Northwest Ohio wellness

Why PRP (Platelet Rich Plasma injections) and how do they work?

80 cc’s (five tablespoons) of blood added to 12cc’s of Sodium Citrate as an anti-clotting agent, when spun at 4000 RPM’s for 15 minutes separates out the blood cells, the clear plasma, the white blood cells, and the ‘Platelet Rich Plasma’ into four distinct layers. By pipetting 6 of the cc’s into a syringe, you concentrate the cells that release the messengers for healing of ligaments, tendons, bone and cartilage.

Using a fluoroscope (mobile x-ray) or ultrasound imaging, anything that can be reached with a needle can have accelerated healing. I have treated thousands of patients for a variety of problems over the past 12 years. I was the first physician in Ohio to use PRP, and the first to get the Bureau of Worker’s Compensation to allow it’s use in injured workers.

How did I get started?

In June of 2010, Harvest PRP Inc. publicly taught the technique and sold the first PRP machine at the international meeting of the American Association of Orthopedic Medicine. I was in attendance, and received treatment to my right shoulder which was barely functioning from a 70% tear of my Supraspinatus tendon. Five days later, I was pain free and have remained well since with no further treatment.

The problem is that the kit itself cost $350 per treatment and then I needed to add profit, and the centrifuge cost $30,000. It was not feasible as I knew my patients could not afford this. I did research on how this was discovered and found that it was being made complex to generate profit. Doing ‘bench’ PRP where you process your own blood was a $3000 machine and $9 in cost!

The cost issue has only gotten worse over the years. Most doctors nationwide are charging at least four times what I charge, and sometimes even ten times. I also designed my system to do a ‘double draw’ of 160 cc’s for very little increase in cost of materials. So when you do two knees, or two of anything, it’s only 50% more.

What do you do to get started?

First of all, you need to feed your healing system. If anyone has given you a cortisone shot for any reason, that shot will block the PRP for 6-8 weeks. Orthopedists, Rheumatologists and Family Physicians give Depomedrol, Decadron and many other cortisone shots very routinely.

Next, you want to make sure you need PRP! Get on 3000 mg of high quality Glucosamine, use 1222 Natural Relief gel on injured joints, AND if you have a family history of arthritis, you may want to take Peptides of Osteoarthritis (Arthroben).

You want to do the right lab and make sure you don’t have inflammatory arthritis (a sed rate), Gout (uric acid) and that you are not in menopause or andropause (men). Check Thyroid Free T3, Free T4, Estradiol,, Total and free testosterone, DHEA sulfate (SO4), and some pituitary hormones.

I am not in the business of doing PRP.

I am in the business of avoiding unnecessary PRP. 40% of my patients are fixed without injections. The most common problem I see is the patient who has had a knee replacement and they are no better. Knee pain can come from the low back, Sacroiliac joint, Hip joint, the ankle at the proximal fibula, drug reactions, Lyme disease and many other causes. The orthopedist who wants to replace your knee is not doing this workup.

Sometimes, PRP is not the best treatment!

If your primary problem is arthritis and your ligaments and tendons are in great shape, Glucosamine and then Synvisc injections (Hyaluronic acid) is the first and cheapest step.

If you have only a deranged meniscus in your knee, Autologous blood injections are even simpler and more direct.

Before you do a complex procedure, you should confirm your diagnosis by putting lidocaine in the joint. That costs pennies, and is quite accurate in proving your on the right track.

What joints can be treated with Platelet Rich Plasma?

(This list is in the order they present in my practice).

KNEE PAIN: Most knee pain if from degenerative arthritis. If you waited until your surgeon is ready to replace your knee, you may be too late. In those cases, you may need Synvisc, THEN PRP. That will fix the arthritis but we also need to address meniscus injury, Anterior cruciate Ligament partial tears, medial and lateral ligaments, fibular pathology, patellar instability and bursitis.When patients come too late, they may need treated every 2-3 years. Moderate cases can stay well much much longer.

