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Dr. Weitz offers holistic wellness assessments, PRP and prolotherapy treatments of the extremities, as well as PRP Facials and Hair Restoration.
What is Regeneritive Medicine?
Regenertive Medicine is a field of medicine that seeks to restore damaged tissue to it previously healthy state. We integrate various specialties in order to obtain optimal results. These include regenerative injection therapies such as prolotherapy, PRP, and Biocellular Medicine. Other fields utilized include hormone therapy, nutrient therapy, Low-Intensity Shockwave Therapy, and physical therapy. To understand regenerative medicine you need to understand what each of these specialties does for you.
Regenerative Injection Therapy (RIT)
RIT is the injection of various nutrients to directly into damaged tissue. The goal of all types of injection therapies is to stimulate the tissue to repair itself by causing various degrees of informtion. That is right! Inflammation is a necessary part of healing. When we take NSAIDs (Ibuprofen, Naproxen, etc) or get steroid shots, it greatly reduces inflammation and pain. However, this process stops the healing. In a recent study, steroid shots into the joint were found to significantly damage cartilage, thereby worsening arthritis in the long run.
Let's go over the various kinds of RIT:
This is an injection of dextrose (a natural sugar) in the the ligaments and tendons. The dextrose causes some minor local irritation and this stimulates the tissue to heal and repair itself. Studies of the tendon fibers after prolotherapy show that it leads to thicker tissue with better structure to the fibers. There is also a tightening effect and, when expertly applied, it can result in correcting instability of an enture region. The effect of dextrose on a ligament is often compared to the tissue reaction a slug experiences after traveling over salt. A more direct visual, would be this excellent before and after MRI from Dr. Chris Centenno, a world leader in regenerative medicine:
Prolotherapy is the least expensive treatment offered in RIT. Typically costing about $150-250 per treatment area. However, it does typically take 4-6 treatments for optimal results. This treatment is best for unstable ligaments, chronic tendonitis, and partial tears. Prolotherapy is a particullary good treatment for back pain.
PRP stands for Platelet Rich Plasma. In this treatment we take some blood (2 ounces/60 ML) and use a specialized sterile system (EmCyte) to spin the red blood cells out and get rid of most of the plasma. What is left o 5-10 ML of plasma with all of the platlets, white blood cells, stem cells, and other growth factors concentrated into a small amount of plasma. This can be injected into damaged or degenerative joints to stimulate healing. The cells all release their growth factors and attract more healing cells. This results in a powerful healing response. PRP is best for more severe damage and degeneration. It cost more than prolotherapy, but typically needs less treatments. Cost is $550 per 10 ML of PRP needed to treat the area. Your SageMED doctor can tell you how much it will take and offer a discount if multiple treatment areas are needed. It typically takes 2-3 treatments to resolve the issue. This treatment is best for torn ligaments and tendons, sacroilliac pain, and erectile dysfunction.
PRP + Hyaluronic Acid:
We utilize the same PRP technology as described above and then we mix it with a very slippery, lubricating, thick gel call Hyaluronic Acid. This allows the PRP to stay in the joint space longer, as well as soothe the irritated cartiliage. A recent study shows that combining PRP with Hyaluronic Acid can make the treatment TWICE as effective. This is best for pain in the joint space (knees, hips, ankles, and shoulders), though it has been succesfully used for arthritis of the spine (facetitis). Cost is $750 per treatment area. Discounts are typically provided if multiple joints require treatment.
Biocellular Medicine (AKA, Stem Cell Therapy):
Biocellular medicine refers to any type of injection that concentrates stem cells in one location. There are many types of biocellular injections. We can harvest stem cells (mesynchymal stem cells to be precise) from fat and from bone marrow. We can also attract stem cells to the area using growth factors derived from donated placental tissue (amnion). At SageMED we offer two types of biocellular injections, adipose (fat) grafts and amnion injections.
Fat grafts, more appropriately called PRP Enhanced Adipose Derived Mesynchymal Cell Grafts, are a obtained by liposuction of the inner tight. The fat is then centrifuged down to get rid of excess fat and focus on the good stuff in the fat (stem cells and growth factors). We make the graft more potent by mixing in some PRP. We then push it through a series of filters resulting in a very fine particle size that is injectable. Fat grafts are more expensive and invansive that other injections and are reserved for the most serious cases of damage and degeneration. We use them for Grade 3-4 arthritis of the knees, hips, shoulders, ankles, and facets (joints of the spine). You can also use a fat graft to patch a torn ligament or tendon. Cost runs about $3000. Usually only one treatment is required.
Amnion injections are recent developements that are currently being refined. These are contrentrated growth factors derived from the amnion layer of donated placentas. These proteins are extracted, purified, and concentrated. The theory is that these growth factors strongly stimulate healing and naturally attract stem cells to migrate to the area (though this point is debated). These agents have recently recieved FDA approval for wound healing and some are even covered by Medicare. Given that osteoarthritis is accurately described as a chronic non-healing wound, these agents are often injected into the joints for treatment of arthritis. In our clinical experience these injections are very effective and very powerful, but also quite painful. They cause a strong aching/burnign sensation in the joint. They are priced between PRP and Biocellular Injections at about $1500 per injection. These injections are a good pick when you need rapid results. They can be used for all tissue damage indications (joints, ligaments, tendons, and open wounds).
A Note About "Stem Cells" - BUYER BEWARE!
