Category: Marketing

  • JCPM2023.12.19 O-Shot® procedure better than Kegels? | PRP Rep Propaganda

    JCPM2023.12.19 pdf file download <—

    Journal Club with Pearls & Marketing 2023.12.05    Cellular Medicine Association

    The following is an edited transcript of the Journal Club with Pearls & Marketing (JCPM) of December 19, 2023, with Charles Runels, MD.  

    The video of this live journal club can be seen here🡨

    Topics Covered

    • Kegels work better combined with our O-Shot® Procedure.
    • Ideas about How the O-Shot® Was Conceived and How It Might Be Modified
    • A Math Formula Worth Remembering
    • William Osler and Chauvinism
    • Here’s an email you could send
    • The Purpose of the Journal Club with Pearls and Marketing
    • PRP Science (Why Our Procedures Work When They Work)
    • Sales-Rep Propaganda and Traps That Make Them Money and Lose You Patients
    • How to Team Up with a Pelvic Floor Physical Therapist

    Figure 1. Charles Runels, MD

    Kegels  +/-  the O-Shot® Procedure for Stress Urinary Incontinence

    Welcome to our journal club with pearls and marketing (JCPM).

    In this beautiful study, they formed two groups of women, 30 per group.[1] They disqualified them if they tested strongly for urge incontinence. One group only received Kegel training—pelvic floor muscle training (PFMT).  The other group received PFMT and a close approximation of our O-Shot® procedure. The PRP group also received a second treatment at four weeks.

    They measured outcomes regarding improvement of stress urinary incontinence (SUI) with both (a) 1-hour pad weight test (PWT) and (b) surveys, therefore providing objective and subjective data.

    The technique they describe is very close to what we do. The following are similarities and differences:

    1. We talk about being within one centimeter of the hymenal remnant. They describe a midline injection at 1 cm from the hymenal remnant.
    2. We do one midline injection on the anterior vaginal wall; they did three injections—adding two injections on either side of the midline.
    3. We also do an injection into the body of the clitoris. They did not inject the clitoris
    4. They use one of the kits approved by the FDA for making PRP, the Regen Kit. We also recommend Regen kits as one of the approved kits on our membership site.
    5. They used a 27-gauge needle; we use the same.
    6. They did not activate the PRP; we do.

    So, they got the basics right but changed some very important variables. For example, PRP inactivated is not the same as PRP activated.[2] [3]

    Ideas about How the O-Shot® Was Conceived and How It Might be Modified.

    I think they complicated the procedure, whatever. Still, they showed a great result. I don’t think you need to have three injection points. Here’s why I think that: If you wanted to fill a sponge that is 3 cm wide, but all the benefit of the filling would occur in the center of the sponge, would you inject all of your material in the center, or would you inject some in the center and some on each lateral edge?

    A Formula Worth Remembering

    Another idea that helps evaluate the infinite number of ways that PRP could be injected in and around the introitus (variations of our O-Shot® procedures) is to think about the physical dimensions of the area being treated. Also, it helps to remember that 1 ml is equal to 1 cc, which is one cubic centimeter.

    So, for example, if the space between the urethra and the anterior vaginal wall is ¼ inch (less than this for most women post-menopausal in the distal urethra), and the urethra is 4 inches long, and you assume that the lateral extension of the area under the urethra is 0.5 centimeters, then that space is approximately 1.2 cubic centimeters (cc or ml) and we are injecting 4 cubic centimeters (cc) of PRP in the midline when we do our O-Shot® procedure.

    If you assume that the space between the urethra and the anterior vaginal wall is ¼ inch (less than this for most women post-menopausal when measuring at the level of the distal urethra); and the urethra is 4 inches long, and you assume that the lateral extension of the area beneath the urethra is 0.5 centimeters, then that space between the urethra and the vaginal wall is approximately 1.2 cubic centimeters (cc or ml); and we are injecting four cubic centimeters (cc or ml) of PRP in the midline when we do our O-Shot® procedure.

    As the research progresses, variations in injection techniques will be evaluated, and we will know more.

    They used one of the kits I’ve used for over a decade. They used the Regen Kit. So, it was a single spin kit.

    So if you look at the results, there’s the graph. Love the picture (see the video or the paper [4]). The blue line is pelvic floor muscle therapy (Kegels) alone—almost no change at all. Then the red line is the one-hour pad weight test after something close to our O-Shot® procedure times two—very impressive improvement.

    This was a beautiful and much-needed study that supports our procedure.. Still, in my opinion, what they did was half of an O-Shot® because they put three CCs divided on either side of the urethra and only two cc beneath the urethra. But it still worked well, and we just calculated that if you put your needle in the correct place, the potential space (counting the layer of muscle in the wall of the urethra) is only about two cc/ml.So they took the CC out that would’ve been put in the clitoris using our procedure and put a total of 5 in the anterior vaginal wall and spread it over 3 injection points (some of which were less effective in my opinion).

    When using a Regen Kit, as you may know, you draw about 10 milliliters of whole blood and then you’re going to get about five CCs of PRP, give or take, based on the person’s hematocrit.

    So (when doing our O-Shot® procedure) we normally put one ml in the clitoris, four in the anterior vaginal wall. In this study, they put two midline where the urethra would be and then divided the other three up on each side, which to me was probably not much more effective than squirting it on the wall (the lateral injections).

    So you could argue, I am arguing, that they really did half of the volume that we normally use. By putting four CCs in the midline, they still would’ve had a dissection laterally, but the bulk of it would’ve been where it needs to be, right there around the periurethral area—creating a “liquid sling” that converts into healthier tissue with time.

    (02:33):

    Also, there’s not a lot of space between the urethra and the vaginal wall, it would be difficult to put needle there without somehow affecting the muscle layers of the urinary sphincter and/or the muscle of the vagina and the associated neurovascular configuration there. So if that’s what we’re doing, then going lateral to the midline on either side, I think you’re less likely to be affecting those muscles of the urinary sphincter.

    Still, even with those changes, it worked!

    More Lucky Than Smart

    When I first came up with the idea for the O-Shot® procedure 13 years ago [5] [6], I was imagining mostly the space between the muscle layers (between the urethra and the vagina) and that somehow PRP might enhance sexual function by enhancing the function of the Skene’s glands and the vasculature and the nerve function in the area—not knowing that Delancey and others had done studies showing that distal to the bladder, very proximal to the urethral meatus, there’s an abutting of the muscles of the urinary sphincter and that of the vaginal wall; the muscle layers are juxtaposed.[7] Therefore, distal to the bladder, it would be difficult to inject PRP between the urethra and the vagina without involving musculature of the urinary sphincter.[8] [9] [10] A pink rose with green leaves Description automatically generated

    So, I was more lucky than smart (13 years ago) when my second patient to receive the O-Shot® procedure (which I gave her to treat dyspareunia) told me that not only did her dyspareunia resolve but she also had started running again shortly after the procedure because she no longer urinated on her leg when she exercised.

    A month later, when she told me that, as I had hoped, her dyspareunia was completely gone; she also added that she had started jogging again because her urinary incontinence had resolved.

    I thought, “Oh, wish I would’ve thought of that—that makes perfect sense!” 

    The best I can tell is that she is probably the first woman successfully treated for urinary incontinence with platelet-rich plasma.

    IMPORTANT: The first one to notice it was not me. It was my patient teaching me what I had accomplished. When you are looking for a better way, you will not find the answers in the textbooks: first, you know everything you can in the textbooks; then you read all the research you can absorb; then the next thing that occurs to you may be of value; then, you listen to your patients, and they will teach you the next chapter to put in the books.

    I’ve always said I’m more lucky than smart, but I’m so grateful for this new research because it backs up what we’ve seen and other research we have done, even though they varied the procedure.

    Here we should address a possible elephant in your room: these investigators are in Thailand. If you live in the USA, you maybe should think some about something that William Osler said in an address to physicians in Canada in 1902.

    William Osler and Chauvinism

    William Osler’s spoke to a group of physicians in Canada in 1902; a transcript of his lecture, Chauvinism in Medicine, could be helpful to those practicing in the US (our CMA group members are spread over 56 countries).