ROTATOR CUFF INJURY to the shoulders: Most painful shoulders show partial tears of the Supraspinatus, Infraspinatus and Biceps tendons plus the AC joint (collar bone). More severe cases show true arthritis which also responds.. Remember my 70% tear is still well 12 years later with no further care.

DEGENERATIVE ARTHRITIS OF THE BACK AND NECK: PRP will not help a herniated disc with radiating leg pain and numbness. Surgery however will not help midline spine pain with stiffness and loss of range of motion. By injecting 1/3 of a CC in each facet joint on the back of your spine, you can see excellent pain relief and increase in range of motion. Unstable rib heads that require frequent chiropractic respond quickly.

HIP PAIN: If you’ve lost a lot of range of motion, you may be too late and need a replacement joint. But many hips are actually bursitis or capsule pain that can be fixed. Best first therapy is Synvisc, then PRP.

WRIST AND HAND PAIN: We use our hands as tools, grasping and wrenching so wrist and thumb pain is very common. Surgery is rarely rewarding, but injecting the individual joints is very useful. Tennis elbow is easily treated.

ANKLE AND FOOT PAIN: Unfortunately, cortisone shots are the go-to solution for feet. Each shot destroys more tissue. Bunions, heel spurs, plantar fasciitis, Achilles tears, ankle arthritis all can respond to PRP.

STRESS FRACTURES and NON-UNION’s: When a bone almost breaks but stays in alignment, it can fail to heal for a long time. Walking in a ‘boot’ or wearing a cast fails commonly. PRP instantly can force rapid healing.

There are four tools to rebuild damaged joints:

1. PRP (Platelet RICH Plasma) injected into tendons and ligaments, this repairs collagen fixing tears and fraying.
2. PPP (Platelet POOR Plasma), is the yellow fluid just above the buffy coat. It is not as powerful but is effective in ligament repair and is just getting thrown away.
3. PRP (Platelet RICH Plasma) injected inside the joint, this repairs cartilage and meniscus.
4. Synvisc (Hyaluronic acid) 2.0 cc’s, can be put in large joints as well. It is very affordable and can accelerate PRP.

When you prepare for a visit, use the following chart and journal carefully what hurts the most to the least. You are going to get 7.0 cc’s of PRP and another 3-4 cc’s of PPP. You want to use every bit of it so don’t ignore that sore thumb or catching jaw joint! Women need about 75% of the volume of men.

Here is a chart to do the math on a single (8cc) or double (16cc) draw. For MEN, women reduce volume 25%:

When I was in medical school, normal testosterone levels were 1300 to 2400 ng/ml. Now the normal is 300 to 900!

Why? Why men and not women?

Testosterone in the body works when it arrives at the testosterone receptor on each cell. On arrival it lands and jumps off right away, Milliseconds! And moves on to another receptor. When a man gets poisoned with estrogen, it lands and stays, trying to fit on the receptor which ignores the failed coupling but prevents testosterone from occupying the site.

How do men get estrogen?

Everywhere! Bottle water, microplastics in our water, K-Cups, Any soy product. Read Kaayla Daniels PhD’s book, The Whole Soy Story.

That’s not all: Read about Endocrine Disruptors, the two worst – Glade Air Fresheners and the scented tree from the car wash. Cheap perfumes are everywhere. Get scent free. Again, Cortisone shots are a severe endocrine disruptor. Women don’t get low estrogen from getting more bad estrogen, they get breast cancer.

Finally EMF – Electro Magnetic Frequency emissions: We not call it 5G, but it’s also your phone, Routers, all those appliances that talk to you like Alexa and Google home. They are all microwaves cooking you quickly. Get your house wired for CAT5 cable. Get off wireless.

How do I know if I have Low T?

