Topics Discussed Include the Following…

*Botox for ED, Bocox™, is here!
*Where I Educate My Own Patients About the Procedure
*Guarantees and Disclaimers
*How much Botox is too much (dangerous)?
*How Does Botox Improve Erection
*Botox LD5
*Marketing it– or letting your patients go elsewhere

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

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

1. Transcript

Botox for ED, It’s coming…

As you guys know, we’ve been working on how to think about and how to combine Botox with our P-Shot, possibly, and how to roll that out.

So I’ve done some more looking into the data, and I have some suggestions. I’ve actually started providing this for my patients, and others in our group are doing the same; with great success, I injected myself with it and several patients. So I have ideas, and I’ve plunged into the research, and I’m eager to show you what I have found. And that’s the topic for tonight. So if that’s not of interest to you, then tonight may not be the night to attend. But I think you’ll find this helpful when treating people with erectile dysfunction.

Where I Educate My Own Patients About the Procedure

First, I’ll show you the page and give you a link. This is my personal website. I feel like it’s not ethical for me to do things with patients if it’s reasonable for me to do it to myself, and also feel like it’s not ethical for me to recommend things to physicians that I’m not also using with my own patients. I’ll put a link to this.

Click to see my personal page advertising Bocox™<—

I looked for a name we could use that is G rated and not taken, and I’ve come up with BoPriapus™ or Bocox™. This name will be available for use for free (no extra cost other than the P-Shot provider membership) to anybody in our group that’s doing the Priapus Shot.

I’m about to show you how I’m talking about it. You’re welcome to copy, paste this page, and use it on your own website. We’ll get to the marketing later, but I have some new insight about safety that I think you’ll find reassuring.

I always like G-rated names, so obviously, Bo, for Botox, and Priapus is another name for the penis. So it means Botox penis, it’s a compound word. So hopefully, you’ll find that palatable.

Botox into the penis alone would be called “Bocox™”

If you’re going to combine Botox with the Priapus Shot, it’s just Priapus Shot 100 or P-Shot 100™ since we use 100 units of Botox when we do the treatment and the double meaning is that we intend for everyone who gets the procedure to get a grade of “100” by their lover.

And again, I’ll protect these names, they’ll be available without any extra charge if you’re in the group and you’re already doing the Priapus Shot® procedure.

Guarantees and Disclaimers

So, I put a link … oh, let me put a link. I just put it on my website, runels.com/bopriapus. And my intention is to make this talked about, so I’m giving you a heads up. But there will be some things I’ll do. Who knows? It may not work this time. But I’ve had good luck in the past, with having some press coverage. And we’ll get to the research. I have, like I said, new insights to that. But I wanted to show you a preview to this first.

You may not want to put this on your website, but I recommend that you have, on your website, a disclaimer that it doesn’t work for everybody and a guarantee. When you’re doing things that not everybody is doing, the biggest arrow that gets thrown at us for doing cash procedures is: are we ripping off patients? So always guarantee people, “You can have your money back if you want, at any time you want.” I put there six months, but they could ask back a year from now.

The only downside is, if they have come to me just for that procedure and they get their money back, they don’t get to be my patient anymore. And maybe they don’t want to be. And you could think, “Well, couldn’t a con man just go doctor, to doctor, to doctor, doing this?” That’s true; they could. But most people are not con men, or Walmart would be out of business, and L.L.Bean and everybody else who offers money-back guarantees. So this is the best money you ever spend (refunding money). And it just deflates the main criticism from our critics, which is that we’re stealing from people.

And the price point needs to be high enough to cover your cost so that if you do give someone their money back you’re still in good shape. So I usually charge $1,900 for the first P-Shot. This is my webpage, where they can click and buy and schedule. So I charge $1,900 for the first P-Shot. If they get a repeat, it’s 997.