    In his essay, Dr. Osler[11] says, “When a teacher tells you that he fails to find inspiration in the work of his foreign colleagues, in the words of the Arabian proverb—he is fool, shun him!”

    As you know, he is the father internal medicine at Johns Hopkins, and he was lecturing to physicians about their prideful stance that somehow in spite of Pasteur and all the best physicians up until not so long ago coming from France, and England, and Germany, and China and not the US and Canada, that we developed a certain destructive pride.

    “When a teacher tells you that he fails to find inspiration in the work of his foreign colleagues, in the words of the Arabian proverb—he is fool, shun him!”

                                                  –Chauvinism in Medicine, William Osler

    So, this paper about the O-Shot® methods and variations comes from Thailand.  Good for them. My humble opinion is that the forces of our organizations (AMA, etc.) browbeat most of us into being afraid to run with research that can sometimes be obvious for fear of actually losing our license and our livelihood, wasting decades of study and work.

    Understandable.

    Still, when good data that is congruent with previous studies and known principles of cell biology supports a change in methodologies, to offhandedly “fail to find inspiration” in the research because the data came from a place that would require a long plane ride for you to visit—that, in the words of Osler, is intellectual “chauvinism” and could be foolish.

    Osler would say, actually, he did say that you should avoid doctors who think that way.

    This study does not imply that you don’t think about physical therapy/Kegels.

    I guess it was six weeks ago when we discussed a study in which they tested women; remember, they graded how hard they were able to contract the levator ani by putting a finger within the vagina and having the woman voluntarily contract. Those who needed the results of the Kegel exercises most were either unable to contract enough to feel movement or had just a slight movement.[12]

    (06:53):

    Those who didn’t need it, who didn’t have much in the way of incontinence or sexual dysfunction, could do a nice contraction.

    I talked about my grandmother saying, “If you could put salt on the tail of a bird, you can catch it.”

    Similar to saying, of course, if you can get close enough to put salt on the tail, you don’t need the salt, right? So similarly, it seems those who would benefit most from Kegels are not able to do a Kegel and not directly the subject of this paper, but indirectly might illuminate why those who did the Kegel training alone without our O-Shot® didn’t do so well.

    I’m making you dizzy now, I suppose, relating “salt on a bird’s tail” to recommending Kegel exercises, but those who did Kegels alone without our O-Shot® had almost no change. Now, these Kegels (comparing Kegels alone) were not using one of the magnetic devices, the Tesla magnets like an Emsella device, or whatever device you have where you could force the Kegel exercises.[13] [14] Still, one may postulate (because of this study[15]) that even if you are forcing Kegels on those who cannot do them voluntarily, you may see a better result if you combine them with our O-Shot® procedure.

    Also, and importantly, one could conclude from all of the above that Kegels alone is greatly inferior to Kegels combined with an O-Shot® and probably greatly inferior to an O-Shot® alone.

    We know studies show benefits by forcing many more contractions and much-increased strength in contractions with a magnet.[16] But the ideal would be if you were making up the perfect treatment, part of it might be the combination of our O-Shot® with the Tesla magnet (Emsella, or something simiarl, or a pelvic floor physical therapist).

    Of course, this flies in the face of studies that show Kegels do help. Bottom line is I think that if someone has enough incontinence to suffer significant incontinence, you owe them to at least do what this and many other studies are showing that our O-Shot® helps.

    Some Tips from David Ogilvy for Finding People Who Need You (Marketing)

    I think if you want a nice little thing to send out to your people, you could put a link to this study in an email and say, “Here’s some new research”, because this did just come out, September of this year, was received, accepted this month.

    So that’s news.

    Remember one of your principles of advertising medical devices, procedures, drugs, straight from David Ogilvy.[17] The guru about whom the Mad Men series was modeled, the champion, end all, greatest of all time, GOAT of marketing was David Ogilvy, and one of his rules is that you should include news.[18]

    A few of the other rules are as follows:

    • maintain a sensitivity to the pain,
    • maintain the doctor-patient relationship, which is why one of the reasons I prefer a less tongue-in-cheek marketing. I think if I were more entertaining, more of a comedian, more of sparkly in front of the camera, I might change my view about that.
    • Teach the person about their disease and they will trust you to treat their disease. Most doctors are great teachers and teaching from the perspective as if you were speaking to one of your patients—that is great marketing.

    Here’s an email you could send.

    Copy and paste the following into a new Word document. Then edit it so that it sounds like you. Add a story or a personal observation if you have time, then fill in the information with your phone number, etc and send it to your patients:

    Your email could go something like this:

    Hey, hello, (merge mail first name).

    A new study just came out showing that our O-Shot® can have tremendous benefit, possibly much more benefit than the Kegels you were trained to do. Certainly, we have some good research now showing that if you’re leaking, you should at least consider adding our O-Shot® to your Kegel exercises and then you put a link. It’s that simple.

    Then you put a link to this paper, which I’m about to give you and you end with “If you think this might help you or someone you love, give us a call.”

    So if you rephrase that in your words and send that email out today, you won’t get 200 calls, but I will be shocked if you don’t get at least some appointments.

    Those in our group who depend on our directory alone to find patients will see a few people. But those who routinely send out emails like what I just described, routinely as in once every week or so, often make tremendously increased incomes and have hundreds of fans whose lives were changed tremendously for the better because they found them through simple little communications like that.

    I have one more paper that won’t take even that long to cover and then a quick little tip or two about kits, and then we’ll call it a day. I know it’s the holidays, and I’m honored that anybody even showed up today.

    The Purpose of the Journal Club with Pearls and Marketing

    My goal is that when you come to these webinars, you go away better able to take care of your people or at least more reassured that what you’re doing is worthwhile and helpful, stronger science and with some ideas about how those who need you most might be able to find you.

    If I do that, then that seems like a good day’s work.

    Okay, putting this in the chat box. Okay. If you click on that, you’ll be able to open that paper and then let me show you this one, and then we’ll get to the tips about particularly the Selphyl kit, but other ideas in general when you’re swapping PRP kits, how you might alter our procedures.

    PRP Science (Why Our Procedures Work When They Work)

    Even though this study was done mostly to give some stats on this particular PRP kit, which I have not used. It may be wonderful, I don’t know. Their numbers are great, but the main reason for showing it to you is that in the process… It’s a good review, which we haven’t done in a while. … of what it is you’re making when you isolate PRP.[19]

    I sometimes get lackadaisical when I think about the platelets, where I describe it to my patients as being containers of growth factors and cytokines that recruit pluripotent stem cells to the area either from the bone marrow, the liver, or the local tissue to regrow new and healthier tissue and remodel scarring with neovascularization, neurogenesis, and collagenases.

    That’s how I think about it, but that’s a very superficial, almost buzzword way to talk about it.

    Because when you start breaking it down to what’s there and then when you add to what’s there that we know the proportions and even the components of what is produced with platelet-rich plasma varies with activation, whether it’s done or not, how it’s activated, and of course, it’s going to vary with the system that prepares it. Whether you have white cells, red cells, the proportion of those, the science is one of those so beautiful that the deeper you get, the more complicated you get until you want to…

    I often wind up saying, “Well, it’s all there. Nobody needs a centrifuge when I scraped my knee on a bicycle when I was 10. The platelets just knew what to do.”

    I think sometimes we can overthink it, and studies are trying to isolate one or two of the factors that are in the platelets as an example of overthinking it.

    Let’s say that you’re able to make VEG. You can make the vascular endothelial growth factor. That’d be a great drug. That’d be wonderful if you could do that, but have you improved upon the platelets, which can make all of this plus things I’m sure we don’t even know about?

    I’m not saying we don’t think about it, but I’m saying that as you go through this basic science when it gets to be complicated, I think it’s reassuring to know that as a clinician, we don’t even have to understand a lot about what’s happening any more than I have to understand what’s going on within the integrated circuits of this computer that I’m using to be able to use it.

    But having said all that, I think it’s worth remembering all the things we’re making because this really isn’t magic. These are not magic shots. We didn’t invent anything when we’re using platelet-rich plasma. We’re just recognizing that whether it’s embryology and what goes on with growing a baby or if it’s healing a wound post-op or after trauma or if it’s propagating regenerative processes with PRP, it all has to do with cell biology and the big mystery has always been turning back the clock.

