thread that runs through everything we're about with our CMA is that if you think about the actual bricks or the marble that you're sculpting with, which of course is the tissue. And if you think about that the healthy cells make that tissue stronger and more functional. If there's a secretive function like with the vagina and the dryness with someone who's had breast cancer, that study you guys know that was published on menopause, you can cut and sew, which is needed, and you need to be a good artisan and a good craftsman to create with that tissue the thing that's more functional.

But at the cellular level, that's what's making the thing you're sculpting with and that's what we're about. And that's what this article is about, that people are finally coming around that PRP helps that cellular level. And you don't have the drama that goes with something like stem cells that needs RVs and puts the microscope of the FDA on your rear end. So, anyway, so I loved this one mostly because of the editorial, but I did want to remind you guys that there are a number of studies, I counted about 12 a couple of days ago when I looked at this, showing that PRP helps with interstitial cystitis.

Popular Trends on Google, how they relate to your practice, and what word to not use

Now last one, and this one I'm getting to, I'm swapping over to marketing. I don't see any hands up so I'll keep going here. This marketing part, the Publication Frequency and Google Trends Analysis of Popular Alternative Treatments. Okay, now we're on the marketing.

First of all, strike this word from your vocabulary. And I can usually spot people that are jealous or angry. You realize, you know, my dad told me this is a child. See, this just came out. My dad told me this when I was a child because in the first grade I wanted to be a doctor. And he said, "Son, just be ready. People will always want..." Listen to this because it's always been this way, it will always be this way. "People will always want their lawyer to be rich and they'll always want their doctor to be poor."

If you read the novels of Dickens, you can tell he was a lover of the art of healing and of physicians. But the physicians of that day either had so much money, medicine was a hobby, or they took a vow of poverty. That's really how people want to see it, they want to think that you're not profiting from their pain. And maybe that's how it should be, maybe it should go back to that and certainly seems to be going back that way.

But what's surprising is this, your colleagues think the same way. This is from the Yale School of Medicine and between the lines here, what they're saying is we think doctors should be poor and it looks like some people are making money and we don't like that.

So if you do become profitable as a physician, my suggestion is that you hide the car that you're proud of and you hide your house because when you talk about your money, little birds talk about it and your money flies away as a physician. If you're a lawyer, yep, you should flaunt it because people will trust you more, you should be as rich, wear the biggest ring you can, drive the fanciest car with the loudest muffler.

Okay. Anyway. So, but the reason I'm rambling about that, it's really what this article is about, is that doctors are making money, using words we don't use at the Yale School of Medicine. But this one I don't like, money or no money, I do not like the word alternative because of the implication and most of us don't use that word. But if it is on your website or you do use it, I want you to contemplate what it means.

Words are the dressings, it's the dress or the suit and tie of our ideas. So the idea is there, you can dress it up however you want, but you put the wrong clothes on it and it gets misinterpreted. Now, I know you don't think this way but if you wear a suit that looks like you're a, I don't know, a prisoner, people may think you're a prisoner. That's a bad example. Anyway, people judge you by the way you dress, they will judge your ideas by how you dress them.

Here's the implication of the word "alternative"...It means that something instead of, and so if you use that word, it's implying that you're doing something and you are denying that the thing at the drug store works or that surgery works. And you want something instead of the things that insurance pays for. Yeah, I'm glad if I can do something that saves someone from a trip to the pharmacy, and I'm glad that I can do something that saves someone from even the excellent skills of a surgeon. On the other hand, when I had COVID 19, and after the fifth day, I was all about those monoclonal antibodies that came from a pharmacy. And I was all about alternating Advil and Tylenol when my fever was 105. And I did not look for something alternative growing out in the grass or in the woods behind my house.

So on the other hand, I also got in my sauna bath, which I had to buy from Canada because it's illegal to sell that in the United States because it goes to 220 degrees Fahrenheit. And I like to run it around 200 to 210 with is illegal to sell one that gets that hot, and you realize that's the boiling point. But I know that alpha interferon works better if I give myself a fever so, in the sauna, my body doesn't have to work to make a fever. And that, to me, that is not an alternative therapy, it's just using basic science about how fever and alpha-interferon and white blood cells demarginate when you have a fever and by giving myself a fever externally, my body doesn't have to go through the work of shivering to create one. So, that is not alternative; I call that adjunctive therapy.

All right. So right off the bat, I know where this guy's going, we should all be broke. But there's still more usefulness in this because what they have found is that people are searching for stem cell therapy, tumor therapy, CBD therapy, and PRP therapy and the number of people searching is going up dramatically.

So that's a good thing for us because that's what we do. Now, that brings me around to the tool that I wanted to show you and I think that's it for the research. I'll show you this insurance tool and then we'll shut it down for the night. A research tool that I like.

More about Wordtracker

Most people don't know this tool but it's extremely useful and it will save you money. Okay, hold on a second let me find it. Yes. Okay. And then I'll show you a way to do something similar for free. So this is Wordtracker, now, and it costs a little bit per month, but look, if you look for PRP I just put PRP for joints, because that's what that article I just referenced about. Oh, I didn't give you the link to it, let me go grab that real quick. The article about the publication frequency for what they called alternative treatments for arthritis. I'm getting distracted now, I'll put it in the email that goes out.

So what Wordtracker does is you put this in and I can look and see how many times people have searched it for all these different things. I like to put Google in there, or I could put YouTube in there. So I put PRP for joints and I got this. So in the past 30 days, that's what this means, you can hover there. Average number of searches per month.

So in the past 30 days, over the past year, people, so over the course of a month, people have put this exact phrase PRP injection of the knee, into the search bar of Google 2,400 times in a month, or about 800 times a day, right? So it's pretty good. But now it gets much better than that. If you look here, it gives you the competition and this is the number I like.

