Adding Regenerative medicine to your practice.

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bronchospasm

bronchospasm

Interventional Pain Physician
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Guys I was thinking about adding Regenerative medicine to my practice. Really don’t know where to start. Need some input from others who are in this space.
Maybe just start with PRP and go from there.
Do’s and Dont’s.
Any and all advice is appreciated.

Thanks.


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Last edited:
bronchospasm said:
Guys I was thinking about adding Regenerative medicine to my practice. Really don’t know where to start. Need some input from others who are in this space.
Do’s and Dont’s.
Any and all advice is appreciated.

Thanks.


Sent from my iPhone using SDN mobile
Click to expand...
Same here. Looking for info on marketing, how to talk to patients about it, vendors for PRP/Stem cells, and where you would recommend starting in terms of the most straightforward procedures with high success rate.
 
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Agast said:
I’ve heard positive anecdotes from my patients about PRP they had elsewhere but nothing miraculous. So far no one has reported improvement with stem cells.
Click to expand...
Improvement from stem cells? Ask the doctor. I think Russo just bought a bigger boat. Now that’s an improvement.
 
bronchospasm said:
Guys I was thinking about adding Regenerative medicine to my practice. Really don’t know where to start. Need some input from others who are in this space.
Maybe just start with PRP and go from there.
Do’s and Dont’s.
Any and all advice is appreciated.

Thanks.


Sent from my iPhone using SDN mobile
Click to expand...

Join IOF and go to courses; read Malanga's book on Regen Med. IOF is the SIS of Regen Med.

Amazon product ASIN B071RNPJQ3
 
I'm doing a Regenexx course this upcoming weekend. I hope I leave with some new tools but I'm skeptical.
 
SommeRiver said:
I'm doing a Regenexx course this upcoming weekend. I hope I leave with some new tools but I'm skeptical.
Click to expand...

Another good platform is the Biologic Orthopedics Society on Linked-In. Lot's of thought-provoking and generative discussions there...
 
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WAPMU just had an excellent Regenerative Medicine course in Chicago. Great overview of basic science, currently available literature, FDA regulations, and ultrasound-guided techniques with little to no industry bias. Not sure when the next one will be held, but I highly recommend it!
 
lonelobo said:
Elite Hospitals Plunge Into Unproven Stem Cell Treatments
Click to expand...

There is nothing new under the sun. Some elite hospitals plunged almost 20 years ago. That's where I got my exposure.

And, elite hospitals in Europe even earlier!

Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress - PMC

Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

"Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis."
 
You are correct Snake oil treatments are not new.....

From article

Hospitals say they’re providing options to patients who have exhausted standard treatments. But critics suggest the hospitals are exploiting desperate patients and profiting from trendy but unproven treatments.

“It’s an out-of-pocket, cash-on-the-barrel economy,” Turner said. Across the country, “clinicians at elite medical facilities are lining their pockets by providing expensive placebos.”

A 2017 study of PRP found it relieved knee pain slightly better than injections of hyaluronic acid. But that’s nothing to brag about, Rickert said, given that hyaluronic acid therapy doesn’t work, either. While some PRP studies have shown more positive results, Rickert notes that most were so small or poorly designed that their results aren’t reliable.
 
lonelobo said:
You are correct Snake oil treatments are not new.....

From article

Hospitals say they’re providing options to patients who have exhausted standard treatments. But critics suggest the hospitals are exploiting desperate patients and profiting from trendy but unproven treatments.

“It’s an out-of-pocket, cash-on-the-barrel economy,” Turner said. Across the country, “clinicians at elite medical facilities are lining their pockets by providing expensive placebos.”

A 2017 study of PRP found it relieved knee pain slightly better than injections of hyaluronic acid. But that’s nothing to brag about, Rickert said, given that hyaluronic acid therapy doesn’t work, either. While some PRP studies have shown more positive results, Rickert notes that most were so small or poorly designed that their results aren’t reliable.
Click to expand...

Complete snake oil... nothing new under the sun...more elitist hospital bull****. F*ck the elitists.

Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience - PMC

A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience
Markus A. Bendel, 1 , * Susan M. Moeschler, 1 Wenchun Qu, 1 Eugerie Hanley, 2 Stephanie A. Neuman, 3Jason S. Eldrige, 1 and Bryan C. Hoelzer 1
Author information Article notes Copyright and License information Disclaimer

Go to:
Abstract
A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients.
Go to:
 
drusso said:
Complete snake oil... nothing new under the sun...more elitist hospital bull****. F*ck the elitists.

Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience - PMC

A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience
Markus A. Bendel, 1 , * Susan M. Moeschler, 1 Wenchun Qu, 1 Eugerie Hanley, 2 Stephanie A. Neuman, 3Jason S. Eldrige, 1 and Bryan C. Hoelzer 1
Author information Article notes Copyright and License information Disclaimer

Go to:
Abstract
A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients.
Go to:
Click to expand...