And realize this isn’t just a procedure; we have to spend time talking with people. And remember that a massage … Okay, Grand Marriott. I just want to show you this, guys, again. Grand Marriott Hotel, Fairhope, Alabama massage. Okay. So here we go, the Grand Marriott Golf Resort. Let’s look at what it takes to get a massage. When you start going in here and looking, you’re going to find that an hour-long massage will run you in the neighborhood of 300 bucks. And they went to school for six months, and there’s no risk involved, no malpractice insurance, and not five employees. So, in other words, if you’re going to make someone’s erection better, it’s worth it. And it’s not just a shot; it’s thinking about the person.

So for the BoPriapus alone, I charge 1,797 because it includes 100 units of Botox. And as you guys know, it’s expensive. And again, you need enough profits so that if someone … it’s going to be about one in 10 that’s going to want their money back. Because it doesn’t always work, nothing works all the time. So you need something that gives an 80 to 90% success rate if you’re going to offer a money-back guarantee. And then you need enough profit margin that when you give the money back you’re still profitable. If you have a 10% margin and you give money back to someone, well, you’ve got to do 10 people before you break even again. So that doesn’t work. The math doesn’t work.

And then if I do the two together, I cut them a little discount. And it’s 2,987 for a first-time P-Shot with 100 units of Botox added to it. And it’s the easiest, simplest thing. People get it.

How much Botox is too much (dangerous)?

Now, let’s look at the science and let’s look at the toxicity calculations, because I want you to … And I’ve made a stab at talking about this before, but we’ll come back to this. Let’s just first go straight to safety. I put these two papers where you can read them, in the download things. So if you want to download that now. So let’s go over and look at this.

Now, there are two, not one, but two double-blind placebo-controlled prospective studies showing benefits with Botox in the penis to people who were resistant to the PDE5 inhibitors. Now, in these studies, they stayed on their Viagra, Cialis, whatever, but when they added in the Botox they got better. So there would just be one variable.

That’s big because these are hard to help people. And they were looking at an implant or something else if this didn’t work.

This one, in Andrology, I think, gives the best explanation for the logical progression of why it should work. So let’s just walk through it. And then I think I’m going to have something you’re going to find extremely reassuring about safety here. But I want to walk through it because I think, if you’re doing this, even though you know how it works, it’s good to rethink it. When I was a ER doc, sometimes I would just get out DeGowin & DeGowin, and just reread how to take a blood pressure or how to listen to the heart. Stuff I think I know, but be a beginner again. So let’s just be a beginner again for two paragraphs.

Botulinum neurotoxin is produced by Clostridium Botulinum, an anaerobic, gram-positive bacterium. Poisoning can cause botulism, which causes generalized paralysis, respiratory failure, and death. And in nature, yeah, this is the most toxic thing known.

Now, there are seven serotypes. And botulinum neurotoxin A is what Allergan produces. I know you can do other stuff, and there is actually this same sort of studies with Dysport. I recommend you stick to Botox, even though it costs more and even though they don’t have to be as sweet to you. I recommend, for this procedure, you stick to Botox because it does have a long history of safety, two decades now of safety.

How Does Botox Improve Erection?

We’ll skip all the history part, how it came about to be used. But let’s go back. Let’s come down. Oh, actually, I do want to come up to this part because it talks about, “It’s used for striated muscle, aesthetic medicine.” But it’s also been used for smooth muscle … let’s see, where did it talk about it? … some smooth muscle disorders, such as achalasia, esophageal spasm, hyperhidrosis, intrinsic rhinitis, blepharospasm, muscle spasm, all this stuff. Axillary hyperhidrosis, neurogenic detrusor muscle overactivity of the urinary bladder. Smooth muscle stuff.

So now, let’s come down here and just review this part, “It works by blocking the release of acetylcholine. But it also blocks other neurotransmitters, not just acetylcholine, such as: noradrenaline, dopamine, glycine. It inhibits noradrenaline release in the urethra in the anococcygeal of rats.”

Now, here’s where … and I’ll stop reading after this … “The erection depends on adequate cavernosal smooth muscle relaxation.” Which is exactly what Viagra and Trimix do. It’s the same mechanism.