These are the number of web pages that Google knows about where that phrase appears in both the title tag and the text of a backlink. So another web page has this phrase. So how many websites have this phrase on them and another link and a link on another page has this phrase on it?

That sounds more complicated so I think you know what I'm saying, but I'm going to draw it anyway. So if this is your website or webpage, and it has this phrase on the title, all right, then another page, which can be on your own website, doesn't have to be another person's website, but another page has this same for raise on it and when you click on it, it takes you to this page.

So out of the whole internet, Google only knows one page that has that, and there are that many searches per month. So that's a pretty good freaking opportunity. But check this out it gets better, wait a minute. Let me erase that thing.

These, so here's one, plasma injection for the knee is searched 6,666 times a month, or just call it, what's that? 10, 60, about 20 times a day, 22 times a day, give or take. And there is no website and there's no competition. So you used to, you could find things in the early days of the internet where this might be a million and no webpage. So you could make a webpage that sold almost anything and you're getting all the traffic. So a lot of early internet millionaires became that way because they found rivers of gold that no one was tapped into. Now it's harder to find these, but you can create a river, right?

So you can create a river by making up your own name, like O-Shot®. And so we'll see how it pops up and how... So my point I was just making, if you're injecting joints and you do that, you grab one of those things that aren't... Let me go back because I didn't finish my thought, I'm giving you the keys to the kingdom here, PRP injection joints. And by the way, I spent about two weeks doing this before I came up with the name Vampire Facelift® because I was looking where's the traffic and where's traffic going that no one's tapping into? So, I must have put a different, I did put a different phrase, let me take that one out.

How to find a river of gold with Wordtracker

Yeah, there we go. So if you find one of these that has a high volume with no competition, now what do you do? You go build a webpage. You realize I could talk about injecting the knee and use any one of these. I could use plasma injection of the knee, PRP in the knee, PRP injection knee, but I pick one or two or three that no one has been using and I make that the title, I use it in some of my descriptions and then I make another web, another mention of it on another page or two or three pages on my own website and I go on Instagram or Facebook or Twitter or whatever you're doing and you put a link with the same exact phrase back to the page where you talked about it, using that exact phrase. And now you have very shortly Google finds that and you have 20 searches a day where you're the only person catching that traffic.

And then you do that same thing for some of these others, that's what is called the long tail. So maybe you can't get the 2,400, but if you get 20 of these with lower traffic and you rule those well, you can wind up with more traffic than actually if you grab the more popular one, but you need to know the culture code, what words are people using? We all have a vocabulary and different cultures have different vocabularies. This is the vocabulary of people who's joints hurt. And you can experiment with different ones, right? All right, so that's... And I'm just showing you one of the ways to use this tool, a very strong tool.

Here's another way to use it and this is what I do before I build, I heard a lot of talk about this much because it's so freaking powerful. It's one of those secrets where I figure you have to earn the right to know how to use it and most doctors are just, they're not there yet. But I figure if you're here tonight, you're there.

So here's another quick, easy way. And that's Wordtracker. Here's a way to do it that's free. So I could also put PRP, it's inferior but it still works. And it's still more than most doctors will do. So I put PRP and look, it's already telling you what's popular. PRP training, PRP injection. I'm going to put PRP knee or yeah, I'll put PRP knee right here, knee injection. See it threw the injection in. Now what I do is I scroll down and at the bottom of the page, boom, related searches.

So it's telling me for free what's close to what other people are putting in there that's very popular. And I could grab some of these and do, and then take them to word tracker and look, because this is blind. It's telling me it's popular for all I know there are 500 more websites with this exact phrase and no websites with this exact phrase, which may be getting more searches. So they're just telling you related searches but you don't know as much. It's still a free, quick way to see what people are saying.

And I think that relates back to the paper I just showed you about where they looked to see what people were saying over the past year. And hopefully, you'll use some of this and the next time you talk on Twitter or make a video, you'll say, Hmm, and whatever it is you're talking about. And the same thing goes for what we do.

Let me show you one last tip and then we'll call it a night unless you guys have questions. Go back to Wordtracker and show you. If you do use Wordtracker and you're going to do, let's say you're doing our O-Shot®. Let's put in the P-Shot®, we already did O-Shot®, the P-Shot® now.
P-Shot®. So in the past year, there was an average of 6,700 searches per month for the word P-Shot®. And there are 191 websites with this in the title tag and another page with a link back to that same page with that exact phrase.

So this says P-Shot® and there's a hyperlink and you click on it and you go to the page that has P-Shot® as a title tag. There are 6,725 searches for that exact phrase, your competition's 191 pages. But, if I'm going to do a P-Shot®, maybe I grab one of these, here are 700 P-Shot® reviews. And then you review, you could obviously take that phrase and talk about just your P-Shot®, P-Shot® reviews and then it's here, I'm going to tell you about some of the results I've seen, the wins and the losses and review my own results. And then you can link another page and then you're going to catch all that traffic. At least you'll be at the top when people search for it.

And you can see as you go down, people who just use the PRP thing without the name, they're literally a hundred times less traffic than if they're using the P-Shot® name, actually more like 300 times more by the time you add all this up. So our name really is bringing us traffic and this doesn't count if I just put P Shot or P-Shot® with a dash. So if I do that, you'll see there's whole different stuff that comes up.

So this is how I don't guess, I know what I'm doing. And it helps me know if I'm paying price per click, it helps me know. So right now a P-Shot® near me that's $42.40 cents is the average price per click if I'm doing a Google click ad. But if I put PRP penis injections, that's very cheap. So if you're on our directory and someone clicks, then according to them, that one click is worth at least $42 which is one reason why to be on the directory, it's not the main reason, but it's one of them.

