Adding Regenerative medicine to your practice.

[Ducttape]

I am always skeptical of “game changers”. I have seen “game changers” in multiple fields of medicine - internal medicine, emergency medicine and pain medicine.

in almost every single case, there is benefit for a limited group of people; maybe the only exception being H2 blockers and PPIs, no paradigm shifts occur.

The current data and experiences touted out there of PRP do not bode well for this being anything other than of limited benefit for a select group of patients (ie healthy athletes come to mind).

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[drusso]

I am always skeptical of “game changers”. I have seen “game changers” in multiple fields of medicine - internal medicine, emergency medicine and pain medicine.

in almost every single case, there is benefit for a limited group of people; maybe the only exception being H2 blockers and PPIs, no paradigm shifts occur.

The current data and experiences touted out there of PRP do not bode well for this being anything other than of limited benefit for a select group of patients (ie healthy athletes come to mind).

What's wrong with good treatments for healthy athletes. Still changing the game for THEM. Recreation is an important value and lifestyle choice.

 

[Ducttape]

What's wrong with good treatments for healthy athletes. Still changing the game for THEM. Recreation is an important value and lifestyle choice.

you miss the point. completely.

I suspect PRP will be excellent for young healthy individuals - those who have good plasma and conditions that are reversible.

I remain skeptical that elderly patients with severe end stage osteoarthritis and advanced spondylosis will improve with PRP.

 

[Doctodd]

you miss the point. completely.

I suspect PRP will be excellent for young healthy individuals - those who have good plasma and conditions that are reversible.

I remain skeptical that elderly patients with severe end stage osteoarthritis and advanced spondylosis will improve with PRP.

Nobody ever claimed PRP was a cure for "severe end stage osteoarthritis and advanced spondylosis"

 

[oreosandsake]

I see young athletes and pro athletes who do very well for their msk issues with PRP. I think a truly accurate diagnosis makes a big difference. If you only know how to stick it into the joint that’s a big reason why your outcomes may be less than ideal. In regards to older patients, I have been completely surprised. I think if you took good care of your body and stayed healthy and exercised your capacity to respond to anabolic treatments is much much greater.

 

[drusso]

you miss the point. completely.

I suspect PRP will be excellent for young healthy individuals - those who have good plasma and conditions that are reversible.

I remain skeptical that elderly patients with severe end stage osteoarthritis and advanced spondylosis will improve with PRP.

Why don't you listen to @oreosandsake ?

 

[SSdoc33]

I see young athletes and pro athletes who do very well for their msk issues with PRP. I think a truly accurate diagnosis makes a big difference. If you only know how to stick it into the joint that’s a big reason why your outcomes may be less than ideal. In regards to older patients, I have been completely surprised. I think if you took good care of your body and stayed healthy and exercised your capacity to respond to anabolic treatments is much much greater.

so, you are saying that if you work with healthy, motivated patients, then your outcomes are better?

many of us don't have the luxury to regularly work with that population. not to mention the fact that many patients dont have the means to pay for the higher-end treatments.

 

[lobelsteve]

Why don't you listen to @oreosandsake ?

He sells PRP like you.

 

[drusso]

He sells PRP like you.

You mean diagnose and treat using all available evidence within standards of care for regenerative musculoskeletal medicine and orthopedics?

 

[Ducttape]

You mean diagnose and treat using all available evidence within standards of care for regenerative musculoskeletal medicine and orthopedics?

just for my information, and not being argumentative - which organization's guidelines should we be using as the standard of care for regenerative medicine?


also... I don't see young healthy people. I don't see old healthy people.

when a new patient comes in that is on fewer than 5 prescription meds, there is a party in the break room.



last I checked the cupcakes are rock hard...

 

[drusso]

just for my information, and not being argumentative - which organization's guidelines should we be using as the standard of care for regenerative medicine?


also... I don't see young healthy people. I don't see old healthy people.

when a new patient comes in that is on fewer than 5 prescription meds, there is a party in the break room.



last I checked the cupcakes are rock hard...

The Orthobiologic Ethics Statement – Orthobiologic Ethics

orthobioethics.com

EULAR Issues Recommendations for Knee OA Platelet-Rich Plasma Injections

An expert consensus on the first clinical practice recommendations for platelet-rich plasma (PRP) injections in knee osteoarthritis was presented at the European Congress of Rheumatology annual meeting.

www.rheumatologynetwork.com

 

[drusso]

just for my information, and not being argumentative - which organization's guidelines should we be using as the standard of care for regenerative medicine?


also... I don't see young healthy people. I don't see old healthy people.

when a new patient comes in that is on fewer than 5 prescription meds, there is a party in the break room.



last I checked the cupcakes are rock hard...