First of all, check your lab, but don’t believe the results. If you are in the bottom half of lab normal, you may be having symptoms. Everyone thinks testosterone is about libido or sex drive but most men with low T have normal drive and function but they are suffering from fatigue (especially late day), depression, loss of muscle mass, weakness, osteoporosis, ligament and joint breakdown, disturbed sleep, sleep apnea, slow hair growth (best seen in facial hair), and anger.

Labwork:

Before you take even one supplement, get fully tested. You need to know your baseline lab.

Minimal lab is Total and Free Testosterone, DHEA sulfate, SHBG, Total estrogens, LH (Lutenizing Hormone), and a PSA (prostatic surface antigen) for prostatic cancer. Any of the following lab work may be useful depending on current medications, family history or special problems.

Comprehensive Lab work: to be done non-fasting./// CBC, Comprehensive metabolic profile, ferritin, R79.89; RBC (intracellular) magnesium, Urineanalysis with reflex culture, sed rate, C reactive protein, Uric acid, M10.9; 17 beta estradiol, FSH, Progesterone, Total testosterone, DHEA sulfate, N95.1; LH, free T4, free T3, E03.9; liver panel with lipase, amylase, lipid panel, Lipoprotein a (lpa), Homocysteine (D51.9), Cardiac CRP, E78.5; glycohbgA1C (Abnormal Blood Chemistry E88.81;), vitamin B12 level, Vitamin D25 (OH) E55.9; , Prolactin, 8AM cortisol, RA titer, ANA.

Try to fix the problem, not replace it!

There are many ways to fix testosterone, but be sure to do the simplest things right away. Get rid of the soy, plastic bottles, bottled water, EMF, and get on one bottle of the right supplements. I’ve personally tried a lot of the TV ad items. None of them worked for very long if at all. The molecule that turns into Testosterone is called DHEA. If your DHEA sulfate is low, take 50 mg a day in the AM. Take Quercetin 600 mg, once a day in the morning. Watch for one month and do a new Total and Free testosterone.

If your estrogens were high in the lab, they need to be fixed. You aren’t out of testosterone, it’s ‘aromatizing’ to the next step, estrogen. Taking Arimadex (anastrozole) blocks the conversion of testosterone to estrogen.

Ok, so you can’t fix it?

Your Family Doctor or Urologist will probably start you on a topical gel first. The problem is- you are totally desaturated, and you will never get filled up. You won’t see a sudden change, so you’ll conclude it wasn’t T.

My preferred approach is to give 300 mg (1.5cc) intramuscular in the buttocks, of Testosterone cyprionate. There are many advantages to this. First, it WILL be absorbed. Second, on day two, if you don’t feel better, I doubt the diagnosis of Low T. By the time you get back in the office a week later to try the gels- Androgel, Testim, Axiron, you may not be totally desaturated. There are lots of down sides to the gels, they are twice a day, they don’t get very high levels but your wife may get VERY high levels from the flakes that fall off in bed. You need 10 cc’s twice a day, she will go high on 0.1cc. Also, they quit working because low T causes thin skin and when you get better, your skin thickens and they quit absorbing.

So the gels work some, so you try the shots?

They work well but they make a lot of estrogen so you have to get on Arimadex. Your Urologist or Family Doc will want to give them in the office (profitable) and he thinks they last six weeks when they actually last no more than 11 days, usually more like 8 days.

My wife is on the patch!

Yes, they’re great for estrogen. Very elegant. About the size of a quarter twice a week. Forty years of research by 3M made them thin and invisible. The Androderm patch comes in two strengths, ‘Way too low’, and ‘Almost enough’ and the patch has the feel of aluminum foil. I only met one man who liked the patch in 50 years in practice. The good news is—the patch gives really smooth level delivery.

So why do pellets?

The Europeans have been doing testosterone pellets for 50 years. In the 1990’s, I was one of the research centers for Testopel, the first U.S. pellet. Great idea except there were 75 mg, they only gave you five (I’ll save you the math 375 mg! and the average man needs 1000 mg. If you beg, they let you go to 7 pellets (625 mg) and they are so narrow they only last 3 months and they won’t let you go sooner than 4 months. This was clearly planned failure since they had 30 years of research on Sottopelle when they made that decision.