Okay, so hopefully I've given you some ideas and I think that hopefully you also got some ideas about things that you can actually do to take care of your people. You got some ideas about words not to use, alternative therapy, a new tool you can use and you now have a research project about the O-Shot®, a research paper about the O-Shot®, but done in this weird, painful way that you could shoot out to your patients and say, Hey, these people had to do general anesthesia, but they showed it worked. I've got a way to do it in the office without pain, give me a call, something like that.

So always flip, and because that paper just came out this month. So you can always use the news to talk about to make news. News comes out, you give that to your patients, here's some news. They're interested, they're smart people and here's what I think about this that just came out. Okay, I think with that, let me see if there are any questions, if not we'll call tonight. If I reviewed, I don't know. Let me look at that out and I'll see Angela. I remember seeing a Turkish paper OBGYN, let me see if, actually I could just throw it in the search bar and see, let's see what we get. Angela pointed out a paper that she thinks might be helpful.

Testicular Injection for Increased Sperm Count

Oh, I forgot to tell you there was also a paper that just came out. It was an animal study though, showing increasing... I'll have to look for it and let you know, I don't want to fiddle too much. Maybe that's it. I don't want to fiddle too much, I'll look for it and we'll talk about it next time. But there was a paper that just came out where they injected the testicles of animals that had been radiated and showed an increased sperm count. So I get asked that question a lot. I've injected my own testicles just to see what it was like and if you do it the right way there's hardly any pain and just sort of a little ache to it. I did it with a 27 needle. I didn't check sperm counts, but believe me, that study's coming. Somebody's going to do it, it just makes sense. But it finally came out in animals at least.

Matthew said easy PRP, easy spin system for the P-Shot®. They're not on my list of the ones that have the FDA device endorsement and so I've not used it. And so I don't want to say good or bad. I just know they've been less supportive of our group and they have less, the FDA doesn't approve blood, but they approve devices as you know, and it's not one of the devices that have been sanctioned to the degree that I would like, but I'm not going to condemn it, don't know it, haven't used it, it's a good question. So let us know if they get approval and I'll start throwing it out as one of the options. And I think with that, we'll call tonight. I hope you found something useful to take away at least don't use the word alternative. Trial Wordtracker before you build your next webpage or at least the free Google version. And I think with that, we'll call it a night. Thank you for coming out tonight.

Relevant Research

Chiang, Ching-Hsiang, and Hann-Chorng Kuo. “The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.” Frontiers in Pharmacology 13 (February 8, 2022): 847520. https://doi.org/10.3389/fphar.2022.847520.
Demyashkin, G. A., T. G. Borovaya, Yu Yu Andreeva, A. A. Nedorubov, Yu Yu Stepanova, M. A. Vadyukhin, V. I. Shchekin, S. N. Koryakin, P. V. Shegay, and A. D. Kaprin. “An Experimental Approach to Comprehend the Influence of Platelet Rich Growth Factors on Spermatogenesis.International Journal of Radiation Biology, March 8, 2022, 1–39. https://doi.org/10.1080/09553002.2022.2047820.
Pathak, Neil, Zachary J. Radford, Joseph B. Kahan, Jonathan N. Grauer, and Lee E. Rubin. “Publication Frequency and Google Trends Analysis of Popular Alternative Treatments to Arthritis.Arthroplasty Today 14 (February 28, 2022): 76–80. https://doi.org/10.1016/j.artd.2021.12.009.
Vazquez, Oscar Adrian, Rachel H. Safeek, Jacob Komberg, and Hilton Becker. “Alopecia Areata Treated with Advanced Platelet-Rich Fibrin Using Micronization.Plastic and Reconstructive Surgery Global Open 10, no. 1 (January 18, 2022): e4032. https://doi.org/10.1097/GOX.0000000000004032.

Relevant Links

-->Next class to learn to inject the major joints (knees, elbows, shoulders, Achilles) with PRP<--
-->Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<--
-->Next Hands-on Workshops with Live Models, worldwide <--

--> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

O-Shot® CBD Arousal Oil. O-Shot® providers order wholesale by logging into the O-Shot® membership site, or by calling CMA Headquarters.

Altar™--A Vampire Skin Therapy™. All CMA members can order wholesale by logging into the membership sites and going to Dashboard-->Supplies

 

 

 

 

 

 

 

 

 

 

Charles Runels, MD

 

 

 

 

 

Cellular Medicine Association
1-888-920-5311

JCPM2021.09.01EDResearch.PenileRehabilitation.AutologousVsHomologousVsMinimallyManipulated.Peyronies.PE

Topics Discussed Include the Following...

*How to find answers on the membership sites
*The Priapus Shot® procedure for Erectile Dysfunction. Research
*How to Do Unnecessary Things, Hurt Your Patient More, and Make the Priapus Shot® less effective (straight from the research)
*Why the PRP Research Moves Slowly
*Injections to Help Premature Ejaculation
*Priapus Shot® for Penile Rehabilitation
*Autologous, Homologous, Minimally Manipulated
*The Priapus Shot® procedure for Peyronie’s Disease

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

Transcript, Relevant Research, & Relevant Links

Transcript

Thank you, guys, for being here. I had several questions this week about the Priapus Shot® and the research supporting what we do. Of course, it's a growing body of research, but there've been a number of papers that came out in the past six months, and I wanted to tie those things together, specifically, (1)

talk about some of the research about applying PRP, using our protocols for erectile dysfunction. (2) Number two, for rehabilitation of the penis post prostate surgery. And (3) number three for Peyronies's disease. Some of the ideas, then I'll take questions.

How to Find Answers to Questions on the Membership Sites

Before I get to that, I also had several questions concerning the O-Shot® procedure, and these questions actually live on the website in a pretty robust, thorough way and much better than I could do answering the phone. So since I wound up referring people to this page, I thought it might be useful to just show you guys how some of the resources that are available to you for being a part of our group.

