Dr. Allan Magaziner of the Magaziner Center for Wellness in Cherry Hill, New Jersey featured on Philadelphia Fox News discussing how to reduce heart disease risk.

Headaches, almost everyone gets them, but for some it is difficult to get rid of them. Watch this news segment from ABC-News 6 in Philadelphia about how Prolotherapy was able to help this patient.

More research is out for the use of Platelet Rich Plasma therapy in knee pain. What is the most appropriate treatment for patellar tendinopathy? At one time it was that that tendinopathy was the result of inlammation. Now doctors know that tendinopathy is a problem of degeneration. Patellar tendinopathy or “jumper’s knee” is the result of overuse and connective tissue breakdown – typically found in athletes who “jump.”

Typically a doctor will prescribe Rest, exercise, medications, heat, therapeutic ultrasound and other treatments. There is no standardized surgical treatment for patellar tendinopathy.

Now researchers are saying Platelet Rich Plasma therapy BEFORE ethoxysclerol, cortisone, and/or surgical treatment for patellar tendinopathy.

Research in the International Journal of International Orthopaedics say Platelet Rich Plasma therapy BEFORE ethoxysclerol, cortisone, and/or surgical treatment!

Researchers in the Netherlands evaluated the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) and whether certain characteristics, such as activity level or previous treatment affected the results. What they found was: “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.”

Platelet Rich Plasma Therapy treatment
First: a small sample of your blood is drawn and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The concentrated platelet rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.

The body’s first response to soft tissue injury is to deliver platelets. Packed with growth and healing factors, platelets initiate repair and attract the critical assistance of stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets.

Because the goal of PRP therapy is to resolve pain through healing, it could prove to have lasting results. Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses.

Research studies and clinical practice have shown PRP therapy to be very effective at relieving pain and returning patients to their normal lives. Both ultrasound and MRI images have shown definitive tissue repair after PRP therapy, confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses and the condition is irreversible.

Magaziner Center for Wellness performs over 1,500 PRP procedures each year. So you know at Magaziner, your wellness is in very good hands.

The articular cartilage is the tough tissue that covers the ends of bones. In the knees, lesions or tears are very common. If the lesions go all the way through to the bone it is called a full-thickness lesion.

The typical method of repairing this injury is surgery. However articular cartilage lesions represent one of the major unsolved problems in the orthopaedic surgery. (1)

Now researchers in China say PRP, Platelet rich Plasma Therapy can present a successful option.

Researchers at the Department of Orthopaedics, Sixth People’s Hospital, Shanghai Jiaotong University say: “Platelet-rich plasma (PRP) can enhance the chondrocyte proliferation and repair of cartilage defects. To explore the safety and efficacy of intra-knee-articular injection of PRP to treat knee articular cartilage degeneration by comparing with injecting sodium hyaluronate (SH).” What they founds was: “Intra-knee-articular injection of PRP to treat knee articular cartilage degeneration is safe, which can alleviate symptoms of pain and swelling and improve the quality of life of patients,” and recommended further study. (2)

PRP for the knee
The body’s first response to soft tissue injury is to deliver platelets. Packed with growth and healing factors, platelets initiate repair and attract the critical assistance of stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets.

To create PRP therapy, a small sample of your blood is drawn (similar to a lab test sample) and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The concentrated platelet rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.

Relieves pain without the risks of surgery or general anesthesia.

No hospital stay is required. The procedure is performed safely in a medical office and takes approximately one to two hours. And that’s including preparation and recovery time. In fact, most people return to their jobs or usual activities right after the procedure.

At long last, long lasting non-surgical pain relief.

Because the goal of PRP therapy is to resolve pain through healing, it could prove to have lasting results. Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses.

Research studies and clinical practice have shown PRP therapy to be very effective at relieving pain and returning patients to their normal lives. Both ultrasound and MRI images have shown definitive tissue repair after PRP therapy, confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses and the condition is irreversible.

Magaziner Center for Wellness performs over 1,500 PRP procedures each year.  So you know at Magaziner, your wellness is in very good hands.

1. Peretti GM, Pozzi A, Ballis R, Deponti D, Pellacci F. Current surgical options for articular cartilage repair.Acta Neurochir Suppl. 2011;108:213-9.
2. Li M, Zhang C, Ai Z, Yuan T, Feng Y, Jia W. [Therapeutic effectiveness of intra-knee-articular injection of platelet-rich plasma on knee articular cartilage degeneration]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1192-6.

Once again research is showing that in the hands of an experienced physician, ultrasound guidance is not needed to deliver a healing solution to the right spot.

