Tag: platelet rich plasma

  • JCPM2025.05.13

    Journal Club with Pearls & Marketing 2025.05.13                   Cellular Medicine Association

    JCPM2025.05.13

    The following is an edited transcript of the Journal Club with Pearls & Marketing (JCPM) of May 13, 2025, with Charles Runels, MD.  

    >-> The PDF of this live journal club can be seen/downloaded here <-<

    Topics Covered

    • What You Should report When You study PRP Procedures (or What Should You Look for When You Wish to Duplicate Research Findings)?
    • Shock Wave for ED: Which is Best, Radial or Focused?
    • Propaganda About Marketing
    • An Email Template to Use for Any Procedure
    • References
    • Helpful Links
    Charles Runels, MD

    Charles Runels, MD
    Author, researcher, and inventor of the Vampire Facelift®, Orchid Shot® (O-Shot®), Priapus Shot® (P-Shot®), Priapus Toxin®, Vampire Breast Lift®, and Vampire Wing Lift®, & Clitoxin® procedures.

    Transcript

    Welcome to our journal club.

    We have three papers that came out this week that, I think, you’ll find helpful.

    What You Should report When You study PRP Procedures (or What Should You Look for When You Wish to Duplicate Research Findings)?

    The first paper considers a problem that has been talked about quite a bit on our journal club: what are the important variables that should be reported when doing studies regarding PRP use in soft tissue. These variables are well defined in orthopedic studies but not so well defined for soft tissue studies.[1]

    Though we talk about joint procedures here in our journal club, mostly we’re talking about soft tissue with aesthetic and sexual medicine. And a way to get to those answers with research is to report a consistent and complete spectrum of variables when we do studies.

    This article was about what those variables might be so that, in theory, when someone publishes something, we can go duplicate it with our patients or with future research.

    So, the gist of it was that we should include the platelet count, the white blood cell count, the red blood cell count, and they talk about some of the classifications we’ve covered in journal club quite a number of times.[2] [3] [4] [5] [6] [7]

    If you just log into the membership site and put PRP classification, you’ll pull up some of those ideas. And what they call establishing minimal reporting requirements.

    => Apply for Online Training for Multiple PRP Procedures <=

    When I taught in Serbia, they did cell counts at the bedside. We usually don’t check CBCs if they’re healthy. I don’t. If someone comes to me for a P-Shot®, they’re a young, healthy person, I don’t do a CBC on them usually, and same with an O-Shot® or a Vampire Facelift®.

    But when we do studies, I think it’s important that we report these variables and not just which kit we use, which could be done, of course, with some little extra expense and trouble.

    And I’m guilty of having done studies without reporting this. I’ve only reported which kit I have used and not as suggested here.[8] [9] [10] [11] [12]

    So, I won’t dwell on it. But some of you’re doing research, and I think it’s a reasonable observation that we should be doing this.

    Shock Wave for ED: Which is Best, Radial or Focused?

    The next one has to do with shockwave. Many of you are combining shockwave with your P-Shot® procedure. There are several devices out and I’ll show you a recent review article that is attempting to give you an idea about which one might work the best.[13]

    If you remember, about three weeks ago there was a review article looking at the combination of shockwave with our P-Shot® or some variation on the P-Shot® with a definite synergy documented.[14] The two together definitely work better for ED than shock wave alone.

    They didn’t actually look at PRP alone versus PRP with shockwave, so there was not that third arm. But the shockwave with PRP worked better than shockwave alone.

    In the article we are considering today, they went looking for the best of studies, and the bottom line is that the focused seems to work better than radial.[15]

    They say, “We postulate that focus shockwave therapy should be considered as one of the treatment modalities, either as a single or combined treatment with medications and exercise.” So interesting that even with the stack of research we have now,[16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33]  [34] [35] [36] [37] including the recent article about the combination therapy, they couldn’t bring themselves to mention our P-Shot® procedure—medications and exercise, but nothing about our P-Shot®.

    I wrote a summary of some of the bias that leaves our P-Shot® out of current protocols after the JAMA article correction was made.[38] [39]

    Anyway, focused seems to work best, but they both work.

    => Apply for Online Training for Multiple PRP Procedures <=

    If you’ve got the radial, then it’s working too, but as soon as you can, I’d swap it out for a focused linear shockwave.

    Okay. And so if you happen to have a focused linear shockwave therapy device, then I would brag about it by sending a link to this paper (it is an open-source article). I’ll copy and paste that into the chat box.

    You could send that to your people in an email and say, “Hey, I have one of these and I do the P-Shot® along with it.”

    And always, I like to do the energy first and then PRP. I know some have reversed it. Still get great results, but most of us are doing shockwave then a P-Shot®.

    It can be in the same visit, but shockwave, P-Shot® or it could be shockwave, shockwave, shockwave, and then a P-Shot® immediately after the third shockwave if you’re going to do a series. So that’s it. I won’t dwell on it, but it’s a feather in your cap if you’re already have a focused that you could brag about.

    Propaganda About Marketing (Rules for Breaking the Arrows Aimed at You)

    Okay, and let’s look at this last paper.

    This one is very political and anytime you are doing something for cash, you’re by definition, doing something political. Because I think, it’s very useful to acknowledge the fact that if you’re collecting cash, you draw a target on your back for those physicians who do not bill cash, most of them resent it.

