"I am considering knee replacement or back surgery. If you were me, what would you do?”
I get this question all the time. Whether it’s knee pain secondary to knee osteoarthritis (OA) or low back pain for which a surgical option may or may not exist. People want to know what I would do if I were in their situation. For knee and back pain, the answer is easy as I have experienced both. For my knee and back pain I have managed it with regenerative injections in the form of stem cells, platelet rich plasma (PRP) and prolotherapy. I often times find it difficult to help people make a decision as I want them to feel comfortable with their choice as they are ultimately in charge of their own bodies. To this end, I have come up with a list of qualifications that must be met prior to a life altering invasive procedure.
1. Find the most qualified doctor to perform the procedure and make sure you trust them.
As I have had the opportunity to teach many physicians regenerative injections techniques nationally and internationally I have come across basically two types of doctors. Those that love anatomy and have a desire to help their patients and those that are looking for a quick way to make a buck. Anyone can sign up to take a course but you soon find out those that are in it for reasons other than to assist people in their journey to health. These are the doctors that always ask, how much do you charge for a certain procedure. Versus the docs that want to know how to identify pathology and then learn a technique to fix the problem. Make sure your doc is in it because they enjoy it, know their anatomy and have mastered the art and not the financials.
2. Make sure you’re actually seeing a doctor (MD or DO) and that they are expert in their field.
The term doctor can imply a number of different things. For my purposes, doctor implies that the person about to perform your procedure has been to medical school. If you ever Google the terms stem cells, PRP, prolotherapy or regenerative medicine and you find a great website but cannot find or have a hard time finding the doctor and their credentials, chances are the provider selling you goods is some other form of provider but not a doctor (MD or DO). This can be tricky as the web site may be awesome.
Make sure that you can readily find your doctors credentials and experience. If the doctor has completed a fellowship that requires a solid understanding of anatomy and body mechanics, you can feel more comfortable with their skill set. If the doctors background is in anything else, make sure they are proficient. Do your research, if there are any other credentials after the doctor’s name, other than MD or DO you may want to do some more research. In some states there are naturopathic physicians (ND) that can and are trained to perform procedures.
3. Secure a diagnosis
Make sure you know what will be treated prior to receiving a treatment. For instance, if you’re being treated for knee pain, there’s a whole lot of structures that reside in the knee and anyone of them could be your problem. If your about to pay cash for stem cells you probably don’t want to rely on the ol’ shotgun approach and hope it fixes stuff. Any type of regenerative medicine, whether prolotherapy, platelet rich plasma or stem cell will have a better effect if you put it in the correct piece of anatomy.
Otherwise you just wasted your time and money and run the risk of complication related to the procedure.
4. Make sure your injections are guided
In most cases regenerative injections can be and should be performed with ultrasound guidance. Ultrasound is great for seeing nerves, tendons, ligaments, bony surfaces, muscles and fascia. Most uses of regenerative medicine have to do with improving the integrity of connective tissues which cannot be seen with x-ray but can be seen with ultrasound. If you have pain in a specific area and you want to put a needle in it, you better make sure that your doctor can get it there. Regenerative injections (stem cells, platelet rich plasma and prolotherapy) work very well when delivered with accuracy. There is a certification for proficiency in ultrasound diagnostics and interventions referred to as, Registered in Musculoskeletal Sonography (RMSK). If your practitioner has this, you know that they have at least some proficiency in finding and hitting the target.
5. Ensure that the cutting edge technique you are about to pay a lot of money for is actually not an old technique repackaged as something new.
I visited a website the other day as a was curious if there was anyone else in my area offering similar procedures to mine. I was intrigued when I came across a web site offering to solve all my knee pain with state of the art guided injections of a lubricating material. As a specialist in musculoskeletal medicine I was at first upset and then jealous. Upset because the product being sold has been around for several years and is often sold as a lubricating injection which does not provide permanent relief and can be injected repeatedly, forever. But after reading about it the way it was being presented I was jealous that someone made me want an injection that doesn’t change the disease process and has been around for many years. I envy that guys ability to take something old and make it appear awesome. If you ever have a question about these sites. Email me, I would be happy to take a look and get back to you: firstname.lastname@example.org
6. Decide if there are any other more viable options.
If you ever hear the words “come back when you’re ready for surgery”, you are not alone. Make sure you know your surgical and non-surgical treatment options prior to any procedure. If the call to do surgery is so iffy that the surgeon can’t help you with the decision, don’t get surgery! There’s always more than one way to skin a cat and the same applies to medicine. If you are ever uncomfortable with the options being presented, go get another opinion. If you’re not comfortable with that option, go get another. You are going to have to live with the decisions you make and they ought to be well thought out prior to doing something you are not sure about.