We've been doing this a decade now and thankfully the combination of the many minds, we're now over 4,000 members; we passed that mark since COVID slowed down; now there are over 4,000 members. The collective of both asking questions, doing research, getting together every week without much exception and talking about, (I think, once I skipped for a Bob Dylan concert and once a hurricane shut me down, but we just didn't have electricity); other than that, we haven't missed many.

Next Workshops with Live Models<---

And those webinars, some of the better ones, or many of the better ones are recorded and transcribed with the transcription searchable. Maybe the people in the group don't know this is available, but one of the questions that happened today I wanted to point out because it's a common question. What happens if the O-Shot doesn't work? What do you do if your person doesn't get better? I wanted to show you where that answer lives and how to head off disappointment by referring something, showing your people this, and then we'll get back to the research.

But I'm just showing you functionality. When you sign into the O-Shot website, the membership side, you're going to be looking at this dashboard. Of course, many of you have already been in the group for a while, so you have a good understanding of how to do the procedure and come up with your own ideas and innovations, depending on what the problem is.

Navigation to Answers to Questions

That's the thing. I want to make it clear. I'm the first person to point out these are not magic shots. These are not magic shots, inaudible 00:02:58. If someone is having dyspareunia inaudible 00:03:02, well, the pathology lives right there in the local tissue and we have something that makes tissue healthier. If they have anorgasmia, that could be any part of the orgasm system, from psychological blockage due to some sort abuse as a child or modal abnormalities, lots of things, other than local tissue.

Depending on the problem makes a big difference about the percentage of the results and the likelihood of a particular patient might get results based on where the etiologies of their person's problem might lie, since their usual, almost always multifactorial was something as complicated as sex.

Anyway, back to what to do, because there is no procedure that's perfect, and so what do you do when the O-Shot doesn't work? If you go and you log onto the dashboard, you'll see this. If you go to this webinar page, you'll see that I posted here, first of all, the difference between an O-Shot® and a G-Shot®. You should know that, because that question comes up a lot, and they are not the same, and we are not aiming for the G spot when we do the O-Shot. We're aiming for, and I explained the difference and why, what thinking is in that video.

Then if you scroll down here, there's this question, what do you do when your first person with an O-Shot doesn't get well? Everything from, first of all, if it's only been two days, they haven't had time, versus the different problems they may have presented with.

And again, I don't claim to be the know-all end-all be-all, I'm far from it. I'm sure many of the things that we're thinking and saying will be proven to be wrong, or hopefully on the path to what's better, but with our best understanding of today, from the research and from talking to 4,000-plus doctors and teaching this almost every month, at least for a decade, my best understanding from curating the ideas of the group for the past decade lives on this website.

Now, if you have a specific problem, you can also go here and search. So if I just put in say, dyspareunia and search, it's going to come up and bring up the transcriptions where we talked about dyspareunia.

Not every video got transcribed, and not every webinar made it to the website, but we do have over 400 videos, and so you'll find lots of conversations.

Then if you just want to see the last one that was posted, say, you get an email and says, "Okay, I just put up a webinar," which will happen after this one, just put up our journal club from last week. You just go to recent posts and you can find the most recent one, so you can see the last one, where we had one of our premier teachers and providers on the group talking about how she treats women who have genital mutilation, and gave a really moving story and some amazing clinical pearls. And I've put the research that backs up what we talked about below it.

Later, when I talk about the research regarding the Priapus Shot®, that's where it will live and I'll have links to all of it. And so, I've shown you where to find the video about what to do, if your first or any of your O-Shots don't work.

Also, I would recommend that you send your people to this recording, which I put here to help answer some of the questions that happen before they get asked. So if you scroll down here, this is just a podcast. And I recommend you listen to this and do your own version of this, either written or recorded, as a podcast or a video, where you put your experience in here. But this is me telling people what reasonably to expect, depending on the procedure and depending on the problem that's being treated.

Hopefully, you found that helpful. Of course, we're always on standby to help you. We have a staff of 10 people, actually, we're down to nine people, depending on...If you want to count our virtual assistants, we're more than that, but people flesh and blood living close enough to report to an office, we have nine full-time people, and others on retainer.

So we have a support staff that's made to help you guys if something comes up that's unusual. Like today, I've got a question that was about an unusual problem. I honestly didn't know the answer, but I went to the research and ask a few other people in the group and we came up with an answer.

Okay. That's our promise to you about how to find the answers, and that same idea would go for all the procedures, you just log in and you can use the search bar to find where we talked about it, if you want to see what we talked about recently, and we do usually cover research that's been out within the past month or two.

And like this one, we talked about research and treating keloid, that's very recent. And we usually have one of our teachers on the call, this one we had inaudible 00:08:42 talking about how he treats scarring and the surgeries he does in combination with how PRPs are used for scarring.

The Priapus Shot® procedure for Erectile Dysfunction. Research

Okay. That's enough about how to find the answers to questions. Let's go into what I think some of the more premier studies are regarding our Priapus Shot procedure since that's... I think, we'll start with this one study, which came out... Oh, it made the cover this year of the Journal of Sexual Medicine. So many of you guys saw it in an email because I was so proud of it. It was like having a picture of your idea of a baby. So you have three sons, and so it's not as fun as having a picture of your baby child, but it's fun to have a picture on the cover of a high-impact magazine that shows a graph, a picture of your brainchild.

This is that study.

How to Do Unnecessary Things, Hurt Your Patient More, and Make the Priapus Shot® less effective (straight from the research)

We briefly mentioned it in a previous webinar, but I wanted to dive a little deeper into it about their study design and tell you why, although I'm grateful for the study because they did show benefit, and this double-one study where this came out of Greece and very well done study, where they used saline as the placebo, which makes me a little nervous, because saline being a physical therapy, if you inject it, it's not exactly a placebo, but they still showed benefit. But I wanted to show you the method and why I think maybe it's wasn't as good, or it's not what I would have done, and why.