    So, it’s good to look at the arrows that might be in the quiver of the person who might consider aiming at you. And if you’re following our recommendations about how to talk about our procedures, then you will be doing what you need to do to make things right with those who might criticize us.

    In this article, Maintaining Truth in the Era of Misinformation, [40] the first thing that jumps out at me is the word I I hate, “misinformation.” You’re either telling the truth, or you’re lying, or you are saying something that I am unsure about (I neither know if it is true or false).

    But what is “misinformation”? It’s either the truth or a lie.

    If I think it may be true, but I do not like it and want to call it false, I call it “misinformation.”

    And I think people in general, when they use that word are afraid to say “lie” when it’s a lie or they’re wanting to make the truth look like a lie. But to me, it’s a wishy-washy word that I don’t like, but that doesn’t matter (that I think of the word) I don’t guess in the big scheme of things, but that’s what I think when I see that word.

    Maintaining the truth in the era of lies or maintaining the truth in the era of truth that you don’t particularly like so you’re going to call it misinformation.

    I don’t know what that word means. But let’s dive into the points that are made and see what we can do.

    One more background thing that’s probably more important than what I just said, is that doesn’t if you are accepting cash, you should by definition, do something for the person that the doctor taking insurance cannot do, or at least is not choosing to do because insurance pay for it.

    Take it one more level and meditate on this: A doctor who chooses to only do what insurance reimburses for, a doctor who chooses to only do that for which reimbursement can be obtained by insurance, that doctor who is letting insurance define the spectrum of available therapies. If insurance doesn’t pay for it, she doesn’t offer it. Therefore, insurance is defining the spectrum of available therapiesThat to me, is by definition, the tail wagging the dog.

    In my opinion, we should read the research, decide what might be helpful to our patient who is sitting in front of us suffering, who may not at 65 years old, my age, have time for 20 more years for insurance to finally decide they’re going to pay for platelet-rich plasma to help with erectile dysfunction.

    Which has almost zero risk, many potential upsides based on now a stack of research that goes back 20 years showing neovascularization and neurogenesis, which are good things in the penis.

    So that background, I think, when you read criticism of doctors who take cash for medical procedures is worth remembering.

    If you’re not doing that, you’re letting the CPT, the insurance codes define what you will do. And remember, there are not any insurance codes for some of the sexual dysfunctions seen in women. If you’re doing surgical repair that corrects some of the causes of anorgasmia in a female, you’re having to fiddle with the codes to get that paid for.

    You’re having to fiddle, waste your time and money and energy to play the insurance game instead of just doing what you know is right for the person.

    Okay. That’s the background, in my opinion, that overlays this wishy-washy article that could have been written by the CEO of Blue Cross Blue Shield.

    But let’s go through it and see, examine the arrows in the quiver of those who might aim for you. And, I’ll get to how our group helps with this: “In today’s digital era, media platforms such as YouTube have become dominant sources of health information, yet much of the content on orthobiological treatments, such as PRP is low-quality, misleading, and unreliable.”

    Okay, you said it, now, let’s prove it. See if they do.

    “Commercial incentives and algorithm-driven content promotion allow misinformation to outpace evidence-based guidance.”

    Okay, still a statement. Prove it. You’re telling me there’s no commercial incentives. And then ads every commercial break (when you watch the news or sports) about ED medicines and rheumatic or rheumatology medicines, there’s always commercial incentives.

    =>Next Hands-On Workshops with Live Models<=

    “Despite this field’s promising therapeutic potential, the unchecked spread of digital misinformation threatens patient understanding, informed consent, and trust in medical care.”

    Okay, you’re still preaching, but prove it.

    “Given digital media’s profound influence, it is an ethical and clinical imperative for academic and medical communities to intentionally produce successful high quality evidence-based content.”

    Rule 1

    That’s what I’m talking about, evidence-based content. So, one of the rules when you’re making your video is to talk about the research.

    Note: I’m not a big fan of YouTube because they are prone to censoring anything about sexual medicine, but I know many of our people in our group have large followings on YouTube.

    Talk about the research.

    Rule 2

    Always say, always, every time, somewhere if I’m speaking, I’m going to say, “There’s no guarantee that any therapy will work every time.”

    Rule 3

    Other things that you do is on your website, on the webpage where you talk about the P-Shot®, have a link to your consent form, which can be based on ours, which pretty much lists everything that could go wrong with the penis, as does the consent form for the O-Shot®.

    Things we’ve never seen happen. Most of it we’ve never seen happen but we list it because we don’t know.

    Have you’ve ever seen all the possible complications in the package insert for Viagra or Cialis or any other medicine really? So, people expect you to warn them that pretty much anything could happen.

    So there’s your first clue to what should be your subject do unlike this person has done so far, and give evidence for what you’re saying.

    => Apply for Online Training for Multiple PRP Procedures <=

    Okay. So there’s a study that says, “‘YouTube is an inconsistent source of information,'” offers compelling and necessary examination.”

    “The majority of YouTube videos addressing orthobiologic treatments, substandard quality.”

    By who’s ruler, “unregulated,” as it should be for freedom of speech, “poorly sourced.”