“Since Botox is a strong inducer of smooth muscle relaxation, it may be effective in the treatment of ED refractory to PDE5 inhibitors.”

So it works just like Viagra. It works just like Trimix. Same mechanism. Well, same end mechanism. It comes about from a different way, but it’s doing the same thing to cause an erection: smooth muscle relaxation with increased blood flow arterially, with venous congestion. Simple explanation, simple understanding. It’s good to have that clear in your head when you talk to patients about it.

Bocox™ and the P-Shot 100™ procedures are now both taught within the Priapus Shot® (P-Shot®) membership site (members log in here, go here to apply for a new membership (click))

So here’s a double-blind placebo-controlled study prospective. This is a double-blind, placebo-controlled prospective study. Now, there was an editorial that came out in the Journal of Sexual Medicine, we went over that last week. I don’t want to go back over it, but I’ll just say that in the paragraph where they talked about safety, they referenced this article. And this article, it was a meta-analysis that included thousands of papers. And their conclusion was: nothing bad’s happened, that the numbers would not allow for seeing something that happened in less than 1,000 people. But the conclusion was that nothing bad happened…

NOTHING

Botox LD50

Being an ex-ER doctor … and this is the new thing we haven’t talked about that I want to bring up tonight, the LD50. Why is no one talking about LD50 in these papers? So I thought, “Well, let’s just calculate the LD50. I’ve heard it’s pretty high, but let’s calculate it.”

So if you go, flip over here. And this is the part that made me feel reassured, and I hope it does you as well. So if you look to see: what’s the LD50 for Botox? It’s somewhere around two nanograms a kilogram if you just IV push it. It’s more by inhalation. But you just IV push it, LD50, for humans, is estimated to be around two. You see ranges of 1. something, up to tHree. But it’s thought to be around two nanograms per kilogram, IV.

Well, let’s just do the simple math. Let’s assume a very small 100 pound woman, so she’s 45 kilograms, then let’s just do … I mean, you’ve already done this in your head. But I just want us to look at it and think about it, because it’s so beautiful it’s worth meditating on. So here’s the math: you have a 100 pound woman, who’s 45 kilograms. And the LD50 … if you guys remember, that’s the dose that would kill half the people if they took it. It’s a standard way to calculate the toxicity of something. So two nanograms per kilogram means her LD50 would be 90 nanograms.

So now, how much Botox is in a vial of Botox? So here … I’ll give you the link to this … if you look at these numbers, a vial of Botox has … and I’m putting this in the chat box. By the way, if you open all this up before the webinar goes down, you’ll have it. It disappears after the webinar. So Botox has, on the average, of 0.9 nanograms per vial. Ranges from 0.89 to 0.94. So 0.9, plus or minus 0.03, nanograms per vial.

So let’s go back to the math. This is what I’m trying to get: if you just shot IV Botox into a 100 pound woman, how many vials would you have to give her?

It’s going to work out to be: 90 divided by 0.9 is 100 vials. 100 vials. The answer to this question is 100 vials. 100 x 100 unit vials.

You see that? Let me go back to this. Got to make sure you see that. These are 100 unit Botox vials. Have 0.9 nanograms. And the LD50 for a 100 pound woman … we don’t treat many 100 pound … we’re treating men, so there are a few 100 pound men. But if this was a 150 pound man, you’d have to give him 150 vials.

Crazy, huh? Basically, however many pounds they weigh, that’s about how many vials you have to give them to kill them. So a 180 pound man, the LD50 would be 180 vials of Botox. So we are giving less than, or we’re giving around, 1% of the LD50, if you shot it IV.

And of course, the reason I wanted to know this is because some might argue that putting it into the corpus cavernosi is equivalent to an IV push. But I like the idea of not even using the constrictor band and let it go into the part of the corpus cavernosi you can’t see. In these clinical trials, they did that. If you wanted to do that, that’s fine. But the point I’m making is, if you just IV pushed it you’re 1% of the LD50 if you shot in 100 vials in a 100 pound woman.

