Introduction:
Regenerative medicine includes any medication, supplement, or procedure that improves the natural intelligence and function of our cells, tissues, and organs, including the brain. All branches and specialties in Western medicine have regenerative medicine treatments. In my primary care clinic, I practice regenerative medicine by optimizing thyroid and sex hormones through the bio-identical hormone pellets method of implanted hormone pellets. This is because hormones improve the function of cells in our brain, bones, muscles, sex organs, skin, and beyond. For instance, many women develop a weakness and atrophy (degeneration) of their urinary tract and vaginal tissues after menopause. The lack of sex hormones causes a decline in normal cell regulation and function, so that the woman experiences urinary burning, frequency, dribbling, as well as vaginal dryness, itching, and pain. This is restored to normal within days of implanting estrogen and testosterone. That’s because the body was designed to run on these hormones, and menopause cuts off the cell’s natural supply. This causes the urinary tract cells to weaken and no longer do their job, which is to provide support and strength for the urinary sphincter, to support vaginal lubrication and immune system control of microorganisms. Is it natural to start losing hormones around age 35-55? Yes, but it is also natural to grow old and die with lots of health problems, like Alzheimer’s, arthritis, heart disease, strokes, cancer, and neurodegenerative diseases like Parkinson’s and multiple sclerosis. But Regenerative Medicine seeks to change this
inevitable and “natural” fate. The truth is that nature does not care about us after age 35. In fact, nature wants us off the planet. It does not provide for sustained health and wellness, only a gradual decline with a predictable and expected series of conditions that reduce function, quality of life, and often involve significant physical and emotional suffering. Implanted Bio-identical hormones alone, when used with regularity, reduce Alzheimer’s by 70%, make osteoporosis reverse back to normal, reduce breast and prostate cancer risk, reduce cardiovascular risk, and greatly improve the brains ability to sleep deeply and maintain a buoyant mood with good confidence and motivation. And there is no higher risk of blood clots with implanted hormones, as there is with oral ingested hormones, like birth control pills. So this is powerful regenerative medicine. Vitamins D3, B12, A, K2, Iodine, and short chain fatty acids made from our gut bacteria (in the form of the new supplement Espere.fca) are all examples of supplements that improve cellular communication and function and decrease the growth of cancer in our bodies, so they are players in the field of regenerative medicine. Meditation and Yoga have been shown to restore brain function and sleep.

That’s also regenerative medicine.

Most recently, advances in stem cell treatments and PRP (platelet rich plasma) treatments have taken center stage in the regenerative medicine world.

PRP Information for Cosmetic, Orthopedic, Urologic, Hair Restoration, and Wound Healing Applications

What is PRP and How Does It Work?

Platelet Rich Plasma (PRP) is an alternative approach to the healing and regeneration of body tissues, including skin rejuvenation, scar reduction, severe inflammatory acne treatment, wound healing, hair regrowth, sexual enhancement (male erections and female orgasmic response), female urinary incontinence, and the healing and repair of ligament, tendon, muscle, fascia and joint injuries. Often, injured or damaged tissues, including non-healing wounds, will stop healing and become a chronic pain and dysfunction. This is because the body, for some
unknown reason, decides to call off the healing process. The best way to activate another round of healing is to call the troops back to the injured area to resume the repair cycle with PRP. Hyperbaric oxygen is also an effective treatment for nonhealing ulcers. To prepare PRP, a small amount of blood is taken from your arm just as is done in the lab for a regular blood draw, and then mixed with an anti-coagulant called ACD-A. The blood is then placed in a patented processing tube and spun down in a preprogrammed centrifuge. The centrifugation process separates the plasma from the blood, thereby isolating the PRP and white bloody cell fraction called the “buffy coat.” The PRP is then activated with calcium chloride, thereby increasing the concentration of platelets growth factors up to 500%. These growth factors stimulate the healing cascade process, including hMSC (human stem cells) proliferation at the site of PRP injection in response to tissue exposure to platelet concentrations 10x above native levels.

When PRP is injected into the skin, hair, or damaged muscle, tendon or ligament, it causes a mild inflammatory reaction that triggers the natural healing cascade. As a result, new collagen begins to develop. As this collagen matures it begins to shrink, causing tightening and firming of the skin and the strengthening of tendons and
ligaments that were damaged.