    I agree with that. Whenever we say something, we should back it up with the research, “and critically lacking in comprehensiveness.”

    Okay, well, I’m not sure what to say to that. How much do you need to say to be comprehensive, right?

    Let’s say you’re going to talk about ED. If you talk about the studies regarding platelet-rich plasma, do you also need to talk about PRP and do you need to talk about all 30-plus cytokines and growth factors that are in the platelets and how they’re activated and how cells grow and how stem cells, pluripotent stem cells migrate to the area and how the cytokines work.

    Obviously, any simple thing can be expanded to require a whole encyclopedia to explain it. 

    So I think, the answer to that is that you talk about the research at hand and you let the references to that article take care of all the back comprehensiveness, and you have your consent form on your page about it.

    “Not surprising, orthobiologics exists with a therapeutic gray zone where scientific promise meets regulatory ambiguity.”

    As you guys know, there’s no FDA control over your blood and your spit and your urine and your hair and your skin, those all belong to you.

    So, if it’s minimally manipulated, autologous and homologous use comes from your body, it’s used in your body and I don’t do much to it and I’m using it for its intended purpose, then it’s not the government’s business. It’s your business and your doctor’s business.

    “33% of the reviewed videos were uploaded by independent users.”

    Great. Should doctors not be able to speak with their patients?

    “With only 1% originating from government or news agencies.”

    God help us if we get all of our medical stuff from the news, “highlighting a significant void left by the academic and medical communities in public education.”

    The medical community is you.

    And so we’re going to talk in a minute about emails, but this is how you stay solid. As you talk about the research, you have a good consent form and you talk as if you are speaking to your patient about the possibilities, about the realities. For example, you can’t fix iliac arterial disease with a shot in the penis. You can’t fix a spinal cord injury resulting in ED with a shot in the penis.

    Although, we did have a study that showed that 40% of people with that and other serious problems of ED not responding to PDE5 inhibitors did achieve erection when the penis was injected with botumlinum toxin combined with the PDE5 inhibitor.[41] So that’s an example of not over promising, but quoting the literature and a solid video by you as part of the medical community.

    “The most concerning was observation that neither video verification status nor uploader identity significantly correlated with content quality.”

    I don’t even know what that means. “

    The illusion of authority granted by high view counts, polished production and self-proclaimed expert labels, impossible for lay audience to discern.”

    Here’s how to think about this: You’re really only talking to your patients.

    Others will listen in. My best example is that one of my YouTube videos, excuse me, one of my YouTube channels completely disappeared.

    Had 140 plus videos on it. If you consider that you spend sometimes a few minutes, but often a few hours to make one. Well, that’s the best part of a half of a year’s work, not counting the other time that might’ve gone into researching it.

    And one of them was a simple little video showing how to give yourself a testosterone injection in the lateral thigh. And 240,000 people had watched it before the video was taken down because one of my videos about how to mix growth hormone, which was made for my patients who were involved in the IRB approved study, was labeled by YouTube as promoting illegal drug use.

    But my point is, obviously I don’t have 240,000 patients, but I was making that for my patients so that when I showed them how to do their own testosterone injection, they could remember it by just looking at that video the next time they needed to give themselves a shot. So, you’re really talking to your people and others will listen in.

    You’re really talking to one of your patients who might have a problem and you talk to that one patient and then the next patient that has that problem that belongs to you will watch it. And if it’s a really good video, others who have that problem will watch it. So, you’re labeled an expert, is what I’m getting at, for good reason because you are the physician of that patient, of that person.

    And others will listen in. Maybe 240,000 of them will.

    Rule 4

    And of course, you have a disclaimer that you’re not their doctor. This is for your patients. And if I’m not your doctor, watching this video doesn’t make me your doctor. Somewhere that’s in a script or in the description or something.

    So, you can tell this person writing this obviously once they’re not a big fan of TikTok, I don’t think. And the implications… So, list a couple more clues about how to make your stuff and then I’ll give you my template.

    “The implications for patient education are profound with non-verified sources drowning out the few authoritative health organization-based sources available.”

    Implication that we should just be watching what some organization puts out?

    “Patients seeking information are frequently exposed to low quality, unreliable, less comprehensive content to the natural minimally invasive therapies.”

    And why not?

    Yes. “But this tendency makes patients more susceptible to unverified claims.”

    Okay, let me skip down here.

    “Patients entering consults with preformed opinions molded by persuasive online narratives.”

    As if that fricking ad on the Superbowl is not molding opinions? That video of the woman smiling, jumping in the swimming pool with her skin cleared up from psoriasis and birds are flying and butterflies are in the background. That’s not molding opinions?

    And somehow that’s okay for that company to spend 10 million bucks on a TV ad, but you can’t make a YouTube video for your patients. So yeah, we are molding opinions, but always by educating people about the research and what we know about how to take care of them.A book cover with a rocket launch Description automatically generated

    Another way to say that is that it’s not the responsibility of your patient to know what you’re able to do. It’s our responsibility to teach them and to have the courage to do it, always referring to the research.

    One more thing and then I want to stop. That’s more about the FDA thing. Okay, here we go. This is really the heart of what’s got this person angry.

    “Patients are following extravagant claims and paying hefty fees for unregulated, potentially even dangerous or fraudulent treatments that are not backed by strong evidence.”