Oops. Hey dave, start using ebp cpt code for all your stem cell shots.
 
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I still disagree with calling blood patches as stem cell therapy.

you aren't spinning down the blood and using PRP for the blood patch, are you? or specifically using stem cells instead of whole blood? cause I am not...
 
Ducttape said:
I still disagree with calling blood patches as stem cell therapy.

you aren't spinning down the blood and using PRP for the blood patch, are you? or specifically using stem cells instead of whole blood? cause I am not...
Click to expand...

You can't explain the difference in mechanism of action between autologous blood acting on the fibers of the dura mater and platelet-rich plasma acting on the fibers of the Achilles tendon?

FDA says autologous blood in the epidural space is NOT homologous use.

A distinction without a difference.
 
drusso said:
You can't explain the difference in mechanism of action between autologous blood acting on the fibers of the dura mater and platelet-rich plasma acting on the fibers of the Achilles tendon?

FDA says autologous blood in the epidural space is NOT homologous use.

A distinction without a difference.
Click to expand...
Sure you can. The way I explain it to patients is that EBP is like fix-a-flat. It forms clots that plug the hole. You aren’t plugging a leak in the Achilles tendon.

www.sciencedirect.com

77. : Uncovering the therapeutic mechanism of blood patching for treatment of spontaneous cerebrospinal fluid leaks

The mechanism of action for lumbar blood patches affecting a therapeutic response in a proximal cerebrospinal fluid (CSF) leak is thought to be via a …
www.sciencedirect.com www.sciencedirect.com
 
drusso said:
Complete snake oil... nothing new under the sun...more elitist hospital bull****. F*ck the elitists.
Click to expand...

Think the crux of the article implies that they are in it for the money........like many on this board who claim it to be a panacea for all ills of man
 
except when we do it for free, it just destroys the narrative you keep trying to push
 
callmeanesthesia said:
Sure you can. The way I explain it to patients is that EBP is like fix-a-flat. It forms clots that plug the hole. You aren’t plugging a leak in the Achilles tendon.

www.sciencedirect.com

77. : Uncovering the therapeutic mechanism of blood patching for treatment of spontaneous cerebrospinal fluid leaks

The mechanism of action for lumbar blood patches affecting a therapeutic response in a proximal cerebrospinal fluid (CSF) leak is thought to be via a …
www.sciencedirect.com www.sciencedirect.com
Click to expand...


You don't even need it to clot at the hole. The immediate relief is from replacement of volume. Have seen epidural blood patches done at lumbar level for cervical level dural puncture.
 
Doctodd said:
except when we do it for free, it just destroys the narrative you keep trying to push
Click to expand...
Yes I am sure the majority of this kind of work you do is for free......LMAO
 
finally lonelobo contributes something to the board.....discuss. Im reading it now....25 patients who had both knees treated(one with saline and one with BMAC+PPP), they all did significantly better. Looking forward to the saline alone study on knee OA.
 
Is an entirely regenerative practice viable?
 
drusso said:
More f*cking elitist doctors and their elitist treatments...
Click to expand...
So in elitist treatments you mean ones that are generally accepted and have been studied to be effective in non-bias way
 
drusso said:
I'm poking fun at the notion that any treatment not covered by insurance is "elitist."
Click to expand...

Please give a breakdown of the costs/time/risk associated with harvesting stem cells, prepping them, and injecting them. Then tell us how it costs $4-8000 per shot.
 
Or just make crap up as you go. But marketing is key.
CB30503A-111A-41AA-A0F7-F5051CF3CADA.jpeg
 
lobelsteve said:
Please give a breakdown of the costs/time/risk associated with harvesting stem cells, prepping them, and injecting them. Then tell us how it costs $4-8000 per shot.
Click to expand...

Dude,

Easy: SOS differential. Good f*king luck. I've been trying to get the hospital to explain why an aspirin costs $8 for 16 years.
 
lobelsteve said:
Or just make crap up as you go. But marketing is key. View attachment 259685
Click to expand...

BTW, that place is chiro quack shop. Don't send your patients there. You've got two legit dudes in your neck of the woods:



"Dr. Williams completed his residency in Physical Medicine and Rehabilitation and he was awarded the resident of the year 3 consecutive years in a row and was voted to serve as the Academic Chief Resident his senior year. Dr. Williams did a 1-year fellowship under the direct mentorship of Dr. Christopher Centeno and Dr. John Schultz, two of the founding pioneers in the field of regenerative orthopedics and orthobiologics."



