Topics Discussed Include the Following…

*Bicycles & ED (a quick look at the research)
*Botox for ED (BoPriapus™, Priapus Shot-100™, and Bocox™

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

Outline of This Page
1. Transcript
2. Relevant Links
3. Relevant Research

1. Transcript

Bicycles & Sexual Function

Thank you guys for being here tonight. Two main topics for tonight, one, a deeper dive into what Botox is doing to improve erections and two, a quick review and just a reminder about bicycles and sexual function. So, we’ll come back to the Botox for erections idea.

Let’s swap over and start off with just a reminder about what happens with bicycles. I don’t really like talking about this. This is one of those subjects I wish it were not true. As a college kid and through medical school, I have very fond memories of doing triathlons with my father and running for miles, and bicycling for miles. Both training and at fun events. We live here in the southeast, and we traveled many miles on bicycle along the coast.

And I noticed that sometimes I would get off the bike and important parts would be numb. And the testicles, the penis would be numb. I thought, “Well, that can’t be good,” but I kept doing it and learned to stand up on my bike often, and fiddle with the seat. My dad wound up crashing his bike. He has no memory of his head injury and went back to doing triathlons again. And that is really what scared me off of the further riding. I know some of you probably ride your bikes. And so, I’m going to show you some stuff that you may not want to see, but at least know about it so that you’re able to talk with your patients.

Obviously, when we’re doing sexual medicine, we’re not just giving shots. We want to know all the possible ways we can help people with their erectile function or their sexual function as females. There was one study where they just looked at playing tennis three times a week. And for me, I’m so bad at it. I wouldn’t even count that as aerobic exercise because I’m mostly just missing the ball. But of course, with good tennis players, it’s good aerobic exercise and that alone was enough to boost ED function or SHIM scores by five to seven. I mean that’s what our shot does. So if you can get people walking daily, along with our P-shot® and healthy lifestyle changes, of course there’s going to be benefit.

But what if the aerobic exercise they choose is the bicycle?

So I just want to show you a couple of things. There’s some disagreement if you look at the studies. When this was first brought to my attention, I heard a lecture by Irwin Goldstein, who I still consider to be probably the most knowledgeable person regarding the research regarding sexual medicine. He edited The Journal of Sexual Medicine for seven years. So, that’s a lot of reading. And, of course, he’s published hundreds of papers. And he doesn’t ride a bicycle and recommends that people just don’t do it. But let’s look at some of the conflicting research and I have a couple of ideas about what maybe you can tell your people.

So here’s a study where they said, “Okay. Pelvic discomfort and erectile dysfunction in adult male cyclist.” And if you look at it, it’s pretty plain. Pelvic pain and numbness are common complaints when you ride a bicycle and they’re also more likely to have ED. When you’re sitting on your branches of your pudendal nerves. So others have thought, “Well, let’s try changing the saddle around.” And this has been… Let’s see if I can find that study for you. Yeah, here we go. Strategies for reducing impact. So they tried no nose saddles or standing on the pedal. After a year, a decade or more of not doing triathlons, I did a couple of spin classes, and I have to stand up, or things go numb. So you don’t see me on bicycles. I have patients who did the Ironman more than once, husband and wife. They quit doing it because one of their friends was killed on a bicycle.

I started noticing doing the triathlons that everyone who had done them more than four or five years had crashed. The question was not, “Have you crashed?” It’s just, “How bad were you injured when you crashed?” So not counting people texting when they drive and not counting the risk of falling on a bicycle, just looking at what happens neurologically. The studies are strong. I want to show you… Let’s go back to this, and I’ll show you something quickly. And then I want to swap over to what we could do to help with it. So if you just go to PubMed, and just put in bicycle and sexual dysfunction and you will be… You may be surprised at the amount this has been talked about, but you will also find studies, like this one is one of them. Where they reach a conclusion “Well, it’s not really causing any problem statistically.” And that’s a lot of people. And in other words, they’re not having more sexual dysfunction than any other type of athlete. There was a study I skipped over a moment ago.

