Taking Charge of Your Health

So something that comes up in
the regenerative injection space, the regenerative injection realm
is discussing with patients, potential patients, current patients I have, patients who reach out
through whatever social media What is the healing trajectory like,
the path of healing like, and what can patients expect, And so the first thing that I want to
say in regards to this is that healing from regenerative injection therapies
is not always a linear process. Meaning we don’t always
start here in terms of our, our improvement of symptoms and just
go and like just instantly have this, you know, straight
path to healing, less pain, all that kind of stuff.
That’s the first thing. And the second thing is that the response
is typically reverse what we see for a typical response for
corticosteroid injections. And so in some patients where they’ve
had a lot of corticosteroid injections in the past, and those haven’t provided the, the full longterm lasting benefits
that some people can get from steroid injections. we have to talk with them just about
the expectations because it’s reverse of what typically happens
with the steroid injection. So let’s talk about the first
one first. So when we undergo a procedure for whether it’s
prolotherapy PRP or stem cell therapy, we have to appreciate and understand
that there is actual tissue healing that can and does typically occur. Now sometimes we don’t see the level of
tissue healing where we can do a pre MRI and do a post MRI and we see a significant
increase in cartilage growth or we see the full closure of a chondral
defect or things like that. Sometimes we don’t get the large
scale tissue changes like that, but we are still getting microscopic
tissue changes that are occurring. It’s just not to the level
that we are being able to grossly see them
under the large imaging studies. But even outside of that we’re getting an orchestration of the
immune system and the other healing properties in that area. And so there
is actual healing that’s going on. We have to appreciate that healing takes
time and that even healing from whether you rolled your ankle or you broke your
leg is not a linear process and that there will be an ebb and flow. And so commonly what we will see is
that patients will start to get a little better than maybe they’ll have
a a day, a few days where they, it seems like they’re not getting better
or they’re a little worse and then it’ll start to increase again. And so you kind of go through this
a little ebb and flow with the trajectory being where
we are getting an improvement in symptoms, permanent
range of motion and permanent function, all that kind of stuff that we’re
looking for over a longer term, like a two, three, four, six week
period, a three month period, a one year period. And so in the patients that we have
a positive clinical response to the regenerative injections, that
is typically what we are seeing. It is a ebb and flow, but we are seeing a gradual improvement
in their symptoms over a longer period of time. Now on the second aspect when we’re talking
about the response versus a corticosteroid injection. So typically what we see with
a corticosteroid injection is that when we look at pain
function, things like that, we get a very drastic improvement
in symptoms relatively quickly. Typically what
that will look like is patients are here in terms of their, their symptoms and they see a
spike in their increase, in improvement. And then what will happen is that we’ll
stay typically up there for however long it’s going to stay up there. typically what we are hoping for is a
longterm resolution where that actually doesn’t ever come back. But commonly what we’ll see is
anywhere between four to 12 weeks, we’ll have that improvement in symptoms. And then all of a sudden it starts to
wear off and that slowly starts to go down and go down and go down. And then
they go back to baseline. sometimes still a little better
than what they were before. The steroid injection, sometimes a little worse than what
they were before the steroid injection. So that response is very positive in
the beginning and then a slow taper off towards the end. Because we are addressing actual healing
in the regenerative injection realm. Prolo, PRP, stem cells,
we’re getting the opposite. We’re getting typically a slow climb
with that healing that continues for some period of time, whether that’s
6 weeks, 12 weeks, 6 months, and then we taper off and we plateau. So we don’t see this big initial
increase and improvement, where you know, a week after the
procedure, patients are 100% pain free. It’s more like we look at six months
ago when I had compared to that, they’re 80% better or 90% better
or sometimes only 40% better. It all kind of depends on the
scenario there but that’s kind of the differences. And so it’s important to understand if
you’re going to go get a regenerative injection procedure that you understand
the difference in that response rate, especially if you’ve had a steroid
injection in the past just because that expectation is extremely important. The last thing I want want to say is some patients will ask about the the prolotherapy
and the PRP are the stem cells wearing off and typically this is how I
frame up answering that question because these injections are creating some
form of regeneration to some degree. Again, we already talked
about, it may not be, you actually see full changes on MRI, but we are getting some some disease modification
with these therapies. The therapies don’t necessarily wear off
unless there is an underlying condition that is contributing to joint
inflammation that hasn’t been addressed. For example, if a patient has a osteoarthritis of the
knee and there’s a lot of inflammation inside the knee joint, if that inflammation is actually
coming from the infrapatellar fat pad, that is then seeding over into the synovium
and then therefore into the synovial fluid inside the knee joint.
If we go into the knee, just the knee joint proper,
not into the fat pad. If we just go into the knee joint and
we inject prolotherapy PRP or stem cells and we have not addressed the
cause of the inflammation, then we can look at those therapies as
wearing off because what will happen inside the joint is we get
this really positive, anti-inflammatory effect where we get
immune system modulation and then over time what’s going to happen is
the inflammation from the fat pad, which is continually
feeding that joint. The anti-inflammatory effects of those
regenerative therapies wears off. And this inflammation from the fat
pad is still feeding into it. Now, if we had a situation where there was
no inflammation in the fat pad and, we’re just dealing with an
intra articular cartilage meniscus, issue, and we’d go in and we put
PRP stem cells, prolotherapy whatever, inside that knee joint,
then the way I think of it, it’s not that when patients start to
plateau and then when they start to see a slight worsening in their symptoms, I typically don’t think
of it as it wearing off. I think of it more so as the, the rate of degeneration has now
outpaced the rate of regeneration or the anti-inflammatory effect, which that, and the reason I say that is because
when we look at patient populations, that tends to happen a bit quicker
in our elderly patient population. So patients over 60 versus
our younger patients. And so we see that the PRP for example, we start to get a decline or like a worsening from
that improvement more quickly in a 65 year old than we do in
a 30 year old. And so when we, we pair it out like that
and look at it what I make of those scenarios is that
the rate of degeneration as we age accelerates versus when we’re younger. And so what we’re seeing is just that
the normal wear and tear of aging, which is in
part due to systemic factors. insulin levels, inflammation,
dietary choices, lifestyle choices, all that stuff causes an acceleration
of that aging process. In those scenarios, I don’t think of
it as PRP or stem cells wearing off. I think of it more so as that there’s
other things that we need to do to decrease the rate of degeneration in
order for those therapies to last longer. Hi, everybody. Hope you
enjoyed this video. As always, please leave a comment with any questions
and I’d be happy to answer them. See you later.

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