Injections to Kick-Start Tissue Repair with Prolotherapy

This article is a bit dated but it does have some nice info on prolotherapy.  Please enjoy:

The original article can be found HERE

The human body is held together by a network of connective tissues that are highly vulnerable to injury — through exercise, accidents and even the normal lifting, pulling and pushing of daily life.

Few of us, for example, get through life without spraining an ankle. And as many sadly know, once an ankle is badly sprained, it may be sprained again and again. That often happens as well with other body parts: shoulders, wrists, neck, back, jaw, feet, even fingers and toes, all of which are subject to arthritic changes after an injury.Prolotherapy san diego clinic of integrative medicine

The risk of reinjury rises when the ligaments that hold bone to bone, or the tendons that connect bone to muscle, fail to heal completely. And such failure is apparently very common. Over time, and with multiple injuries, this incomplete healing can result in lax connective tissues that cannot fully support a joint.

Dr. K. Dean Reeves, clinical associate professor of physical medicine and rehabilitation at the University of Kansas Medical Center, likens the damage to a partly shredded rope that lacks the strength of an intact one, and to stretched putty that will not return to its former length. Dr. Reeves is one of several hundred physicians and osteopaths who specialize in a therapeutic technique called prolotherapy, an alternative medicine method to promote connective tissue repair even years after the damage occurred.

The technique received an endorsement of sorts from the Mayo Clinic. In its April 2005 health letter, the clinic stated that when chronic ligament or tendon pain fails to respond to more conservative treatments like physical therapy and prescribed exercises, “prolotherapy may be helpful.” And when surgery is the only remaining option to relieve chronic pain, prolotherapy is a much less invasive and expensive technique that may be worth a try — if you can find an experienced and skilled practitioner.

What Is Prolotherapy?

Prolotherapy involves a series of injections designed to produce inflammation in the injured tissue. To appreciate the value of such a seemingly counterproductive measure, you need to know something about connective tissue and how the body normally repairs it.

When tissues are injured, inflammation is a common natural response. It stimulates substances carried in blood that produce growth factors in the injured area to promote healing. Ligaments, tendons and cartilage have very poor blood supplies, which can result in incomplete healing.

The healing process can also be impeded when injuries are treated with anti-inflammatory medications like ibuprofen or Naprosyn, or prescribed nonsteroidal anti-inflammatory drugs (Nsaids) to relieve pain and swelling.

Unlike injections of corticosteroids, which also suppress inflammation and provide only temporary relief for a chronic condition, prolotherapy injections given over the course of several months are meant to provide a permanent benefit. In effect, prolotherapy tricks the body into initiating a healing response.

The technique reactivates the healing process by injecting a mildly irritating substance — commonly a somewhat concentrated sugar solution along with the painkiller lidocaine — into the injured area to stimulate a temporary low-grade inflammation. In some cases, growth factors themselves may be injected.

With growth factors in place at the site of inflammation, new tissue is said to be produced that strengthens lax or unstable ligaments and tendons. The technique may even support damaged or degenerated cartilage, which normally does not repair itself, by strengthening the fibrous connective tissues that stabilize the area.

Practitioners cite experiments in laboratory animals that demonstrated tissue growth in ligaments and tendons stimulated by prolotherapy injections. Two animal studies also showed healing of cartilage defects.

Prolotherapy cannot correct mechanical problems like spinal stenosis, in which two bones pinch a nerve, nor does it reverse arthritic changes. But it may reduce or even eliminate the discomfort associated with arthritis by tightening the connective tissues that support an arthritic joint.

A leader in the field, Dr. Donna Alderman, an osteopathic physician who is medical director of the Hemwall Family Medical Centers in California, published two long articles on prolotherapy this year in the magazine Practical Pain Management. She wrote that “prolotherapy has been used in the United States for musculoskeletal pain since the 1930s,” that it has been endorsed by former Surgeon General C. Everett Koop, and that it is increasingly being used to treat injuries in professional athletes.

Prolotherapy is also now the subject of a controlled clinical trial sponsored by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health.

Since prolotherapy is a nonsurgical technique, patients who are now facing surgery because all else has failed might consider trying it before having an operation. Unlike many drugs and surgery, prolotherapy has minimal side effects when performed by an experienced practitioner who uses sterile techniques. Patients may experience bruising and a temporary increase in pain in the injected area because of the induced inflammation. Rare risks include infection, headache, nerve irritation or allergic reaction.

Does Prolotherapy Help?

