Practice What You Preach…

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!)


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.”


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.

[This news segment highlights a little known but clearly typical insurance company tactic.  There is so much written about how pharmaceutical companies are to blame for the health care system breakdown.  And everybody is taking shots at them… including different medical organizations. 


Even the American College of Rheumatology, of which I’m a member, publicly distances itself from pharmaceutical companies, but privately demands funding from these companies for various functions.


Insurance companies get a pass for reasons which are a complete mystery to me.  Any patient or doctor in practice knows that insurance companies call the shots when it comes to tests that patients can have or medicines that are ordered. 


I may order drug A, but the likelihood is about 80% the patient will receive drug B, because that’s what the insurance company wants them to have.  I have a patient who’s been taking a medicine that works great for her for three years.  But now the company says “they made a mistake” authorizing that medicine in the first place. They want her to take something she’s already failed.  GRRR!


I recently ordered a diagnostic test for a patient.  The insurance company denied it.  When I called the medical director and accused the insurance company of making medical decisions that were not in the patient’s best interest, he said, “We’re not making medical decisions.  She can have the test.  We’re just not going to pay for it…” 


I’ve got to admit, it takes alot of balls to say something like that…]



Segment highlights how health insurers hit consumers with unexpected fees.


On its website, KTVT-TV Fort Worth, Texas (6/12) highlights “how some health insurers get you to pay more — so they can pay less.” Several incidents are presented, such as the plight of Camille Privitt, who “slipped down a flight of stairs” and fractured “three thoracic vertebrae.” Privitt received a letter from her “insurance company, United Healthcare,” which among other things, said the “ambulance was an ‘out-of-network’ service” and said the fees “for the medical supplies that held Privitts’ neck in place” were not covered. The segment also provides “Tips to Fight Back” against insurance fees, such as calling the insurer and send letter via certified mail; and, as a “last resort,” consulting a lawyer.

[I thought this was a real good indicator of a couple of things.  The first is that the health care system is too focused on treatment rather than prevention.  And that orthopedic surgeons do far too many joint replacements. 


Most joint replacements are done for arthritis.  The emphasis should be on slowing the disease process and maybe even reversing it, rather than subjecting a patient to a potentially dangerous – even life-threatening- procedure.  The point CBS was trying to make was that informed consent- the process where risks of a procedure are explained to the patient- is confusing and most patients don’t understand what’s going to happen.  And that’s true.


I have many patients who have gone through joint replacement and are happy… however, I also have a significant number of patients who have had bad outcomes and rue their decision.  Too late!


That’s why more emphasis should be placed on regrowth of connective tissue- ie. prolotherapy, the use of natural growth factors such as platelet-rich plasma (PRP) and the use of stem cells to regrow cartilage.  Natural healing.


There are efforts now at some centers evaluating the use of stem cells for spine-related disorders.


Our experience with the implementation of an autologous stem cell program (using the patient’s own stem cells harvested from their bone marrow) for osteoarthritis of the hip and knee  is proving that tissue regeneration is an option- a far better one that joint replacement.  That’s why the orthopods are so angry with us!!!]



Study indicates informed consent forms may be of “limited value.”

The CBS Evening News (6/9, story 10, 3:45, Couric) reported that “the high cost of medical care is a huge issue today, and…patients often make the problem worse by giving doctors permission to do procedures they don’t need. Experts point to four procedures — coronary angioplasty, spinal fusion, knee replacement, and hip replacement — that are responsible for billions of dollars in hospital costs every year.” In fact, data indicate that 30 “to 40 percent of those procedures are considered unnecessary.” But, Dr. Elliott Fisher, the Dartmouth Institute for Health Policy, noted that “proper informed consent would eliminate 30 to 40 percent of other unnecessary expensive procedures.” He explained, “The problem starts with consent forms. A review of hundreds of consent forms at more than 150 hospitals found them to be of, quote, ‘limited value.’ They are not standardized, loaded with confusing language. They are often missing specific risks, and generally not well explained by doctors.”

If you are a Baby Boomer who wants to stay active and stay in the game…. (and no, I’m not talking about male enhancement)…and recover from nasty problems like tendonitis and arthritis, you ought to pay attention to this post …

Because this past week I interviewed Dr. Sean Mulvaney, a sports medicine doctor who specializes in PRP (platelet-rich plasma) techniques and Dr. Dean Reeves, a specialist (in fact one of the foremost experts in the world) in prolotherapy.

Both of these physicians discussed the  revolution in natural healing of conditions such as tendonitis and arthritis using the body’s own growth factors.

While our ability to regenerate new tissue declines as we age, it is not completely lost.  It’s possible to turbocharge it using newer methods.

With old technologies like prolotherapy and new technologies like PRP and stem cells, we are able to accomplish amazing things.  Some of these medical approaches sound like stuff out of Star Wars. Truly amazing stuff and important if you’re a Boomer who wants to continue to do the things you want to do without having to take toxic medicines or worry about joint replacement surgery lurking in the background.

Dr. Mulvaney discussed the biology and indications for PRP. 

Since he is an Army guy with hush-hush connections, he told me that if he revealed any more, he’d have to kill me….

… and Dr. Reeves talked about the amazing regenerative and rejuvenating properties that our bodies have if given the right opportunity.  While he uses the standard prolotherapy solutions (generally dextrose), he is also an advocate of PRP.

In future discussions, I’ll be yapping about PRP and stem cells. 

The reason? …I’m working a on a big project  on regenerative medicine.  In the upcoming weeks, I’ll be telling you more about it. Stay tuned.

I ran across this article recently.  We’ve all heard about brain tumors and cell phone use and highway driving and cell phone use.  Well… how about this hazard…

Cubital tunnel syndrome may be caused by excessive cell phone use, researchers say.

HealthDay (6/2, Thomas) reported that, according to research published in the May issue of the Cleveland Clinic Journal of Medicine, “the latest affliction of the wired age” appears to be “cell phone elbow.” The condition, which is “medically known as cubital tunnel syndrome,” consists of “numbness, tingling, and pain in the forearm and hand caused by compression of the ulnar nerve, which passes along the bony bump on the inside of the elbow,” and may be caused by “too much gabbing, often brought on by those cell phone plans with unlimited minutes, experts say.” In some people, “holding the bent-elbow position for extended periods can lead to decreased blood flow, inflammation and compression of the nerve,” explained Peter J. Evans, MD, PhD, director of the Cleveland Clinic’s Hand and Upper Extremity Center. And, “as symptoms progress, they can include a loss of muscle strength, coordination, and mobility.” Dr. Evans explained that “in chronic, untreated cases, the ring finger and pinky can become clawed.”

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