    Okay, that’s a political preaching statement right there. What’s extravagant? What’s a hefty fee? Our initial P-Shot® is 1,800 bucks and then if it’s a new patient, it’s around 1,000 for repeated treatments. A series of six Xiaflex treatments for Peyronie’s disease, if you had to pay for it instead of insurance paying for it would cost around $27,000.

    So, and if your Xiaflex happens to cause a penile fracture, which is understandable, you might wind up needing a penile implant for $10,000 (total $37,000).

    I don’t begrudge the money for the drug. The companies recover their research and development. The urologist deserves every penny of that penile implant.

    Every penny of it. I think it should cost twice as much or more.

    But a massage therapist at the hotel on the bay near where I live makes $350 per hour and a half massage. And that’s a six-month course. And nobody calls you at night and there’s nothing serious could possibly happen versus okay, 1,000 bucks, three times that for a P-Shot®, and you have to know how to handle the blood safely.

    You have to know how to talk with a person to make sure they’re a potential candidate and follow up with them. You spend an hour of your time or more on that first visit, and you don’t deserve $1,000 versus 350 for a massage versus $27,000 for Xiaflex?

    So, this is a political ranting in my opinion, but let’s look at the errors that he’s asking us to go put stuff out there but he’s also definitely a company, organization person.

    Rule 5

    So, there was one thing I was looking for. He talks about protocols, okay? Having a protocol, which we do. Here we go.

    “Scrutiny should be employed to indicate trusted health sources and flag promotional material, lacking scientific backing.”

    Who’s going to decide that flagging? I think that should be left up to our patients to decide whether they believe something or not and let them flag it.

    But I just told you I got flagged and lost a whole channel because some, I don’t know, some little college co-ed somewhere working for YouTube decided my video, which was part of a research protocol explaining to my patients how to mix growth hormone. And I’m a licensed doctor with a licensed pharmacy in my office. Somehow I’m encouraging illegal drug use.

    Like Larry Flynt said when Jerry Falwell sued Larry Flynt; Flynt took him to the Supreme Court because he said, “I could have settled for 150 grand. But you must take up for the right of people to say things you do not want to hear. Once they get to where they can censor you, they will take away the things you need to hear.”

    So anyway, thinking people are too stupid to look at a video and decide whether this is real or not. Long as they can’t go do it themselves, they need to get to a doctor, you’re never going to get a P-Shot® on Amazon One.

    You can’t get it through a video.

    So, as long as we’re regulating who actually is licensed to do our P-Shot®, which we do through our Cellular Medicine Association, and as long as you’re talking about the research and you have a consent form on your website that tells every possible thing that can go wrong with somebody, even though we haven’t seen any serious sequelae of granulomas, no necrosis, you still put all those possibilities because who knows, maybe it could happen.

    Rule 6

    The other way to break one of the arrows in the quiver of the person who likes to talk about misinformation (because they’re too cowardly to call something a lie or to discover if it is true) is that they’re worried about the money you’re going to make so: make sure that you have a money back guarantee that breaks that arrow. You must tell everybody that you have to love what I’m doing or I won’t keep your money.

    Now that arrow is completely broken (as an example) because you’re charging less than Xiaflex, way less than an implant, much safer than a PDE5 inhibitor, and you are not keeping the money if they don’t love what you did. So, all the arrows are broken.

    And so I think, let me end this. I just wanted you to see what’s being said in this era: where people are afraid to say the word “lie” and they want to, because they’re not sure if it’s a lie or not, they just don’t like it.

    I say it’s either the truth or it’s a lie or “I don’t know”—it is never “misinformation.”

    You said something, I don’t know if it’s the truth or not, but I’m not going to label it some stupid word like misinformation.

    An Email Template to Use for Any Procedure

    Okay. So, let me show you, let me swap over and show you a really nice template to do some of these educational type things for your patients. That’s who you’re talking with.

    Okay, let’s go to this template and then I’ll call it a day. I think you’re going to love this. Just a moment.

    Okay, I’m inside over the course that I spent a 8 weeks doing; I call it my
    5-Notes course

    And in this ninth lesson, I have email templates.

    I’ll put them to where you can see them (see the video). So there’s 26, so you could send out one every other week for a year by just filling in the blanks and have a very well thought out email campaign.

    Most people have trouble staring at a blank page, but if I can give you an outline, then you can roll with it. And it’s all in your brain.

    I don’t have to make you smart (because you already are smart), but if I can unblock you so that you’re just able to get out of your brain what’s in there, you will have all of the writing material you would ever need for books and articles and web pages and magazine articles and news reports and standing on stage…by just getting it out of your head.

    So, here’s a nice example. “Jumpstart your writing and keep your readers in the know by identifying trends in your niche. Let’s say you’re an expert on we’re going to use cars. Know everything there is. But you want to expand your writing repertoire, finding writing about”…

    Okay, “In order to identify trends in your niche, find out what other people know.”

    So, this is what we just did. You go to PubMed, it’s a good example. And you do, instead of searching the news, you just search PubMed. You could go to Google and put in incontinence or ED or dyspareunia, whatever it is you’re treating.