In this new study, researchers compared the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome.

What they found was no statistically significant difference in the injection location accuracy between ultrasound guided and “blind,” injections.

They concluded “Blind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines.” (1)

Recent research also suggested a higher rate of injection therapy efficiency if performed under ultrasound guidance. But there is a paradox.

Researchers suggest that a disadvantage of ultrasound-guided injection technique is the long learning curve that is required for the medical professional to be well acquainted with the simultaneous manipulation of ultrasound equipment, placement of needles, and the correct interpretation of musculoskeletal sonographic images. (2)

So you need an experienced clinician to interpret the images, manipulate the needle, manipulate the equipment, etc. However, many clinicians, such as myself, who can do Prolotherapy and PRP under ultrasound guidance choose not to. Why, when some suggest its absolute superiority?

People who have chronic joint pain, typically have many spots of that joint causing pain. It is usually not a localized singular event. So a clinician may isolate a single point in the knee per se that is causing pain, inject that point and consider the job done. The clinician may not see other areas causing pain because they are not obvious on the image.

When physically examining the knee, palpitating the knee can reveal other painful areas that need treatment. So it is possible for an ultrasound reliant knee pain specialist to miss these other pain causing areas. Then we see patients who insist Prolotherapy does not work as they had it done under ultrasound guidance with no benefit. They did not get Prolotherapy, then got a single injection, to a single spot under ultrasound. We practice Prolotherapy differently here.

Many of our patients are aware that we train other doctors to perform Prolotherapy. Recently one of our physician trainees attended an ultrasound guided injection course and when he displayed his technique of needle insertion without ultrasound guidance, he was spot on  only 1 mm off – statistically insignificant.

In the hands of an experienced clinician, prolotherapy can be delivered without ultrasound guidance with the same degree of accuracy BUT without the extra time and expense.

1. Dogu B, Yucel SD, Sag SY, Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in Subacromial Impingement Syndrome: A Randomized, Double-Blind, Prospective Study. Am J Phys Med Rehabil. 2012 May 2. [Epub ahead of print]

2. Chen CP, Lew HL, Tsai WC, et al. Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil. 2011 Oct;90(10):860-7.

Here is an update to our April 23rd post on the importance of getting rid of that “spare tire.”

Update May 12, 2012
Abdominal Obesity or “pot belly,” and the risk of sudden cardiac death From a press release by the Heart Rhythm Society, May 9, 2012

“For the first time, a significant and direct correlation has been shown between the specific region of the body where obese individuals carry their weight and the increased risk of sudden cardiac death (SCD). Specifically, obese individuals with an “apple” shape figure, or larger waste-to-hip ratio (WHR), are at greater risk than those with a more “pear” shaped figure, or smaller WHR. These findings were presented May 9 at the Heart Rhythm 2012, the Heart Rhythm Society’s 33rd Annual Scientific Sessions.

An analysis of the more than 15,000 people enrolled in the Atherosclerosis Risk in Communities (ARIC), a United States prospective biracial cohort study, showed that not only does obesity have a linear association with sudden cardiac dewasit-to-hip ratio WHR, or carry their weight in the abdominal region, have double the risk of sudden cardiac death.’

April 23, 2012
The battle to rid yourself of “belly fat” may have become a little easier. Researchers writing in the American Journal of Clinical Nutrition say that their findings suggest that calcium and/or vitamin D supplementation contributes to a beneficial reduction of VAT (visceral adipose tissue) or “belly fat.” (1)

The researchers took two groups. Randomly gave one group Vitamin D and calcium enriched Orange Juice, and the other group plain Orange Juice. The researchers noted “significant” visceral adipose tissue loss in the Vitamin D/Calcium group(s).

There has been an incredible amount of research published on the obvious. Abdominal fat is the strongest indicator of future and present health risks. Researchers in the medical journal Obesity noted that the best test to determine risk for heart disease, stroke, diabetes, insulin resistance, and other chronic disease was a tape measure to measure your waist. (2)

Researchers writing in the medical journal Diabetes Care agree. They say while overall body fat and fitness levels are important in predicting health risks, it is your waist size or the measurement of abdominal obesity that is the still the measurement to assess health risk among older adults. (3)

Weight loss is both complex and simple. The complexities come from not understanding what is best for your body – and this is why diet programs fail. At the Magaziner Center for Wellness we offer many weight loss programs to look at things like low vitamin levels such as vitamin D and calcium and others and test your body chemistry.

If you want a simple and effective diet program, that is physician assisted and gets to the root of your problem of abdominal “belly” fat. Please consider contacting us for an appointment.