What Exactly is in Platelet Rich Plasma?
Platelet Rich Plasma is your blood plasma processed to isolate the fraction that is loaded with platelets. There are no allergic or sensitivity reactions to PRP because it’s your own blood processed in a closed, sterile system. The concentrated platelets found in PRP contain many growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production and initiate skin improvement due to aging and sun damage, trigger connective tissue healing in ligaments and tendons, and promote angiogenesis, the development of new blood vessels that stimulate circulation and the wound healing process. In hair restoration, these factors act like fertilizer to the dormant or thinning hair follicles, stimulating long-term thickening and regrowth of the follicle. In sexual response therapy, penile erections, both hardness and maintenance, are enhanced for up to 18 months after PRP, while orgasmic response and urinary continence in women with nerve and vaginal tissue injury after childbirth greatly improve after PRP treatments to the G spot and peri-urethral areas . Here are the primary factors in PRP:

1. Epithelial Growth Factor (EGF): This is a released during platelet breakdown after injection, and stimulates epithelialization (skin cell proliferation), angiogenesis (development of new blood vessels with improved circulation), and collagenase activity (to increase new collagen production).
   
   
2. Fibroblast Growth Factor (FGF): Stimulates angiogenesis, endothelial cell proliferation, collagen synthesis, wound contraction, connective tissue matrix synthesis, epithelial proliferation, and keratinocyte growth.
   
   
3. Transforming Growth Factor-Beta (TGF-B): reverses the inhibition of wound healing caused by release of glucocorticoids, stimulates monocytes to secrete FGF, PDGF, Tumor Necrosis Factor (TNF), TNF-a, and interleukin, stimulates fibroblast chemotaxis and proliferation, decreases dermal scarring.
   
   
4. Transforming Growth Factor-Alpha (TGF-A): This variant of EGF stimulates mesenchymal, epithelial, and endothelial cell growth synthesis.
   
   
5. Platelet Derived Growth Factor (PDGF): This is produced by the alpha granules of the platelet cell. It activate TGF-b, stimulates white blood cell activity in neutrophils and macrophages, stimulates chemotaxsis to attract the healing cells and growth factors to the site of injury, stimulates mitogenesis of fibroblasts and smooth muscle cells, stimulates angiogenesis and collagen synthesis.
   
   
6. Interleukin-1: stimulates lymphocyte proliferation and influences collagenase activity.
   
   

SKIN IMPROVEMENT, SCAR REDUCTION AND ACNE TREATMENT:
In the skin of the face, neck, chest, elbows, knees and back of the hands, PRP greatly reduces wrinkles, firms, smooths, tones, and improves texture and pore size. It is perhaps the single best treatment for inflamed, active acne, as well as acne scars, keloids, and other traumatic scar tissue. The PRP can be carefully injected into the skin with a fine needle after topical anesthetic, or can be applied topically after the skin has been prepared by micro-needle or eMatrix radio-frequency sublative technology. Injections are especially helpful for wrinkles around the eyes and mouth, and dark circles under the eyes. When combined with hyaluronic acid filler (also known as the “Vampire Lift”), a lift of the cheeks, nasolabial folds and jowls can be achieved.

MALE AND FEMALE HAIR REGROWTH:
Up to 60% of scalp hair that has thinned and regressed can be revived by PRP regeneration procedures. These are done up to three times over 1 year after a careful and gentle block using topical and local anesthesia. The thinning area is then treated with a disposable micro-needle, and then the PRP is both injected and topically applied. This is completely painless. A special sterile cellular matrix compound called Acell is mixed with the PRP before injection to create a time-release effect and hold the growth factor elements in the desired location for up to a year. Yearly treatments will help maintain the new fullness of the hair.

WOUND HEALING
Difficult wounds that often fail to heal include diabetic foot ulcers, venous stasis leg ulcers, foot and leg injuries in the elderly or in people with venous insufficiency or edema. Studies consistently show enhanced, accelerated wound healing and skin graft success in patients treated with PRP.