They were randomized. They used inaudible 00:10:45, which is a double-spin centrifuge, as you guys know, that part of the criticism of all of the PRP studies, especially the man analyses, is that there's still no real consensus about what exactly PRP is. It's a lot of apples to oranges. And in their conclusion, they even stretch it to say, "Well, we can't really extrapolate this to other PRP preparation systems, which is somewhat true in that a double centrifuge would be much different than say a gel kit, but maybe not that much difference between double centrifuges.

Anyway, that's right, you can't extrapolate to every PRP prep kit, but they did show a benefit.

Okay. With this kit, I can tell you, they've got about five times the concentration of whole blood, doing what they did.

Now, this is the part I wanted you to see. After repairing the injection, they're placed in the supine position, a tourniquet was clipped around the base of the penis. Now some of the people in our group do this, most do not, and I'll show you why I don't. I'm going to show you a picture. You guys, of course, don't need to see a picture because you can visualize it. But if you look at a picture of the penis, if I put a tourniquet right here, we're missing out on treating a good portion of the penis.

Now what really this tells me is that, and I'm just going to speak plainly. I've already prefaced it by saying I may be completely wrong or shown to be wrong down the road, but we've been getting great results without tourniquets. It's not something that I didn't consider the first time I did this, which was on my own penis, now 11 years ago. I thought, well, maybe I put a tourniquet.

The reason I didn't is to think about it. When we do the facelift, we don't put a tourniquet around their neck. And actually, when you do it, you can see that it stays there. And the reason it stays there, is the PRP, which you guys know is activated and then the platelet-rich fiber matrix is formed from this gelatinous matrix that's set up, that's intended.

It's the thrombin cascade. You don't really have to put a tourniquet to keep it from going back into the circulation, but it could be a worry because technically it's an intravascular space.

Now, the other thing that gets batted around sometimes, which I'll just tell you it's going to happen because first, they laugh, and then they take it, and then they bar you from it. That's what happened with a heart catheterization. The radiologist first did it.

And a radiologist who attended my class, an interventional radiologist, just told me once, he said, "Charles, watch. What happened with us was we did it and then the cardiologist took it over."

He says, "Eventually, this is going to be shown and widely done, but then the urologist may want to be the only ones who do it."

That could happen.

If you think about it, and I've already had a couple of urologists suggest, this should only be done under ultrasound.

Now here's my argument against that. What is smaller: Putting a needle into the vein of someone or putting a needle into the corpus cavernosum?

For most guys, I would say that the corpus cavernosum is significantly larger than the veins on their arm and I don't need an ultrasound to do it.

Now, there does need to be some understanding of the anatomy, but if a man can do his on Trimix injection and get a needle into the corpus cavernosum, I do not need an ultrasound to do a Priapus Shot, but I've had some urologists look at me with a straight face and tell me that's the way it should be done. I think that's just a prelude to saying that only urologists should be doing it.

Okay.

The other thing that I think about, back to the tourniquet thing, I think what happens is that those who have injected the face and have seen how PRP behaves, would know that the tourniquet is probably not necessary. Again, these guys are brilliant.

They did the study.

I love them for doing it.

It strengthens our position, but when you read the study, I want you to know why I think maybe they're changing of our method was based upon their having not injected faces for a decade.

Okay.

Then the other thing, and this really makes me cringe more than if someone were scraping their nails across the proverbial blackboard. A total of five cc's was infused in each other corpus cavernosum, get a load of this, by slowly retracting the needle for better distribution of PRP into the rectal tissue over a two-minute period to minimize platelet cell injury.

Are you're getting the picture?

It looks to me like they put a needle, and threaded it through the corpus cavernosum, and then slow ...

My penis is retracting right now.

It's an innie instead of outie.

And then they slowly over two minutes, retrograde injected PRP into the penis.

I mean, okay. So, all right, whatever. I don't know. I think I'm going to leave it at that, but I don't think that's necessary.

These poor guys.

They should have called one of us up and then asked us about ... Or maybe come and watch one of us inject faces to know that when you inject a sponge, it's this corpus spongiosum and the corpus cavernosum is similar with all the sinusoids, you wouldn't have to take a needle, and thread it, and slowly move it out of the sponge to fill it. Just inject it and let it spread well.

Well and what about this minimizing platelet cell injury?

I want the platelets to be injured when I inject them. Actually, I'm going to activate them and make them release those growth factors and put them into the penis very quickly within a minute or two, so while they're still active. This really made me cringe and I didn't want anybody thinking that's the way it should be done.

Again, great respect for these guys, but holy smoke, I'm glad I wasn't one of their patients.

Okay, was performed under sterile conditions without anesthesia. Thank you very much.

Following administration, additional compression of the penis with a dressing placed around the penile shaft. And then, the tourniquet was removed after 20 minutes. Holy smoke…

Tourniquet two minute retrograde per side, without anesthesia, so we got four minutes per total of injecting. And then, you're going to put some sort of compression dressing with a tourniquet at the base for another 20 minutes. And then, they're instructed after the tourniquets removed after 20 freaking minutes, then they go home and take the compression bandage off four hours after the injection.

All right.

What's the idea behind that, the compression bandage? So you don't bruise. Get a clue.

We're making a bruise. We're creating an artificial hematoma.

When you do this, what happens when you get a bruise? Plasma comes out of the blood vessel, activates the thrombin cascade, and you get a bruise or a hematoma. That's all we're doing. The only difference is that we're taking the blood out and because we're fractionating it, instead of just the amount of blood ... Let's say you have a bruise or a hematoma that's a centimeter. Okay. That'd be a cubic milliliter, a milliliter. We're injecting five milliliters, so that'd be five centimeters if it were water. Now, remember, your definition of a millimeter is a cubic centimeter.