There are many clinics claiming to deliver Stem Cell treatment for many different ailments, ranging fro arthritis to parkinson's disease. The FDA has not approved "Stem Cell Therapy" for any indication. Since it is your own tissue, rather than a drug, you are free to choose to get a procedure done after appropriate education and risk assessment by your doctor. However, there is little research to support stem cell therapies outside of the uses mentioned above, and even those are continually being assessed. Systemic use of stem cells outside of safe spaces such as joints and into more risky places like your eyes, lungs, or blood stream (IV stem cell use) are not currently recommended. Moreover, many clinics are advertising "Stem Cell" injections but are actually using freeze dried stem cells or amnion preparations. As described above, these can be very effective, but they are not stem cells. They contain no live, viable, stem cells as you would get with a fat graft or bone marrow graft. Some of these clinics are charging $5000 for these injections, which is 3-4 times the actual value. This may be done out of ignorance, but more often than not it is done with full knowledge of the deception. These places should be avoided.
As you have read above, regenerative medicine requires your body to participate in the healing process. There are quite a few factors that can get in the way of optimal results, such as:
Smoking: RIT is not recommend for moderate to heavy smokers. It is frankly a waste of money. Smoking greatly impairs the healing process. Let us help you get smoke free first! Something that could add up to 7 years, on average, to your lifespan!
Diabetes: We will work to get your blood sugar down to "well managed" levels, prior to injection. This is a hemoglobin A1C score of 7% or less.
Autoimmune disease: there are many connective tissue diseases that cause chronic pain. If the underlying problem is not addressed then RIT will not be effective and could even worsen your pain.
Alcohol abuse: alcohol causes systemic toxicity and decreases the potency of RIT. Even moderate drinking can cause issues. Light drinking (less than 1 serving per day) may not be as problematic. If you have difficulty controlling your alcohol intake let us help you get sober now!
Obesity: carrying excess weight causes great stress to your joints and spine. Even losing just 10 pounds can improve your chonic pain. Our weight loss programs are individualize to help you meet your goals in a sustainable and healthy way.
Hypothyroidism: undiagnosed hypothyroidism can greatly impair healing. This can be ruled out with a simple blood screening. If positive, we will work to restore your thyroid function naturally prior to prescribing long term thyroid replacement therapy.
Low testosterone and estrogen: low hormone levels make it very difficult for your body to repair itself. These hormones make muscle and connective tissue repair possible. Modern clinic research has shown that hormone replacement therapy (HRT), if indicated, can be delivered safely and effectively by appropriately trained physicians. Poorly done HRT can be dangerous and increase your risk of cancer and heart disease. When expertly done, it can reduce your risk of those same conditions, as well as revitalize your body.
Infectious disease: there are many infectious disease that cause chronic pain. Lyme disease, Epstein-Barr, and bacterial infections are the most common culprits. There are accurate and simple tests available to screen for these if infected.
Nutrient deficiencies: The most common nutrient deficiencies that lead to musculoskeletal pain are vitamin D, magnesium, and iron. We also screen for copper excess and zinc deficiencies. These are usually corrected with dietary changes, dietary supplements, or IV therapy.
Toxicity: We all experience some degree of daily toxic exposure. If we take good care of ourselves and make reasonable efforts to keep our food, water, and air clean then our bodies can get rid of these chemicals quite easily. It is a myth that humans regularly need help with "detox". That being said, overexposure to heavy metals, pesticides, herbicides, and hydrocarbon fumes can cause issues. Especially for those in professions that require regular exposure to those things. In rare cases, these issues need to be medically addressed.
If you have one or more of the above issues, a good RIT provider will address those as much as possible prior to letting you invest hundreds of dollars into regenerative injection therapies. Often times the injections are not necessary after we correct all of the above. These is a relief for those with needle phobia!
Muscle atrophy or imbalance is quite common. We regularly see people come in after having expensive PRP or Stem Cell treatments from other clinics and they have not improved. After a quick assessment we often find that they have easily correctable muscle atrophy or imbalance. Common culprits include: tight IT band, weak adductors (inner thigh), weak gluteal muscles, and imbalance between push and pull muscles (chest and back, for example). Skilled physical therapy can address these issues. A study by the Osteoarthritis Centers of America indicated that adding physical therapy to RIT increased the satisfactory improvement rate from 65% to 95%.
Low Intensity Extracorporeal Shockwave Therapy
Shockave therapy is a very useful adjuct therapy. It is a small machine that delivers powerful sound waves through the tissue. The waves are so powerful that it mimic cell damage and stimulates your body to start the healing process. This is great for old injuries or degenerated tissue that your body has learned to ignore. Animal studies have shown a 6-9 fold increase in growth factors and stem cells in the tissue after treatment. It can be used with RIT or on its own. It is a very powerful tool when combined with PRP.
Regenerative Medicine is a powerful system of healing that can be used to treat chronic back pain, joint pain, muscle pain, tendonitis, and many more chronic conditions. To learn more about how you can benefit we invite you to schedule an appointment with one of our Regenerative Medicine providers listed below.
Dr. Bhandari offers expert exercise rehabilitation and movement assessments, as well as wellness assessments. He is experienced in PRP and Prolotherapy of the extremities.
Dr. Deichert offers wellness assessments and Amnion injections of the knees and hips.
Dr. Sage is the owner and medical director of SageMED. He offers all aspects of our regenerative medicine program.
Your SageMED provider will want to obtain previous imaging, such as X-rays, CT, and MRI records. New imaging may be required based on your assessment. It is vital that all information needed for an accurate assessment be obtained. Your provider may also use real-time ultrasound imaging for assessment prior to injection, as well and during the injection to ensure accurate needle placement.