I like it when you're argumentative...

 

[oreosandsake]

so, you are saying that if you work with healthy, motivated patients, then your outcomes are better?

many of us don't have the luxury to regularly work with that population. not to mention the fact that many patients dont have the means to pay for the higher-end treatments.

Yes.

if you see healthy motivated patients your outcomes are better.

Patient selection. Number 1 criteria is not $

You can also do free work or near cost.
If your treatments are taking away from their cigarette and beer money your outcomes aren’t going to be so great no matter what you do

 

[oreosandsake]

He sells PRP like you.

😄

I used to mock dextrose prolo therapy.
I started experimenting with it and I’ve come to really see the benefits in my patients.

I don’t sell PRP. I treat problems with an anabolic approach

 

[lobelsteve]

I am glad for you. But science. We only see what we desire. I have never seen an ESI work in overweight women. It is a bias. I have seen scs work for fbss. Patient said it “was like being on vacation “. Device turned off and leads coiled in pocket.

 

[oreosandsake]

I am glad for you. But science. We only see what we desire. I have never seen an ESI work in overweight women. It is a bias. I have seen scs work for fbss. Patient said it “was like being on vacation “. Device turned off and leads coiled in pocket.

Placebo is amazing.
I always acknowledge that. Teach the residents that’s one of their most helpful tools in the tool belt.
Regen outcomes are weeks and months later. There is level 1 evidence.
All the while we are mental masturbation flagellating each other on this forum there are guys posting things like this hi fiving each other

 

[oreosandsake]

Placebo is amazing.
I always acknowledge that. Teach the residents that’s one of their most helpful tools in the tool belt.
Regen outcomes are weeks and months later. There is level 1 evidence.
All the while we are mental masturbation flagellating each other on this forum there are guys posting things like this hi fiving each other

 

[oreosandsake]

And I don’t ignore the negative studies in regen either. Neither do I discount the negative studies for epidurals, and rfa

if dextrose or PRP had the marketing campaign for a single stimulator company we would see a different tune.

 

[oreosandsake]

I don’t subscribe to the church of IOF so I don’t know what their standard of care is.
I recognize that it sounds really arrogant when I say “you need to make a good diagnosis”

but you only treat what you know and think of. In Sonogrthere’s a saying that “you only see what you know.”

perhaps one way regen msk care works for some of us is because of the dedication to pathology, anatomy, and biomechanics.

I have met too many interventionalists that have cookie cutter therapies.

when you evaluate a knee, how does your treatment change if it’s anterior vs posterior vs posterior lateral or posterior medial inferior etc pain go?

I’ve seen iA injection for everything that can hurt in the knee. Went to train an older doc on US. Was in his office and he had a patient cc knee pain. He didn’t even take a history or examine her. Offered her CSI and she said ok. It was new onset Pain less than 2 weeks.

If it doesn’t work I’m sure next is genicular rfa PNS or drg...

back to the self aggrandizing soap box
Are you familiar with the 5 heads of the semimembranosus? Which head is prone to injury in soccer players? Did you know that the mcl has two layers and there is a bursa in between? What borders make up the rotator cuff interval? which of those shoulder stabilizers has been most often implicated in adhesive capsulitis?
Do you have less than 3 shoulder injections? What happens when you order an XR and the GH and AC joint are clean? Do you go for PNS and call it all neuropathic?

saw a patient with tennis elbow. US findings support the diagnosis. Exam as well but not perfectly. Did PRP to his common extensor tendon and he was 10-15 percent better. Kept mentioning fatigue in his forearm when he boxed. On return I tracked his radial nerve and found it engorged between the two heads of his supinator. Used some of the PPP and injected around the nerve and within an hour he was 100 percent. I still keep in touch with him and that was over 2 years ago.

