Dallas PRP and Stem Cell Institute

10/15/2024

*Who cares about patient reviews*
I don't post much about patient reviews.
It used to be that most new patients came from other clinician referrals and other patient referrals. With the rise of the internet and the many doctor review sites.....along with the increasing cost of insurance and rising deductibles...things have been changing over the last 15 years.
The most common referral source listed by our new patients at Texas Orthobiologics is the insurance company website (searching for local in network docs) and then they go to patient reviews and see who is highly ranked on websites like doctor.com, healthgrades.com, vitals.com, usnews.com, trustpilot.com, google.com, and even yelp(ugh!).
So, like it or not, we have to care about reviews if we want to take care of patients... This is one major way potential patients get "social proof" about clinicians. Internet reviews are also a way patients get to "know, like, and trust" us.

10/14/2024

* Dosing Probably matters in aesthetics too!*
Ok, so I don't do PRP microneedling or hair loss or "P" or "O" shots or any other aesthetic procedures but because of my use of PRP I get questions from patients about these aesthetic uses. Last week I got a question from a patient that forced me to take a deeper dive. The question was whether or not the patient should pursue PRP injections to improve the appearance of her aging hands. I had no clue so I told her I would get back to her. Here is what I found. There is a just published level 2 study out of Mayo Clinic looking at this exact subject. There were only 18 hands in the PRP versus normal saline group so most likely underpowered. The protocol called for a total of 1cc of PRP injected into the hand dorsum every month for 3 months. At 6 month follow up there was no significant difference noted.

Thoughts: There was no mention of the PRP blood volume draw (we have the PRP volume) and there was also no mention of the platelet counts or leukocyte content. Extrapolating assuming a platelet count of 200 and a PRP count of 1200 (being generous based on other aesthetic studies)....the patients may have received 1.2 Billion platelets per month for 3 months.
Just like the recently published knee studies (PEAK trial and RESTORE trial) this study suggests that if we treat people with a platelet dose under a therapeutic level.....it doesn't matter how many times we inject.....the "response" never gets going.
Future PRP studies in aesthetics should mirror those in orthopedics....looking at and documenting higher platelet doses...not lower!

10/12/2024

Have you heard of exosomes? Exosomes are a type of regenerative medicine injection. It is not a stem cell injection. It is not a PRP or Platelet Rich Plasma Injection. Exosome injections are made from the secretions of stem cells which are purified and then shipped to a doctoer's office. The FDA has ruled that exosomes are a drug and therefore require derug approval for from the FDA. Currently, there is no FDA drug approval to use exosomes for anything. SO we cannot use them.....we could study them if we have a FDA approved study.....but that work takes many years and often millions of dollars. No such studies are currently actively registered in the USA as of this writing!

10/11/2024

Texas Orthobiologics

*Baseball Fun Fact*
55 years ago on this day, dad became the first player to ever hit a leadoff home run in the first game of the World Series. The Baltimore Orioles beat Tom Seaver and the New York Mets in that game but lost the World Series 4-1. The Orioles won World Series in 1970, beating Pete Rose and Johnny Bench and the rest of the Cincinnati Reds "Big Red Machine". They went back in 1971 but lost again to Roberto Clemente and Willie Stargell and the Pittsburgh Pirates.

(Check out my two youtube channels for more surgery and lectures and orthobiologics stuff....don't forget to like and subscribe lol!)

Back to regularly scheduled programming......

Don Buford Sr. Home run in 1969 World Series Game 1

10/09/2024

This brief presentation shows how we can use ultrasound in the office to diagnose a meniscus tear and avoid the time and expense of a MRI scan.It is faster a...

10/04/2024

If there is a better indication for recommending a well done bone marrow concentrate injection than Avascular Necrosis of the Femoral Head.....I don't know what it is.....
Too many papers now to list but here is a link to just one 2022 review.
Helping this friend out next week!
https://lnkd.in/gtmS6hh9

10/03/2024

*Why are we using ice ..... who started R.I.C.E and is it even the right thing to do?*
So, based on the fantastic review by British Journal Of Spoerts Medicine (see pics below) maybe clinicians should keep using ice for acute injuries BUT not for a long time. In the regenerative medicine world, I use it acutely after the injection but just that day in the office and at home for pain relief. In the orthopedic surgery world, I stopped using the chronic ice machines over a decade ago....and maybe that was a good move based on this summary....I know it sure has not make a difference in my surgical outcomes!