Okay. Hopefully that reassures you on the safe side.

Marketing it, or letting your patients go elsewhere

So, back to how to talk about it. I think whether you’re ready to go or not, there’s going to be some who are, and some who want to give it some time. I’m going to put this again, here’s the … As you guys know, we are early adopters of the PRP. That’s coming around with double-blind placebo controls and lots of stuff coming out. The interesting thing about this is we’re 10 years into research with our PRP for erectile function and sexual function. We’re only four years into this. So some of you may not be ready to adopt it. But that’s the safety data.

Oh, and the how to do it part, I’ve promised you guys this. It’s all done. I didn’t want to put the how-to-do part on the P-Shot website until I had a better idea of how to market it. So now you have a name to use. Either way, you can use Priapus Shot 100™ to combine the two. Make up your own name if you want. But I’m going to try to make these go viral. And if you’re doing the P-Shot, it’s available to you for no extra cost.

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

That’s all I have tonight. But I will answer questions. If I missed something and I said something that sounds stupid to somebody, I want to know about it. I’m happy to open up the mic so you can tell me where I’m wrong because I don’t want to go to sleep not knowing. But that’s the way I’m thinking about it. And I saw I put the three papers I showed you in the handouts. So if you click on those, they’ll be available for you to look at too when I shut this blank thing down.

Let’s see, looks like Dave Harshfield may have a question. Let’s see. Hold on a second.

Oh yeah, good question. Okay. I should have mentioned that. So in this double-blind … thank you for pointing that out, Dave … so you got Trimix, which you have to do for every erection. Let’s see, which one was it? This study right here. Let me pull it back up for you. Unlike Trimix, remember Botox lasts three months in the face. But for some reason, and this is where they postulate it may have something to do with the same thing that happens with the … there may be a central effect, because we do know that Botox migrates down the axon. But if you look at the conclusions here … let me see, let me pull it … the bottom line is it lasts for months. All patients were evaluated at two weeks, three months, six months, following post-treatment. But the 100 unit dose was still going at six months and the 50 unit dose had worn off.

So let’s see if I can find that. And the same thing with the flaccid, not the girth … it’s only a centimeter … but the length was a centimeter bigger or longer with the 100, but that … Here we go.

This is what I’m looking for. “High, significant improvement in the SHIM score within two weeks, which is when Botox is full effect; which is in agreement with the other study that I showed you. This improvement is at maximum at the third month, with no difference between 50 and 100. But it was diminished in the 50 group while endured at six months post-treatment with the 100 unit dose.”

So they stopped looking at six months. The reason that’s interesting is that you can’t explain that with the acetylcholine effect. And they postulate that it could be the same thing we talked about with depression, there could be migration along the axon and something to do with the Langerhans cell in the spinal cord. And remember, a ED is a parasympathetic response, so perhaps that migration along the pudendal nerve to the spinal cord is causing something with Langerhans cells. But these are hard to treat people, with hypertension and diabetes that were not responding anymore to their Cialis. And then they got this and they did respond. Remember, they didn’t just come off their medicine, but their medicine started to work again.

So this is something that I think not everybody’s going to want, but I think it makes sense. And especially for the hard-to-treat case, you could put it in with your P-Shot. I don’t foresee … So far, I haven’t done it as a standalone, except for one person who had recently had a P-Shot. And I gave it to him to see if he saw a boost. And he did. But again, that’s anecdotal.

But here are the two papers. You have them to read. That’s how it works. So it’s somewhere around six months, it was still working at 100 unit dose, which is why I picked that. Now, there are others, that when you look at this safety review, you’ll see they look at … some things take … which you would know, Dave … sometimes you’re putting 300, 400 units when you’re treating torticollis or something, spasticity in a larger muscle.