    I usually go platelet-rich plasma and I look for problems that we talk about dyspareunia and urinary incontinence and such. You can also go to the Google, you can just ask Google for Google trends and see what is trending.

    And then you start with the headline.

    Write about the trend, starting with the headline that has to do with it and then with a question mark. And there you go.

    There’s your outline. “Provide examples of the trend, if the trend is for something the reader can take advantage of.”

    So, we talked about, as an example, we talked about the article about radial versus focused shockwave. So that trend would be that people are going towards focused shockwave. You could put that out and you could talk about that trend and send it out there. So, there’s your title, there’s your outline for it, where you got it.

    Your conclusion would be that yes, shockwave combined with PRP within our P-Shot® protocol works very well and the trend is towards focused and we have a focused shockwave.

    There you go. So there’s, let me download this and send it over to you.

    Of course, if you have… I’m not going to go through all 26 of them, but if you have the course you would have one for… Maybe I’ll do one next week, I’ll do another one. But let’s see. Pull this up and I’ll put it in your download section. And then if you have no questions, we’ll call it a day. Here we go. Okay, there it is.

    So, you have that outline for an email you could do. Of course, you could just keep doing that one every other week. But I think, part of what happens is if you go through the exercises in that course, or if you just subscribe to my emails on one of the membership websites, go to the Priapus Shot® website or the O-Shot® website, subscribe to those emails and rewrite them.

    After you do a few times, you get the hang of it, and you’ll be able to do marketing in such a way that your patients want to see what you’re teaching them, and you’ll do it in such a way that you’re not, you’re allowing that person with a quiver full of anger to shoot his stuff at you, calling you misinformation.

    Let’s see if there’s any questions. If not, we’ll call it a day. Okay. Hope that was helpful to you. I’ll give you another second or two to download that outline for an email. And I guess, that’s it. Have a great week. Thank you for being on the call.

    => Apply for Online Training for Multiple PRP Procedures <=

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    References

    Anastasiadis, Eleni, Razna Ahmed, Abbas Khizar Khoja, and Tet Yap. “Erectile Dysfunction: Is Platelet-Rich Plasma the New Frontier for Treatment in Patients with Erectile Dysfunction? A Review of the Existing Evidence.” Frontiers in Reproductive Health 4 (August 16, 2022): 944765. https://doi.org/10.3389/frph.2022.944765.

    Banu, S. Amitha, and Khan Sharun. “Minimum Reporting Requirements for Platelet-Rich Plasma in Biomaterial Research.” Biomaterials Advances 175 (April 9, 2025): 214314. https://doi.org/10.1016/j.bioadv.2025.214314.

    Brandeis, J, S Lu, R Malik, and C Runels. “(130) Increasing Penile Length and Girth in Healthy Men Using a Novel Protocol: The P-Long Study.” The Journal of Sexual Medicine 20, no. Supplement_1 (May 22, 2023): qdad060.125. https://doi.org/10.1093/jsxmed/qdad060.125.

    Chung. “A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction.” Medical Sciences 7, no. 9 (August 29, 2019): 91. https://doi.org/10.3390/medsci7090091.

    Chung, Doo Yong, Ji-Kan Ryu, and Guo Nan Yin. “Regenerative Therapies as a Potential Treatment of Erectile Dysfunction.” Investigative and Clinical Urology 64, no. 4 (July 2023): 312–24. https://doi.org/10.4111/icu.20230104.

    Chung, Eric. “Medical Sciences A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction,” 2019, 1–11.

    DeLong, Jeffrey M., Ryan P. Russell, and Augustus D. Mazzocca. “Platelet-Rich Plasma: The PAW Classification System.” Arthroscopy: The Journal of Arthroscopic & Related Surgery 28, no. 7 (July 2012): 998–1009. https://doi.org/10.1016/j.arthro.2012.04.148.

    Du, Shaokang, Shiwei Sun, Fuyu Guo, and Hongyao Liu. “Efficacy of Platelet-Rich Plasma in the Treatment of Erectile Dysfunction: A Meta-Analysis of Controlled and Single-Arm Trials.” PLOS ONE 19, no. 11 (November 14, 2024): e0313074. https://doi.org/10.1371/journal.pone.0313074.

    “Errors in Text.” Accessed May 15, 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798201.

    Fermín, Theodorakys Marín, Jacob G. Calcei, Franco Della Vedova, Juan Pablo Martinez Cano, Claudia Arias Calderon, Mohamed A. Imam, Miguel Khoury, Markus W. Laupheimer, and Pieter D’hooghe. “Review of Dohan Eherenfest et al. (2009) on ‘Classification of Platelet Concentrates: From Pure Platelet-Rich Plasma (p-Prp) to Leucocyte- and Platelet-Rich Fibrin (l-Prf).’” Journal of ISAKOS, August 2023, S205977542300545X. https://doi.org/10.1016/j.jisako.2023.07.010.

    Finkle, Alex L. “Sexual Impotency: Current Knowledge and Treatment I. Urology/Sexuality Clinic.” Urology 16, no. 5 (November 1980): 449–52. https://doi.org/10.1016/0090-4295(80)90592-0.