ORTHOPEDIC USES:
PRP has been studies and used extensively for acute sports injuries, as well as chronic degenerative joints, tendinitis, bursitis. Nagging injuries that have failed conservative care (rest, ice, elevation, wraps, braces, and anti-inflammatory medications) and even cortisone shots are candidates for PRP. In fact, professional athletes under lucrative contracts and race horses worth millions of dollars are not given cortisone shots, but PRP instead! Athletes who had recently received PRP treatments include Tiger Woods, Andrew Bogut, Dwight Howard, Kobe Bryant, and Enes Kanter. Canadian figure skater Kaetlyn Osmond attributes her comeback and ability to participate in the 2014 Winter Olympics to PRP treatments for a seriously torn hamstring muscle. She did not go the usual road of cortisone injections because cortisone reduces inflammation and pain quickly, but causes the injured area to heal weaker than it would have naturally. This means re-injury and rupture after cortisone shots can lead to shortened careers in athletes and horses, which is not worth it to the teams and owners. In the 2014 Winter Olympics, PRP for the treatment of injuries of Olympic athletes was removed from the World Anti-Doping Agency’s (WADA’s) list of prohibited substances with this statement:

Despite the presence of some growth factors, platelet-derived preparations were removed from the (Prohibited) List as current studies on PRP do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect.

PRP triggers a powerful cascade of factors and cells involved in the healing response to achieve stronger tissues after healing that are less likely to re-injure. In fact, tissues can heal up to 40% stronger and thicker after PRP than before the injury! Common orthopedic problems treated in the outpatient clinic include acute tears and chronic strains of the plantar fascia, Achilles’ tendinitis, elbow epicondylitis (tennis elbow), hamstring and quadricep tears, knee ACL, MCL, LCL injuries, wrist pain, foot, ankle, “jumper’s knee”, knee patellar chondromalacia, meniscal tears of the knee, lab real tears and hip instability, shoulder tendon tears (including rotator cuff tears), patellar tendinitis, biceps and deltoid muscle tears, lumbar and rhomboid muscle injuries causing low and mid back pain, hip, groin, and iliotibial band strains, as well as all major joints with “wear and tear” arthritis.

SEXUAL ENHANCEMENT AND FEMALE URINARY INCONTINENCE
Improvement in male erection from a PRP injection can last up to 18 months. Similarly, PRP G-spot, clitoral and peri-urethral injections can safely restore female orgasmic response and urinary continence lost due to vaginal trauma in delivery, especially as a result of forceps delivery.

FAQs

What is the Frequency Of Treatments?
While responses to treatment vary, most people will require 1 to 4 injections of PRP. The treatments are spaced 4 to 6 weeks apart.

What Are The Potential Benefits and Risks?
Patients can often see a significant improvement in symptoms as well as a remarkable  return of function. This may eliminate the need for more aggressive treatments such as long-term medication or surgery. PRP cannot cause cancer or any serious health complication, although bleeding and infection are a possible complication of any injection.

How Soon Can I Go Back To Regular Activities?
After PRP, you will be on a physician-supervised program. Most often, you can resume all normal daily activities immediately after PRP. The exception is Achilles tendinitis, which may limit activity for several weeks. Sometimes, the injected area is a bit more sore for a few days after the injection. This is normal. Listen to your body and don’t push it. If you go to a gym program, you should reduce exercise to 40 % of your full daily routine for 4 weeks, then 50% for the fifth week and 60% for week 6. Then you can resume 100% of your workout after that, as long as you feel good and strong.

Special Instructions:
You are restricted from the use of steroid and non-steroid anti-inflammatory medications (NSAIDs) one week prior to the procedure and throughout the course of treatments. This includes over-the-counter Advil and Aleve, turmeric, and arnica products.


Initially the procedure may cause some localized soreness and discomfort. Most patients only require some extra-strength Tylenol to help with the pain. Some will predictably need a short course of a narcotic pain medication, like Norco or Percocet, and a prescription for this will be provided at the time of the procedure. Pick this up on your way home, as the local anesthetic will wear off after a few hours. Ice may be applied to the area as needed. Patients with Achilles’ tendon treatment may need crutches or a Cam walker boot for the first week, and it can take up to three weeks to start feeling improvement.