JCPM2022.03.08.InterstitialCystitis.SUI.RiversOfGold.FxAnatomy

Topics Discussed Include the Following...

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

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

Transcript, Research, Relevant Links

Transcript

Top 5 Marketing Tool

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

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

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

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

PRF vs PRP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interstitial Cystitis Research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More about Wordtracker

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

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

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

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

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

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

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

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

How to find a river of gold with Wordtracker

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

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

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

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

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

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

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

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

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

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

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

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

Testicular Injection for Increased Sperm Count

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

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

Relevant Research

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

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Charles Runels, MD

 

 

 

 

 

Cellular Medicine Association
1-888-920-5311

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.