    If you think about it, our tissue is aging, but there’s something in the gamete. So that when you have a sperm fertilizing an egg, it goes all the way back to zero even though the sperm and the egg is the same age of the woman.

    So you have an increasing risk of Down syndrome with a woman over 40 years old because the egg is 40 years old—the same thing with the cells of the male making the sperm. Sperm might be young, but they’re being made with older tissue.

    But then, when that 40-year-old egg joins together with a sperm coming from a 40-year-old man, the new cytoplasm grows as a new creature, and that’s the part we don’t know. We don’t understand it. We’re describing it. We’re naming things that happen. We’re drawing pictures of it as we see it under the electron microscope. I’m not trying to get metaphysical on you here. I’m just saying that even this degree of description you’re looking at in this paper is still description.

    It’s not really understanding.

    I think that’s reassuring, at least to me, to know that I don’t have to know what it’s all doing. It’s fun, it’s encouraging, but it isn’t necessary as long as I know that I have a process that’s been shown to work. But it also emphasizes that we are not just doing a shot, and I wanted you to see this paper to remind yourself that there is a lot of nuance and intellectual property.

    PRP Sales-Rep Propaganda

    In my opinion, if you want to be doing the best medicine, you should be using a kit that’s FDA approved for use for preparing plasma to go back into the body, because it’s not just where we put the needle. It’s not even the number of RPMs and the circumference of the centrifuge. It’s not even with the gel kit, the constitution of the gel, the diameter and size and volume of the tube.

    It’s all of it combined. That formula for that particular kit is what has been shown and measured for them to get FDA approval to be creating something that’s of the right concentration and the right sterility and sterility and the proper methods to not cause serum sickness or infection. That’s all baked into your kit from this lab testing. Even if you buy a RegenKit or a Selphyl kit and you throw it in your lab centrifuge or you’re changing the circumference of the carousel, you’re changing the G-forces and you’re changing what you’re going to have at the end of the time. Then if you just wing where you put in the needle or you decide to do it a different way than what we’re doing it, you’re doing something but you’re not doing an O-Shot®.

    You may be doing something better, but you’re not doing an O-Shot®.

    So when someone calls me and says, “My last three patients didn’t do so well,” I’ll get to ask them, and it’s often because of one of the things the rep has said. So I’m going to cover a couple of those things, and this how we’ll end today. Let me give you the link to this because one of them has to do with… Here we go. Hold on a second, put this in the chat box. All right. Maybe that’s a good kit. I don’t know. I haven’t heard from them and I don’t know anybody that’s using it. So if some of you are, let me know. My hope, as you guys know, some of you, I could be selling a PRP kit.

    I don’t because I like to stay Switzerland and the kit that’s offering the best product at the best price, the one we should use as long as it’s FDA approved, best product at the best price. We’re allowed to swap kits around and the rep that’s supporting you, we have our favorite reps that take good care of our people. Jeff Petrillo has been good to us and many others in the region company. Others have deserted us and not been so good to us and taking us for advantage, like the guy running around on his wife, because he just forgot how pretty she is and how kind she’s been to him. We have companies that have treated us that way. So you have the individual reps, you have the companies, and you have the science. It all fits together.

    The rep, the company in your town may be different than the one in Thailand. The most ubiquitous good service I’ve seen has been without a doubt, the Regen company. They’re just worldwide, and everywhere I go, they’re taking good care of their people. They seem to be chunking down the most money for research, but there are many others and shop your best. Just make sure it’s FDA approved. Okay. So a couple of nuances and things that the rep may tell you to throw you off track. One of them came from a Selphyl rep. I was told a question from one of our people and what the rep said was that this person did not have to use our recommended volume doing a P-Shot®.

    What prompted it is if you look at the volume of the Selphyl kit, the Selphyl kit is I think tremendous. It does one thing better than any other kit I know of. I don’t know exactly what it means, but I think it’s something good. The Selphyl kit is the only one that comes with calcium chloride. It’s the only one, excuse me. So the Selphyl kit is the only one that comes with calcium chloride. The others, as far as I know, all of the others, you have to buy calcium chloride, calcium gluconate, or thrombin, something else to go with it except Regen has a kit that comes with thrombin and another that comes with an HA, non-cross-linked HA to act and that will activate it.

    So they actually have two different kits that come with an activator, but Selphyl is the only one that comes with calcium chloride as an activator. For some reason, that Selphyl kit gels faster and I’ve lost track of the number of kits that I’ve used. When you add calcium chloride to that Selphyl kit, it turns into platelet-rich fibrin matrix faster than any other kit I have ever used, reliably so, consistently so with every patient. If you go longer than three minutes without getting it out of your syringe after you’ve activated it, you probably will not be able to push it through the needle. I think that’s a good thing. It means to me that whatever their process is, and it isn’t just the calcium chloride because you can do this, it’s just math.

    You can do the calculations, the percentage of calcium chloride and the volume of the PRP. I have and that’s how we’re come up with that number that I give you to calculate how much calcium chloride to add. It’s volume of PRP divided by 20 is how much 10% calcium chloride to add to your PRP to activate it. All that’s covered in the membership website. If you’re not activating the O-Shot® and the P-Shot® with something either calcium chloride or thrombin or an HA, you’re not doing the O-Shot® or the P-Shot®. You’re doing something else, maybe better, but you’re not doing what we do. Oftentimes when I get word that someone’s O-Shot® isn’t working, I find out the rep has told them that they do not need to activate the platelet-rich plasma.

    It will be a rep that’s selling something other than Selphyl and they know their kit doesn’t use calcium chloride. As an example, I won’t say which kit, but years ago, one of the reps showed up and was pushing me or pushing for me to recommend their kit to our group and it did not come with calcium chloride. They said, “You don’t need it to do it.” I said, “Well, all the research I’ve read shows that you may not need it, but you definitely get something different when you activate it.” It appears to me that it’s a more complete activation and probably a more effective treatment without activation.

    You could make the case that because it’s incompletely activated, you basically turned it back into non-centrifuged PRP, because let’s say you concentrate it to twice the concentration, but then you only activate half the platelet-rich plasma or the platelets and you effectively could have just injected the whole blood. So without adequate activation, you’re undoing the effectiveness of your centrifuge. So I said that to him in a briefer, less considerate way, and he said, “Oh, well, you’re right, but I couldn’t talk about it until you brought it up because it’s off-label.” I’ve got some in the car. So you walked outside and came back in with a bottle of calcium chloride, because as you know, the rep is breaking a rule if they bring up something off-label.

    But if you bring it up, then it opens up the ability for them to talk about it by the FDA rules. Back to the Selphyl kit, it comes with calcium chloride to me is a huge advantage. The fact that it activates quickly but no quicker for almost everybody than three minutes, so you have time to get the procedure done. To me, I’ve loved the Selphyl kit. The problem with it, of course, is that for some reason, they chose to make the tubes eight milliliters, instead of 10. Almost every other kit, double spin and single spin centrifuges, their protocols are usually making PRP a multiples of five. So you’ll make 5 CCs, 10, or 20. That’s why our procedures are recommending amounts in multiples of five.

    The first time I picked up a PRP kit, it was a Selphyl kit and their kits back in 2009, 2010 were $375 to spin eight CCs of blood to get four milliliters of PRP. So PRP cost you $100 per CC, roughly $100 per milliliter. I think our group is partly responsible for them coming off of that price because they tried to hold that price point using their uniqueness and having calcium chloride as part of their FDA approved kit. They tried to hold that price point for a number of years and Regen came to town. We swapped over to Regen, which was a much lower price point and eventually Selphyl had to follow. So our person was using a Selphyl kit, talked to the rep, and said, “Hey, my P-Shot® protocol calls for a total of 10 milliliters in the penis.”

    The man or woman, don’t know which one, reportedly, it wasn’t on the phone but reported by our member, told the person, “No problem. You don’t need that much volume anyway.” In other words, cut it from a total of 10 milliliters made with a single spin centrifuge to 8 milliliters total, instead of spinning two 10s to make two aliquots of five, spin two eights to make two aliquots of four. Well, that could be true. We don’t really know what the adequate dose of it is, but what we do know is we have 10 years of success with an adequate dose of the platelets they’re in most people’s blood for. I realize these are not absolute numbers, but there’s a range of platelets that most healthy people have.