I saw an active younger pharm sales guy. Injury from volleyball and basketball. He had meniscus, LCL, pathology. Saw few docs had scoping etc never got better. At least when I saw him his issue was primarily tendinoathy of the distal insertion of his biceps femoris. PRP x1, back to his sports at 6 months after years of PT

I could go on. It is anecdotal of course. But it’s hard to placebo long term benefits

there is something about putting something non catabolic in the actual spots causing problems. Level 1 evidence for tendinpathy even published in NEJM

we will get this right. We didn’t invent the healing cascade or platelets. They’ve been around for a long time

When SIS guys adopt MSK US with the fervor they had in the 90s to figure out the lumbar medial br was in middle 2/5th of the way up the SAP the light will turn on

 

[Ducttape]

Yes.

if you see healthy motivated patients your outcomes are better.

Patient selection. Number 1 criteria is not $

You can also do free work or near cost.
If your treatments are taking away from their cigarette and beer money your outcomes aren’t going to be so great no matter what you do

I might not be making the point clear.

these therapies appear highly unlikely to work in the older age group, where degenerative bony arthritis is the primary issue. Do you see PRP “dissolving” years of calcification due to misuse/abuse/underuse? Maybe it occurs.
If it does, please point out specific studies rather than anecdotal information. I would love to see severe spondylosis dissolve, or anterolisthesis self correct, or tricompartmental osteoarthritis suddenly vanish. Heck, the one therapy where it might happen might be Avascular necrosis. But has it been proven to improve?

Most of my approach is not on curing these incurable conditions with injections. If PRP does, then I will change my approach for those.

since I don’t do PRP, for the younger musculoskeletal patients, I discuss PRP and refer onwards to someone who does PRP.


Finally... I am being cynical when I comment how patients are likely to respond to placebo or we assume they are better when they are too ashamed to let you know that they cannot afford to pay out of pocket for advanced therapies. They come in and say “doc, I feel great! That shot worked! I’m cured!” all the while wondering how to afford the copay for the appointment...

 

[Ferrismonk]

If your treatments are taking away from their cigarette and beer money your outcomes aren’t going to be so great no matter what you do

This is my new favorite quote.

I don’t subscribe to the church of IOF so I don’t know what their standard of care is.
I recognize that it sounds really arrogant when I say “you need to make a good diagnosis”

but you only treat what you know and think of. In Sonogrthere’s a saying that “you only see what you know.”

perhaps one way regen msk care works for some of us is because of the dedication to pathology, anatomy, and biomechanics.

I have met too many interventionalists that have cookie cutter therapies.

when you evaluate a knee, how does your treatment change if it’s anterior vs posterior vs posterior lateral or posterior medial inferior etc pain go?

I’ve seen iA injection for everything that can hurt in the knee. Went to train an older doc on US. Was in his office and he had a patient cc knee pain. He didn’t even take a history or examine her. Offered her CSI and she said ok. It was new onset Pain less than 2 weeks.

If it doesn’t work I’m sure next is genicular rfa PNS or drg...

back to the self aggrandizing soap box
Are you familiar with the 5 heads of the semimembranosus? Which head is prone to injury in soccer players? Did you know that the mcl has two layers and there is a bursa in between? What borders make up the rotator cuff interval? which of those shoulder stabilizers has been most often implicated in adhesive capsulitis?
Do you have less than 3 shoulder injections? What happens when you order an XR and the GH and AC joint are clean? Do you go for PNS and call it all neuropathic?

saw a patient with tennis elbow. US findings support the diagnosis. Exam as well but not perfectly. Did PRP to his common extensor tendon and he was 10-15 percent better. Kept mentioning fatigue in his forearm when he boxed. On return I tracked his radial nerve and found it engorged between the two heads of his supinator. Used some of the PPP and injected around the nerve and within an hour he was 100 percent. I still keep in touch with him and that was over 2 years ago.

I saw an active younger pharm sales guy. Injury from volleyball and basketball. He had meniscus, LCL, pathology. Saw few docs had scoping etc never got better. At least when I saw him his issue was primarily tendinoathy of the distal insertion of his biceps femoris. PRP x1, back to his sports at 6 months after years of PT

I could go on. It is anecdotal of course. But it’s hard to placebo long term benefits

there is something about putting something non catabolic in the actual spots causing problems. Level 1 evidence for tendinpathy even published in NEJM

we will get this right. We didn’t invent the healing cascade or platelets. They’ve been around for a long time

When SIS guys adopt MSK US with the fervor they had in the 90s to figure out the lumbar medial br was in middle 2/5th of the way up the SAP the light will turn on

This is great. Obviously you know what you're doing. Is there any particular resources you found most helpful for learning this other than a good anatomy book and spending more time with patients? Classes? Certifications?

