Topics Discussed Include the Following...

*Soldier regrows his penis after war injury
*Vampire Facial® on the cover of New Beauty
*O-Shot® [Orgasm Shot®] in Glamour magazine
*What to expect after an O-Shot® [Orgasm Shot®]
*Please make your own version of "What happens after an O-Shot®"
*Lichen Sclerosus & Clitoral Hood Phimosis (when & how to treat)
*Combining Electro-magnetic chair therapy with the O-Shot® procedure

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

Transcript

Soldier regrows his penis after a war injury

Journal Club & Pearls & Marketing (JCPM) 2018May16

Charles Runels: So this was a wonderful month, actually an amazing month for our marketing. So Dr. Shirin Lakhani over in London just killed it again with this amazing story...

Click to read about soldier regrowing penis<--

This solider had an injury in active duty and because of the trauma to his penis, lost some size and function. And then after treatment you can see he's a happy man and back with his lover, and regained some of the size that was lost due to trauma. So I think we can all be proud.

There's doctor Shirin over there in London who's been very successful as a teacher and a provider of our procedures. And this man is lucky to have met her.

In case you think this is outrageous...
PubMed. Wound Healing with PRP<--
PubMed. Penis regeneration with PRP<--

Anyway, so this is a great one to put out to our people. Obviously this amount of growth is not something that we see often, but because it was repairing an injury and he had multiple treatments, we do see it even in people without injury and the fact that he might have regained some tissue that was damaged actually makes sense.

I pulled up for us here, just so you can see, if you look at just wound healing fairly ... And you go to PubMed and look at wound healing & platelet rich plasma, right at 1700, there's 1,689 papers. And of course they keep doing papers because it works. And it's quit being about "does it help with injury." It's become about "what's the best way to have it help with injury." Whether it's diabetic wounds, or old tissue injury to the solider.

So I highly recommend that you let this be out. Take a link from this or a screen shot, I'll put the thing right now in the chat box so that you'll have it easily available,

Copy, paste the following link to an email, tweet, or facebook post....

https://www.thesun.co.uk/news/6265996/ex-soliders-penis-grows-1-5-inches-thanks-to-new-jab-after-it-was-torn-in-an-explosion/

but I'll also shoot out an email so that you guys will know. And when you put that out, just don't over promise. I think I would downplay it by saying this guy achieved some size increase because he was repairing an injury and this is not the usual result.

But there are a lot of men who've had injury to their penis. Usually it's either a bike accident/injury, or what's common is women in top sexual position and when the woman comes down it can be a loud "pop", then injury of the penis, which sometimes leads to Peyronie's and sometimes not--can just lead to loss of sensation and erectile dysfunction. So things happen and most of the guys who've had something happen, they've been told there's nothing to do.

One guy that emailed me today said that as a child he had something, I can't remember what. For some reason he had some rash and they were putting cortisone in his penis and one of the corpus cavernosi didn't develop to the same extent as the other. So palpable difference in size so he asked is this is something that would work. The answer is I do not know. But it's his best chance of repair, is to do that. Or to use our platelet rich plasma to encourage some recovery.

And most of us that have done this for any length of time have treated people that have old injuries that recover years afterwards. Years afterwards. So that's one thing.

Vampire Facial® on the cover of New Beauty

The other thing. I'll let you look at this. I'm proud of this. Let's see if I can pull it up for you again, hopefully I didn't lose it. Oh I don't see it. Anyway. We made the cover of New Beauty this month.

 

 

 

 

 

 

And it's the spring summer edition, so it will be out on the newsstands for a couple, three months at least. And right in the title it says Vampire Facial™, right on the title. And it's interesting because when you finally get to the article the movie star they interviewed, all she has to say is that she's afraid to try it because she's afraid it will hurt. And for that comment they put it on the cover of New Beauty. Which just goes to tell you that even when it's a stretch people love our name because it does sell magazines.

O-Shot® [Orgasm Shot®] in Glamour magazine

 

 

 

 

 

 

Another one of our people had an episode on the local news about the Vampire Facial® and in that one they, the newscaster, I don't know why they always feel inclined to say this, but said there's no research to back it up. So I want to show you ... I put another link to make it very easy to find. If you go to vampirefacial.com/research. I had some individual links, but just to make it easy ... I don't know where the doctors get that there's no research. I mean I could understand maybe there's not enough research to convince me yet, or something to that effect. But to say there is no research to back it up is just not true. Anyway. So here are, for the vampire facial different very strong papers. And this just takes you to a collection of papers about microneedling combined with PRP and the results were positive. And we even make compare of vitamin C or saline, it's positive.