There have been dozens of studies purporting to show benefits of prolotherapy for people with chronic pain as well as those with sports injuries. Among scientifically designed controlled studies, most showed a significant improvement in the patients’ level of pain and ability to move the painful joint.

According to Dr. Alderman, in a study of people with chronic low back pain resulting from injured ligaments in the sacroiliac joint, biopsies done three months after treatment showed a 60 percent increase in the diameter of connective tissue. The patients reported a decrease in pain and an increased range of motion.

In studies of knee injuries, patients with ligament laxity and instability experienced a tightening of those ligaments, including the often disabling anterior cruciate ligament in the center of the knee, Dr. Reeves showed in a double-blind study. Other studies showed a significant improvement in the symptoms of arthritis in the knee one to three years after prolotherapy injections.

Dr. Alderman cautions that prolotherapy is appropriate only for patients with musculoskeletal pain who do not have underlying conditions that would interfere with healing and who are willing to receive painful injections in an effort to recover.

 

Contact San Diego Clinic of Integrative Medicine for more information about prolotherapy today.

 

Breakthrough Discovery in Heart Disease

Coronary Heart Disease May Be an Early Form of 

Scurvy

Please enjoy this fascinating development in heart disease- Dr. Drew Collins

Original Article Link: http://www.drrathresearch.org/discoveries/heart-disease.html
heart disease san diego clinic of integrative medicineDr. Rath’s discovery reveals that coronary heart disease occurs exactly for the same reason thatclinical (early) scurvydoes – a deficiency of vitamin C in the cells composing the artery wall. Humans, unlike animals, develop heart disease because their bodies cannot produce vitamin C. The average diet provides enough vitamin C to prevent scurvy, but not enough to guarantee stable artery walls. As a consequence of vitamin C deficiency, millions of tiny cracks and lesions develop in the artery walls. Subsequently, cholesterol, lipoproteins and other blood risk factors enter the damaged artery walls to repair these lesions.

In the case of chronic vitamin deficiency, this repair process becomes continuous. Over the course of many years, atherosclerotic deposits develop. Deposits in the arteries of the heart eventually lead to heart attack; deposits in the arteries of the brain lead to stroke.

Dr. Rath identified and our research has proven that atherosclerosis is nature’s plaster cast for weak and cracked arterial walls that are chronically deficient in vitamin C and other essential nutrients. One of these nutrients is the amino acid lysine. Lysine is called an essential amino acid because, similar to vitamin C, it cannot be produced in the human body. Lysine, together with another amino acid, proline, is the main component of collagen. These two amino acids comprise about 25% of all amino acids in the collagen molecule. A deficiency of lysine and proline can also trigger blood vessel wall weakness and instability.

Research and clinical studies conducted by Dr. Rath confirm that the most important function of vitamin C in preventing heart attacks and strokes is its ability to increase the production of collagen, elastin, and other reinforcement molecules in the body.

This groundbreaking discovery in heart disease should be taught in every medical textbook and school and explains why other cardiovascular conditions, including heart failure, irregular heartbeat, high blood pressure and circulatory problems in diabetes, occur in the case of long-term vitamin deficiencies.

Tiger Woods and Kobe Bryant Use Platelet Rich Plasma (PRP)

I found this article about how top professional athletes are using Platelet Rich Plasma (PRP) with success. I hear testimonials from my patients all the time, but when superstar athletes give testimonials it will really bring Platelet Rich Plasma (PRP) into the spotlight. I’ll repost the article below. Please contact our office if you have any question about how it works. I hope you enjoy the article – Dr. Collins

Reposted from Bloomberg News

Blood Therapy Used by Tiger Woods Lures Everyday Athletes

When Ira Schneider’s right hip started to hurt, the Los Angeles-based chiropractor wanted to avoid a repeat of the surgery he’d undergone on his left side, and the months of painful recovery that followed.

Instead, he turned to platelet-rich plasma therapy, better known as PRP, a treatment gaining ground after headlines touting its use by elite athletes including golfer Tiger Woods, tennis’sRafael http://www.sandiegohealthclinic.com/services/platelet-rich-plasma-prp.htmlNadal and basketball’s Kobe Bryant. Last week, Andrew Bynum, of the Philadelphia 76ers’ NBA team, said he’ll travel to Germany next month for the procedure, in which a concentrated dose of tissue-repairing platelets taken from the patient’s blood is injected into an injury site.