We were looking at that research, but where they just looked at the sports where people have problems with sex and they were biking, and sports had involved head injuries. Obviously, pituitary gland, shearing forces. So people who play football, our American football and people who rode bicycles were more likely to have sexual dysfunction. But you can go on, there’s 67 papers. You can search it a different way and get a little different numbers. But there’s some strong research, except there’s this confounding research. And you’ll see this mentioned. Those who just ride amateur they’re not writing every day. They’re just writing and get to work every now and then, there doesn’t seem to be a difference. So you see cycling is usually associated with perianal numbness, but that numbness did not lead to lower international scales. So yeah, your penis is going numb, but don’t worry about it. It’s going to work just fine.

Amateur cycling has no effect on erectile function. I don’t know to me, that’s a warning sign, but at least know about it. And if you have someone, male or female who is complaining of erectile dysfunction or sexual dysfunction, at least know that the way I look at it, like those people who are triathletes, they don’t have a problem for some reason but they’re like superhuman people. Of course, the downside is aerobic exercise helps sexual function, and you don’t want to keep people from cycling if that’s their favorite flavor of aerobic exercise.

But anyway, if you know that’s a cause, and you keep it in mind, it’s the main purpose I bring it up. Because if we’re treating sexual dysfunction, men and women know this is a possible cause. And at least advise people to maybe lay off the bike for a while and do another form of aerobic exercise for at least three to six months while your shot’s working to see if you can make things better. Now we’ve had a couple of urologists on the call when it comes to how our procedures might help, who have suggested because we know PRP helps with neurological function, many studies with that. And I can just pull it up right here. So if you just put in platelet rich plasma and you add in nerve regeneration, you get a pretty impressive collection of papers where they’re documenting regenerating nerves.

And so the idea of using plate-rich plasma. So the idea that injecting PRP not just in our usual areas, but if you had someone who’s riding their bike more in a saddle block kind of area, you might see something. Now I haven’t done the study. I’m just putting that in your head. I guess someone could take a hundred people with bicycle-induced sexual dysfunction and do some sort of PRP injections. I’m not sure that our regular O-Shot® or P-Shot® would help because the damage I think would be more proximal to the spinal cord and not in those distal branches where we’re injecting. But it’s something to think about and at least realize the research is pretty strong that if you’re trying to make someone’s sexual dysfunction improve, you might ask them to lay off of the bicycle. So we’ll come away from that. I think that’s enough about that, but I’ll put these papers on a page for you guys to see the articles. A lot of this is online stuff that you don’t even have to buy. It’s open source articles. Let’s go over to Zotero again.

Botox for ED (BoPriapus™ or Bocox™, whichever name you prefer)

This is my favorite way to keep track of papers. And I want to go deep into this paper. We mentioned it before… Oh, let me show you something else real quick before we do that. So you guys know I’ve been working on my in-depth Botox course, and I’m creating a page about creating… Or treating ED with Botox. Once I have it complete, I’m going to put it on the Priapus Shot® website. And some of us have been trying this. I’ve tried it on myself. I’ll show you the research that convinced me shortly. I’ve tried it with some of my patients, others in our group are doing it, and there’s going to be a separate name for it that I’ll roll out in an email this week. And I own botoxpenis.com. And so there can be a listing of people who do the P-Shot® who want to combine Botox with it on botoxpenis.com. And my intention is to make this something that your patients start asking for.

And I’m not going to charge you any extra money. I’m just going to put the videos that show how to do it on the Priapus Shot® website. Okay. And so I’ll show you how to mix it up. How to mix the PRP with Botox and where to inject it. And it’s pretty simple. It’s just basically doing your regular P-Shot®, but in the shaft or the corpus cavernosum, you add in the Botox, and people love it.