The only one that wins out over PRP is interesting, is one study that compared PRP with microneedling and PRP with TCA immediately following for acne scaring. And the TCA, they both worked, but the TCA beat out the PRP for [inaudible 00:06:33]. So we're thinking maybe some rotation of those two.

So I'm getting to a question, let's see who's on the call because ... Yeah. Yeah. So I see Dr. Singer's on the call.

That's good because this one has to do with lichen sclerosus and I want one of the gynecologists to answer it. Let's see, what else. In the ... Yeah. So in the marketing department, here's kind of an outline of where we're going. Let me pull this up for you guys so you can look at it.

So we have the sign about the P-Shot, all within the past 30 days or so. The vampire facial is in New Beauty. And it's a little bit old now, but in the April issue of Glamour there's a big half a page quote from one of our doctors talking about how wonderful the O-Shot works for orgasm. So all this is out on the stands right now at the same time which is just amazing to me.

So I've had several people this week ask for a very specific thing about what to expect after the O-Shot. And I think it would be helpful to take this part of it and maybe make a video about this. And I'm happy to do it, but it would be nice I think, if some of our multiple people did this. I'm going to do my version of it. And what I think would work wonderful is if ... Let's see Dr. DeLucia is on the call,

we have some really nice people on the call. I'm not even going to name everybody. There's just a bunch of really smart people on this call.

And so if you guys do a version of what to expect and I'm going to give you my version, but if you will do your version of it, I will put it on the main website. I will put it places where it will be seen, it will be helpful, both before and after. Because we don't want to obviously over promise people and then on the backside it's much needed. I used to have one. I can't remember why I took it down. There was something about it I didn't like so I took it down.

But we desperately need a what to expect video, or videos. So I'm going to do this and I would implore you guys to do your version of it and then shoot me a link to it and I will put it out there everywhere. And thousands of people will see it, it will help your practice and will help patients.

So here we go.

What to expect after an O-Shot® procedure

Very rarely, and usually I don't even mention this or I try not to stress this, because sometimes people will think it's not working if they don't experience it. But rarely, probably 1 in 100 women in their twenties or thirties will experience, and sometimes older, hypersexuality. I mean really to the point that it would qualify as persistent genital arousal disorder where there's just no getting relief. Constant need to masturbate to the point [and multiple powerful orgasms that offer no relief] where it can be a nuisance if you're trying to work or something like that. Although it might be fun for a day or two if you're with your lover. It could be an absolutely nuisance.

And people with persistent genital arousal disorder that goes on for years actually have a higher instance of suicide than do people with chronic pain. It's a real problem. But for a few days it could be fun and it can happen in someone who gets the O-Shot® who is already experiencing normal sexuality and they're just kind of doing it to tune up.

I think it has to do more with the increase blood flow, the cytokines, and the increased rubor and calor that come with just things that happen with the process/cascade involved with wound healing. And it's not a permanent effect. We have not seen it last more than a few days in any of our people. So that's on the consent form. I talk about it. I'm talking about it first here, but I usually downplay it because if you tell everybody about it, which I started off doing, and you stress it too much then people think it's not working if they don't experience it.

The usual experience for the first two to three weeks is the rule of threes, is nothing, absolutely nothing [happens for the first 3 weeks]. Maybe a little tenderness from the injection site. Maybe a little bruising. Maybe a little spotting in their panties, that's why we keep panty-liners and baby wipes in the office. But otherwise nothing. And the analogy here is if you watch your seeds if you have a garden, like we did when I was a child, and you put seeds of corn in the ground and you watch for them, it's going to be a few days before you see the sprouts come up. So in the same way the PRP is just the, as the guys know this is way I'm explaining to patients, it recruits the pluripotent stem cells to the area, activates them and then it has to develop.

3 Days-the PRP is gone (3-14 days)
3 Weeks-the effects of new cell growth START (3-6 weeks)
3 Months-full effect of the procedure and new cell growth (2-4 months)

So although you may have blood flow and sensations that go on with that from the cytokines and growth factors that are in the platelet rich plasma or the platelets, that's not the permanent effect. And that's usually minimal and it can be all over the map what people experience. So it can be dysuria, urinary frequency, hypersexuality, decrease sexuality because you create a basically a hematoma, so they may have a time when there's decreased arousal because it kind of feels numb. Just like you have a hematoma on your hand. You might feel sort of boggy and not as much sensation. On the other end it might feel more sensation.