    Francomano, Davide, Stefano Iuliano, Federico Dehò, Paolo Capogrosso, Piergiorgio Tuzzolo, Sandro La Vignera, Gabriele Antonini, and Antonio Aversa. “Regenerative Treatment with Platelet-Rich Plasma in Patients with Refractory Erectile Dysfunction: Short-Term Outcomes and Predictive Value of Mean Platelet Volume.” Minerva Endocrinology, September 2023. https://doi.org/10.23736/S2724-6507.23.04060-5.

    Garcia, MM, TM Fandel, G Lin, AW Shindel, L Banie, CS Lin, and TF Lue. “Treatment of Erectile Dysfunction in the Obese Type 2 Diabetic ZDF Rat with Adipose Tissue-Derived Stem Cells,” 2010, 14.

    Geyik, Serdar. “Comparison of the Efficacy of Low-Intensity Shock Wave Therapy and Its Combination with Platelet-Rich Plasma in Patients with Erectile Dysfunction.” Andrologia 53, no. 10 (2021): e14197. https://doi.org/10.1111/and.14197.

    Giuliano, Francois, Pierre Denys, and Charles Joussain. “Effectiveness and Safety of Intracavernosal IncobotulinumtoxinA (Xeomin®) 100 U as an Add-on Therapy to Standard Pharmacological Treatment for Difficult-to-Treat Erectile Dysfunction: A Case Series.” Toxins 14, no. 4 (April 16, 2022): 286. https://doi.org/10.3390/toxins14040286.

    Goldstein, Andrew T., Michelle King, Charles Runels, Meghan Gloth, and Richard Pfau. “Intradermal Injection of Autologous Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus.” Journal of the American Academy of Dermatology 76, no. 1 (January 2017): 158–60. https://doi.org/10.1016/j.jaad.2016.07.037.

    Hinojosa-Gonzalez, David E, Gal Saffati, Daniela Orozco Rendon, Troy La, Shane Kronstedt, Akhil Muthigi, and Mohit Khera. “Regenerative Therapies for Erectile Dysfunction: A Systematic Review, Bayesian Network Meta-Analysis, and Meta-Regression.” The Journal of Sexual Medicine, October 17, 2024, qdae131. https://doi.org/10.1093/jsxmed/qdae131.

    Hu, Shaohua, Zhenli Zhao, Zhisheng Wan, Weizhen Bu, Songqiang Chen, Tianhong Han, and Yiqun Lu. “The Effect of Platelet-Rich Fibrin on the Biological Properties of Urothelial Cells.” Scientific Reports 14, no. 1 (October 18, 2024): 24527. https://doi.org/10.1038/s41598-024-75699-1.

    Javier, Angulo, Fernández-Pascual Dr. Esaú, Curvo Dr. Raphael, Fernández Dr. Argentina, Bueno José Luis, Martínez-Salamanca Juan Ignacio, and Instituto de Salud Carlos III Funding: Ministry of Economy and Competitiveness and co-financed by FEDER funds PI17/02001, Spanish Government. “(219) AUTOLOGOUS PLATELET-RICH PLASMA IMPROVES ENDOTHELIAL AND TADALAFIL-INDUCED RELAXATIONS IN CORPUS CAVERNOSUM FROM PATIENTS WITH ERECTILE DYSFUNCTION.” The Journal of Sexual Medicine 20, no. Supplement_4 (July 1, 2023): qdad062.007. https://doi.org/10.1093/jsxmed/qdad062.007.

    Magalon, J, A L Chateau, B Bertrand, M L Louis, A Silvestre, L Giraudo, J Veran, and F Sabatier. “DEPA Classification: A Proposal for Standardising PRP Use and a Retrospective Application of Available Devices.” BMJ Open Sport & Exercise Medicine 2, no. 1 (February 2016): e000060. https://doi.org/10.1136/bmjsem-2015-000060.

    Masterson, Thomas A., Manuel Molina, Braian Ledesma, Isaac Zucker, Russell Saltzman, Emad Ibrahim, Sunwoo Han, Isildinha M. Reis, and Ranjith Ramasamy. “Platelet-Rich Plasma for the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” Journal of Urology, April 30, 2023, 10.1097/JU.0000000000003481. https://doi.org/10.1097/JU.0000000000003481.

    Matz, Ethan L, Amy M Pearlman, and Ryan P Terlecki. “Safety and Feasibility of Platelet Rich Fibrin Matrix Injections for Treatment of Common Urologic Conditions.” Investigative and Clinical Urology 59, no. 1 (January 2018): 61–65. https://doi.org/10.4111/icu.2018.59.1.61.

    Narasimman, Manish, Max Sandler, Ari Bernstein, Justin Loloi, Russell G. Saltzman, Helen Bernie, and Ranjith Ramasamy. “A Primer on the Restorative Therapies for Erectile Dysfunction: A Narrative Review.” Sexual Medicine Reviews, March 17, 2024, qeae012. https://doi.org/10.1093/sxmrev/qeae012.

    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.

    Olsen, Reena J., Ishan T. Modi, and Prem N. Ramkumar. “Maintaining Truth in the Era of Misinformation.” Arthroscopy: The Journal of Arthroscopic & Related Surgery, May 2025, S074980632500355X. https://doi.org/10.1016/j.arthro.2025.05.001.