Men already know about Botox, and they want it. They’re not sure exactly how it works because intuitive, you think, “Oh, if Botox makes things looser, how’s it going to make a penis stiffer?” So before I show you the science, I do want to show you this, because this is one of my favorite stories. And I think when I show you the editorial in the Journal of Sexual Medicine, it will be useful to have this in mind.

So first I want you to look at Dr. Barry Marshall. Now, Dr. Marshall is the one who got the Nobel Prize for figuring out that he will go back to helicobacter pylori can cause ulcers, but he tells his story, right, in this interview, he tells it lots of places, but he tells one of my favorite places and all these links going to be on the Priapus Shot® website. He tells the story here. It was years. He saw it, and remember, many of you are old enough to remember when we were taught no bacteria can live in the stomach because it’s too acidic. And then he looked in there, and he saw some bacteria and they shared the prize. Dr. Marshall and Dr. Warren worked together. I love that cowboy tie he’s wearing. And so they worked together on this. And of course, nobody believed him and thought he was crazy because they already had a way to treat. They had a way to treat ulcers. It was Zantac and surgery. H2 blockers in surgery.

That’s how you treat ulcers. And he caught so much flack for that. And so when he got his Nobel Prize and actually I want to show it to you on here somewhere, because he always, best I can tell every time he’s interviewed, he brings this up. Let’s see. Well, I pulled it out of there and put it for you to read in this article right here. There, it is the illusion of knowledge that holds up medical progress. It’s not stupidity. It’s the feeling that you already know how. So with that in mind, let’s look first at the study that came out recently; I love it because it’s a double-blind, prospective, randomized placebo control study. And I would like to go through it with you in detail. Because after reading it, I’ve decided I will start treating patients who have ED with Botox. So prospective, randomized, double-blind, placebo control trial, all right. Now what did they do? Oh, and the patient selection. They picked the hard patients. So these people had to be people that failed PDE5Is.

Let’s see if I can find it. They have to have failed, not responding; there it is. Not responding to any pharmacological agents. So they couldn’t have a response by the Trimix even high dose Trimix and they couldn’t be responding to Viagra or Cialis. That qualified them. And then they couldn’t be crazy. Couldn’t have unstable psychiatric problems or have such bad heart disease. They get out of breath. But if they just had bad ED then they qualified. All right. And look at all the other stuff they had. 14% of them had diabetes, hypertension, diabetes, and hypertension. And only 13% of them didn’t have some of this stuff. So comorbidities were rough. These are people that I would mostly not treat with a P-Shot® and they go into some of the history of how it works. And it’s not exactly what I would’ve predicted. And after reading more about it it’s pretty fascinating. So it blocks one mechanism… Oh, by the way, it worked longer than Botox normally worked. The dose of a hundred units worked for six months.

I don’t know when the last time you had someone’s frown lines stay away for six months for using Botox. But that’s how long a hundred unit dose worked when it worked. Okay. So… Oh and their penis has got longer. So we’ll get to that part. So it blocks the release of acetylcholine and norepinephrine mediated sympathetic pathway and increases the expression of vascular endothelial growth factor in CD31, the activation of its downstream-signaling cascade, enhances vasodilatation and endothelial cell proliferation. Get a load of that. That’s what you hope stem cells do to the penis. So it actually helps grow a healthier penis and they point out that no one… I’m getting to more about the mechanism coming down to here. Oh, oh, but this part, I don’t know, I just don’t want to massage penises for five minutes, but they gave the penis a five-minute massage after the injection and they used a constrictor band because they were afraid they’re going to somehow hurt people when they injected a hundred units of Botox.

Now I’m going to get to some stuff about safety in a second. That’s going to, I think, blow you away. Okay. Let me get down to this part. Okay. No change in the girth, but the treatment a significant increase in stretched penile length and Doppler parameters. So not just improved SHIM scores, but Doppler parameters with no systemic side effects, zero. The only side effects they saw was when they did the Dopplers they used Trimix to cause an erection and they had some side effects from the Trimix but not from the Dopplers. I mean not from the Botox. So some of the mechanisms of action inhibits sympathetic androgenetic, cholinergic vasoconstriction, sensory nerves, and or endothelial exocytosis of endothelin 1 which are involved in pathophysiology of erectile dysfunction. So in other words, some of the research shows that it might be mediated by non-nitric-oxide, but their hypothesis is that the reason that some people were helped by this who were not helped by Viagra and Cialis, had something to do with the non-nitric-oxide mediated pathways.