 Instead, he turned to platelet-rich plasma therapy, better known as PRP, a treatment gaining ground after headlines touting its use by elite athletes including golfer Tiger Woods, tennis’s Rafael Nadal and basketball’s Kobe Bryant. Photographer: Andrew Redington/Getty Images

Costs running as high as $250 an injection that aren’t covered by insurance and uncertain scientific evidence about the therapy haven’t stopped people from peppering doctors with requests to try it. While probably hundreds of athletes have undergone PRP since 2009, when Woods first used it for a painful knee, it hasn’t been subject to large-scale testing in wide groups that include less-athletically gifted people.

“Athletes are always seeking an edge and, at an elite level, it makes sense for them to look for any possible shortcut to healing,” said Dennis Cardone, at New York University’s Langone Center for Musculoskeletal Care in Manhattan. “But too often the newer procedures are done in people who don’t need that physical edge, without good evidence they actually work.”

Testing Requirements

While drugs generally undergo 10 or more years of regulated clinical trials before being sold, treatments such as PRP don’t face the same requirements. The Food and Drug Administration doesn’t overview therapeutic procedures, as long as the blood product isn’t shipped across state lines, is for individual use only and no claims are made that it will correct a specific medical problem, Heidi Rebello, an FDA spokeswoman, wrote in an e-mailed response to questions.

As a result, most people learn of treatments such as PRP through the Internet, word-of-mouth or news reports after they’re used by celebrities seeking quick results.

In PRP’s case, the use of the therapy by Pittsburgh Steeler professional football player Hines Ward, just prior to his winning Super Bowl appearance, Alex Rodriguez of the New York Yankees, and Bryant, of the National Basketball Association’sLos Angeles Lakers, created a drumbeat of headlines about the procedure, following Woods’s announcement he had used it.

PRP is one of a wide range of new treatments, including whole-body vibration and hyperbaric therapy, being used by elite athletes to recover from career-slowing injuries. Whether shot-gunning platelets using PRP helps in all cases remains an open question, researchers have found.

Growth Factors

The therapy can take from about 20 minutes to two hours, starting when a doctor draws a small amount of blood from a patient. The blood is placed in a centrifuge to separate out platelets that carry so-called growth factors, which are thought to help naturally in healing. The platelets are then re-injected into the patient at the point of injury, the idea being that the regenerative properties of the growth factors will work even more efficiently at a higher concentration.

Because the plasma is an extract of the patient’s own blood, there’s little danger of an adverse reaction or disease, and it can be given multiple times, said Allan Mishra, a physician at Stanford University Medical Center’s clinic in Menlo Park, who offers the procedure in his practice.

Schneider, 56, said he learned about PRP while working in his job as a chiropractor with athletes at California State University, Northridge. While he said he isn’t the type to jump on the latest hot therapy, he was desperate to avoid another hip surgery.

Pain Free

The result for him “has been pretty much amazing,” he said in a telephone interview. “It’s been six or seven months since my last injection, and I’m still 75 percent pain free. It’s a wonderful alternative to having a replacement done.”

Since Woods first said he had used the therapy in 2009, though, scientists have reported mixed results in limited trials done with relatively few participants.

In January 2010, for instance, a report published in the Journal of the American Medical Association, or JAMA, found PRP to be no more effective than salt water at inducing healing in 54 patients with injured Achilles’ tendons. In separate trials done last year, PRP lowered blood loss in 81 patients with knee replacements, and lessened pain for 21 with tennis elbow.

Those trials, though, didn’t directly measure whether the therapy increased the speed of the healing process. Other studies are in progress in ankle sprains, cartilage degeneration, muscle injuries, rotator cuff injuries and more, according to the U.S. website ClinicalTrials.gov.

Little Known

Leon Creaney, a London-based physician, wrote in a commentary last year in the British Journal of Sports Medicine, that too little is known to offer use of PRP to patients, except on an experimental basis. The lack of a standard procedure in administering the therapy may send “a completely confusing message” to cells that affect healing, he wrote.

The anecdotal result reported by athletes could be nothing more than a placebo effect, in which a patient’s condition will sometimes improve simply because the person has the expectation it will be helpful, Creaney wrote. The only way to know for sure is to test large numbers of people in a blinded trial.

“It would seem hopelessly optimistic and naive to presume that we are accurately reproducing biological complexity” that occurs naturally within the healing process, Creaney concluded in the article.

Despite this, the therapy is entering the mainstream as a less-painful and time-consuming alternative to surgery, according to Mishra, the Menlo Park clinician.

Thousands Done

While there’s no way to determine how many PRP procedures have been done in the U.S, Mishra said the number may be in the thousands.