So that part lasts for around three days. It could last longer but three makes it easy to remember. Because it starts the effect, no longer than a week. Then the effects start to kick in at about three weeks, from the new growth, the new blood flow. That's when if they have pain it start to go away. That's when they have decreased orgasmic intensity. It might improve. Things get better.

So, with full effect at three months, two to three months. Although we'll repeat it at eight weeks if people are having no results. Just to keep them from having to wait the three months. Full effect with orthopedic procedures are six months to a year. But with soft tissue and wound healing it's usually about eight to 12 weeks or three months.

So then as far as what happens or who gets success. I hear people say "Well, it didn't work." As in that means it doesn't work for anybody anytime. So analogy there is one in five people who have pneumonia in the hospital, hospital acquired pneumonia, die from it. But we don't say antibiotics don't work. They work 80 percent of the time and that's a good effect for hospital acquired critical care pneumonia. It's not what we would like, but that's about the best we get. And in the same way the 65, 85. When I just survey our providers for every problem the easy to get well and the difficult. It's 65 percent of our patients love it the first time around, 85 percent of them love it after the second time around.

But these are hard to treat people. If they were easy to treat they would have gotten well with their insurance with their regular doctor. These are people with dyspareunia, incontinence that won't go away with kegels, but they don't want to have surgery. Try another ... These are difficult problems. Or Lichen sclerosus. So 65, 85.

Now if it's an easy to treat problem it would be 85 first time around 95 or more second time a round. For example stress incontinence in a younger woman, or even an older woman that has good pelvic floor integrity. But if it's a woman who's never had an orgasm in her life and she's trying to have her first orgasm it's probably more like 35, 55. Still one in three is wonderful for a woman who's gone for years without an orgasm. And now she's able to achieve orgasm. Either because she's never had one in her life, or she's trying to have an orgasm with penis in the vagina sex for the time in her life. So those are my best stats from surveying our people, surveying our patients.

And so you might think "Well, why not just have everybody do two." Because ... And many of our people do that. But the reason I don't do that is that I'm thinking, well, if you required that then you have over half of the people who would be getting that second one, perhaps even though they didn't need it. On the other hand if we're to require ... If we only give people one and we make them think that's all they're likely to need, then we're going to have somewhere around 35, 40 percent of them are not happy.

So the way I usually do it, there's enough profit built into this that you can give them the second one for free if nothing happens with the first one. If they have enough effect with the first one that they're happy then I'll charge for a second and third if they're just trying to get things even better. But if they think the first one did nothing I'll give them the second one free. And then you still get a nice profit because the second one doesn't take much time since you've already done your interview.

Then if they have no effect after the second one. Just give them their money back. You have enough profit that you're going to be fine and still profit on the next patient. Don't keep their money or they will be angry at you. So those are the stats.

You'll repeat it based on the etiology. If the etiology is still present they'll probably need another one in about a year. For example, if it's a woman that has dyspareunia and dryness because she has breast cancer and she still doesn't want to take hormones of any kind. She will usually get results, that's an easy win for us. But because she still can not take hormones and she's post menopausal she will probably need a repeat in nine months to a year and a half. The same with Lichen sclerosus, whatever the inciting etiologies was, she'll probably still ... It will probably still be there and she'll need another procedure done in somewhere around nine months to a year and a half.

On the other hand if you're treating a scar for an episiotomy, if she doesn't have another big baby and need another episiotomy, I have people that are seven years out still without pain. So etiology's still present. She'll need to repeat it nine months to a year and a half. Etiology gone, it could be permanent but I'd still hedge my bet and tell them about a year.

So the decreased orgasm, they'll probably see some improvement hopefully in about three months, excuse me, three weeks to eight weeks. But this one is the most difficult, excuse me, no orgasm is the most difficult. They almost always are going to need a therapist and testosterone to go with it. Decreased orgasm likely to get better and probably better in about three weeks.

Incontinence often gets better, stress incontinence, the day you do it. Just because the platelet fiber matrix is creating a sling basically where you put it. And then as that matrix gets replaced with new tissue their incontinence stays gone so as far as the patient's concerned it goes away the day you do it. But to hedge my bet I usually tell them it starts in three weeks, full effect two to three months because that's what I usually see but again you will often see it go away the day of the procedure. If it's not better at eight weeks, I'll repeat it.