    Our procedures have been done with at least 10 milliliters of blood being spun, coming close to doubling the concentration of that whole blood, 20 milliliters, two 10s, doubling the concentration of that and down 10 milliliters and then injecting that in the corpus cavernosum and the corpus spongiosum, the way it’s explained on our website. We had great result. Then you have two double-blind placebo-controlled studies that show that it works along with other studies, and then someone did a double-blind placebo-controlled study and cut the dose in half, cut the volume in half. They used to double spin.

    So you could say, “Well, maybe they got the same number of platelets”, but when you’re trying to infiltrate the tissue of the average-sized penis, it’s why I upped it to 10. Remember? I found that that’s not enough volume to completely fill the sponge. The corpus cavernosum, as you know, is not just on the outside. A big portion of it is subdermal just like the clitoris. The first time I did the P-Shot®, it was my own penis. I was fearful of what might happen, and I spun a Selphyl kit. I got four CCs and I put two on each side of the penis about a third of the way up. You can see the volume, it plainly did not hydrodissect into the distal penis. So a couple of days later, I could see the difference.

    So then I put two injections on each side, third from the distal end and another one into the glands, and then I got a more ubiquitous spread. You can say, “Well, maybe just do one of the studies in and you run the spinal needle, thread it through the corpus cavernosum”, and inject over two minutes or whatever they did to torment those poor guys. Well, you could do that or you could just squirt enough volume in there that it hydrodissects without having to torment somebody, or another way of saying it, you could use more to spread it further instead of trying to spread it with this threaded needle tormenting torture session. Spreading a tiny bit throughout more space.

    Anyway, here’s a rep who’s not having a decade of doing this, more than a decade, and teaching literally thousands of doctors, but more importantly, getting feedback from thousands of doctors for a decade deciding it’s okay to just tell one of our people, “Oh, 20% less is fine. Don’t worry about it.” I don’t know about you. That just to me is just… I won’t even finish that sentence. … not good. If the procedure is altered, in my opinion, what I look for, because I do recognize there are dangers of very well-defined, well-known dangers to me, to my brain when I’ve been teaching something for over a decade that I’m in danger of starting to believe everything I say. I have actually altered the procedures with the help of people in our group multiple times and all of them multiple times.

    What I look for though is, “Does this innovation make sense biologically? Secondly, is it complicating it, making it more complicated than it is now without any added benefit?” Like threading one of those studies that was published, it was great, showed benefit, double-blind placebo-controlled, but they threaded a spinal needle down the corpus cavernosum when we know it spreads perfectly beautifully well as aqueous without having to do that. So does it complicate it without adding potential benefit? Does it significantly change the amounts or how it’s being done? Decreasing the volume by 20% is a significant change with no reasoning, no experience at least to compare what our group has.

    So bottom line is there’s enough profit built into these procedures for a reason. It allows you to go up on the volume. It allows you to drop a tube. It allows you to give money back when someone doesn’t think the procedure is helpful and still be profitable on the next procedure. It’s done that way. If you think about it, it’s counterintuitive too. The ethics of charging a very low price to everybody are really unethical, because it makes it such that you have trouble staying in business without keeping the money of those who are not helped. But if you have not a scary amount of profit, we’re not charging people the price of a car. We’re charging people the price of two nights in a good hotel or the price of a transmission repair or a set of tires, not even very good tires.

    So with that price point, if we still have enough profit built in that we can refund money to those who are not helped or we can go up and use three Selphyl tubes, instead of two, and still have a nice profit, then that’s better than keeping the money of those who are not helped and losing money and therefore going out of business and not being able to offer the procedure. Counterintuitive, right? You still do things for free for those who just wouldn’t have enough money to buy a new set of tires, but you don’t discount it often, because then I have seen people want their money back just because they have an unexpected bill. If they’re really that broke, you just give it to them. Again, you make enough profit to be able to do that.A book cover with a rocket launch Description automatically generated

    (33:02):

    So those are two ways that the reps can trap you, telling you can significantly change the procedure by either going down on the dosage or by not needing to add something to the plasma to activate it. I think with that, I’m going to end the call unless you guys have questions or comments. Let’s see what we got here. Several people told me that kit’s mostly used by orthopedics. Actually, the Selphyl kit was a renamed kit that used to be an orthopedic kit and then someone got the idea of rebranding the same kit. I guess these people just weren’t smart enough to rebrand it, but that’s how Selphyl was originally an orthopedic kit that they gave a different name. Redo the verbiage for the OSHA news. Yeah, I could do that.

    Let’s see. I’ll give you an outline and then I’ll type it into the chat box and then you just write this as if you were writing to a friend. The outline would be one, hello. If you just pretend like you’re writing to your mother or your best friend, sister, someone who you can imagine having incontinence that you are fond of, then the letter will write itself. Hello. Then if you would say something like, “Hope you’re having a good holiday or Merry Christmas” or whatever you say to people these days when you’re writing letters. It would be hello and then that. Then it would be the new research and the verbiage for me would be something like, “Hey, this article just came out that supports the idea that I can draw your blood and help your incontinence better than sitting around doing Kegels all day.”

    How to Team Up with a Pelvic Floor Physical Therapist

    I should mention this. If you take this article to one of your pelvic floor physical therapists and say, “I appreciate what you’re doing, but what I’m doing could make your therapy work a lot better, so we should team up together”, you may get some takers. It’s worked for many of our providers. I used to do that back in the days when I had a more active hormone replacement. I’m about to give you a big tip if you’re doing hormone replacement. I was a member of five gyms, Planet Fitness, Omni, YMCA, a 24-hour gym and a local gym. I rotated where I went. I didn’t just go there. I went and worked out there and people see me sweat there. I would get to know the different personal trainers and the people at the front desk and such.

    Then I’d start leaving my cards around with the trainers and say, “If you have someone who’s stuck, I’ll support what you’re doing on the exercise side and your exercise is going to work a lot better when I fix their thyroid and their testosterone levels. Send them my way and I’ll send them back.” I got a lot of people that way. That same thing can work with your physical therapist if you think of them like a personal trainer for the pelvic floor, and this is one of the studies you take with you to go talk with them. They want to have success too. Problem is many of them, unfortunately, sex therapists and physical therapists, they’re I think afraid of us because we think, at least in my case, I’ve had them tell me that they think that I think this is a magic shot and it makes what they do unneeded.

    Truth is oftentimes they need it more when their sex drive goes up, because say on the sex therapy side, when now her sex is outrunning the abilities and libido of her husband and his refractory period, then you have a different sex therapy than when his libido is outrunning hers. We all are worried about our livelihood and those who might threaten it. So it has to be a very cooperative thing. I’ve had people bring in their physical therapist to the gynecologist office and bring a patient with them so they can see them. The physical therapist can see the doctor doing an O-Shot®. Then you have this conversation, show them that you two could have a good working together relationship. So back to the email, the outline is hello, whatever greeting you would have. It’s so much more difficult.

    I have to train myself to do this. Even after a decade, I have to catch myself sometime. It helps to even put a picture of one person, pin it up on the screen of your computer, and pretend like you’re writing to them. But if you’re in your brain, you start writing to all your patients or all your people out there in TV land, it will sound that way and I think it’s not as effective. So a greeting that you would give to someone you’re fond of. Then this research came out this month and it supports what I’m doing with the O-Shot® for incontinence, however you would say that to your friend.

    So new research shows that our O-Shot® works better. If you put the R symbol behind it, which will [inaudible 00:38:10] by hitting Option and then the letter R. If you have a PC, I feel sorry for you that you’re still taking that abuse. So shows that our O-Shot® procedure, put the word procedure after it, that emphasizes that it’s not just squirting PRP somewhere. That it’s everything you do before and after the procedure, how you prepare the plasma before and after the actual shot, how you prepare the plasma, where you put the needle, who you treat, who you don’t treat. Everything else you do, that’s the whole procedure. It’s not just spinning blood any way and putting a needle somewhere down there between somebody’s legs.