“We’re not quite the blind caveman feeling around in the dark on this,” said Mishra, who has been credited with creating the PRP system in the U.S. “There are a few cracks of light. It’s just going to take some time to understand it. You can’t do randomized control trials on NBA players.”

Mishra offers the therapy in his practice and is studying its usefulness for a variety of ailments, including tennis elbow, which he says is currently the best-supported use for the therapy.

Whether unproven therapies should be undertaken for patients that request them is a “complex” issue, Mishra said. “It’s messy, and it’s fascinating. The enthusiasm for the therapy is partly driven by the patients themselves in this case, and we should embrace that.”

Two New York physicians who are top specialists in caring for the body’s complex system of joints show the range of opinions on the questions.

No Confidence

Giles Scuderi, a surgeon who specializes in knees at Insall Scott Kelly Institutes for Orthopaedics and Sports Medicine in New York, says studies done on PRP haven’t given him enough confidence in the therapy to offer it.

NYU’s Cardone said that while he doesn’t push PRP he will perform the procedure for patients who ask for it. First, though, he said he makes a special effort to ensure they understand that the therapy, while safe, hasn’t been proven to work during wide testing in multiple groups of people.

The Internet traffic and news reports put doctors in a bind, Cardone said, balancing their wish to work with their patients on new treatments with concerns about using a procedure that hasn’t been proven.

While his patients increasingly ask for PRP, Scuderi said he refuses to do the procedure.

‘Questionable’ Science

“The science is still questionable” Scuderi said, and the injections aren’t covered by insurance.

Recreational athletes “don’t realize that the elite athlete, because it’s their livelihood, can get rehab every day,” Scuderi said in a telephone interview. They have resources “not available to the amateur, and a greater time commitment because it’s financial for them.”

Schneider, the Los Angeles chiropractor who had the therapy in his hip, said he was about a month away from having surgery again when he decided to try PRP.

In 1980, Schneider was a good enough athlete to try out for the U.S. Olympic team in volleyball. Because it was a boycott year, he went instead to Europe and played there professionally, he said. Soon after that, he had his first hip operation.

“I recovered from the surgery,” he said. “But that was the end of volleyball.”

Now he’s glad he found PRP as a way to avoid a third operation and has returned to cycling, he said.

Quick Recovery

For others using PRP, the advantage is less about the pain of an operation and more about getting back to their sport more quickly.

That was the case for Mark Fretta, 35, once the world’s top-rated triathlete, who said he used the experimental procedure before competing in the U.S. Olympic trials in May.

Fretta said had suffered a hamstring tear prior to the trials and, figuring it may be his last chance to compete in an Olympics. He was devastated, he recalled. Undergoing PRP seemed a reasonable bet to make, he said, since getting back to training even a day earlier would help him better prepare.

After the injection, Fretta — who was ranked No 1 in the world in his sport in 2006 — competed pain-free in the trials after just under four weeks of recovery time, compared with the 6 to 8 weeks normal for the injury.

Though he didn’t qualify, he says he was happy he got the chance to try.

“I think the PRP injection I received was a huge accelerant in my healing process,” he said. And although he was advised before using it that the scientific verdict was still out, “I’d recommend it to my friends.”

Testosterone Replacement Therapy

Sometime people don’t realize how many factors are related to testosterone production. Testosterone isn’t simply about libido and lean muscle mass but rather it relates to overall wellness. Here is a nice breakdown worth reading from the Cleveland Clinic. I hope you enjoy – Dr. Collins

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone density, sense of well-being, and sexual and reproductive function.

Inadequate testosterone production is not a common cause of erectile dysfunction (ED). When ED does occur with decreased testosterone production, testosterone replacement therapy may improve the ED.

What causes testosterone deficiency?

As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life. The significance of this decline is controversial and poorly understood. Among other potential causes of testosterone deficiency are:

  • injury or infection to the testicles
  • chemotherapy or radiation treatment for cancer
  • genetic abnormalities such as Klinefelter’s Syndrome (extra x chromosome)
  • hemochromatosis (too much iron in the body)
  • dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)
  • medications, including hormone analogues used to treat prostate cancer and steroids
  • chronic illness
  • cirrhosis of the liver
  • chronic renal (kidney) failure
  • AIDS
  • inflammatory disease such as sarcoidosis (a condition that causes inflammation of the lungs and other organs)
  • stress
  • alcoholism
  • congenital conditions, Kallman’s Syndrome (low hormones, inability to smell and other abnormalities)

What are the symptoms of testosterone deficiency?