A decade ago, Sottopelle came out with a franchise (never a good thing) and I trained in Kansas City. All kinds of politics and issues and I learned about Qualgen. They make the same pellet but you don’t join anything.

The average patient needs five pellets, mostly based on weight, though I’ve seen as little as two and as high as 7 pellets. 75% of men are 5 pellets.

Smooth as silk, in ten days, you’re levels are up and stay up four to five months, in the last month, you may be able to tell you’re down slightly, do a lab, prove it’s falling and get new pellets at six months. 20% of men are 5 months.

Because the release is even, aromatization to estrogen usually goes away., What causes the symptoms of high estrogen is the spikes from the gel or shot. Since there is no spike in pellets, you can stay near the top.

Where do you put them?

Each pellet is 200 mg, they are 4mm by 15 mm in the shape of a cylinder.

You numb the skin about where the top of your back pocket lays, make a small nick in the skin, put in more anesthetic and advance a trocar in the space between the skin and fat. Remove the inner spike and slide in the pellets and put in one stitch for 7 days.

You do lab in six weeks to determine if your first dose was good, high, or low.

You do a lab at five months to prove they last six months.

Once a year you do a PSA and a CBC along with Total estrogens, Total and Free testosterone at 6 weeks.

My own observations:

IV radiation chemotherapy for my thyroid cancer at age 31 wiped out my testosterone. I managed with just DHEA for many years. At age 55, I lost ground fast and added every supplement plus Cialis 10 mg. (this drug-not Viagra-causes the testicles to enlarge and make more testo). I made it to 68 and I started losing weight, getting weak, lost sex drive and my 5 o’clock shadow moved out about two days. This was in spite of using the gel.

One year ago, I finally found a place to get the pellets and in a matter of days, my 5 o’clock shadow moved back to midnight the same day. My weight dropped but muscle mass increased. Strength improved. Memory improved but the big benefit was to mood.

Platelet Rich Plasma

20 Articles in Google Scholar on Non Union and Stress Fracture and PRP

A Case Series on Natural Conceptions Resulting in Ongoing Pregnancies in Menopausal and Prematurely Menopausal Women Following Platelet-Rich Plasma Treatment

A Fraudulent Study on PPP, not PRP, as an Example of Why You Must Read the Research, not the Title or Abstract

A Summary Statement by Dr. Nielsen About the PRP Research Listed with Comments on the ‘Agendas’ of Publications

Allergic Reaction to Platelet-Rich Plasma (PRP) NOT!

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year

Chinese Study on PRP vs Synvisc

Cost Effectiveness of a Platelet-Rich Plasma Preparation Technique for Clinical Use

Effectiveness of Platelet-Rich Plasma in the Management of Hip Osteoarthritis – A Systematic Review and Meta-Analysis

Effectiveness of Topical Administration of Platelet-Rich Plasma on the Healing of Methicillin-Resistant Staphylococcus Aureus-Infected Full-Thickness Wound Model

Evaluation of Platelet-Rich plasma vs Intralesional Steroid in Treatment of Alopecia Areata

Evaluation of Wound Healing in Diabetic Foot Ulcer using Platelet-Rich Plasma Gel – A Single-Arm Clinical Trial

How Foot and Ankle Surgeons Can Benefit From PRP

Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection (Synvisc) for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Improving Function

Is Platelet-Rich Plasma an Ideal Biomaterial for Arthroscopic Rotator Cuff Repair – A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Platelet-Rich Plasma Injection for the Treatment of Chronic Achilles Tendinopathy

Platelet-Rich Plasma in Treatment of Patients with Idiopathic Carpal Tunnel Syndrome

Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis – A Randomized Clinical Trial