    Posey, Kathleen, and Charles Runels. “In-Office Surgery and Use of Platelet Rich Plasma for Treatment of Vulvar Lichen Sclerosus to Alleviate Painful Sexual Intercourse.” Journal of Lower Genital Tract Disease 19, no. 3 (July 2015): S1–25. https://doi.org/10.1097/lgt.0000000000000121.

    Poulios, Evangelos, Ioannis Mykoniatis, Nikolaos Pyrgidis, Filimon Zilotis, Paraskevi Kapoteli, Dimitrios Kotsiris, Dimitrios Kalyvianakis, and Dimitrios Hatzichristou. “Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.” Journal of Sexual Medicine 18, no. 5 (May 1, 2021): 926–35. https://doi.org/10.1016/j.jsxm.2021.03.008.

    Ramadhani, Taufik, Syah Mirsya Warli, Ramlan Nasution, Dhirajaya Dharma Kadar, and Muhammad Haritsyah Warli. “Comparative Effectiveness Radial Shockwave Therapy versus Focused Linear Shockwave Therapy as an Erectile Dysfunction Treatment Systematic Review and Meta-Analysis.” Urology Annals 17, no. 2 (2025): 84–91. https://doi.org/10.4103/ua.ua_13_25.

    Ruffo, A., M. Franco, E. Illiano, and N. Stanojevic. “Effectiveness and Safety of Platelet Rich Plasma (PrP) Cavernosal Injections plus External Shock Wave Treatment for Penile Erectile Dysfunction: First Results from a Prospective, Randomized, Controlled, Interventional Study.” European Urology Supplements 18, no. 1 (March 2019): e1622–23. https://doi.org/10.1016/S1569-9056(19)31175-3.

    Runels, Charles. “A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction.” Journal of Women’s Health Care 03, no. 04 (2014). https://doi.org/10.4172/2167-0420.1000169.

    ———. “Memo in Response to the JAMA Article: ‘Analysis of Direct-to-Consumer Marketing of Platelet-Rich Plasma for Erectile Dysfunction in the US.’” Priapus Shot® (blog), May 3, 2023. https://priapusshot.com/memo-in-response-to-the-jama-article-analysis-of-direct-to-consumer-marketing-of-platelet-rich-plasma-for-erectile-dysfunction-in-the-us/.

    Runels, Charles, and Alexandra Runnels. “The Clitoral Injection of IncobotulinumtoxinA for the Improvement of Arousal, Orgasm & Sexual Satisfaction- A Specific Method and the Effects on Women.” Journal of Women’s Health Care 13, no. 3 No. 715 (March 20, 2024). https://doi.org/10.35248/2167-0420.24.13.715.

    Schirmann, A., E. Boutin, A. Faix, and R. Yiou. “Pilot Study of Intra-Cavernous Injections of Platelet-Rich Plasma (P-Shot®) in the Treatment of Vascular Erectile Dysfunction.” Progres En Urologie: Journal De l’Association Francaise D’urologie Et De La Societe Francaise D’urologie, June 10, 2022, S1166-7087(22)00130-0. https://doi.org/10.1016/j.purol.2022.05.002.

    Sheean, Andrew J., Adam W. Anz, and James P. Bradley. “Platelet-Rich Plasma: Fundamentals and Clinical Applications.” Arthroscopy: The Journal of Arthroscopic & Related Surgery 37, no. 9 (September 2021): 2732–34. https://doi.org/10.1016/j.arthro.2021.07.003.

    Siroky, Mike B., and Kazem M. Azadzoi. “Vasculogenic Erectile Dysfunction: Newer Therapeutic Strategies.” Journal of Urology 170, no. 2S (August 2003). https://doi.org/10.1097/01.ju.0000075361.35942.17.

    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.

    Taş, Tuncay, Basri Çakıroğlu, Ersan Arda, Özkan Onuk, and Barış Nuhoğlu. “Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction.” Sexual Medicine 9, no. 2 (April 1, 2021): 100313. https://doi.org/10.1016/j.esxm.2020.100313.

    Towe, Maxwell, Akhil Peta, Russell G. Saltzman, Navin Balaji, Kevin Chu, and Ranjith Ramasamy. “The Use of Combination Regenerative Therapies for Erectile Dysfunction: Rationale and Current Status.” International Journal of Impotence Research, July 12, 2021, 1–4. https://doi.org/10.1038/s41443-021-00456-1.

    Yogiswara, Niwanda, Fikri Rizaldi, and Mohammad Ayodhia Soebadi. “The Potential Role of Intracavernosal Injection of Platelet-Rich Plasma for Treating Patients with Mild to Moderate Erectile Dysfunction: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials.” Archivio Italiano Di Urologia e Andrologia 96, no. 3 (October 2, 2024). https://doi.org/10.4081/aiua.2024.12687.

    Tags

    protecting patients, PRP procedure, FDA-approved kit, advertising, vampirefacelift.com, BrandShield, opt-in emails, O-Shot® products, low-hanging fruit, sperm count, testicles, marketing tips

    Helpful Links

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    Charles Runels, MD             888-920-5311              CellularMedicineAssociation.org

    Page  of


    [1] Banu and Sharun, “Minimum Reporting Requirements for Platelet-Rich Plasma in Biomaterial Research.”