    It shows that our procedure works better than Kegel’s for stress urinary incontinence. Then you put a link to the article, which I just gave you. So that’s the news part. Then I like to always put something that downplays the promises. It usually goes something like I know nothing treats everybody. Nothing gets everybody well, or in this case it might be I know that Kegel’s worked for many people, but oftentimes the people who need it the most can’t even do a Kegel, something like that. So you put the new idea, the news. Next part, you put a disclaimer of some kind that has to be honest humility, and then the next part is but there is some hope here. So then you put the link of the article, a disclaimer. I’m giving you an outline that it’s what I use. It works.

    Disclaimer, humility and honesty and offer to help. That’s part of it. The offer for me usually goes, if you think this might help you or someone you know, contact us, that simple. But then in the closing, put every way to contact. So that would be your email, your telephone number, fax if you take a fax, cell phone, text. If you’re doing that with your patients, which I recommend if you’re running a cash practice, they should know how to at least text you. Then there you have it. I think that answers all the questions. Let me see what else. On P-Shot® post-radiation, actually, I might can just drop it in the chat box. Hold on a second. Nope, but I can drop it in the handouts. I’m going to drop it in your handouts.

    Last journal club, I’d reviewed… No, it wasn’t the last, it’s been three weeks ago, but I finally actually did the… Good, there it is. Click that right now. It’s in the file section. I finally did the transcript. It wound up being 12,000 words and 91 references. So it took me a little time. Look, we’re not asking for sympathy. I’m just telling you, it took me a little while to get it done, but that’s the journal club we did November 21st, where I went through almost all of our procedures and did include the P-Shot®, and talked about penile rehabilitation post-prostate surgery and some of the disclaimers and what works and what doesn’t work, who to treat, who not to treat, some of the urban legends out there that’ll get you in trouble, some of the traps with all the procedures.

    If I could push a magic button without hesitation, I would pay 50 grand to make sure everybody in our group reached that. I may actually do that in some way by mailing it out, a hard copy of it. But print it out, read it, and it’ll keep you out of trouble and it’ll make you much more effective. It’ll also answer that question you just put, I think. Let me look at it again. The question about post radiation or post-surgery for prostate cancer. Okay, ideas for January and Christmas, Hanukkah marketing campaigns? I’m going to confess to you here something and then we’re going to end with this one. My confession is that I have never been able to make a December not the lowest month in my medical practice ever. That’s 20+ years of being a physician.

    In the ER days, people will stay home. It was crazy. They will stay home and the ER will be so freaking quiet. Many of you guys know this. Then all those people who were determined not to be sick but really should have come to the hospital, they had the chest pain and the vomiting for the past three days, all those people that are dehydrated, they will come to the ER Christmas day evening or the day after Christmas or the day after New Year’s, but the week before Christmas, they’ll stay home. So you get this sudden surge and I think people are just so distracted. So the holidays are so rough on people. Everybody’s missing the ones they used to see, sad, they’re broke. It’s just a tough time for grown-ups. That’s where I would see the most suicidal attempts in the ER.

    I work in a town where there’s Mardi Gras and I used to leave town during a big portion of Mardi Gras because there’s so much trauma in the ER. I always like to take vacation, just leave mobile during Mardi Gras. But in Christmastime, you don’t see that many people except the depressed broke people. So the bottom line is that when you’re talking around the last half of December, you do education, but in my opinion, mostly you’re priming people up and they’re going to call you in January, because that’s your question. Any ideas for promotions or campaigns starting in January? My first idea is start in December. So that when January gets here, you’ve already taught them what you want them to know and they will read it and they’ll think about it, but then they’ll call you after the first of the year. If you start in the first of the year, they’ll call somebody else possibly.

    Actually, David Ogilvy did that research. Scientific advertising/marketing was not a thing not that long ago. Ogilvy was one of the pioneers who made a science out of it that can be measured. One of the things he showed was that those who continued to market during the down times benefited and gained more market share. He’s looking at big companies, but it works with doctors too. They gain more market share when the downtime is over. So if you’re staying in communication with your people, not in any fake way, but just because you’re truly concerned and you want them to know the ways you can help them and encourage them, then talk to them through the holidays and you’ll start to get the calls in January.

    Once January hits, then I think you flip it and you start talking about ways to have a better new year. Very quickly you start adding in Valentine’s Day, which of course is mid-February. That becomes your topic about the importance of love and relationships. If you show up to journal club or you see the emails that come out, I’ll be giving you fresh emails to write about that and new ideas. But that’s your basic overall strategy. I think with that, we’ll call it a day. Always just amazing to me that so many smart people have interested in any word I have to say. I hope I’ve not wasted your time. Good luck with everything. You guys have a wonderful December. Bye-bye.

    References

    Charles Runels, MD. Activate the Female Orgasm System: The Story of O-Shot®, n.d. https://a.co/d/fawyO3y.

    DeLancey, J. O. “Correlative Study of Paraurethral Anatomy.” Obstetrics and Gynecology 68, no. 1 (July 1986): 91–97.

    ———. “Structural Support of the Urethra as It Relates to Stress Urinary Incontinence: The Hammock Hypothesis.” American Journal of Obstetrics and Gynecology 170, no. 6 (June 1994): 1713–20; discussion 1720-1723. https://doi.org/10.1016/s0002-9378(94)70346-9.

    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.

    Ogilvy, David. Ogilvy on Advertising. 1st Vintage Books ed. New York: Vintage Books, 1985.

    Okumo, Takayuki, Atsushi Sato, Kanako Izukashi, Masataka Ohta, Jun Oike, Saki Yagura, Naoki Okuma, et al. “Multifactorial Comparative Analysis of Platelet-Rich Plasma and Serum Prepared Using a Commercially Available Centrifugation Kit.” Cureus 15, no. 11 (November 16, 2023). https://doi.org/10.7759/cureus.48918.

    Omodei, Michelle Sako, Lucia Regina Marques Gomes Delmanto, Eduardo Carvalho-Pessoa, Eneida Boteon Schmitt, Georgia Petri Nahas, and Eliana Aguiar Petri Nahas. “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.” The Journal of Sexual Medicine 16, no. 12 (December 1, 2019): 1938–46. https://doi.org/10.1016/j.jsxm.2019.09.014.

    Pipitone, Fernanda, Zhina Sadeghi, and John O. L. DeLancey. “Urethral Function and Failure: A Review of Current Knowledge of Urethral Closure Mechanisms, How They Vary, and How They Are Affected by Life Events.” Neurourology and Urodynamics 40, no. 8 (2021): 1869–79. https://doi.org/10.1002/nau.24760.

    Popova, Maria. “10 Tips on Writing from David Ogilvy.” The Marginalian (blog), February 7, 2012. https://www.brainpickings.org/2012/02/07/david-ogilvy-on-writing/.

    Richard Maurice Bucke, MD. Cosmic Consciousness: A Study in the Evolution of the Human Mind, 1902.

    Saraluck, Apisith, Orawee Chinthakanan, Athasit Kijmanawat, Komkrit Aimjirakul, Rujira Wattanayingcharoenchai, and Jittima Manonai. “Autologous Platelet Rich Plasma (APRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI): A Randomized Control Clinical Trial.” Neurourology and Urodynamics, December 18, 2023, nau.25365. https://doi.org/10.1002/nau.25365.

    Smith, Oliver J., Selim Talaat, Taj Tomouk, Gavin Jell, and Ash Mosahebi. “An Evaluation of the Effect of Activation Methods on the Release of Growth Factors from Platelet-Rich Plasma.” Plastic and Reconstructive Surgery 149, no. 2 (February 2022): 404–11. https://doi.org/10.1097/PRS.0000000000008772.

    Smith, Stephanie A., Richard J. Travers, and James H. Morrissey. “How It All Starts: Initiation of the Clotting Cascade.” Critical Reviews in Biochemistry and Molecular Biology 50, no. 4 (July 4, 2015): 326–36. https://doi.org/10.3109/10409238.2015.1050550.

    “Trademark Status & Document Retrieval.” Accessed December 29, 2023. https://tsdr.uspto.gov/#caseNumber=90975954&caseSearchType=US_APPLICATION&caseType=DEFAULT&searchType=statusSearch.