You put five cubic centimeter hematoma, but you have, because you fractionated and concentrated the PRP, you had the same amount of growth factors as if you would have had a 60-milliliter hematoma, or a 30-milliliter hematoma the way they probably did this Magellan kit, or 60 milliliters total, which of course, would be fricking amazingly painful. Still, it's a hematoma, and it's going to stay there, and you don't have to create it slowly because you want everything to be activated.

I just wanted to go through how they tortured these poor guys and realize it still worked, everything is great, but we don't have to do it that way.

You guys know we have a better way of doing it.

And I think doing it the way we do, you are actually treating all of the corpus cavernosum, both the part that's outside in the room and the part you can't see that's just as important and necessary for erectile function.

But yay for these guys, I still want to congratulate them. Great study.

I just wished they would have come and done Vampire Facelift® with us for a week or two before they designed these things and tortured these poor guys.

Okay.

But still, cover the fricking Journal of Sexual Medicine. That's huge.

All right. This one I wanted to look at, this is a review of current ... One more about erectile dysfunction and then we'll get to Peyronie's disease and penile rehabilitation. This one, they go through just reviewing, just like it says, current therapies for erectile dysfunction. They have a section for a PRP, which let's see, here we go, which they give us a good review. It's the same criticism, which we deserve. There's a need for standardization of PRP processing methods, which is part of the reason for our group. We've agreed that you should be at least one and a half times, you should activate the PRP with calcium chloride and calcium gluconate, thrombin, or something because we know without activation ...

See that's the other thing. These guys did the slow through the needle, so that means they only had 65% activation by one of the platelet experts that I talked with in Serbia when I was there. And so, they basically undid their centrifuge, if they happen to not activate them all.

There is a need for standardization, which is what we're doing.

The reason for our group, is we're trying to come up with some ideas. At least we're going to use an FDA-approved kit, so we know whatever amount of PRP we think we have, we at least have that. It may be different than someone else's kit, but we know what we did with our kit, which is something. When you look at some of the studies, they're just using yellow tops and pipetting, which is completely non-reproducible because maybe your lab tech pipettes today and everything's fine, and tomorrow they smoke two joints and had a fight with their wife, so their pipette technique is a little different.

I like something that's standardized in an FDA-approved kit, and it's sterilized in a way that you're able to say that this PRP is safe to go back into the body.

That's some standardization, and there's a need for more of it, and we do need more randomized control trials with larger patient samples.

Why the PRP Research Moves Slowly

Part of the hindrance with us, of course, is that we're grassroots. We don't have many millions of dollars, like a drug company. There is no patent on blood and the PRP companies, about all we can have them do when we do our studies, is they'll give us free kits sometimes. That's about it. It's hard to ... One of the Emcyte/PureSpin reps, Jeff Petrillo, gave us some cash for a study, but other than that, I've never gotten anything from anybody other than free tubes for the studies we've done.

So including the Magellan people who did that, who provided the kit for our lichen sclerosus, two of those studies and for the one you just saw that was done at the University of Aristotle in Greece.

Okay, so that's two very nice peer-reviewed articles. One of the Journal of Sexual Medicine, the other out a couple of years ago in Medical Sciences talking about PRP for erectile dysfunction.

Injections to Help Premature Ejaculation

This one, frankly, I haven't done for my patients, but it's coming, and some of the people in our group are doing so I didn't want you not knowing about it, and I wanted to bring it up because we now have some studies talking about it, plural. I'm giving you one of them, and this is peer-reviewed International Journal of Impotence. This is a high-impact journal.

And what they're doing is they're using HA as a way to decrease the sensitivity, and of course, the side effect is the penis gets bigger, which is for most guys, not a bad thing. So this is coming, and you can see some pictures, you can see how they're doing it.

I'm a little bit hesitant to do injections in the glans because technically... With HA, because technically you're putting HA in the intravascular space. I'm less hesitant to put it subdermally for just pure girth, and also it could have some decreased sensitivity in that case, because you're subdermal, not in the intravascular space.

And we know a long, long history of HA not causing neoplasia, and I liked Juvederm Ultra Plus because the granuloma formation is almost zilch and good safety profile.

So I don't teach this, but I wanted you to know about this study. Again, I'll have links to all this when I put it on the website and just showed you how to find it, and it'll be up by next week.

So that's for... I've actually put... I won't show it to you now, but if you go on Amazon, I put one chapter of a book I've been working on about premature ejaculation, and I honestly think the best way to treat it, it's probably not with our injection techniques, but I think adding it, injections, to other things could be very helpful.

So I think that's all I'm going to say about this. Now, the next one, though, I think is extremely, the next two, I think are very important. One about Peyronie's and the other about post-prostate surgery, and then we'll shut the place down the.

Priapus Shot® for Penile Rehabilitation

The first one is about post prostate surgery.

We've been doing this now for a decade. Finally, I love that someone's talking about it.

Reading between the lines, I like people that give us a hard time. Always be grateful for your intellectual enemies, because they make you be smart. They make you smarter. They make you have to think and work and do research and think about your position. So I'm not offended by this, but I also want to walk it through line by line because there's some...

First of all, they rightly point out the legal problems of stem cell therapies in the United States. Be careful. In my opinion, if you're in the US, you should not be saying the word stem cell in relation to your procedures, unless you're talking about how platelet rich plasma recruits themselves from the bone marrow. Unless you have an IRB-approved research protocol.

Autologous, Homologous, Minimally Manipulated

Now, because platelet-rich plasma is autologous and homologous and minimally manipulated, and those three words, if you're not sure what they mean, we have some stuff online that explains that, but briefly autologous, from the person, homologous in that it's doing the same thing where we put it, that it was intended to do had it occurred naturally. So we put it in the penis to help it regenerate neovascularization, neurogenesis, collagen production, which is what it would do if there were an injury. So we're asking it to do what it would normally do, which is homologous. And it makes sense. You shouldn't have to do, we want to, but you don't have to prove that making blood flow, if you treated a wound in the leg, would help a wound in the arm. And by the same token, because PRP is not a drug, you don't have to prove that it would help with those things in the penis if it helps in the leg.