Dyspareunia, difficult problem but for us for some reason we have a really very high success rate, much higher than placebo, but this one will get worse the first week and then start to improve starting the second or third week with full effect at eight weeks to three months. I would also recommend you use little vibrators here, about the size of your little finger and gradually going up to a vibrator the size of their lover about once every week or two. I prefer that over dilators because I think the vibration helps with the pain, helps with the physical therapy of it and probably encourages the woman to practice having an orgasm as well.

Lichen sclerosus you plan on them coming back at six weeks and treating whatever still bothers them. The full effect at eight to twelve weeks and out so I'd space these two treatments six weeks apart with full effect six weeks after the second treatment or about twelve weeks in or three months and then they're usually good for about a year.

Decreased libido, there's so many things involved here. It often improves for us but this idea of sexuality being arousal, plateau, orgasm, and then a recovery time is really not how it works for most women. It's really more of this circular, either spiral up or spiral down. So let's talk about the spiral down, then let's talk about the spiral up, then I will be through explaining what I think your patient should understand post O-shot.

Let's say the woman has decreased libido but she's got an element of dryness or pain so she has arousal and she starts to spiral up. Then she has sex but it hurts and she's disappointed and her lover is disappointed so she comes back down. Now it's going to take more to encourage her the next time to have sex because she has a negative association with sexuality. So two or three rounds of that, let's say she does attempt sex again, she spirals down another notch. So it becomes more and more difficult to interest her in sex because every time she has it, she has pain or perhaps it's not pain but a lover with premature ejaculation or that leaves her frustrated instead of satisfied. So whatever reason, if it's not a satisfying response, there's a spiral down and every time that spirals down it becomes more difficult for her to be interested in sex the next time around.

So if we take something to break that cycle, if we do something to increase orgasm a little bit or pain goes away mostly, for some reason she's able to now when she has an encounter that it's satisfying. Now there's a positive association and the next time she has an opportunity to have sex it's more easy for her to become aroused and there becomes a spiral up into, I think, a nirvana that actually becomes a spiritual awakening for her and her lover. But it doesn't happen immediately, it's a climbing effect that happens over time.

The cause, or back to our O-shot. If you can break that cycle by doing something, even if it's not the ultimate cure for every part of her relationship, if you can start the cycle to circling up instead of down, you've done an amazing thing for that woman and her lover.

Please make your own version of "What happens after an O-Shot®"

Hopefully that helps and hopefully you guys will take that and do a better version of it. I think it would be wonderful if it comes from especially some of the women in our group. I love it when women are talking to women and so I would love it if you guys...I'll put the recording out. But you guys know it. Just do your version of it and I'll put that video everywhere.

Lichen Sclerosus & Clitoral Hood Phimosis (when & how to treat)

The next one is a question and then I'm going to open it up after I read this question for you guys to give me an answer. So here's...let me see if I can pull up...let's see, I think I can show that...Anyway so lichen sclerosus question...So here we go...and then I need to be quiet, let you guys talk some...So please find attached two photos of a patient referred to me by her local gynecologist for treatment of her biopsy proving lichen sclerosus. She's been managed off and on with Clobetasol for four years, and...is it...Clobetasol four years ago had PRP injection...that's good!...by a California dermatologist that was very painful...huh...she is a menopausal 65-year-old woman who tells me that her primary symptomatology is painful inflammation of the introitus and vulvular skin (pictured), stress incontinence, is sexually active without severe dyspareunia although she feels her clitoral area is quite insensitive. She rarely has an orgasm. Her clitoral area is completely closed. She says it happened a couple of years ago. She says she has considered the idea of clitoral surgery and I would refer her out for this if it became necessary. She wishes to try the O-shot and one of...and a vaginal laser treatments first.

I am one of the O-shot providers and a Board Certified Plastic Surgeon, and while I perform labioplasty and clitoral hood reduction, I don't perform vaginoplasty or clitoral surgery such as this patient might require. In addition, and to the benefit of my own patients suffering with LS, I do clinical research for various device manufacturers...that's impressive...and published...okay, so wonderful, she talks for a lot of people...Can you give me your thoughts on this patient prior to my O-shot procedure in about a month? Is she likely to need corrective surgery to open the clitoris?...

and let's see...so...beautiful! Oh there you are, you're on the call! Let me unmute you so you can tell us about this patient...Dr. Samuels...I'm waiting...I think your microphone should come live here in a second...[silence]

Dr. Julene Samuels: Okay, It just opened up! This is Dr. Samuels, Julene Samuels.

Dr. Samuels: Thank you for featuring my question

Charles Runels: Thank you very much for the fascinating patient. So tell us about the patient. I'm going to try...while you're talking I'm going to try to get a better view of your photographs for everybody to talk about. Tell whatever I left out.

