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Platelet-rich plasma (PRP) does work… I told you so… March 12, 2010

Posted by nathanwei in Arthritis Treatment, Elbow pain, Lateral epicondylitis, prp, PRP-Platelet rich plasma, Tendonitis, Tennis elbow.
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Ran across another article that showed in a very nice study that PRP works a heckava lot better than cortisone for tennis elbow…

Platelet-Rich Plasma May Heal Tennis Elbow Faster Than Corticosteroid Shots.

WebMD (3/10, DeNoon) reported that, according to research presented at the American Academy of Orthopaedic Surgeons meeting, “platelet-rich plasma (PRP)…heals tennis elbow better than corticosteroid shots.” After randomizing “patients with chronic lateral epicondylitis — tennis elbow lasting longer than six months and pain ranking at least 5 on a 10-point scale — to get either PRP or corticosteroid injection,” researchers found that “patients in the PRP arm were much more likely to have less pain and more function than those who received the corticosteroid” after 26 weeks of treatment. However, the patients who received the corticosteroid injection had considerably faster relief of their pain.

This study confirms our findings.  I try to use a lot less cortisone now.

Why I think the Dutch PRP study ain’t much… January 17, 2010

Posted by nathanwei in Achilles tendonopathy, Arthritis Treatment, Heel pain, platelet-rich plasma, prp, PRP-Platelet rich plasma, Tendonitis.
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A recent study

[de Vos RJ, Weir A, van Schie HTM, et al. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial. JAMA. 2010;303(2):144-149]

cast a negative light on the use of platelet-rich plasma (PRP) for chronic Achilles tendonitis.

Dutch researchers randomly assigned 54 patients suffering from Achilles tendinopathy to receive either platelet-rich plasma injections or a placebo shot of saline.

Both groups also did conventional rehabilitation consisting of 180 heel drops (an exercise in which the toes are placed on the edge of a step and the heels are lowered toward the step below) daily for 12 weeks.

Results showed no difference between the two groups at six, 12 or 24 weeks after the procedure. Both groups improved about 20 points on a standardized scale that measures pain and function.

Robert-Jan de Vos, MD, in the Department of Orthopedics at Erasmus Medical Center, the lead author, says researchers don’t know why the injections didn’t work and they’re very disappointed by the results.

“These tendon injuries are very hard to treat,” Dr. De Vos said in an article reported in Arthritis Today.  He continued,  “We know that less than 50 percent of the patients with chronic Achilles tendinopathy are free of symptoms after one year. We still cannot prescribe a very promising conservative treatment, which is frustrating for the patients and treating doctors.”

Author’s note:

Many people will point to this study and say that PRP doesn’t work.  My take on it is this.  I think it was a well designed study. Really.  However, there are many explanations for the outcomes reported.

First, the technique used by the person performing the procedure was described as placing three holes in the tendon.  Those of us who do a significant number of Achilles tendon cases know that using a single entry point only and putting that single entry point on the top of the Achilles at an acute angle going from proximal to distal is critical.  Otherwise, the PRP leaks out and the patient won’t have as good a result.

Second any time a tendon is poked with holes without any other type of treatment given, it will improve.  The injury itself sets up an inflammatory response which leads to more healing.

The platelet concentration used was not mentioned.  Some PRP machines only provide a concentration of 2-3 times normal.  That’s not enough.  A good concentrate contains 7-10 times baseline counts of platelets.

No mention of tendon architecture changes was made.  I bet the tendon structure was improved in the PRP group (if a high enough platelet concentrate was used.)

This is a problem when a single study is touted as “being the gospel”. There’s more to the story

My heel kills… could it be plantar fasciitis? December 7, 2009

Posted by nathanwei in Arthritis Treatment, Heel pain, prp, PRP-Platelet rich plasma, Tendonitis.
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Plantar fasciitis is an extremely common problem, particularly in the summer when people walk around in flip flps all the time.  But I still see alot of it now in people where it is a chronic condition.

And chronic conditions call for the heavy artillery.

I can’t stand it when I hear about a patient getting a cortisone shot for this condition.  It just shouldn’t be done.

Let me tell you what should and can be done…

A tibial nerve block using ultrasound guidance anesthetizes the bottom of the heel.  Then using ultrasound guidance I can poke small holes in the plantar fascia and get rid of any spurs that are there at the same time.  Then I inject PRP (platelet-rich plasma), a derivative of a patient’s own blood.  The PRP is loaded with growth and healing factors which help the plantar fascia to regenerate new tissue. And- gets rid of the pain!

Just did this procedure last week in a patient.  He’s doing great!