And it's not even off-label because it's not a drug.

Now the kits were made to do PRP for a specific indication, but that's the kit.

The PRP, once it's made, it's not even FDA business. So autologous, homologous use is minimally manipulated in that we haven't done so much to it that it quits being the person's body as what happens with stem cells. So, so that's why it's safe and long, over a decade, close to two decades now of safety, many studies. The safety profile is amazing.

So let's just look at these two paragraphs. The use of PRP to improve erectile function has been reported. Now, remember, we're talking about rehabilitation following prostate cancer treatment or surgery. And of course, this would vary based on the surgery, and hopefully, we'll have more of our urologists, we have quite a number of urologists in our group who will extend these ideas.

So there have been preclinical and clinical studies in vitro, in vivo, and rat studies, it's been shown to work. So promising data with good short-term safety, and he goes through some of the studies that are out there.

Now here's the part where it gets a little bit political, but that's okay. Again, I like people who rough us up a little bit so we think harder. The evidence to support PRP in treatment is not strong especially in the setting of prostate cancer. Well, depends on how you want to define strong. Not strong enough, obviously, that every urologist is doing it. So I'll go with that. But we have now at least a dozen very good studies in high-impact journals. But he's also right that using it as part of a penile rehabilitation protocol post-prostate surgery has not been studied that much.

In other words, we don't know how much it adds to the penile rehabilitation protocol. But we know that it seems to make sense, and when it has been looked at, it seems to help. So I and others in the group, after the person has gone through whatever the urologist intended, and now they're as good as they're going to be, I've put people back through the normal penile rehabilitation protocol, which is daily Cialis, daily vacuum device, and then added in a Priapus Shot with great results. That's not a study, I know, but it makes sense. It's not waving a crow's foot and doing something that's not supported by research.

So my thinking is there's no finish line. There's just a gradual knowing and learning and a gradual, but reluctant, understandably reluctant, acceptance until insurance is paying for it and everybody's doing it.

But if I'm the guy who loves my wife, taking one of the veterans I treated, I'm close to Pensacola, so a lot of veterans live there since there's a base, who have been married for 50 something years, he had prostate surgery, he was several years out, wanted to do another honeymoon with his wife and wanted things to work. So I put him back through the protocol, the usual penile rehabilitation protocol.

He's several years out from his surgery. And within a couple of months using Cialis, he was able to have an erection again. But before the protocol, using Cialis, he was not.

Now, is that worth doing?

I think so. I think it's worth doing, and it doesn't mean that it needs to be that everybody's going to do it. But my thinking is that if there's enough research to support it, it's safe, you have a person sitting in front of you that might benefit, then I say do it.

And he's right, none of these studies were...

This is where it gets political, the medical hype and the commercialization within a limited regulatory framework have deterred high-quality research data. Here's where I'm going to call BS because commercialization doesn't limit high-quality research. Actually, you can't commercialize blood. Commercialization of a drug gives you billions of dollars of research, and add on the fricking Superbowl and gorgeous supermodels who walk in your office and give you an erection trying to get you to write a prescription for something.

So it's the opposite. We will never have that with platelet-rich plasma ever because there's no patent on it.

So this I'm going to call total BS and it should be struck out, the editors should have struck this out because commercialization doesn't limit research. Commercialization helps research. And because we cannot commercialize PRP, we can't do the kind of research we want to do.

But what he really means here is that “It aggravates me that somebody is charging the cash for this instead of doing only whatever Blue Cross Blue Shield decides is appropriate.”

And this is why this sentence is why you must, you very must always swear before whatever's holy to you that you will give every patient all of their money back if they ask you to, because the person who wrote this sentence will crucify you and call an audience to applaud if you keep somebody's money who is not happy.

There's a lot of anger in that.

It's completely wrong because remember, commercialization pays for research, and our little fees that we charge allow us to make a living, but they don't allow us to do half a billion-dollar research as Flibanserin does. So this is a BS sentence, but whatever, I'll forgive them, because it makes us smarter and it makes us want to do whatever research we can afford to do.

Now, none of these studies is designed specifically as part of a penile rehabilitation protocol, which is true, in addition to clinical application and specification of PRP needs to be optimized and standardized.

All that is absolutely true. Okay.

But the bottom line is thankfully it's being talked about, and I'm so grateful this person wrote this article because it's a high-impact journal and the discussion has been going, but now has been brought, you can see this is fairly recent. It's been brought to the forefront and hopefully, you guys, you can see this was this year it came out. So we will just keep doing this discussion and gathering data.

The Priapus Shot® procedure for Peyronie’s Disease

Okay. So now, that last one, and then we'll call it a night, talking about Peyronie's disease. This one's been out for five years now, but it's still my favorite because this guy's a wizard. I have a textbook of sexual medicine and Ronald Virag's pictures in the front of it. This is not a lightweight.

And he did, instead of using a placebo, he used a positive control. He did good ultrasound studies with visualization and showed that PRP worked better than the positive control—Xiaflex.

And he showed that PRP works better than Xiaflex for Peyronie's disease. And the side effect of course, is with PRP or the Priapus Shot, the side effect is you get a better erection, a harder erection on the erection scale. Virag usually documents an average of about an increase in seven on that scale of five to 25 versus Xiaflex where you have a 5% or one in 20 chance of developing a penile fracture.

So Priapus Shot side effect, harder erection.

Xiaflex side effect, fractured penis, limp noodle.

PRP side effect: bruising, cost a couple of grand.

Xiaflex side effect: fractured penis, costs you the price of a nice car, 50 grand.