Dr. Samuels: No that's very good. This patient has actually...she came to me primarily because she was definitely in search of the O-shot and but she also had done a significant amount of research on other options that she thought would be of help to her because she has suffered with lichen sclerosus for over twenty years. So the...her...the reason that she kind of narrowed her search down to me was because I have some of the devices that I show here and in particular the CO2RE Intima Laser was one that she had personally researched and she lives part of the time in California, part of the time in Kentucky and part of the time in Florida so she does have access to several of our O-shot providers if that becomes necessary and also to some of the gynecologists that I know join you on your webinar.

And I actually have treated quite a few patients with our fractional CO2 laser, and although the study that I'm publishing in the Plastic Surgery Journal, the Aesthetic Surgery Journal, does not deal with lichen sclerosus patients, it deals with forty menopausal women who also have components of not just dryness, itching and dyspareunia, but stress incontinence so she would like treatment for the stress incontinence as well and we've talked to her about an electromagnetic therapy chair that we have as well as the CO2RE Intima. The spotty treatment with Clabetasol was really more, I think, a noncompliance issue. She has no problems with insertion of a laser handpiece. She thinks her introitus will accommodate that because she is sexually active and it's, as I said in my question, is she's not experiencing a lot of dyspareunia but she has had complete phimosis and closure of the clitoral area.

I can just barely, not when she's stretched like she is in this photo, I can see where the...attachments to the labia minora used to be...you can barely make that out so I was envisioning being able to do a nice clitoral block and the first portion of the injection, I think I can tell where to put that but the clitoral opening is completely obscured so the primary symptom she's having, as you can see in the photo, are the inflammatory changes in the vulvar skin near the introitus. Intra vaginally, it's a completely normal exam. She's actually quite lubricated and I suppose that's from her hormone replacement therapy and the estradiol cream that she uses. She uses that more faithfully than she does the Clabetasol. But she, in my talking to her today, she wants to proceed with the O-shot and the CO2RE Intima treatments and I think both would help her, but I don't know if this is...

I've probably done a dozen O-shots now. I just joined you guys earlier this spring. All of my patients have experienced incredible results and I will say some even amazing so I have no failures at this point but I'm sort of been very attentive to the videos. The technique videos are awesome and I...my learning curve, I'm probably still experiencing yet, but my patients are doing well.

I'm wondering, first of all, is this a case I should tackle? She desperately wants me to do it and if you have some advice and then beyond that what should I tell her to expect? She kind of would like to know am I still facing clitoral surgery? And I need help with those expectations.

Charles Runels: So just so you guys know I have unmuted Carolyn DeLucia and Stephanie Singer, who are both gynecologists on the call that have treated lichen as well so I'll tell you my two cents worth and then they can chime in.

Usually...Kathleen's on the call as well but she's not on tonight...So first of all I saw a very interesting study done by a gynecologist presented at the...at one of the meetings of the International Society for the Study of Vulvovaginal Disease where she took women who had lichen sclerosus to this degree and she just did a ultrasound and the whole purpose of the study was just to prove to these women and to us that the clitoris is always spared--that down there somewhere there's a happy, normal clitoris that's feeling neglected and so...I think along those same lines it's always sad to me. I've seen two women now, one in a teaching environment where the chief complaint was anorgasmia and with a history of frequent UTIs and she was young and the woman had had lichen sclerosus and her poor husband didn't know the difference and neither did she and she'd spent her whole life, both of these women with their clitoral hood phimosed but it was never active enough and somehow went dormant and they just didn't know so the point I guess I'm making is that I think she will benefit from someone going there and retrieving it and with your skill set I would love for you to hook up with one of the people in our group who does this on that level, if it's something that you're not quite ready to tackle.

Obviously, with your skill set you can tackle anything. It's like see it, then you're going to do it but if this is something you want to see someone do there's several people in our group that are very good at it and so I would recommend that if you're not seeing her for a month, that you go visit one of these people and offer her that. .

Dr. Samuels: An opening of the clitoral area, just to clarify, Dr. Runels, are you talking about to open the scarring and then do the O-shot after that has healed?

Charles Runels: It can actually be...the exact timing of that could be debated but most of the people I talk to are doing it all at the same time. For example...I was looking for a picture is why I sound distracted...but I'll look for it in a second. Usually it's all done, so do the regular O-shot, inject the area, dissect the clitoris out, inject the clitoris and then bring them back six weeks later and then inject wherever you still see active disease. And because of the injection around the time of surgery we have a better success rate of keeping things looking pretty.