    Tags

    communication, marketing, advertising, market share, holidays, email, patients, income, directory, patients, science, reassurance, tips, kits, PRP, platelet-rich plasma, procedures, journal club, post-radiation, post-surgery, prostate cancer, December, incontinence, research, physical therapists, cooperation, sex therapy, O-Shot

    Helpful Links

    🡪 Next Hands-On Workshops with Live Models 🡨

    🡪 Dr. Runels Botulinum Blastoff Course 🡨

    🡪 The Cellular Medicine Association (who we are) 🡨

    🡪 Apply for Online Training for Multiple PRP Procedures 🡨

    🡪 Help with Logging into Membership Websites 🡨

    🡪 Sell O-Shot® products: You make 10% with links you place; shipped by the manufacturer), this explains and here’s where to apply 🡨

     

    Charles Runels, MD

    1-888-920-5311

    Page  of


    [1] Saraluck et al., “Autologous Platelet Rich Plasma (A‐PRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI).”

    [2] Smith et al., “An Evaluation of the Effect of Activation Methods on the Release of Growth Factors from Platelet-Rich Plasma.”

    [3] Smith, Travers, and Morrissey, “How It All Starts.”

    [4] Saraluck et al., “Autologous Platelet Rich Plasma (A‐PRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI).”

    [5] Charles Runels, MD, Activate the Female Orgasm System: The Story of O-Shot®.

    [6] “Trademark Status & Document Retrieval.”

    [7] I had already written a course on how to facilitate a the female ejaculation and the O-Shot® became and expansion of that work.

    [8] DeLancey, “Correlative Study of Paraurethral Anatomy.”

    [9] DeLancey, “Structural Support of the Urethra as It Relates to Stress Urinary Incontinence.”

    [10] Pipitone, Sadeghi, and DeLancey, “Urethral Function and Failure.”

    [11] William Osler, of course, was thought to be one of the leading physicians of his day. He was a physician to Walt Whitman. Walt Whitman writes about Dr. Osler and praises him, but Whitman thought Richard Maurice Bucke, MD, was the better physician. Bucke also wrote a metaphysical text that many have found inspiring: Richard Maurice Bucke, MD, Cosmic Consciousness: A Study in the Evolution of the Human Mind.

    [12] Omodei et al., “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.”

    [13] Gözlersüzer, Yalvaç, and Çakıroğlu, “Investigation of the Effectiveness of Magnetic Field Therapy in Women with Urinary Incontinence.”

    [14] He et al., “An Effective Meta-Analysis of Magnetic Stimulation Therapy for Urinary Incontinence.”

    [15] Saraluck et al., “Autologous Platelet Rich Plasma (A‐PRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI).”

    [16] Omodei et al., “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.”

    [17] Omodei et al., “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.”

    [18] Ogilvy, Ogilvy on Advertising.

    [19] Okumo et al., “Multifactorial Comparative Analysis of Platelet-Rich Plasma and Serum Prepared Using a Commercially Available Centrifugation Kit.”

  • JCPM2023.05.30.BackPain&TennisElbow&PRP.1,000FansFor1MillionDollars

    Topics Discussed Include the Following…

    *PRP for Back Pain
    *PRP for Tennis Elbow
    *The Magic of 1,000 Fans (and the criteria that make 1 million a year)

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

    Transcript, Relevant Research, Relevant Links

    Transcript

    JCPM2023.05.30\

    Charles Runels, MD:

    Welcome to the Journal Club. Those of you who’ve been win our group for more than a year have heard me talk about this article, 1,000 True Fans. It’s a true classic in the internet world. Tim Ferris featured an edited version of this in one of his books.

    The essay went viral for the first time in 2008. It’s one of the things that I try to read at least once a year just to remind myself of some basic principles. So we’ll go over this and how I think it might actually be very encouraging to your practice, especially those of you who are trying to make the move from an insurance-based practice to an all-cash practice. I just wanted to run some numbers by you that I think will shock you and encourage you.

    But before we do this, a couple of papers. I don’t think we’ll be on for the whole hour tonight unless you guys have questions. A couple of papers that have been helpful.

    PRP is better than steroids for back pain

    First one is one that hit my blind spot regarding a question that I get frequently, has to do with back pain. And I put both of these articles in the downloadable version. If you look, if you click on the little orange button and pop it up and download it before we close the thing out, you’ll have it. This one is regarding the effect of PRP for low back pain.

    For a control, they used steroids and they had people rate their pain. And you’ll see a common theme here. I didn’t know this had been studied to the extent it has, but if you look at the references here, not too shabby. A number of papers use basically an epidural like you would with steroids.

    And this is the picture I wanted to show you: In the beginning, the steroids look great and then they fall off where the platelet-rich plasma falls off faster. So if you’re looking at a week or two out, the people who got steroids are doing better. They have less pain than the ones who got PRP.

    Next Hands-On Workshops with Live Models<—

    But then if you follow them for six months, those who got the PRP do better. Much better!

    PRP is better than steroids for tennis elbow

    Now, if you go flip over here to this one, this one has to do with tennis elbow, and they showed the same thing. In the beginning … Both of these are out within the past month. I mean, if you just go to PubMed, every week, there’s at least 20 significant papers out, just logarithmic growth of this, of the research regarding regenerative therapies.

    Let me just show you this so you see where I come up with some of this. It’s so easy because there’s so much to choose from. Let me just show you. We’ll come back to this paper. Won’t belabor it, but I want to show you something. So if you go to PubMed and you just put in platelet-rich plasma and you look at what’s come out over the years, well, let me go back to this beginning. You see this starting about 1954 and then it just shoots up, and it looks like maybe the past year or two might have leveled off some because 2022 looks like it was about like 2021. But lots of papers and when I flip through it, a lot of it is redundant. For example, this one, how many times do we need to show that a double spin makes more platelets than a single spin? We know it. Whenever I read that, I think, well, wonderful, but how does that apply to our particular indications? We know you need a certain number of platelets. Lots of research show you need a certain amount for joints.

    But we don’t have that same knowledge about most of the soft tissue medications we’re doing. And I always think, well, we don’t have to go spin platelets to heal from surgery. So obviously there’s some ideal level or maybe not. Maybe there’s just continuing returns as concentrated as you can make it with maybe some minimal effective level that makes it better than just whole blood for each of the different indications. But anyway, I’m not sure. I think maybe the people who did this study just needed more street cred for their centrifuge, so a harvest centrifuge. But how many times you need to show that you can put more platelets in a smaller space and pull out more red cells and white cells if you’re doing double spin centrifuge.

    So that’s how every week when I go through what’s out, I’m listening to what we’re doing, how does it apply specifically to our indications for our specific trademark procedures, but also what’s going on clinically versus what might be shown in the laboratory or even in a study that’s not relevant or it’s old news. That’s where I’m coming up with some of this. And if you look, there are just so many … There are pages and pages every week to choose from, and I’m somewhat arbitrary, but my hope is that I’m picking the ones that are most helpful.

    Next Hands-On Workshops with Live Models<—

    So this one caught my eye this week because it’s out just in the past month or so, and I have that question a lot. Someone has back pain, they wanted to know, well, what can I do?

    We have radiologists in our group that do that sort of thing, and some are even involved in research with stem cells, but honestly, I have lots of blind spots and this was one of them. I didn’t have a lot of knowledge about this or know that as much had been done. But there seems to be this biphasic thing that goes on or asynchronous thing, I should say, that goes on that I think is with a lot of these studies where they compare steroids. And this is the time, and the slope of the line might vary some, but this is the common theme.

    Steroids make you feel good for a week or two, but once you’re a month or two out, you’re experiencing the benefits of new healthier tissue while the steroids are wearing off and you’re just hurt again, and faster joint destruction.

    We see that theme played out over and over again, and it’s played out in the back as well as tennis elbow.

    And I didn’t even pull it up, but there was another study out this month showing that multiple injections in the knee worked better than one. I used to wonder if that was really a thing with the hair, if someone finally did this study, or the second to … if you’re doing hair every six weeks times three, maybe you don’t need the last two because it would’ve gotten better without them. But someone finally did that study. We covered it in the Journal Club, and you actually do see a better result if you give multiple treatments separated six to eight weeks apart.

    What’s the ideal separation with joints?