 

[oreosandsake]

This is my new favorite quote.




This is great. Obviously you know what you're doing. Is there any particular resources you found most helpful for learning this other than a good anatomy book and spending more time with patients? Classes? Certifications?

I study at least 15 hours a week. It’s not self flagellation. I’m trying really hard to wrap my brain around things that I never learned and cared about when Resident brain was focused on spine and pain. I’ve contemplated going back and doing a sports Med fellowship. There are amazing resources by the amssm (sp?). Sport’s Med folks that will amaze you. The rabbit hole for anatomy and then msk US runs so far and deep it it will swollow you whole. I am humbled by what is out there and recognize that our pain treatments are grossly simplistic and driven by industry and payors. I promise you I am not that good.


I heard a great talk once by a Brazilian pain doc who made the case that there is no crps 1 just crps 2 that we didn’t figure out the inciting cause.

 

[oreosandsake]

I study at least 15 hours a week. It’s not self flagellation. I’m trying really hard to wrap my brain around things that I never learned and cared about when Resident brain was focused on spine and pain. I’ve contemplated going back and doing a sports Med fellowship. There are amazing resources by the amssm (sp?). Sport’s Med folks that will amaze you. The rabbit hole for anatomy and then msk US runs so far and deep it it will swollow you whole. I am humbled by what is out there and recognize that our pain treatments are grossly simplistic and driven by industry and payors. I promise you I am not that good.


I heard a great talk once by a Brazilian pain doc who made the case that there is no crps 1 just crps 2 that we didn’t figure out the inciting cause.

YouTube amssm videos, ortho, sports Med, radiology etc

amazing resource for learning.

 

[Dr. Ice]

YouTube amssm videos, ortho, sports Med, radiology etc

amazing resource for learning.

Awesome that you are so committed. Just out of curiosity, and of course you don’t have to answer, but do you have a family? You are studying an extra 15 hours a week on top of being a full time doc. And this is a just a question for all of you out there..those that can post as much as you do and read all the research and study 15 hours extra a week..do you guys have kids? Wives? Do you just not sleep ever? Or are you all so unbelievably robotically efficient that you can do all of this and more?

 

[oreosandsake]

I might not be making the point clear.

these therapies appear highly unlikely to work in the older age group, where degenerative bony arthritis is the primary issue. Do you see PRP “dissolving” years of calcification due to misuse/abuse/underuse? Maybe it occurs.
If it does, please point out specific studies rather than anecdotal information. I would love to see severe spondylosis dissolve, or anterolisthesis self correct, or tricompartmental osteoarthritis suddenly vanish. Heck, the one therapy where it might happen might be Avascular necrosis. But has it been proven to improve?

Most of my approach incurable conditions with injections. If PRP does, then I will change my approach for those.

since I don’t do PRP, for the younger musculoskeletal patients, I discuss PRP and refer onwards to someone who does PRP.


Finally... I am being cynical when I comment how patients are likely to respond to placebo or we assume

Awesome that you are so committed. Just out of curiosity, and of course you don’t have to answer, but do you have a family? You are studying an extra 15 hours a week on top of being a full time doc. And this is a just a question for all of you out there..those that can post as much as you do and read all the research and study 15 hours extra a week..do you guys have kids? Wives? Do you just not sleep ever? Or are you all so unbelievably robotically efficient that you can do all of this and more?

You can play videos and podcasts while you’re in the shower, car or while you’re making breakfast or having your morning coffee. I haven’t sacrificed everything for my career but my tbh the last decade has been busy. Success begets success. I have seen where that train goes and it’s not the trajectory I want to base my life on.

 

[oreosandsake]

these are great. don't get lost in the rabbit hole

 

[oreosandsake]

not to spam this thread but they have a video on medial knee, lateral knee, posterior knee as well.

 

[drusso]

not to spam this thread but they have a video on medial knee, lateral knee, posterior knee as well.

Spam away! These are awesome for new grads interested in getting into Regen.

 

[drusso]

I might not be making the point clear.

these therapies appear highly unlikely to work in the older age group, where degenerative bony arthritis is the primary issue. Do you see PRP “dissolving” years of calcification due to misuse/abuse/underuse? Maybe it occurs.
If it does, please point out specific studies rather than anecdotal information. I would love to see severe spondylosis dissolve, or anterolisthesis self correct, or tricompartmental osteoarthritis suddenly vanish. Heck, the one therapy where it might happen might be Avascular necrosis. But has it been proven to improve?