Platelet Rich Plasma Injections for Meniscus Tears

Platelet-Rich Plasma (PRP) Therapy for Knee, Elbow, and Tendon Injuries Produced Better, Long-Lasting Improvements than Surgical or Steroid Treatments for Some Patients

Platelet-Rich Plasma and Its Utility in Medical Dermatology – Skin Ulcers

Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review

Platelet-Rich Plasma Injection for Proximal Plantar Fasciitis

Platelet-Rich Plasma Injections Delay the Need for Knee Arthroplasty for Five Years – A Retrospective Study and Survival Analysis

Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers

Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis – A Systematic Review of Systematic Reviews

Platelet-Rich Plasma versus Hyaluronic, Comment by Dr. Nielsen, They Should Try BOTH, Not Just Compare

PRP for Knee – OA Study

PRP for Non Union Very Effective

PRP Platelet Autologous Serum rather than Synvisc in Knees for OA, Osteoarthritis

PRP Research in Google Scholar

Research on Rotator Cuff and Platelet Rich Plasma PRP Shoulder

Role of Platelet-Rich Plasma in Healing Diabetic Foot Ulcers: A Prospective Study

A New Approach to the Treatment of Osteoarthritis of the Knee

Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy

Systematic Review—The Potential Implications of Different Platelet-Rich Plasma (PRP) Concentrations in Regenerative Medicine for Tissue Repair

Tendon Tears Do Not Get Well Enough If Left Alone

The Influence of Naproxen on Biological Factors in Leukocyte-Rich Platelet-Rich Plasma – A Prospective Comparative Study – Avoid For One Week Prior To PRP!

Treatment of Lateral Ankle Sprain with Platelet-Rich Plasma – A Randomized Clinical Study

Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections

Treatment of Symptomatic Degenerative Intervertebral Discs with Autologous Platelet-Rich Plasma: Follow-Up at 5–9 Years

Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears

What Does It Take To Heal Connective Tissue?

Wow – Putting PRP in the Uterus before IVF for Fertility Works

Testosterone Repair Therapy: Hypogonadism

Testosterone replacement reduces all disease, Meta analysis by Jeff Dach MD

A Great Article on Testosterone Deficiency, Side Effects, and Treatment for the Lay Person

A Randomized, Double-Blind, Placebo-Controlled Trial of Testosterone for Treatment of Postmenopausal Women with Aromatase Inhibitor-Induced Arthralgias

A Review of Testosterone Pellets in the Treatment of Hypogonadism

Acute Portal and Superior Mesenteric Vein Thrombosis with Topical Testosterone Therapy – An Adverse Drug Event Case Report

Blood Testosterone Threshold for Androgen Deficiency Symptoms

Clinical Pharmacology of Testosterone Pellet Implants

Erythrocytosis in Subcutaneous Testosterone Replacement Therapy

Experiences Over 11 Years Subcutaneous Testosterone Implants in Hypogonadal Men

Low Complication Rates of Testosterone in Over a Million Procedures, Largest Study Ever

Oral Testosterone Not a Great Idea

Patient Satisfaction with Testosterone Replacement Therapies – The Reasons Behind the Choices 

Pharmacokinetic Evaluation and Dosing of Subcutaneous Testosterone Pellets

Pharmacokinetics and Safety Outcomes of Generic versus Branded Testosterone Pellets in Men with Testosterone Deficiency – A Single Center, Open-Label, Randomized Trial

Suppression of Human Spermatogenesis by Testosterone Implants – ie, Pellets are The Best Birth Control

Testosterone Release Rate and Duration of Action of Testosterone Pellet Implants

Trough Serum Testosterone Predicts the Development of Polycythemia in Hypogonadal Men Treated for Up to 21 Years with Subcutaneous Testosterone Pellet

Additional Topics

Are Stem Cells Legal in the United States?

Meniscal Repair using Fibrin Clot from Autologous Blood

Interventional Treatments for Sacroiliac Joint Pain

A New “Old” Therapy for Back and Joint Pain – Page 1