1. Rosenblum JL, Castro VM, Moore CE,et al. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults. Am J Clin Nutr January 2012 vol. 95 no. 1 101-108

2. Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat.

3. Racette SB, Evans EM, Weiss EP, Hagberg JM, Holloszy JO. Abdominal Adiposity Is a Stronger Predictor of Insulin Resistance Than Fitness Among 50–95 Year Olds. Diabetes Care 29:673-678, 2006

In the medical journal Pain Practice, researchers noted that in their study of over 100,000 patients with chronic low back pain or osteoarthritis – “Opioids were the most frequently prescribed medication (more than 70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs more than 50%). Over 30% received antidepressants, more than 20% received benzodiazepines, and 15% in each group received sedative hypnotics.

Use of alternative treatments was as follows: chiropractor, Osteoarthritis 11%, chronic low back pain 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), Osteoarthritis 14%, chronic low back pain 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, less than 3% in both groups.

A case history from a patient:
“I had been experiencing pain in my lower back across my buttock and down my left leg. The pain was so bad at times I would lose my balance. I fell as though I have a high tolerance for pain and I am not a big believer in medicines especially painkillers. I asked my Doctor to send me for an MRI. I hoped the answer would be there and it wasn’t. I was told it was not bad enough to operate on and I was glad because that was my last choice and was told it would go away as fast as it came on. The pain that is. I had been going through this for eight months and that was a little much for any pain, especially this type which was my back, my buttocks, my leg and my mental being.

It was at this point I was recommended to see Dr. Greenberg, whom made me feel very comfortable at our first meeting. I felt confident with his confidence in what he was going to do to solve my problem. For the rest of the month the pain subsided and after three great treatments all pain was gone and some preventive measure was put in place. I feel great and thank you again Dr. Greenberg. I am now pain free.” RVH

Prolotherapy is a treatment where a cure for pain is sought, not a means to suppress symptoms. If you have tried the medical treatments including opioids, nonselective nonsteroidal anti-inflammatory drugs, antidepressants, benzodiazepines, sedative hypnotics, or chiropractor, physical therapy, transcutaneous electrical nerve stimulations (TENS), osteoarthritis acupuncture, hydrotherapy, and/or massage therapy, with less than hoped for results, then please consider and appoint for a Prolotherapy evaluation with us here in Cherry Hill, NJ.

These new findings, led by investigators at Beth Israel Deaconess Medical Center (BIDMC) identify a novel strategy for preventing thrombosis, and help pave the way for clinical testing of this popular flavonoid as a therapy for the prevention and treatment of stroke and heart attack, as well as deep venous thrombosis (DVT) and pulmonary embolism.

A bioflavonoid that is naturally found in many fruits, vegetables and teas including onions, apples and citrus fruits, rutin is also sold as an herbal supplement, having received a special designation for safety from the U.S. Food and Drug Administration (FDA). Surprisingly, studies of the rutin molecule demonstrated that the same part of the molecule that provides rutin with its ability to inhibit PDI also prevents the compound from entering cells.

Study coauthors include BIDMC investigators Reema Jasuja (first author), Freda H. Passam, Daniel R. Kennedy, Sarah H. Kim, Lotte van Hessem, Lin Lin, Sheryl R. Bowley, Sucharit S. Joshi, James R. Dilks, Bruce Furie and Barbara C. Furie, all of the Division of Hemostasis and Thrombosis.(1)

Press release May 8, 2012

http://www.bidmc.org/News/InResearch/2012/May/Rutin_BloodClots.aspx

More on Flavonoids
Flavonoids and reduced cardiovascular risk

http://www.drmagaziner.com/flavonoid-and-reduced-cardiovascular-risk/

Flavonoids are plant-based phytochemicals with cardiovascular protective properties. Few studies have comprehensively examined flavonoid classes in relation to cardiovascular disease mortality. Researchers in the American Journal of Clinical Nutrition examined the association between flavonoid intake and cardiovascular disease (CVD) mortality among participants in a large, prospective US cohort study.

Fruits, Vegetables, Vitamins, Stroke
New research continues to confirm that a diet rich in anti-oxidants can help protect against stroke.

Slow down! That is what researchers are recommending to patients at risk for Type 2 diabetes when they eat. People who eat rapidly are two and a half times more likely to suffer from type 2 diabetes than those who take their time according to new research presented at the joint International Congress of Endocrinology and European Congress of Endocrinology in Florence, Italy.

While numerous studies have linked eating quickly to overeating and obesity, this is the first time eating speed has been identified as an independent risk factor for type 2 diabetes.