Dr. Samuels: Okay.

Charles Runels: Did that answer your question?

Dr. Samuels: Yes.

Charles Runels: And I know...I know Red Alinsod, Kathleen Posey, Oscar Aguirre, Michael Goodman, & Alex Bader, there are others in the group. Those come to mind who both teach and who are doing this quite a bit and if you wanted to touch base with one of those people.

Dr. Samuels: Actually, I'm going to see Dr. Alinsod this weekend. We're presenting at a summit conference for BTL, both of us and a couple other presenters in Orlando so that's a very good suggestion. I'll take these pictures to them.

Charles Runels: Beautiful, beautiful. Well we appreciate...

Carolyn: I'll be there too. I'll be there too. This is Carolyn Deluccia. I'll be there even though I don't know what it's about.

Dr. Samuels: Oh that's awesome! Awesome! That will be great!

Carolyn: Yeah.

Charles Runels: So Carolyn has been teaching for us for how many years now Carolyn?

Carolyn: Over three years!

Charles Runels: Well thanks for chiming in. Have you had the opportunity to treat someone like this? Can you add to...I know you have something to say about this case...

Carolyn: Well yes I have and I also... I'm just going to throw this in there as something I've started even more recently is before they get to this extent of complete scarring if there's just a little bit of scarring I will do the O-shot and treat all the lichen around the clitoral hood and if you push back you can see the little tip of the clitoris beginning to come out. I'm instructing the patient to, as long as it's not too painful, to do that in between her visits with me, is just kind of pull back and gently stretch the tissue open and as it's healing from having been injected with the PRP, it's separating on its own without even having to do the cutting. So...

Charles Runels: Interesting.

Carolyn: Not completely.

Dr. Samuels: I don't want to interrupt you but where you see me really stretching the clitoral area, she barely felt me starting to touch up there and she just about had a mental breakdown because she just had so much pain associated with that spot and I was just barely separating things but as you mentioned, not having quite this degree of lichens sclerosus before, I did start to see the clitoral head.

Carolyn: Mmm-hmm. Correct, correct.

Charles Runels: Interesting...

Dr. Runels: See the clitoral head.

Stephanie S: Mm-hmm (affirmative). Correct, correct.

Dr. DeLucia: Interesting.

Stephanie S: Yes.

Dr. Samuels: And I can still see the corpus spongiosum when I put it on stretch I can see where it is still. It's barely distinguishable because it is so scarred down, but that's why I wondered if maybe the O shot if I should try that first or if I should even do that. Should I even send her, possibly to somebody who could do a corrective procedure if it didn't work? But I then also thought-

Stephanie S: I do. [crosstalk 00:36:32] I inject the PRP first.

Dr. Reynolds: Okay.

Dr Runels: Yes. So let me jump in and add to that as well. So you guys can now see this case where I saw this person first and I could put my thumb maybe to the fingernail. That was all that would go into her introitus. Had not had sex with her husband for seven years. Most of you heard me talk about this case but I think it's very instructive. Kathleen now has an atlas of about 60, 6-0 patients that she's done like this. I'm encouraging her hopefully to publish it.

But to answer your question, I went ahead and injected the area even though I couldn't obviously get to her clitoris. I inject in the interior vaginal wall. I infiltrated the area and with the idea that when she got to Kathleen a few weeks later and had this procedure done, the tissue might be healthier. And then of course Kathleen re-injected it and dissected it out in the office. This is eight weeks later. This woman now, I think she's pushing three years out.

She's been treated one more time in between about a year, year and a half out. So the possibilities are pretty remarkable. But to answer your question, whether it helped or not I don't know, but my imagining was that somehow the tissue would be healthier when she did have the surgery. And if I were a surgeon, which I'm not, I might consider doing it that way just to kind of prep the tissue. I don't know that it's necessary, but it makes sense that it wouldn't hurt anything.

Dr. Samuels: Yeah I kind of was thinking that too.

Dr. Runels: Then they can go have the procedure done then follow up with you if she's back in your town and you repeat the PRP maybe six or eight weeks after the procedure and hope she's good for a year or more.

Dr. Samuels: 'Cause I have joined you guys before and seen some of these pictures that are treated only with the PRP and they're quite amazing.

Dr. Runels: Mm-hmm (affirmative).

Dr. Samuels: And I'm happy that her introitus is only inflamed and not scarred and closed.