Symptoms of testosterone deficiency include the following:

  • decreased sex drive
  • decreased sense of well-being
  • depressed mood
  • difficulties with concentration and memory
  • erectile dysfunction

What are the changes that occur in the body with testosterone deficiency?

Changes that occur with testosterone deficiency include:

  • a decrease in muscle mass, with an increase in body fat
  • variable effects on cholesterol metabolism
  • a decrease in hemoglobin and possibly mild anemia
  • fragile bones (osteoporosis)
  • a decrease in body hair

How do I find out if I have a testosterone deficiency?

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. It sometimes may take several measurements of testosterone to be sure if a patient has a deficiency, since levels of testosterone tend to fluctuate throughout the day. The highest levels of testosterone are generally in the morning. This is why doctors prefer, if possible, to obtain early morning levels of testosterone.

What options are available for testosterone replacement?

The options available for testosterone replacement are:

  • intramuscular injections, generally every two or three weeks
  • testosterone patches worn either on the body or on the scrotum (the sac that contains the testicles). These patches are used daily. The body patch application is rotated between the buttocks, arms, back or abdomen.
  • testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.

Each of these options provides adequate levels of hormone replacement. Each has side effects and advantages and disadvantages. Intramuscular injections produce wider swings in hormone concentration, with higher levels shortly after the injection and lower levels just before the next injection is due. They may also produce increases in blood cell count that are higher than normal.

The body patches may produce skin irritation in a significant number of men, requiring discontinuation of the patch. The gels require care in making sure that the hormone is not accidentally transferred to another person or partner.

There are currently no pills available in the United States that provide adequate levels of hormone replacement. In addition, oral medications may produce liver abnormalities and are to be avoided.

The choice of hormone replacement therapy is best made with a thorough discussion between a patient and his physician.

Who shouldn’t take testosterone replacement therapy?

Testosterone replacement therapy may stimulate growth of the prostate. If early prostate cancer is present, testosterone may stimulate the cancer’s growth. Therefore, men who have prostate cancer should not take testosterone replacement therapy. It is important for all men considering testosterone replacement therapy to undergo prostate screening before starting this therapy.

Although it is a rare condition, men who have breast cancer should not take testosterone replacement therapy.

What are the side effects of testosterone replacement therapy?

In general, hormone replacement therapy is safe. It is associated with some side effects, including:

  • acne or oily skin
  • mild fluid retention
  • stimulation of prostate tissue, with perhaps some increased urination symptoms such as decreased stream or frequency
  • breast enlargement
  • worsening of sleep apnea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness)
  • decreased testicular size

Many of these side effects are not common.

Laboratory abnormalities that can occur with hormone replacement include:

  • changes in cholesterol concentrations
  • increase in red cell count
  • decrease in sperm count, producing infertility (especially in younger men)

Please contact  us at 619-440-3838 to have your testosterone levels checked.

 

Adrenal Fatigue or Burnout?

Possibly you have been to a health care practitioner of some sort and when you mentioned you were feeling tired they might have said you have Adrenal adrenal fatigue san diego clinic of integrative medicineFatigue.

You’ve probably wondered what that even was or if Adrenal Fatigue even a real medical condition?

The answer is both yes and no.

Your adrenal glands are small glands that reside atop of your kidneys.  Their job is to release cortisol when there is stress in the body.  Cortisol gives you the extra energy to get through “the tiger chasing you” which is how we perceive our boss giving deadlines or our kid’s soccer schedule or both.  It also has to do with metabolism and glucose regulation. http://en.wikipedia.org/wiki/Cortisol

We are often moving targets in our daily life and we fuel up with venti lattes (caffeine, a stimulant) to get through our afternoons.

Over time, our adrenal glands can’t keep up with the demand placed on them.  Here is where the fatigue part comes in. You might start getting tired in the afternoons, soon you have trouble sleeping and then you notice your midback starts hurting.  You start getting more colds and you have higher inflammation which means more aches and pains. Worst of all weight gain.

There are complicated processes going on in the body that cascade into these symptoms and there are stages to all of these symptoms.  At any point things can get complicated and turn into more alarming conditions.

We can help get you back to great working order at any stage of symptoms.

Sometimes it as simple as the right supplements and lifestyle changes. Sometimes treatment for Adrenal Fatigue can be more aggressive in treatment, perhaps a series of IV nutrition.

So yes and no, Adrenal Fatigue is a series of symptoms lumped together to be called a condition.

Come in and let’s talk about it.