Most of my approach is not on curing these incurable conditions with injections. If PRP does, then I will change my approach for those.

since I don’t do PRP, for the younger musculoskeletal patients, I discuss PRP and refer onwards to someone who does PRP.


Finally... I am being cynical when I comment how patients are likely to respond to placebo or we assume they are better when they are too ashamed to let you know that they cannot afford to pay out of pocket for advanced therapies. They come in and say “doc, I feel great! That shot worked! I’m cured!” all the while wondering how to afford the copay for the appointment...

 

[Ducttape]

not to belittle your position, or the fact that i agree that steroid injections are not a long term solution, but...

what you posted is expert opinion.

i think that is also called "lowest level of acceptable evidence."



fwiw, i do roughly 1 knee injection every 6 months. total for the entire practice.

 

[drusso]

not to belittle your position, or the fact that i agree that steroid injections are not a long term solution, but...

what you posted is expert opinion.

i think that is also called "lowest level of acceptable evidence."



fwiw, i do roughly 1 knee injection every 6 months. total for the entire practice.

Just do a meta-analysis on opinion surveys filled out by experts. Fixed it.

 

[DOctorJay]

I study at least 15 hours a week. It’s not self flagellation. I’m trying really hard to wrap my brain around things that I never learned and cared about when Resident brain was focused on spine and pain. I’ve contemplated going back and doing a sports Med fellowship. There are amazing resources by the amssm (sp?). Sport’s Med folks that will amaze you. The rabbit hole for anatomy and then msk US runs so far and deep it it will swollow you whole. I am humbled by what is out there and recognize that our pain treatments are grossly simplistic and driven by industry and payors. I promise you I am not that good.


I heard a great talk once by a Brazilian pain doc who made the case that there is no crps 1 just crps 2 that we didn’t figure out the inciting cause.

Oreos is my generation’s Jay Smith. He’s an absolute animal for self study.

 

[drusso]

Oreos is my generation’s Jay Smith. He’s an absolute animal for self study.

Jay Smith is my generation's Jay Smith...

 

[Ducttape]

Just do a meta-analysis on opinion surveys filled out by experts. Fixed it.

to quote the esteemed Dr. Russo: "GIGO"...

 

[oreosandsake]

I might not be making the point clear.

these therapies appear highly unlikely to work in the older age group, where degenerative bony arthritis is the primary issue. Do you see PRP “dissolving” years of calcification due to misuse/abuse/underuse? Maybe it occurs.
If it does, please point out specific studies rather than anecdotal information. I would love to see severe spondylosis dissolve, or anterolisthesis self correct, or tricompartmental osteoarthritis suddenly vanish. Heck, the one therapy where it might happen might be Avascular necrosis. But has it been proven to improve?

Most of my approach is not on curing these incurable conditions with injections. If PRP does, then I will change my approach for those.

since I don’t do PRP, for the younger musculoskeletal patients, I discuss PRP and refer onwards to someone who does PRP.


Finally... I am being cynical when I comment how patients are likely to respond to placebo or we assume they are better when they are too ashamed to let you know that they cannot afford to pay out of pocket for advanced therapies. They come in and say “doc, I feel great! That shot worked! I’m cured!” all the while wondering how to afford the copay for the appointment...

no, prp is not pixie dust and I am a mortal. spondylosis doesn't dissolve anterolisthesis doesn't correct, tri compartment OA doesn't vanish. I don't think anyone is making the argument for that. when you are at the end of the road for any disease, there are few treatments that really work. the care is palliative at that point.

genicular RF in true bone on bone OA in an obese medicare patient? sure. all the time
genicular RF in a sub 40 year old weekend warrior with sports related injury, un-diagnosed and chalked up to "OA" might be par for the course in a lot of parts of the world, but is likely poor care.

when medicare pays for the interventions (aka, free-ish) people want everything, all the time. when they are paying out of pocket and come back, it suggests they really felt enough of a difference to pay for it again.