Diabetes mellitus is a very common disorder caused by high levels of sugar in the bloodstream. It affects 6.4% (285 million) of the worldwide population and is associated with an increased risk of heart attacks, stroke and damage to the eyes, feet and kidneys. In type 2 diabetes, which accounts for 90% of all cases, insulin – a hormone that allows cells to take sugar from the bloodstream and store it as energy – does not work properly. (1)

Here are more articles we recently posted on Diabetes Management
Variety of Fruits and Vegetables help type 2 Diabetes
Depression and Diabetes Treatments
Metformin and insulin controversy
Statins and Diabetes
Diabetes, Dementia, and Depression

1. http://www.alphagalileo.org/ViewItem.aspx?ItemId=119945&CultureCode=en
Press release from the European Society of Endocrinology May 7, 2012

There isn’t a week that goes by when a patient who has experienced relief of chronic lower back pain asks, “why did it take so long for me to find out about prolotherapy?.”  often followed by, “I cannot believe that prolotherapy is not the first treatment that should be recommended for my back”, as it was the only treatment to work.

 
Most patients that seek either prolotherapy and platelet rich plasma (PRP) treatment of their lower back pain have almost always come as a last ditch effort.  They have tried nearly every other treatment and have exhausted all possibilities – chiropractic, acupuncture, epidurals, steroids, physical therapy, massage, and a litany of medications such as anti-inflammatories, Lyrica, Neurontin, anti-depressants, muscle relaxers, and others.  Some patients have also had surgeries on their back – fusions, laser spine surgery, discectomy, and decompression.  Unfortunately, most patients who have chronic lower back pain sometimes give up, and are told to “deal with it”, or end up on large amounts of opiates like Oxy Contin.

 
So why would prolotherapy and PRP work so well for this large subset of patients?  Why would a patient who suffered each and every day in pain for 20 or 30 years experience relief within a few months of starting prolotherapy or PRP?  The answer is simple.  The back is not just a disc problem.  The disc is mearly a shock absorber for vertebrae, and while this shock absorber can become defective, there are so many other parts of the lower back and support structure for the lower back that can cause pain.

“Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies are needed to confirm the safety of the procedure and to validate an appropriate injection protocol.” (1)

“Ninety-one percent (91.0%) of (Prolotherapy) patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work.” (2)

 
Take, for instance, the sacroiliac joint (or SI joint).  Not only can this joint become arthritic, but all of the ligament and tendon structures that hold this joint together can become stressed, strained, or torn but may appear normal on MRI (which is not very accurate at diagnosing sacroliliac pain).  Additionally, most back pain patients have a functional leg length discrepancy / tilted pelvis which further exacerbates sacroiliac joint pain.  While epidurals, steroids, or surgery cannot repair the damage that cause sacroiliac pain, prolotherapy and platelet rich plasma (PRP) injections can!

 
If you have the opportunity to examine and study the anatomy of the lower back and pelvis, look at the ligament structure.  The ligaments that insert into the L4 and L5 vertebrae (which are the most common to herniate in the lower back), actually are contiguous structures with the sacroiliac joint, coccyx, and insert into the ischium (sit bones).  Therefore, dysfunction in any part of this ligament structure can impact what happens with the L4 and L5 disc and vertebrae.  Just a tilt in the pelvis completely disrupts the balance between the left and right sides of the back and contributes to back and pelvic pain.

Now if you are skeptical, and still think that prolotherapy and platelet rich plasma injections to the lower back are without merit, realize not only has this treatment withstood the test of time, with doctors practicing prolotherapy dating back to the 1950s, but randomized medical studies have shown significant success (greater than 85%) in patients with chronic lower back pain.  In fact, in my home town of Philadelphia, PA, the head orthopaedic spine surgeon, Abraham Myers, MD realized that the back surgeries that he performed on his patients did not help, he decided instead to treat his patients with prolotherapy.  He practiced prolotherapy for back pain until he was in his 80s, and had a satisfying and successful career curing patients with chronic back pain.

Yes, many insurance companies may not cover prolotherapy, and often patients are driving or flying to our office to seek our expert treatment, but in the long run think about how much time, aggravation, and wasting time on other procedures, medications, and therapies you will spend, hoping for a cure, when prolotherapy may be it.  All it takes is a careful history, physical examination of the back, pelvic tilt, feet, hips, reflexes and strength in skilled and experienced hands to determine if someone has an excellent chance at being cured of their back pain with prolotherapy and/or platelet rich plasma.

1. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90.

2. Hooper RA, Ding M.Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy.J Altern Complement Med. 2004 Aug;10(4):670-4.