09/06/2024

*Surgical images in this post*
We might have saved a knee today!
Our friend had a large defect in the medial patellar facet.
He is under 23 years old.
The top row are the before pictures.
The bottom row shows the result after an osteochondral allograft bone/cartilage plug and some cartilage graft used to reshape the medial patellar facet.
Fingers crossed, he now has a good chance to recover and hopefully return to all his activities.

09/06/2024

*Can an ultrasound exam predict if a full thickness rotator cuff is repairable?*
Short answer: Yes!
Here is a level 3 paper published last year in the Journal of Shoulder and Elbow Surgery International where we figured out how to answer that question.
Spoiler Alert: If the tendon edge is clearly seen on the coronal then the positive predictive value is about 97%.
https://lnkd.in/gQsm9KZ7

08/25/2024

*2024 FDA Untitled Letters and what it means for Orthobiologics*
In 2024, there have been 5 Untitled Letters sent out for regulatory noncompliance with biologics. Untitled letters typically give the company or person a chance to correct the variance before any further FDA regulatory action and clearly show the current FDA regulatory stances on various orthobiologics.
#1 www.achievevitality.net (Wharton's Jelly/human umbilical cord based products) This company was asked to correct or remove their marketing and sales since human umbilical cord based products need FDA drug approval....according to the FDA!
#2 www.exocelbio.com (Exosome products for hair, aesthetics and orthopedic applications) Exosomes are considered drugs and therefore cannot be sold or used in humans without FDA approval. The FDA also clearly states there is no such thing as an off-label use of a product that has no FDA approvals....refuting claims made on the Exovex youtube channel by Dr. Shanthala. Virtually any company still selling and using exosomes is non compliant with FDA regulations....DYOR
#3 https://amnion.us Amnion Florida (amniotic membrane and fluid)
This company was also informed that amniotic membrane and fluid products are indeed considered drugs by the FDA so they cannot be sold in the US and used in the USA without FDA regulatory compliance or a valid exception
#4 https://lnkd.in/gkzycAqz (Wharton's Jelly/umbilical cord)
This company was asked to correct or remove their marketing and sales since human umbilical cord based products need FDA drug approval....according to the FDA! They were also marketing these products as stem cell treatments....incorrectly in my opinion.
#5 www.vitacellbiologics.com (exosomes, umbilical cord)
Same story, same regulatory non-compliance......same FDA notification that exosomes and umbilical cord products can not be sold or marketed or advertised for use in humans in the USA in the manner that virtually all are currently.
DYOR.... I am not an attorney nor is this legal advice.
Given the straightforward FDA explanations and requirements, there is simply no way I would risk my medical license, medical practice, malpractice insurance, or assume the personal liability for using exosomes, wharton's jelly, amniotic fluid, placental tissues, or any other allograft topical or injectable product without FDA approval!
https://www.fda.gov/vaccines-blood-biologics/enforcement-actions-cber/bimoteam-biologicsinternet-surveillanceother

This is the main page for the CBER BIMO/Team Biologics/Internet Surveillance/Other.

08/05/2024

*Shouldn't we all want to know the and BMC/Stem Cell data?*
I confess I have a type A desire to know how things work and why! Especially with human biology, orthopedic surgery, and regenerative medicine topics.
For that reason, I do the best I can to quantify, describe and track any procedures/surgeries/interventions so that on the off chance they work....I can do it again for the next person. At Texas Orthobiologics we use a hematology machine to quantify the PRP doses and concentrations we are giving patients. We have an abundance of high level clinical data giving us dosing parameters (from hematology machines) for various orthopedic conditions. It isn't perfect but it is the best we can do in the office at the point of care. Likewise, getting a cell counter so we can determine a total nucleated cell count for a bone marrow concentrate(BMC) procedures make sense. But TNCC also has limitations.....TNCC doesn't directly correlate with the actual MSC or HSC count....but it is a good proxy same day metric for quantifying BMC procedures. Three papers out of India this year already have looked at BMC data for knee osteoarthritis using a total nucleated cell count as the metric for dosing evaluation. Below is today's PRP printout from the Horiba Micros ES 60. 60cc of blood--->6 cc of PRP. 6x concentration. Platelet count from 288 to 1707 with a lowered granulocyte percentage in the PRP (ie. LP-PRP) DOSE? 10.24 Billion platelets in 6 cc.

05/31/2024

*PRP is not just for humans!*
Biology works and is similar in most if not all mammals.
A recent pilot study on 6 patients revealed that a single PRP injection helped the felines with joint DJD.
Patients were followed for 6 weeks and all showed improvements in Feline VAS and Feline Musculoskeletal Pain Index (FMPI).