    I think it might be longer than the six weeks in the soft tissue studies. I don’t know. But there was a study that came out in the past month showing that three knee injections with PRP work better than one, as you might expect.

    Charles Runels, MD:

    You’re on.

    Jeffrey Piccirillo, DO:

    So, thanks for inviting me to speak.

    The guy in the United States that has done more research on this than anybody is a guy by the name of Kevin Pauza and he is at Texas Spine Institute and he has been doing intradiscal injections now for probably about the last seven or eight years and has been having some really amazing results and looking at MRIs both before and after injection and has been able to increase disc height by several millimeters with PRP injections into the nucleus pulposus . And so I think that reading the study, and I know … I’m not sure everybody out there knows, but you sent it over to me about an hour before Journal Club and I looked at it, and the one thing I couldn’t tell just looking at the abstract, whether they were going intradiscal or they were going into the epidural space, but now looking at it, I think the perfect combination would be to do both at the same setting.

    When we had patients that would come in with low back pain and no radicular symptoms, so no nerve symptoms going down the leg, usually the pain generator was the disc. And so if you could do something …

    We were doing ablations of the facet joints and things like that, but if you could treat the discogenic pain, then you could get this pain to go away. And a lot of times, that was really hard to treat.

    They were using intrathecal morphine and things like that to try to treat that pain through a pain pump.

    But now with PRP, I think we have the perfect opportunity. We can put PRP into the disc. We can put PRP into the epidural space and that way, we treat both the exterior of the disc and the interior of the disc at the same time and we can get rid of that pain generator. One of the biggest problems in orthopedics was what do you do with somebody with low back pain with no radicular symptoms? And there’s not a great answer.

    Spine fusion often is where the surgeons go, but those are fraught with all kind of havoc and bad outcomes. And so I think this is a great option.

    Charles Runels, MD:

    Yeah, I’m still not sure where you go to have it done. I have my favorite radiologist in our group that I send people to. But I …

    Jeffrey Piccirillo, DO:

    Yeah, probably the biggest guy is Kevin Pauza, P-A-U-Z-A in Tyler, Texas. He’s probably done more than anyone else.

    Charles Runels, MD:

    All right. Great. Great tip. Maybe we can get him on the call sometime.

    Marina asked, any studies to show PRP helping with trigeminal neuralgia? We actually had someone one of our classes recently that we injected hoping it might be of help, and I don’t have feedback. I’ve looked for research in that regard and I haven’t found much.

    One study done in Poland that is in Polish that just clustered it the numbers in with headaches other than migraine. So that’s definitely an area of someone wanting to do a study. We don’t have it. inaudible 00:12:39

    Jeffrey Piccirillo, DO:

    There are some studies out, Charles that show injecting the facial nerve for Bell’s palsy does bring nerve function back faster. So you would think that injecting the trigeminal nerve for trigeminal neuralgia would absolutely work.

    Charles Runels, MD:

    Yep, that’s a great point. I think the last time I counted … There’s three of those. I’ve treated one person with Bell’s palsy. I mean, who knows? It gets well on its own, anyway.

    Jeffrey Piccirillo, DO:

    Yeah, right.

    Charles Runels, MD:

    It’s one of those where a one-off, you’re not sure, but then I’ve also had a couple of people recover sensation in the face years after some sort of trauma. All right, let me go over this. Thanks for jumping in, Jeffrey Piccirillo, DO. inaudible 00:13:19.

    Jeffrey Piccirillo, DO:

    Oh, thanks, Charles. Thanks for asking.

    The Principle of 1,000 Fans

    Charles Runels, MD:

    Okay. All right, so the next thing I want to go over is this idea of 1,000 fans.

    It’s really hard to emphasize. There aren’t many things that I’ve just put on my list to read once a year. Some things you know, but they come out of consciousness and either you get unfocused or you … I’m saying maybe not you, but I. I become unfocused or think about the wrong thing and become less effective or more discouraged than I should.

    So I’m going to put this link and I recommend you go. I’m not going to copy paste it because it’s his intellectual property, but I’ll put a link to this in the chat box.

    Read about the Principle of 1,000 Fans, the Original Article<—

    I hope you’ll click it and after the call is over, you’ll just pull it up and read it, print it out, maybe read it at least once.

    Hopefully you’ll read it once a year. I’ll read to you my favorite parts. I’ll do some math that’ll take five minutes, and we’ll call it a night. All right.

    By the way, I met the man who made Taylor Swift famous. When I say … He didn’t make her an amazing performer. I mean, I’m 63. I would love to go see Taylor Swift.

    Her last concert I was reading where she did three shows in a row and altogether performed for 250,000 people, that’s crazy.

    She’s the daughter of a physician and he paid a man 250,000, ironically, $250,000 a year and it only took a couple years for this man to do what he could to promote Taylor Swift. And then once she reached a certain level, they turned her over to another agent. But when she was first starting, that’s what they did. And when you try to think about becoming a Taylor Swift or a Dr. Miami even in our field, someone who has millions of followers, it can be daunting and you can start thinking that’s what you have to do.

    But I want to do some math for you right now. I’m just going to get this out of the way. Actually, let’s read part of this first. I won’t read you the whole thing.

    To be a successful creator, you do not need millions.

    And I know you guys have probably read this whole page, but I just want to say it out loud. You don’t need millions of dollars or millions of customers, millions of clients to make a living as a craftsperson, a photographer, a musician, designer, author, animator, entrepreneur or inventor. You only need thousands of true fans.

    Now, most people in private practice … I’m going to compare this to an internist. Internist might have 3,000 charts, 5,000 charts depending on how long they’ve been in practice and an internist making 250, we’ll just use round numbers, 250 to 500,000 a year, taking that much home. I don’t mean gross, I mean taking that much home, is working pretty hard. I think we can all agree. Family practitioner, internist, they’re answering the phone a lot, seeing lots of people and they’re working pretty hard.

    So, let’s just kind of get a frame of reference about how many fans you would need on a cash-paying basis to see something like that in your practice. For those of you who are trying to move from the ER or hospitalist or your primary care and your burnout, you want to sell your practice and move to all cash, or you have a busy practice, but you’re thinking, “Well, how can I grow it?”

    All right, a true fan is defined as a fan that will buy anything you make.

    These diehard fans will drive 200 miles to see you sing. They’ll buy the hardback and the paperback and the audible version of your book.

    They’ll buy your next figurine. They’ll pay for your best DVD. They’ll come to your chef’s table once a month.

    I read that Gene Simmons put out a book, I think it cost $1,000, some outrageously huge book of just pictures of KISS performing. And he said he personally picked up the checks and took the book and mailed it, but it was a thousand-dollar book, so you don’t have to mail too many of those to make it worth walking to the post office.

    Anyway, he had those sorts of fans and inaudible 00:18:04

    I wasn’t a huge KISS fan, but they actually are up in the top five for the most moneymaking band ever.

    And he (Gene Simmons) managed his own band towards the end, said he’d never been drunk in his life, never had anything like Kool-Aid up his nose. While all of his bandmates were getting drunk and crashing cars, he was saving his money, and didn’t even buy a car until he was 35. His mom was a refugee from a Nazi war camp. He’s a very smart, hardworking businessman. Anyway, but they had … Back to the fan. They had diehard fans.

    Now, as you guys know, if you’re in medicine, you have diehard fans already, but how could you get a measure for the quantity of diehard fans you need to be able to have a practice that approaches either hardworking, internist, or prospering surgeon?

    Two Things Needed to Make it All Work

    Okay, here’s how the math works. You need to meet two criteria.

    Criterion 1: Create or Do Enough Each Year to Collect $1,000 from Each Fan

    First, (in this article) you have to create enough each year that you earn an average of $100 profit from each fan. But, with us, that’s 1,000. 1,000 to 2,000 profit from each fan is what you’re looking for, right? Yeah, it’s easier to do in our business than in some.

    Now, if you’re selling music on iTunes now, it’s not too much of a hit to sell one song. It’s always easier to give your existing customers more than it is to find new fans.

    Criterion 2: You need a direct relationship.

    No middleman. You cannot do this with an insurance-based practice.

    You must fire the pimp.

    With an Insurance practice, you have 2 or 3 middlemen.

    And this is why this is so key to cash-based doctors. You cannot live the same lifestyle when you have a middleman.