Oh, here’s the measurements. So here’s SHIM scores, Botox 150 units, placebo group. And you come down here, the stretched penile length increased. Okay. It didn’t turn him to a porn star, but there’s a range there and it went up what, a half an inch or so versus no change with placebo. Preventing release of norepinephrine is it causes a decreased tone in the resistance in the penile vessels and an increase in the resting blood flow and a reduction in persistent cavernosal smooth muscle tone. So the tone relaxes and there’s more blood flow in the flacid state. That makes sense. And because it’s more relaxed, it’s easier to achieve an erection because parasympathetic tone is increased. Remember erection is parasympathetic. So where the mechanism happens in the blood flow, the mechanism of action from parasympathetic nervous system, that same thing happens when you use Botox. It induces sinusoidal dilatation of cavernosal tissue, which seems to be mediated by smooth muscle relaxation, makes senses. So relaxing the muscle that’s involved with blood flow is what’s happened. Let’s see there was something else important here. Wait a second.

Oh, some of these people used more than… Some of the pilot studies, this has been going on for three or four years. They use more, these guys tried 50 versus a hundred and the 50 wore off at three months and the hundred lasted six months. Oh this I thought was important. So is that it? Wait a second. Yeah. Yeah. Okay. So in a second, when you read, because there’s an editorial that says we should not start doing this yet. So this is a tough call politically speaking. But when you think about it when people are doing Trimix, when they say plaque or scar formation 10%, what they’re really saying there is there’s 10% risk of Peyronie’s disease in men who are doing Trimix, 10%. Penile pain, bruising, restlessness, all this with Trimix. Okay. That doesn’t happen. Or it’s going to be less likely to happen if your injection is every six months, instead of every time you have sex.

And one of the side effects of the Trimix is your penis shrinks, one fifth of them, 20% developed a new curvature. Well, that’s more than 10, but whatever, different numbers, but 27 different studies… 27% of them complain of shortening. 20% of them got a new curvature. Okay. That’s been known, that was out there. Actually one of the things I did when I came up with the P-Shot® is I read the Trimix literature, like crazy. Like, “I’m about to put a needle in my penis. Let me go read about what people have been doing with needles in the penis. And what’s it cause.” And and it’s 10%, that number’s been known for a decade. It’s what I read in 2010, when I decided to inject my penis with PRP. But now we know that PRP helps prevent or helps treat peyronie’s disease.

So if we’re doing a P-Shot® with… I mean, with PRP we should see a less incident. I’m not saying never, ever, because I think it’s still possible. But when we have multiple studies now showing that PRP helps treat peyronie’s. And we know that PRP helps with scarring, helps remodel scar tissue into a normal tissue. Then it makes sense we should be less likely to see scar formation doing a P-Shot® versus injecting Trimix. And of course Trimix does nothing to improve the health of the penis, nor does Viagra, Cialis or of course a penile implant. So their proposed mechanism for the penis getting longer and having done this to myself and others, I think that’s right. It’s more relaxed. You have a more full flacid penis, a more easily erect penis, and things are just more relaxed. So it hangs lower and it stretches longer. So it’d be like your penis already did yoga after you’ve had a Botox. It’s worth mentioning that the single intracavernosal injection of Botox for the management of ED demonstrated durable effects with acceptable adverse events.