Dr. Runels: Mm-hmm (affirmative).

Dr. Singer: If I may interject a bit, Doctor Reynolds. This is Stephanie Singer here. Did you say this patient is refusing Estradiol vaginally or she's been using it?

Dr.Samuels: She's been using it. She's not terribly compliant with the Clobetasol.

Stephanie S: Well the Clobetasol I don't think is the greatest idea. I definitely think that she needs estrogen as well.

Dr. Samuels: Yeah I have not treated her with those topicals. She's been under someone else's care for that for years and I just met her today.

Stephanie S: I just see these kind of cases and I think the PRP plus the Estradiol is really the key and then they will clearly, unless it's been so phimos that it's permanent scarring which is really unusual which you were saying earlier, that these patients really all do respond. Just like Doctor Posey is seeing in her reviews.

Dr. Runels: You know the other thing is Kathleen's a big fan of testosterone cream. I know that's old school but she's a big believer that following and keeping them on testosterone cream post procedure is also helpful. I don't think the studies-

Go ahead.

Stephanie S: Yeah I'm a fan of intramuscular testosterone for most menopausal women. But that's another [inaudible 00:39:56].

Dr. Runels: Yeah before I had a no shot and I was just treating women with hormones. I did have really good result with testosterone creams for dyspareunia. And my thinking on it was that, and I'm also a big fan of intramuscular testosterone, but my imagining was that by applying it topically I can get really high doses at the site of disease. Higher than I could by doing an injection and then wanting the parental testosterone to be as high locally.

So start it off and do some of both. Some low dose testosterone at the site of the dyspareunia since the vagina does have testosterone receptors like the penis. Plus minus something parentarally, or IM injection or pellet. So Doctor Singer's also a gynecologist who's had some great success, I think, with our O shot.

Anything else anybody wants to say? This is a great case and I appreciate you being brave enough to bring it up and listen to what people have to say. We'll be curious to how things go.

Dr. Samuels: Thank you.

Dr. Runels: And talk to us about, I know people are starting to talk some about the electromagnetic chair and it's not really why we're doing the call but it sounds like you're going to speak about it. You're having nice results combining that with the O shot.

Dr. Samuels: Yes. So I was asked by BTL to be chair the committee in the US to gather some data on its use. And so Red Allenside, Nathan Garrett and myself and two dermatologists and Brian Kenny, another plastic surgeon have been working about the last six to eight months pooling our data. Doctor Garrett and I presented 150 patients. Our own pooled data at ASLMS in Dallas a couple weeks ago. It was really BTL's launch of the chair. And it works upon the mechanism of action is electromagnetic high fem, high intensity electromagnetic field therapy.

And it works on the muscle where as all of our other vaginal devices and devices [inaudible 00:42:35] externally in the vulvar areas as well, work on the soft tissue. So this is the first device with the mechanism of action directed to the muscles. And our pilot study had really incredible results. We took all types of urinary incontinence, but they were all menopausal women.

We didn't have any men in the study, however there are some indications, forthcoming, to use the chair for male nocturia anuria and post prostatic urinary leakage. So the results were very good. In summary, they kind of went like this. What we did was we measured, we had patient surveys and after treatments, which involved a package of six treatments, two per week. It's a 28 minute treatment.

The patient sits on a chair with, basically sits on this magnet, like sitting on an MRI. And the muscle is stimulated through pulsed electromagnetic fields which are creating super maximal contractions, much stronger than a kegel. So in many of these patients with pelvic floor weakness and pelvic floor muscle weakness and pelvic organ prolapse can't really even do a kegel. And one could argue that those are not effective anyway.

And so its super maximal contractions sustained for three or four seconds. And the machine pulses and the patients are slowly increased from 50% of max power to 100%. And the results showed 75% improvement, clinically significant improvement, which was measured through patient diaries and follow up questions on their follow up visits. But we measured the number of pads that they were using in a day and 65% of patients either reduced the number of pads they were using in a day to a minimum of one to three, even when they started out using eight to 10 in a day. Or completely stayed dry.

So we didn't weight the pads. We didn't do any urine dynamic testing or anything like that, but it was just a pilot study that we planned to follow up on with a larger patient sample. Perhaps comparisons with electrostimulation, Botox, medication, PT, non-surgical measures. But Nathan Garrett, Red Allenside and myself and the others that I mentioned were very impressed. And those that do the pelvic floor reconstructions, I'm not one of those, I'm a plastic surgeon. But they have really reduced the number of pelvic floor reconstructions they've had to offer patients.