    You actually have two middlemen or three. You have somebody filling out the forms. You have someone who’s an expert at collecting the money out of your pimp, the insurance company, and then you have the insurance company.

    So you have really three people sharing your payday.

    If you have a direct relationship and they’re actually paying you, that takes out the middleman.

    All right. If you keep the full hundred dollars, then you only need 1,000 then to earn 100,000 per year, and that’s a living.

    Well, it’s a living if you have no overhead. It’s a decent living.

    And if you multiply … If you knew how many hours it would take to do that with our practice, you might have some idea, hours of your life, of how long you might need to work to accomplish the same thing.

    Again, he makes a big point. This is not an absolute number. It’s just to give you a multiplier, a factor to get some level.

    A Day’s Wages is All You Need

    His thing is the person should be willing to spend a day’s worth of their pay, whatever they make per year, a day’s worth of it per year on your stuff.

    Not a bad guideline.

    Would your patient be willing to pay one day’s worth of their take-home pay to you per year?

    Amazing Math to Change Your Life

    All right, so let me do some math for you. Hold on a second. Let me see if I can make this thing inaudible 00:21:43 for you. All right. This is where I hope it gets interesting for you.

    All right, imagine we’re just going to use a neuromodulator, and we’re going to say the person gets $500 worth per treatment. And let’s say that you’re using Xeomin or Jeuveau where you get a decent markup, and you’re going to profit from that, not counting the lights and whoever’s helping you. I’m going to get to that part. I’m not going to ignore that part. I’ll get to it. But you’re going to make somewhere around that much. This is a fairly routine treatment for neuromodulators, and that would be a fairly routine profit.

    $500/2 = $250

    Treatment every 3 months -> 4 x a year

    So, $250 x 4 = $1,000 per year

    And they come every three months, so that would be four treatments a year.

    So there’s your thousand dollars profit per year. Not a hundred; a thousand per year. They haven’t done a Vampire Facelift®.

    They haven’t done a P-Shot®. They haven’t done filler or hormones or anything else, just that. N

    Now, we can throw in a cream, and we’re going to tell you how to think about, or one way you might think about your employees in a moment.

    But let’s think, well, how much time would that take? Let’s decide that you’re like me and you like to spend time with your people. I mean, today, I had a Botox patient. I still see people, I don’t feel like I have any right teaching anything I’m not doing anymore.

    One of the ladies I saw today was from the town where they make Hatteras boats, and I have a super old, very cheap, but I love it, Hatteras boat.

    And she was telling me about Hatterases and her husband makes a lots of money designing. He’s designing somebody’s $10 million boat right now. Anyways, we talked about boats. That was fun for me learning …. She was a new patient. Learning about her and her knowledge of boats because she’s helped make them before. She’s from the town where lots of people do that. They build Hatteras boats. It helped me understand her more and it made my day better.

    The person before her was from my hometown and we talked about some dive that we both used to hang out at in Birmingham.

    So let’s say that you like to do that too. And a Botox treatment, even though you can do in five minutes, takes you 30 minutes.

    An eternity, right? A 30-minute Botox treatment is more like visiting with your mama. All right?

    So how many … If you saw them four times a year, how much time are you going to spend with them?

    That would be two hours. All right, and let’s just for … Something to get an idea about. Let’s say that you have … And the reason I’m picking this number is I noticed that my income approached what it was when I was an internist working a lot with people in the hospital answering the phone. At around 300 people on my email list, I was doing what I did as an internist.

    But let’s pick 250. So if you did 250 people times two hours, that’s 500 hours.

    All right? Now, let’s make the math easy and let’s say that you take two weeks off per year, so you only work 50 weeks out of the year.

    That means that you only have to work 10 hours a week, 500 divided by 50, that would be 10 hours.

    So 10 hours a week to take care of 250 people who are going to net you $250,000 a year.

    This is why some people make millions just doing Botox parties. It’s been done more than once.

    That’s 10 hours a week and all you’re doing is neuromodulators and you’re talking with them like they’re your lost cousin for Thanksgiving dinner. You’re not even rushing people through, and you haven’t done anything else with them.

    So where does it fall apart? Why is it so hard for people to make profit?

    It’s because they get rid of the pimp, and they get what I call … Okay, I’m just going to give you an Alabama term. I think that some people make blood, and some people are what I used to pull off of my bird dogs behind the ear.

    They would get this thing called a tick, and those ticks would get so fat from sucking the blood out of my dog.

    By the way, if you want to know how to get a tick … This is an old ER trick. If you want to get a tick off of you without leaving its innards into your skin. Actually, I didn’t learn this as the ER doctor. I read it in a Red Cross book when I was about seven years old after getting a tick on myself. You just pour a little motor oil on it. Since the tick breathes through its skin, it starts to suffocate. It lets go and try to just … crawls away. So there you go.

    Anyway, some people make blood and some people suck blood.

    And in my opinion, every employee, if you look at the numbers, you should only be spending somewhere around 20% of your money, your gross, on employees.

    So what I tell my employees is that when you’re bringing in five times what I’m paying you in gross, because by the time I pay your taxes and I buy your insurance, and I buy the place where you sit and the space where you stand in the office to do whatever it is you do and pay taxes on the money you bring in, I can’t really afford to pay more than 20 to 25% on employees. So that’s their guide. When they’re making 5X what they’re bringing in, it’s time to ask for a raise. If I’m paying them … If that number’s out of kilter and they’re only bringing in $100 metaphorically and I’m paying them 50, their job is at stake.

    And of course, so what happens is everything in your office should be that way. And the reason people struggle is they have machines that are eating away at their income, not bringing them 5X or even equal to what they’re paying for the machine.

    They have people that are costing them more than they’re bringing in. And then you have people driving around in their sports car making a cool million dollars a year with no overhead, basically just doing Botox parties.

    So that’s a long way of saying if you’re trying to go all cash and you can keep your overhead reasonable … Now, if I can have an employee that makes me 5X what I’m paying them, another 20%, in other words, then I’d like to have 10 more like that employee, as long as there’s enough business to go around.

    Right?

    And so they’re your nurse practitioners and your estheticians and such.

    Now, the hospital used to call an ER a money loser because, in the scheme of a hospital, so many people come through that are non-payers, but they had sometimes to lose money in the emergency room because they had to have one or they couldn’t be a hospital. And you may need someone who answers the phone that doesn’t do any selling, but as much as possible, try to make sure everyone in your office has a job that brings … something they’re doing is bringing in 5X what you’re paying them.

    Maybe it’s they’re calling and doing reminders and bringing back people that would’ve not re-booked or that missed their appointment, so they get back in, and that’s money too that would’ve been lost.

    So I’m not here to try to be the success guru. Most of you are already making lots of money, and all of you are successful, or you wouldn’t even be a part of our group. But the point I’m making is for the new people, you can see, can reach the 250,000 a year mark working 10 hours a week just doing Botox if you keep your overhead low.

    Let your business pay for your business. And if you want to make a million a year, okay, work 40 hours a week, and by then, you’re going to have to have some employees. But let the person answering the phone also sell the cream or do facials or something.

    They’re on the phone answering and selling people into coming to see you that you don’t have time for.

    Okay, that’s all I have to say about all that. Let me see if there are any questions. If not, we’ll call it a night, but I hope that you’ll click on that link that’s in the chat box.

    Okay, I think that’s it. Hopefully, there was something helpful tonight. Grow your list. Have a list, grow it, watch your overhead, and have a good time.

    You guys have a good night. Goodbye.

    Relevant Research

    1.
    Hohmann E, Tetsworth K, Glatt V. Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet rich plasma at 1 month but platelet rich plasma is more effective at 6 months: An updated systematic review and meta-analysis of level 1 and 2 studies. Journal of Shoulder and Elbow Surgery. Published online May 2023:S1058274623003956. doi:10.1016/j.jse.2023.04.018
    2.
    Singh G, Talawar P, Kumar A, Sharma R, Purohit G, Bhandari B. Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomized controlled trial. Indian J Anaesth. 2023;67(3):277. doi:10.4103/ija.ija_821_22

    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 <–

    Dr. Runels Botox Blastoff Course<–

    –> 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

  • 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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