This important characteristic imparts a clinical advantage for the wide application in the treatment of ED for the more intracavernosal injection is administered by well trained medical providers that’s us. Now look at the limitations. Different cohorts of ED should be included. After reading this my fear is more… Not Peyronie’s, is priapism, because these people got statistically better. And they were hard cases. So my worry is more priapism. If you’re going to start doing this, you need to know how to treat priapism. And so looking at other things like radical prostatectomy, spinal cord injury and such. Patient inclusion may be better enlarged to include all the non-responders and a longer follow up period is needed. Okay. Yeah because at six months it was still going. That’s a good problem. A limitation. Now just parenthetically one of the things that makes people want Viagra is when they hear that warning sign. As doctors I’m not going to imply it. We never ever want anybody to get priapism, but patients love the idea that they’re taking a medicine that’s so strong. It could make them have to go to the ER after they’ve had a six hour erection.

So isn’t an interesting that something this strong that’s been out for this long is still not being done. Now I think this is probably one of the reasons is the best I can tell is this the first… Oh one other thing I failed to mention. In this study, if you look, which is unusual, in this study, there was no response from the placebo group, which is unusual because usually with erectile studies, there is a response from the placebo group, but they had no response on all parameters. So the authors had to come up with some reason for that. And I think there’s was a good one. That, because these people had such horrible ED, they had less inclination to believe anything was going to help. And they use this, they compare it or bring up a study. Let’s see if I can find it. There was a study with shockwave therapy, actually that may be in another paper, but there was a study with shockwave therapy where the placebo group did not get better. But I don’t know how you do a placebo with shockwave.

I mean to me that’s bogus. Because you can tell if something’s zapping your penis or if you’re just getting a massage. But I just think there’s some things you can’t do a placebo study with. We can pretend we’re doing one, but we’re really not. Okay. So now let’s talk about this. Because this is strong. This is from the Journal of Sexual Medicine. So let’s look at what I think is… I’ll just say it, I think this is… Well, I won’t use the P word and I don’t mean penis. I could be saying… I won’t say propaganda, but this to me feels like it could be that. Despite its long safety, and I want to show you what I find… I just find this to be misleading. I won’t say dishonest, but I’ll call it misleading. Despite its long track record of safety and efficacy, by the way, why would you even need to write this? Let’s think about that for a moment.

Someone just did it. This is a response, by the way to that double-blind placebo control study. If you look, this one came out about the same time, right after the other one so they’re going to comment on it as often happens. Okay. Yeah. So despite its long track record of safety and efficacy in other areas for use treating sexual dysfunction has not been fully explored. Okay. So they bring up… By the way, we know that we use Botox at much more than a hundred often 200, 300 units treating torticollis and spastic muscles, and people with cerebral palsy and stroke and such. So a hundred units isn’t jack really. Okay, despite his favorable safety profile, providers of Botox should be aware of its local mild side effects. UTI? Give me a break. Or urinary retention, yeah that’s happened if you’re treating urinary incontinence in a female or something, but no one’s ever documented freaking urinary retention from injecting the penis with Botox. Okay. It gets worse. As well as potential, systemic, significant side effects like muscle weakness. Well, yeah I mean that’s why you’re doing it, and respiratory difficulties.

Now when I read that, I said, “Oh, okay, let me go see what they’re talking about.” So we go down here to reference number four, which is the only reference they give for respiratory difficulties. Safety of botulinum toxin type A systematic review and meta-analysis, 2004. From this Naumann. I’m hoping I’m saying that right. Okay. So here’s the study they referenced, right. There’s the guy, this is the study. Now let’s read their conclusion. The result of this meta-analysis experience from long term open label investigations demonstrate the formulation of Botox. Favorable safety and tolerability profile across a broad spectrum. And now look at this… Oh wait a minute. Let me get to the… There was no significant difference between botulinum and control groups and the occurrence of other adverse events. None of the included studies reported the occurrence of any systemic adverse events.