And I don't know if any of you say 60 Minutes this Sunday, but they really, really hit hard. The source of the mesh that's used in the United States for pelvic floor reconstructions and the mesh that is sold here in the US, a large portion of it comes from China. Which is not the same therapeutic product. And I think that the market, especially since stress incontinence, stress urinary incontinence, mixed urinary incontinence, and urged urinary incontinence were the ones that had the best results that it will be technology that you'll hear some more about.

We've actually treated some patients with interstitial cystitis, intrinsic sphincter dysfunction, and even rectal and fecal incontinence that have had pretty nice results and prolapse as well. Different grades of prolapse.

Dr. Runels: So have you combined it with the O shot?

Dr. Samuels: I have. So I usually will sit with a patient. Try to figure out what the degree of symptomatology that have is. Is it mostly vaginal? Dryness? Itching? Dyspareunia or is it mostly incontinence? And how much of a quality of life decrease or the incontinence is and either start them with the chair as a stand alone therapy or I might combine that with some of the vaginal devices.

For the electromagnietic chair discussed. 
Call David Carraway 1-770-316-1647
or email here (be sure to let him know you're in the O-Shot® provider group for special pricing)...
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And Red Alinsod has a lot of patients who are in combination treatments. I've incorporated the O shot with probably about a third of them if not a half of them. But I haven't been offering the O shot as long as the other things and that does seem to make everything better as well. This patient, the one that you presented tonight, she's going to start with the CO2RE Intima treatments and the O shot. And if the stress incontinence is not improved enough then she plans to proceed with the chair treatments.

Dr. Runels: Mm-hmm (affirmative). So from a business standpoint I spoke with one of our providers today who is doing extremely well. She's doing quite a bit of O shots and the way she structures it is she'll give half price on the ThermiVa if they get an O shot. So she'll do an O shot a few weeks later, two or three weeks later with ThermiVa. A second ThermiVa. A third ThermiVa. And then two weeks after that an O shot.

And she says the results are pretty spectacular, so I can see some protocol like that being worked out. Of course with all these devices. And what's left to be decided, we have all these tools now, what's the best algorithm? 'Cause we know each one of thems working to some degree, so if you want the Lamborghini treatment for stress incontinence, when do you do what and how far apart? And so hopefully you guys can help us figure all that out. But that's what one of our providers is doing.

Dr. Samuels: I think there has been a little bit of talk also with some of our patients. And I have a patient who's in my office today doing it on more of a proactive basis. I think she sort of hears what's coming and before her pelvic floor falls to pieces, she's kind of doing a couple things in tandem. And Gwyneth Paltrow actually has had a blog recently where she was promoting the chair in a fairly proactive way. And it's not expensive.

Most of the early users now are settling somewhere between 250 and 300 dollars per treatment. And if it means that a woman doesn't have to change her PJ's two or three times at night and can leave the house without a pad they think that's a pretty good alternative. And I think following the 60 Minutes segment, more women will want to do non-surgical things.

Dr. Runels: Just a quick idea about how when to do what. I get this question sometimes. Of course if you're using energy of any type, it's probably better to do the O shot afterwards, but it could be done immediately afterwards. For example, [inaudible 00:50:08] or IGF1, all those small proteins, growth hormone, all those small amino acid chains are fragile.

You can't even shake Genotropin in the bottle or it tears the chains apart. So we're either frying the egg with laser or we are breaking up the amino acids with our shock wave treatment if we do the PRP first. But there's not reason not to do the O shot immediately afterwards. Same visit.

Any of these procedures, or any of these devices where it's laser or radio frequency or shock wave or electromagnetic treatments. If you go back to the literature, there's actually a time when PRP was banned from being used by athletes. It is no longer banned. But there is a small, but measurable increase, in IGF1 systemically. And some of the basic research even talks about systemic done regulating of the autoimmune response with PRP systemically.

So to the point to like where I said for a while it was banned. But if you think about if what you're trying to do is build muscle then from that standpoint alone, it could be that there's a nice energy there. Not to mention the fact you're creating a possible [inaudible 00:51:34] sling. And so I would think they would work well together.

But working out when or how or how you structure it, I don't know. I just mentioned one possibility. I think that's enough unless you guys have anything else. That's right at an hour and there are no other questions on the blog. So thank you guys for coming. I'll get this up on a recording with a transcript and thank you very, very much Doctor Samuels for that interesting case and keep us posted. You guys have a good night. Bye bye.

Dr. Samuels: Thank you.

Dr DeLucia: Thank you.

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