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

    [3] Magalon et al., “DEPA Classification.”

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

    [5] Sheean, Anz, and Bradley, “Platelet-Rich Plasma.”

    [6] DeLong, Russell, and Mazzocca, “Platelet-Rich Plasma.”

    [7] Fermín et al., “Review of Dohan Eherenfest et al. (2009) on “classification of Platelet Concentrates.”

    [8] Runels, “A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction.”

    [9] Brandeis et al., “(130) Increasing Penile Length and Girth in Healthy Men Using a Novel Protocol.”

    [10] Posey and Runels, “In-Office Surgery and Use of Platelet Rich Plasma for Treatment of Vulvar Lichen Sclerosus to Alleviate Painful Sexual Intercourse.”

    [11] Goldstein et al., “Intradermal Injection of Autologous Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus.”

    [12] Runels and Runnels, “The Clitoral Injection of IncobotulinumtoxinA for the Improvement of Arousal, Orgasm & Sexual Satisfaction- A Specific Method and the Effects on Women.”

    [13] Ramadhani et al., “Comparative Effectiveness Radial Shockwave Therapy versus Focused Linear Shockwave Therapy as an Erectile Dysfunction Treatment Systematic Review and Meta-Analysis.”

    [14] Geyik, “Comparison of the Efficacy of Low-Intensity Shock Wave Therapy and Its Combination with Platelet-Rich Plasma in Patients with Erectile Dysfunction.”

    [15] Ramadhani et al., “Comparative Effectiveness Radial Shockwave Therapy versus Focused Linear Shockwave Therapy as an Erectile Dysfunction Treatment Systematic Review and Meta-Analysis.”

    [16] Javier et al., “(219) AUTOLOGOUS PLATELET-RICH PLASMA IMPROVES ENDOTHELIAL AND TADALAFIL-INDUCED RELAXATIONS IN CORPUS CAVERNOSUM FROM PATIENTS WITH ERECTILE DYSFUNCTION.”

    [17] Narasimman et al., “A Primer on the Restorative Therapies for Erectile Dysfunction.”

    [18] Chung, “A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction.”

    [19] Taş et al., “Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction.”

    [20] Ruffo et al., “Effectiveness and Safety of Platelet Rich Plasma (PrP) Cavernosal Injections plus External Shock Wave Treatment for Penile Erectile Dysfunction.”

    [21] Du et al., “Efficacy of Platelet-Rich Plasma in the Treatment of Erectile Dysfunction.”

    [22] Anastasiadis et al., “Erectile Dysfunction.”

    [23] Anastasiadis et al.

    [24] Chung, “Medical Sciences A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction.”

    [25] Schirmann et al., “Pilot Study of Intra-Cavernous Injections of Platelet-Rich Plasma (P-Shot®) in the Treatment of Vascular Erectile Dysfunction.”

    [26] Poulios et al., “Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.”

    [27] Masterson et al., “Platelet-Rich Plasma for the Treatment of Erectile Dysfunction.”

    [28] Chung, Ryu, and Yin, “Regenerative Therapies as a Potential Treatment of Erectile Dysfunction.”

    [29] Hinojosa-Gonzalez et al., “Regenerative Therapies for Erectile Dysfunction.”

    [30] Francomano et al., “Regenerative Treatment with Platelet-Rich Plasma in Patients with Refractory Erectile Dysfunction.”

    [31] Matz, Pearlman, and Terlecki, “Safety and Feasibility of Platelet Rich Fibrin Matrix Injections for Treatment of Common Urologic Conditions.”

    [32] Finkle, “Sexual Impotency.”

    [33] Hu et al., “The Effect of Platelet-Rich Fibrin on the Biological Properties of Urothelial Cells.”

    [34] Yogiswara, Rizaldi, and Soebadi, “The Potential Role of Intracavernosal Injection of Platelet-Rich Plasma for Treating Patients with Mild to Moderate Erectile Dysfunction.”

    [35] Towe et al., “The Use of Combination Regenerative Therapies for Erectile Dysfunction.”

    [36] Garcia et al., “Treatment of Erectile Dysfunction in the Obese Type 2 Diabetic ZDF Rat with Adipose Tissue-Derived Stem Cells.”

    [37] Siroky and Azadzoi, “Vasculogenic Erectile Dysfunction.”

    [38] “Errors in Text.”

    [39] Runels, “Memo in Response to the JAMA Article.”

    [40] Olsen, Modi, and Ramkumar, “Maintaining Truth in the Era of Misinformation.”

    [41] Giuliano, Denys, and Joussain, “Effectiveness and Safety of Intracavernosal IncobotulinumtoxinA (Xeomin®) 100 U as an Add-on Therapy to Standard Pharmacological Treatment for Difficult-to-Treat Erectile Dysfunction.”

  • 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

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    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.”

  • PRP. Centrifuges & Definitions

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    Transcript…

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

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

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

    Male student: Just estimate by …

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

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

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

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

    Male student: Two times.

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

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

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

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

    Male student: The calcium, what’s the …

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

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

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

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

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

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

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

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

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

    Male student: Yeah.

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

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

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

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

    Class: No.

    Lecturer: No. Why? Can you elaborate?

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

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

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

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

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

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

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

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

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

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

    Class: Yeah.

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

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