 

[oreosandsake]

Oreos is my generation’s Jay Smith. He’s an absolute animal for self study.

that's really flattering. I don't hold a candle to Jay Smith. the sports fellowship I have been considering would be to go train with him. but I don't really find sideline coverage interesting, or unwinding my life/practice to move to MN

I spent 3 hours two nights ago scanning my anterior neck looking at the strap muscles, brachial plexus, carotid artery, SCM, scalenes, superficial cervical plexus, cervical nerve roots etc. spent an hour combing NYSORA videos, and published articles trying to figure out which tiny shiny dot between my SCM and anterior scalene was my phrenic. you can fool yourself with US looking for small hyperechonic honeycombs. I'm going to do a combined US/fluoro Cervical TFESI next week. will post images. I have been wanting to do a cadaver study on needle placement with fluoro vs US on stellates but I don't have a cadaver to work on...

I find this stuff fascinating. I hated anatomy in med school but now spend my free time studying it.

 

[lobelsteve]

that's really flattering. I don't hold a candle to Jay Smith. the sports fellowship I have been considering would be to go train with him. but I don't really find sideline coverage interesting, or unwinding my life/practice to move to MN

I spent 3 hours two nights ago scanning my anterior neck looking at the strap muscles, brachial plexus, carotid artery, SCM, scalenes, superficial cervical plexus, cervical nerve roots etc. spent an hour combing NYSORA videos, and published articles trying to figure out which tiny shiny dot between my SCM and anterior scalene was my phrenic. you can fool yourself with US looking for small hyperechonic honeycombs. I'm going to do a combined US/fluoro Cervical TFESI next week. will post images. I have been wanting to do a cadaver study on needle placement with fluoro vs US on stellates but I don't have a cadaver to work on...

I find this stuff fascinating. I hated anatomy in med school but now spend my free time studying it.

I can get you some cadavers. Price is steep. Meet me on pier 14. Midnight. Bring cash.

 

[Ducttape]

no, prp is not pixie dust and I am a mortal. spondylosis doesn't dissolve anterolisthesis doesn't correct, tri compartment OA doesn't vanish. I don't think anyone is making the argument for that. when you are at the end of the road for any disease, there are few treatments that really work. the care is palliative at that point.

genicular RF in true bone on bone OA in an obese medicare patient? sure. all the time
genicular RF in a sub 40 year old weekend warrior with sports related injury, un-diagnosed and chalked up to "OA" might be par for the course in a lot of parts of the world, but is likely poor care.

exactly.

the proposal that PRP cures everything is flawed.

that is the postulate that has been put out by many of those who support PRP, some on this board.

when medicare pays for the interventions (aka, free-ish) people want everything, all the time. when they are paying out of pocket and come back, it suggests they really felt enough of a difference to pay for it again.

you may be venturing on to placebo effect.

 

[oreosandsake]

exactly.

the proposal that PRP cures everything is flawed.

that is the postulate that has been put out by many of those who support PRP, some on this board.


you may be venturing on to placebo effect.

placebo - it helps a lot of medical interventions. look up the ritual of medicine.

just got off phone with a hospital employee (county employee health plan) who came to me with elbow pain 2 months ago. referred by pcp for corticosteroid injection for tennis elbow

the diagnosis was correct, the treatment suggestion not the best. I did dextrose prolotherapy under US guidance. broke up the calcium deposit, fenestrated the tendinopathy. at 4 weeks she reported being 40% better. today, " it doesn't hurt anymore. I am so grateful to you!"

there's a saying, "people think you're crazy when you talk about things they don't understand"

I'm honestly not offended if you don't want to learn how to do this. People are surprised that I am not a big fan of neuromodulation based on where I trained. but when people need it, i know where to refer.

 

[Ducttape]

i have no issues at all with referring out young healthy patients for PRP for certain pathology ie tendonopathy (because thats what the literature supports) - thats what i do.




i just dont see a lot of them. my patients generally are not young nor healthy. i get young healthy patients as often as we get leap years.

 

[drusso]

i have no issues at all with referring out young healthy patients for PRP for certain pathology ie tendonopathy (because thats what the literature supports) - thats what i do.




i just dont see a lot of them. my patients generally are not young nor healthy. i get young healthy patients as often as we get leap years.

If the literature shows tomorrow that it supports mild to moderate OA too, then would you feel guilty about all the patients you didn’t refer over the years? How does “**knowing** if something works” actually change the reality of whether something works? Arthroscopic meniscus resection doesn’t work, but people still get referred for them. Up to date still says kyphoplasty doesn’t work, but we know it does...And then there are opioids, no one thinks that they work, but everyone knows a patient that says they do...

 

[Ducttape]

no, because the patients I see cannot afford the expensive healthcare costs you are talking about.