An anniversary and the stem cell/PRP program past the halfway point September 24, 2009

Posted by nathanwei in Arthritis, Arthritis Treatment, health, hip, Hip Pain, knee, Knee Pain, nathan wei, Osteoarthritis, platelet-rich plasma, Prolotherapy, prp, PRP-Platelet rich plasma, shoulder, stem cell, Stem Cells, Tendonitis.
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Wow! Yesterday was our 25th anniversary.  Judy is in Boston helping her parents out.  One of them had a medical event.  Things are under control. At least up there.

Here… it’s a different story.

I can’t believe we  started the stem cell/PRP launch just a couple of days ago.  We’re past the halfway point and my staff and I are thinking about “pulling the project off the shelves soon.  Permanently or  temporarily.  Can’t say.

My advice… get it while you still can

http://www.domainnamesanity.com/webumake/wwwsites/www.aocm.org/StemcellandPRP.html

You’ll be glad you did.

Stem cell/PRP launch is going nuts!!! September 22, 2009

Posted by nathanwei in Arthritis, Arthritis Treatment, Hip Pain, Knee Pain, nathan wei, Osteoarthritis, platelet-rich plasma, Prolotherapy, prp, PRP-Platelet rich plasma, shoulder, stem cell, Stem Cells, Tendonitis, Uncategorized.
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A bit over 24 hours ago, we launched our new informational project and the response has been sensational.

If you or someone you care about has painful osteoarthritis or tendonitis you need to check this out.

It’s about as natural as you can get (your own biologic material) and you can often avoid surgery and its risks.

It’s possible that joint replacement may be come a thing of the past.

Go to:

http://www.domainnamesanity.com/webumake/wwwsites/www.aocm.org/StemcellandPRP.html

My Achilles tendon… July 15, 2009

Posted by nathanwei in Arthritis Treatment, PRP-Platelet rich plasma, Tendonitis.
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It’s been a little more than 3 weeks since my tenotomy/PRP  procedure for my Achilles tendon.  I have to confess, it hurt alot for the first 2 weeks.  But this past week I’ve seen the light at the end of the tunnel.

I’ve done my eccentric stretching exercises religiously- the ones Dr. Mulvaney gave me.  (And believe me, I’m the world’s worst patient when it comes to following orders). And I have no pain and I no longer limp.  The lump that was really painful where my tendonitis and tear was located isn’t tender anymore.

I haven’t started to run yet but I can do the bike and the elliptical without pain.

Would I recommend this procedure to others?  Absolutely!  In fact, now that I have first hand experience with tenotomy and PRP, I am a real zealot.

I’ll go way out on a limb and say that this is the procedure of choice for people with chronic Achilles tendonitis with or without a partial tear.

Great news for us Baby Boomers.

New treatment for shoulder tendonitis July 1, 2009

Posted by nathanwei in Arthritis Treatment, PRP-Platelet rich plasma, Tendonitis.
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Healthday (6/30 Preidt) reported a study from the University of Milan, published in the July issue of Radiology, showing that a minimally invasive procedure is helpful for patients with calcific tendonitis of the shoulder. 

What the researchers did was to randomize 287 patients with calcific tendonitis of the shoulder to one of two grouops.  One group underwent ultrasound guided needling of the tendon with “washing out” of the shoulder and the other control group had no treatment.

Followup of the patients showed that the treatment group had significantly less pain and more mobility at one month, three months, and one year.

[This study actually describes a not so new procedure.  The “new” part is the use of ultrasound guidance, which actually is “old news”.  And the ability to break up the calcific depositis and wash out the shoulder is something that’s been done by many practitioners for several years.  This study confirms through a controlled study what has been known for quite some time. 

What really is new is something I’ve written about before… and that is the use of tenotomy… poking holes in a diseased tendon under ultrasound guidance  and injecting platelet rich plasma to heal the tendon and make new stronger tendon tissue. This is particularly useful for people with chronic rotator cuff problems.

My feeling is that  any press regarding the use of ultrasound guidance is a good thing since it informs prospective patients that they should demand a technology that will help them recover faster. NW]

Practice What You Preach… June 20, 2009

Posted by nathanwei in Arthritis, Arthritis Treatment, PRP-Platelet rich plasma, Stem Cells, Tendonitis.
3 comments

This past Friday was a busy day.  I performed three stem cell procedures on patients with osteoarthritis of the hip and knee, a PRP procedure on another patient with posterior tibial tendonopathy…  and then (drumroll please….)

…had a PRP procedure done to me… on my Achilles tendon.