"Dr. Mautner is an expert in diagnostic and interventional musculoskeletal ultrasound and teaches and directs courses across the country on how to perform office based ultrasound. He regularly performs Platelet Rich Plasma (PRP) and Stem Cell injections for patients with chronic tendon and joint related problems."
 
Do you foresee regenerative medicine becoming covered by insurance in the next 5-10 years?
 
drusso said:
BTW, that place is chiro quack shop. Don't send your patients there. You've got two legit dudes in your neck of the woods:



"Dr. Williams completed his residency in Physical Medicine and Rehabilitation and he was awarded the resident of the year 3 consecutive years in a row and was voted to serve as the Academic Chief Resident his senior year. Dr. Williams did a 1-year fellowship under the direct mentorship of Dr. Christopher Centeno and Dr. John Schultz, two of the founding pioneers in the field of regenerative orthopedics and orthobiologics."



"Dr. Mautner is an expert in diagnostic and interventional musculoskeletal ultrasound and teaches and directs courses across the country on how to perform office based ultrasound. He regularly performs Platelet Rich Plasma (PRP) and Stem Cell injections for patients with chronic tendon and joint related problems."
Click to expand...

The quacks advertise the heck out of quackery. This is your competition. If they qualify for Kenneth’s study id send them. I give the folks who want to hear current shpiel on sc ams info. I warn them the data has not been gathered on if it will work. I tell them it is safe and it’s their money.
 
whats a "Seninar"?

lobel does hit upon an important point - the fact that these procedures are essentially wild wild west means that everyone is going to do them, and they will not be effective - since they will be done incorrectly. it will put a black mark on these procedures, and will perpetuate the Medicare notion that they are not effective and should not be covered.
 
lobelsteve said:
How do you explain charging thousands of dollars for your magic beans in your office?
Click to expand...

I'm certain it's the same process your employer uses to set your professional fees (some multiple of Medicare payment) and facility fees (usual and customary charges). For patients whose insurance pays for our procedures, we are contractually obligated to accept the negotiated rate just like anyone else. For patients whose insurance does not pay for the procedure, we can offer a cash discount. You can check here to see if your insurance covers regen med procedures:

regenexxcorporate.com

Regenexx Corporate Program - Regenexx Corporate

regenexxcorporate.com regenexxcorporate.com
 
lobelsteve said:
The quacks advertise the heck out of quackery. This is your competition. If they qualify for Kenneth’s study id send them. I give the folks who want to hear current shpiel on sc ams info. I warn them the data has not been gathered on if it will work. I tell them it is safe and it’s their money.
Click to expand...

I've already written about this extensively.
 
Cassowary said:
Do you foresee regenerative medicine becoming covered by insurance in the next 5-10 years?
Click to expand...

It already is by some insurers. Check your health plans "summary of benefits" to determine if it is or not. If it is not, then call your broker or contract representative and ask, "How do I submit a request for determination of service coverage?"
 
drusso said:
I'm certain it's the same process your employer uses to set your professional fees (some multiple of Medicare payment) and facility fees (usual and customary charges). For patients whose insurance pays for our procedures, we are contractually obligated to accept the negotiated rate just like anyone else. For patients whose insurance does not pay for the procedure, we can offer a cash discount. You can check here to see if your insurance covers regen med procedures:

regenexxcorporate.com

Regenexx Corporate Program - Regenexx Corporate

regenexxcorporate.com regenexxcorporate.com
Click to expand...

Ok, so give me your CPT code used for SC knee, how many times (1-3?) and show me CMS has that in the fee schedule. If it not, then this is not something we offer. We will do self pay if insurance refuses T MBB or if a patient does not want to fail PT for 6 weeks before getting an ESI. But your treatment is a different entity altogether.
 
drusso said:
I'm certain it's the same process your employer uses to set your professional fees (some multiple of Medicare payment) and facility fees (usual and customary charges). For patients whose insurance pays for our procedures, we are contractually obligated to accept the negotiated rate just like anyone else. For patients whose insurance does not pay for the procedure, we can offer a cash discount. You can check here to see if your insurance covers regen med procedures:

regenexxcorporate.com

Regenexx Corporate Program - Regenexx Corporate

regenexxcorporate.com regenexxcorporate.com
Click to expand...
How is your experience with Regenexx? I’ve heard variable things. Does a lot of the money for the procedure end up going to them?

I have a partner who does stem cell injections but he sends to a surgeon who does the adipose extraction then sends the cells and some PRP back to him to actually inject. Technically, the patient pays the surgeon for the stem cell treatment and the surgeon pays my partner to do the injection. I would want to do it all myself though if I end up offering it. I’m just not sure I really believe in it enough to suggest it to patients - even the outcomes on Regenexx’s own website aren’t that impressive in terms of %pain relief...
 
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