I have stated seemingly ad infinitum - I do not see a lot of patients that can afford your high price procedures.

just looking at this week and last, I average one private insurance patient a day. over 50% are Medicaid.


in addition, your statement is specious. you are often not using science to base "knowing" that something "works", just patient - or, worse - and performer assessments. that's why I keep asking to post more studies.

 

[oreosandsake]

PubMed

PubMed® comprises more than 36 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

pubmed.ncbi.nlm.nih.gov

great website. it's free.


re "young healthy patients for PRP" as mentioned previously, they do better. they are not the only one's that respond.

 

[drusso]

PubMed

PubMed® comprises more than 36 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

pubmed.ncbi.nlm.nih.gov

great website. it's free.


re "young healthy patients for PRP" as mentioned previously, they do better. they are not the only one's that respond.

One of my favorite sites!

 

[bedrock]

no, because the patients I see cannot afford the expensive healthcare costs you are talking about.

I have stated seemingly ad infinitum - I do not see a lot of patients that can afford your high price procedures.

just looking at this week and last, I average one private insurance patient a day. over 50% are Medicaid.


in addition, your statement is specious. you are often not using science to base "knowing" that something "works", just patient - or, worse - and performer assessments. that's why I keep asking to post more studies.

I think your perspective is skewed by your patient population. Reminds me of 101N. That guy didn’t believe in any procedures because 80% of his patients were on Medicaid.

PRP works great for many patients. They don’t have to be 23 yr old athletes, just not 70+ Medicare patients or any age Medicaid patient.

PRP can work very well on a 50 year old , as long as they aren’t a diabetic smoker.

most of use don’t see the terrible patient population that you say that you see, so maybe that’s why we’re open minded.

And we see regenerative medicine work every month, because it does work as long as 1-your patient isn’t ancient, and 2- patient doesn’t spend all day on the couch like most Medicaid patients.

 

[lobelsteve]

I think your perspective is skewed by your patient population. Reminds me of 101N. That guy didn’t believe in any procedures because 80% of his patients were on Medicaid.

PRP works great for many patients. They don’t have to be 23 yr old athletes, just not 70+ Medicare patients or any age Medicaid patient.

PRP can work very well on a 50 year old , as long as they aren’t a diabetic smoker.

most of use don’t see the terrible patient population that you say that you see, so maybe that’s why we’re open minded.

And we see regenerative medicine work every month, because it does work as long as 1-your patient isn’t ancient, and 2- patient doesn’t spend all day on the couch like most Medicaid patients.

My average patient age is 73. I am now 50 and most days only 1-2 patients younger than me.

 

[SSdoc33]

I think your perspective is skewed by your patient population. Reminds me of 101N. That guy didn’t believe in any procedures because 80% of his patients were on Medicaid.

PRP works great for many patients. They don’t have to be 23 yr old athletes, just not 70+ Medicare patients or any age Medicaid patient.

PRP can work very well on a 50 year old , as long as they aren’t a diabetic smoker.

most of use don’t see the terrible patient population that you say that you see, so maybe that’s why we’re open minded.

And we see regenerative medicine work every month, because it does work as long as 1-your patient isn’t ancient, and 2- patient doesn’t spend all day on the couch like most Medicaid patients.

lets call a spade a spade. the private guys are seeing the young, well to do athletes with the good insurances. the hospital employed docs are seeing the older patients and medicaid patients. obviously there is some crossover

 

[Doctodd]

no, because the patients I see cannot afford the expensive healthcare costs you are talking about.

I have stated seemingly ad infinitum - I do not see a lot of patients that can afford your high price procedures.

just looking at this week and last, I average one private insurance patient a day. over 50% are Medicaid.


in addition, your statement is specious. you are often not using science to base "knowing" that something "works", just patient - or, worse - and performer assessments. that's why I keep asking to post more studies.

this explains alot. But you can do it for free on your patients if you choose to, but you dont. You dont need a kit anymore.

 

[Doctodd]

if you are adding regen med to your practice, here is a good video showing you how to count cells to know if you did an adequate harvest. Your MA can do the counts.

 

[Ducttape]

this explains alot. But you can do it for free on your patients if you choose to, but you dont. You dont need a kit anymore.

I would have to look it up, as I don't do a lot of knees, but I believe there may be some limitations to what you inject for Medicaid and medicare patients.

this is definitely the case for epidurals, facet joint injections or Si injections.