None. And I read through here and I’m thinking, “Well, where does it talk about respiratory depression?” It doesn’t. That’s the conclusion, safe and generally well tolerated, no serious or severe adverse events were noted. Virtually no systemic adverse events were reported in any of the studies included in this analysis. There have been no published reports of anaphylaxis and even when I go through, I can’t like… Where is this? Or other rare serious systemic adverse associated with inaudible 00:32:00 that the findings from the meta reflect clinical experience. In other words, they can’t find anything bad. There was no serious adverse… They say it over again, of the 36 included trials, therefore is not possible because they had no events you can’t calculate something or fraction of zero. So they couldn’t even calculate one of the measures. None of the randomized control trials include, it says the long term safety and adverse events.

Okay? So in other words, we don’t know what happens if you do it for 60 years and some people get resistant to it. The only thing that caught my attention is if it happened in fewer than one in a thousand patients, this meta-analysis would not have picked it up. But they didn’t find that respiratory depression those people were talking about, the reported were temporary, mild to moderate non-systemic and related to the mechanism of action. Otherwise focal weakness was the only adverse event, which is why you’re giving Botox to make focal weakness. And this is the paper that this paper refers to, this editorial in the journal of sexual medicine refers to the one and only paper. When they talk about respiratory difficulties, I found that shocking. Maybe not surprising, but still shocking. Okay.

So let’s kind of go through because I want you to… You cannot be smart by ignoring your critics. So if you’re going to do Botox or use Botox to treat ED you should know what the critics say. Okay. And this is the most high powered critical article I have seen written about Botox for ED. And it was written in response to this very strong paper. To me, it almost feels like they read this and said, “Oh crap, everybody’s going to be given Botox for ED. We better stop that.” So restorative therapies aiming… Okay, they’re bringing up the point here… Oh, let’s go back here. Because I skipped over. We have all these things to treat with, okay. Lifestyle modifications, mental health counseling, vacuum erection devices, intraurethral alprostadil intracavernous injections. But all of these things, we’ve talked about this a lot on our journal club, none of these things make the penis healthier except maybe actually the vacuum device. There’s some research that it may actually be making the penis healthier.

We talked about that a couple of times because the hypoxia, there’s studies showing you get a sustained transcutaneous O2 measurement that’s increased. And the intermittent hypoxia may be making the tissue healthier. But whatever, except for the vacuum device, the oldest thing we’ve had, none of this makes the penis healthier. Then they talk about restorative therapies that include low intensity shockwave therapy, which mean if you do stem cell therapy, which we don’t do, unless you’re under a IRB now in the U.S. And platelet-rich plasma. Isn’t that fun? They mention our P-Shot®. Currently there is a lack of robust evidence to support the clinical use of respirative therapy for ED. Even though we also have a double-blind placebo control study that has come out in at least two dozen other studies showing that PRP helps… Where’s the line? That’s the thing, if you run a two mile race, I used to run the two mile in high school. You knew where the finish line is. Where is the finish line? You know where I think the finish line is? It’s when insurance starts to pay for it. I really think that’s where it is.

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When insurance starts to cover it, when you reach the finish line. I feel like that well, what if they did this editorial saying everybody should get this? Now people are going to hit up the insurance company saying, “You should pay for this.” I don’t know. That may not be right. That’s just me talking. I’m down in Alabama. We have dirt roads and we have lots of wild conspiracy theories, but whatever. I mean, why shouldn’t we be using it? The three things that might make your penis healthier we don’t think we should do them yet. Considered off label, only conducted with an IRB, and you shouldn’t charge anybody for it.

In other words, don’t do it or we’re going to rough you up. That’s a scary statement. The use of botulin toxin is relatively new that’s true. Only about four years the best I can tell. And they talk about, they go through some of the animal studies and they get around to talking about this study, okay. Which is really the purpose of this whole paper. And they summarize it here and we just went through it. So we don’t have to do that. But they summarize it. The thing that’s the big elephant in the room to me that no one’s talking about is these were really hard to treat people. Like these were people that Viagra was not working on and they still showed benefit in a double-blind placebo control, randomized study. Holy smoke. Okay. And then they go a little bit into what we just talked about, what causes it to work. Now we’re getting to some of the… Here, this is the part where I want you to know. Because they talked about why it might work.