So not saying Xiaflex goes out the window, but for my thinking, we have a good, strong case in a high-impact journal by a very prominent physician about this.

Now, a couple of things about his methods, then we'll shut it down. He injected them once a week and he injected into the plaque. My thinking, two things about that, if you look at soft tissue studies and there's a lot of them because platelet-rich plasma, as you guys know, has been used in wound care. So there's a lot of studies about PRP and looking at soft tissue. Also, now in the past 10 years in the aesthetics space, look what happens to soft tissue. So full effect is eight to 12 weeks. So to repeat it weekly, to me seems like more than what's needed. It's like fertilizing your lawn before it has a chance because this is growth.

This is not a pharmaceutical effect. It's propagating cell growth. And to do something to propagate growth before you've achieved the optimum growth from procedure number one to procedure number two, in my opinion never hurt anybody.

There's no downside, but perhaps they were treated more frequently than what's necessary.

Secondary, again, no harm done, but if you look, Dr. Virag is doing this, his disclosure is that he was doing it for the region company, Regen Lab. So again, I know the Regen people are ethical, but there's a different motivation than there would be--say with a clinical person like myself in rural Alabama, where having this treatment done every week would be beyond the convenience and budget of many of my patients.

But I'm glad he did it.

And it could be that doing it weekly maybe and made it more likely to work. I'm sure there was a lot to this. I'm just saying that interval doesn't necessarily translate clinically. And I wanted to point that out.

Second thing is that probably the person that I know this to have done more Priapus Shots® than anyone on the planet literally at seven clinics now, all of them doing seven or eight P-shots® per day: when he treats Peyronie's disease, he just does a normal Priapus Shot. In other words, it may not be necessary to inject into the plaque.

I'm not saying it didn't help, perhaps it makes it more likely, but we don't have a study that shows Peyronie's disease injecting into the plaque versus Peyronie's disease just injecting into the corpus cavernosum. It's one of those things we discovered a decade ago accidentally by just trying it in some people years before the study was done, just trying with people and getting great results.

Also, I actually spoke with Dr. Virag. We shared the podium in Venice, and when I asked him, clinically, when he treats a person outside of study, he combines it with a vacuum device because there was a study in the British Journal of Urology showing that 51% of men canceled their surgery for Peyronie's disease if they used a vacuum device twice a day for 12 weeks. So just traction, physical traction, and hyper expansion, and I think it needs to be vacuumed, not a traction device for best results, because you're going to expand the erection more than... It'll be like hyper-inflating a balloon. And then when it goes back to normal, I think there's some correction of some of the scarring and helping with the curvature more than if you just did say traction or try and mix injections.

Okay. So that's the studies I wanted to go over and I'm looking to see if there are any questions. And the penis pump, that's right, they didn't use the penis pump, Elizabeth. By the way, I saw your idea. Great. I won't bring it up today, but one of the leaders and teachers in our group, Elizabeth Owings wrote a book about clitoral anatomy. And she had an idea she sent to me today in an email. So hopefully I'll have her develop it to the place she wants to teach you guys about it.

But yeah, no penis pump in this study. And if you look at these studies, that's part of the study problem, if you go back to penile rehabilitation. The guy's giving us a hard time for not doing the thing, but to really look at the rehab protocol, you'd have a three-variable study. It would be a pump, vacuum device combined with Cialis combined with the Priapus Shot versus one of those things alone.

Yeah. I mean, you see, as we all know, doing multi-variable studies are difficult to show results in, so much so, I guess it's been six years ago now, there was an editorial New England Journal of Medicine talking about this problem and the FDA trying to encourage people to do multi-variable studies, but no one really wants to do them because they cost a lot of money and you wind up having trouble showing what you intended to show.

So I think with that, I don't see any other questions. I just wanted to go over those things. And hopefully, you found that helpful looking at the studies and I'll put links to these what I think to be critical ideas in the membership site and on the research page for you to refer patients to, along with the recording of this meeting. So thank you very much.

You guys have a great night.

Good-bye

Relevant Research

Chung. “A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction.” Medical Sciences 7, no. 9 (August 29, 2019): 91. https://doi.org/10.3390/medsci7090091.
Chung, Eric. “Regenerative Technology to Restore and Preserve Erectile Function in Men Following Prostate Cancer Treatment: Evidence for Penile Rehabilitation in the Context of Prostate Cancer Survivorship.” Therapeutic Advances in Urology 13 (January 1, 2021): 17562872211026420. https://doi.org/10.1177/17562872211026421.
Littara, A., B. Palmieri, V. Rottigni, and T. Iannitti. “A Clinical Study to Assess the Effectiveness of a Hyaluronic Acid-Based Procedure for Treatment of Premature Ejaculation.International Journal of Impotence Research 25, no. 3 (2013). https://doi.org/10.1038/ijir.2013.13.
Poulios, Evangelos, Ioannis Mykoniatis, Nikolaos Pyrgidis, Filimon Zilotis, Paraskevi Kapoteli, Dimitrios Kotsiris, Dimitrios Kalyvianakis, and Dimitrios Hatzichristou. “Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.” Journal of Sexual Medicine 18, no. 5 (May 1, 2021): 926–35. https://doi.org/10.1016/j.jsxm.2021.03.008.
Virag, Ronald, Hélène Sussman, Sandrine Lambion, and Valérie de Fourmestraux. “Evaluation of the Benefit of Using a Combination of Autologous Platelet Rich-Plasma and Hyaluronic Acid for the Treatment of Peyronie’s Disease.” Sexual Health Issues 1, no. 1 (2017). https://doi.org/10.15761/SHI.1000102.

Relevant Links

-->Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<--
-->Next Hands-on Workshops with Live Models, worldwide <--

--> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

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Charles Runels, MD

 

 

 

 

 

Cellular Medicine Association
1-888-920-5311

 

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.

Our Special Pricing for Amnion (click)<--

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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