So the other thing we have going with us … the table I’m looking for … so in these different indications, you’re seeing doses that are over 100 units. But even that, we just went through the LD50, you’re still at 1%, 2% of the LD50. So we have a logical reason why it should work. I’ve given you my two favorite studies, because they’re prospective double-blind and all that. But we only have four years of it and it’s not widely adopted, so it may not be time for everybody to do it. You may want to do it on a limited basis while you studied the research, or not at all. But the other thing I think we have going for us is we have two decades of injecting much higher doses, with a safety profile that’s amazing.

Let’s see if there are other questions. Thank you, Patrick. Let’s see. “Would you use the pump post-procedure?”

Yeah. If they tolerate it, I use the pump post-procedure. David sent out an email recently showing how just intermittent hypoxia can cause a response that precipitates some regenerative processes. I also have the postulate that perhaps you’re activating … when you’d use the pump, you’re pulling blood into the penis and then you’re activating platelets with vacuum, which we know happens every time you have a difficult phlebotomy and it clots in your tube. We know vacuum activates platelets, and you’re keeping it pliable. And we have a study showing that it makes your Viagra work better. And we have a British Journal of Urology study showing 51% of people cancel their surgery for Peyronie’s disease, just using a pump twice a day for 10 minutes for 12 weeks.

It (the pump) quit being this old-fashioned thing, and the old has become new, with … Research is coming out in another study, showing transcutaneous oxygen levels are higher throughout the day for people who use a penis pump once a day.

So yeah, if they’ll use it, I recommend they use it. And these studies, of course, are looking at one variable. But when I’m trying to get someone where they can make love to their wife again, I do everything I know that might be safe that they can afford. But thanks for pointing that out, David, because I didn’t realize I was giving that impression, that it was a once every time you do a have sex.

Would I avoid the corona … Yeah, thanks for bringing that up, Tiffany. Actually, my fiance’s pointed that out to me. There’s no reason to actually put it (Botox) in the glands. So when I do it now, I just put the Botox in the corpus cavernosi part of the procedure. I don’t think you would hurt anything. And I want to think more about it, because if it’s actually going into Langerhans cells and creating an enhanced parasympathetic response, vasodilation, then, I don’t know, maybe it’s better to hit it from every possible way? I have to think about it. But it makes sense, that since that’s the part that causes the erection, that that’s where you would put it. And that’s what some are doing.

Thank you, Alex. So lots of good feedback, that it’s working.

Yes. Thank you, David. So yes, there has to be nitric oxide for anything to work. Yes. There was actually some mention in one of these papers that there may be something other than nitric oxide going on, that I need to go think more about when we use the Botox. Of course you have the block of the synapse, but there may be another … They’re not sure what all is happening there, and may be something more profound than even we’ve talked about. Because the mystery is: why is it lasting longer than it does in the face? So I don’t have a good answer for that.

Oh, one more question. Nope, that’s it. Okay, I hope that gets you guys to thinking. Patrick, as far as the procedure, I’ve been promising you guys that I would do this, but I was waiting until I had something to call it. And you can use something different. But once I pull the trigger, I want to make it where it’s out there and people are asking about it. That’s really how our procedures have become popular. It’s not really from us talking so much about it as it has been pushing a few buttons and getting the press and others to talk about it, and then go looking for somebody who will do it.

So I don’t know, watch and see. But hopefully I’ll have it to where these names are being talked about over the next few weeks. If you put them around, on your website, it could be that the search engines see you as one of the first to do it so keep you at the top of the page.

Okay. I think I’m rambling now, so I will stop with that. I hope you guys have a good night. Now that we’re ready to pull the trigger, I will pull the stuff that’s on my Botox class, and you’ll have … If you go to botoxclass.com, I have 40 different videos in there. I go through everything, from how to market it, and then I talk about medical stuff like migraines and bruxism and ED. And all that, that’s in there about ED, I’m going to pull it out and put it on the P-Shot website.

All right. Hope you guys have a good night. Always an honor to have the attention of such amazing people. Bye-bye.

Relevant Links

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

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—>Dr. Runels Botox Blastoff Class<—

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Relevant Research

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