The mechanism, they talked about the fact that a study just showed it work in very hard to treat people. The therapeutic potential that’s used holds some potential, but has not seen widespread adoption. A limitation includes its limited efficacy duration of months. What? Whatever. What’s the duration of your Viagra pill or your Trimix injection? One encounter on your Trimix injection, you got to do it every time and you have a 10% risk at best of creating Peyronie’s disease. Because you’re jacking up your penis with a needle. I’m not saying we shouldn’t do it because for some people that’s all that works. But really this is the reason because it doesn’t last longer than six months?

Evidence is scarce. Well, I don’t know. Four years of research, where’s the finish line? We don’t have a large multi-center double-blind, randomized control trial with extended follow up. But we have two decades of people using Botox every three months of their life. So that’s going to be worth something. That’s the thing that’s so strong about this. We’ve been jacking people up with Botox. I found an article from 2002 and I was there, right. I remember when Botox became a thing in 2002 and everybody worried, well what’s going to happen? Well we’re 20 years later and some of us are still doing Botox and millions and millions of doses every year, and all the little spinoffs like Dysport and such. But here’s where the real propaganda is that I want you to see. This just reeks. I’m sorry, this reeks, I’m going to call it like we call it in Alabama.

My mother would say, “That just reeks.” Okay. Given the multitude of treatment, remember what we talked about? Remember the guy that discovered Helicobacter pylori and ended chronic ulcers for many people. And how he said the hindrance to learning is not ignorance. It’s the imagining that you already know the answers. Okay. So now with that in mind, read this paragraph, given the multitude of treatment options currently available, Viagra Alprostadil, Trimix and a penile implant, and the many currently being investigated, even though we don’t want you to do this, and we don’t want anybody paying you to do it. Isn’t that ironic? They use the P-Shot® as a reason not to do Botox, but they tell you not to do the P-Shot®. But even though we have this thing Botox, which should also be regenerative, remember we just went through that. There’s a possibility endothelial growth.

A substantial advantage of Botox would need to be demonstrated to warrant its inclusion in the treatment algorithms. Well, what about the advantage that you don’t have to take it every day and risk blindness, which now we know you do risk. When you take long term, when you take Viagra and Cialis, it’s a real thing at every dose. You don’t have to stick something up your urethra or give yourself a shot every time you want to make love. And you don’t have to risk being the one in 10, who doesn’t like his implant because it gets infected, it hurts or doesn’t work. Well, maybe that’s a reason to warrant its inclusion, but there you go. That’s the propaganda that’s out there. And I admit that might be enough to scare some of you guys off.

I don’t blame you, but I’ve started doing it. I’m going to call it, well, I’ll roll out the name for it in an email this week. And I own botoxpenis.com. And I’m going to list anybody that does the P-Shot® on it as a provider for free, no extra money. I’m never going to go up on price for any of you guys. I’m just going to try to keep adding new ways to help you. New ways to help you find patients, new ways to help patients. Find them and help them. So I don’t know to me this is heartbreaking. It really is heartbreaking, but you know why it’s heartbreaking? Because this is not a game. These are people you guys know these are people that are coming to your office. They’ve had their prostate cut out or their Viagra doesn’t work like in the study, but they have a wife. They have a lover, they have a life. They don’t want to be sexually impotent. Okay. I’m done.

Hope that’s helpful to you guys. I’ll put out an email that has a link to all these references. Actually I can go ahead and give you… I can give you the… You know what, I’ll give you all of it. It’s going to be all there, including the videos on the P-Shot® website within the week. I’ll promise you that. Okay. You guys have a good night.

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–>Next class to learn to inject the major joints (knees, elbows, shoulders, Achilles) with PRP<–

–>Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<–

–>Next Hands-on Workshops with Live Models, worldwide <–

—>Dr. Runels Botox Blastoff Class<—

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

Relevant Research

Cellular Medicine Association
1-888-920-5311