So let me explain…

As you know my area of expertise is regenerative medicine for patients with arthritis.  That’s why my practice focuses on conditions like OA, RA, and tendonitis.

And when my nurses and I talk to patients and prospective candidates for these procedures, we tell them what to expect.  But how  can you tell a patient what to REALLY expect unless you’ve undergone the experience yourself.

Actually, one of our nurses had a stem cell procedure on her knee for osteoarthritis (yes… I did it),  so she’s been there and can tell patients bout the experience.

Now… don’t think I had this procedure done to me because I just wanted to be able to tell patients what to expect.  I think I’m a pretty empathetic physician but there are limits!

Here’s the background…

Twenty-seven years ago, I tore my left Achilles tendon playing basketball… (so beware, Mr. President).  It was not fun.  The injury was painful, plus I had to undergo major surgery to repair it, then I was confined to a long leg cast for 7 weeks, then a short leg cast for another 6 weeks.

For the last 10-15 years I’ve had intermttent pain in my right Achilles with activities like running and so forth.  My fear was that I was going to tear it like I did the other (there is an increased risk for tearing the other Achilles if you’ve torn one side).

So, I made my mind up to have a percutaneous needle tenotomy with PRP done.  If you’re experiencing chronic tendonitis, this is by far and away the best treatment for it.

But what do you do when you feel like you’re THE GUY.

What I mean is this…  There are those who think I’m the person to see when it comes to these types of ultrasound-guided tissue regenerative procedures.

But what do you do if you can’t do this type of thing to yourself?  Well… I did the next best thing.  I arranged  it for when doctors I really trusted and respected would be around.

I had planned for Dr. Tom Clark, the world’s foremost ultrasound anatomy expert and Dr. Sean Mulvaney, one of the best sports medicine physicians  in the area, to visit me Friday to observe and assist me in my cases.

So at the end of the afternoon, I said… “OK, let’s do it…”

Before I go on, let me explain one thing.  I am a WUSS.  I hate needles and I hate pain. I am a wimp, a coward when it comes to pain.  I admit it. So this thing was scaring me.  I had this upside down feeling in the pit of my stomach and I was breaking out in a cold sweat.  But, I told myself, “Nathan… how can you honestly talk with patients about this procedure … be brave… suck it up!)

So…

I had my nurses draw my blood for the PRP collection, then I went to our procedure room and Dr. Mulvaney did the procedure.  Probably half the staff came in to observe and giggle.

(By the way I had the whole thing videotaped and you’ll be able to see it sometime soon).

I can tell you it hurt.  Not unbearable, but not like laying out on a beach, listening to the waves (but that’s what I focused on to take my mind off what was happening).

Afterwards, Dr. Mulvaney gave me post-procedural instructions:

He told me, “Tonight, it’s going to hurt.”

I asked, “How much?”

He said, “You’re going to feel ‘this hurts so bad there’s gotta be something wrong’ kind of pain.”

Comforting.

Well later that evening, Judy and I watched  the DVD, ‘Risky Business’ (by the way if you haven’t seen this movie with the young Tom Cruise, you should).

I had some discomfort… OK… I had pain. and I actually had to take some pain medicine (which I ordinarily dislike doing). But not excruciating… even for a wimp like me.

But today, even though it’s sore, I think I’m going to make it.  I start my stretching exercises tomorrow.

I know this procedure will make my Achilles tendon strong and normal so I won’t have to worry about tearing it.  No substitute for peace of mind. And I know it won’t hurt when I run – a major plus.

And I’m going to see my son, Jeffrey, in a play tonight, so when I hobble in with my crutches, maybe I won’t have to wait in line.

Is Prolotherapy Something You Should Consider? May 16, 2009

Posted by nathanwei in Arthritis, Arthritis Treatment, Osteoarthritis, Tendonitis.
4 comments

Prolotherapy is type of treatment where dextrose (sugar water) is injected into a tendon, ligament, or joint.  The dextrose acts as a “proliferant” to induce inflammation.

This artificially created inflammatory response then leads to increased blood flow and migration of inflammatory cells into the area.  The end result is acceleration of the healing process and creation of stronger connective tissue.

An added plus is that symptoms of pain also improve.

Prolotherapy has been used to treat chronic tendonitis, whiplash, fibromyalgia, sports related injuries, ligament tears, back and neck pain, osteoarthritis, degenerative disc disease, sciatica, and temperomandibular joint dysfunction (TMJ syndrome).

Multiple treatments are often required.

Prolotherapy has been referred to as the “poor man’s PRP”.

In the right hands, prolotherapy is very effective and has been shown to be a cost effective solution for the treatment of many soft tissue injuries.