• Regenerative Medicine Roundtable

    by Central Massachusetts Podiatry
    on Dec 20th, 2017

Please enjoy the following video from Dr. Pelto's Healthy Living series. 

 

This video is an in-depth discussion about several types of medical treatments that fall under the umbrella term of "regenerative medicine". In this video, Dr. Pelto has Dr. Feldman and Dr. Saviet as guests where they discuss the uses, mechanisms, and outcomes of many of these ground breaking treatments offered at Central Massachusetts Podiatry by our doctors. 

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 Full Video:

 

 Section breakdowns:

What is regenerative medicine?

 

What is Amniotic tissue therapy?

 

What is Shockwave therapy?

What is platelet rich plasma therapy?

 

Transcript is below:

Hello and welcome to healthy living I'm
your host Dr. Donald Pelto today we're
gonna be talking about a relatively new
topic
called regenerative medicine I have the
privilege of having two guests with me
Dr. Neil Feldman and Dr. Bejamin Saviet
yet they're both board-certified
podiatrists and they're going to join us
for this kind of conversation today
we're gonna discuss some of the newest
types of treatments to help athletes
recover quicker from injuries and many
times avoid long surgical recoveries so
first we're going to look at what is
regenerative medicine to start I want to
define regenerative medicine but I would
ask either of the doctors to contribute
as well regenerative medicine is a
game-changing area of medicine that can
help heal damaged tissue and organs for
people that thought their conditions
were beyond repair
one aspect of this regenerative medicine
involves boosting the body's natural
ability to heal itself for example if
you get a cut in your finger it will
usually heal in a few days however other
tissue for example on the bottom of your
foot if you're a diabetic can be slow
healing using a specially engineered
covering on the wound can boost your
body's natural healing process for this
wound here's a picture of this type of a
graft that is used on a foot won't
another type of regenerative medicine
involves replacing damaged tissue or
organs from living or deceased donors
such as a heart or a liver transplant
if these heart or liver cells could come
from the patient's own tissue that would
help solve the problem of tissue
shortages for organ transplants and also
the problem we currently have of organ
rejection but today specifically we're
going to talk in our conversation about
the regenerative process inside of
tissues this involves delivering
stimulated specific types of cells or
cell products to go to diseased tissues
where they will restore the tissue
function remember the goal of this area
of medicine is to stimulate the body's
own repair mechanism to heal something
that previously couldn't be repaired we
are going to folk
on three modalities within regenerative
medicine the first is going to be
platelet-rich plasma
the next is shockwave therapy and then
finally we're going to talk about
amniotic membrane therapy first I'm
going to ask dr. Feldman to talk a
little bit about platelet-rich plasma
therapy so if you could first just start
out explaining to me what is
platelet-rich plasma therapy
alright thanks dawn thank you for
inviting me to the show platelet-rich
plasma is also called PRP and it's taken
from your own body we would draw blood
from your arm most likely your arm and
there's a centrifuge that we have in the
office and it'll get spun down plasma is
your red is your blood taken out of your
body and spun so the red blood cells are
separated out the red blood cells are
heavier so they end up at the bottom of
the test tube and there's a yellow
liquid it's the blood components without
the red blood cells that has it's called
plasma and inside of that is a larger
concentration of platelets we take that
and then we'll we'll inject it into the
diseased tissue and the tissue being
tendon fashio ligaments or joints or
even bone for that night so with this
platelet-rich plasma that you get does
everyone if you take it from me and from
dr. seven yet from yourself are we all
going to get the same amount and same
quality of platelets no it's going to
depend on your body
our platelet production is different for
all of us at different ages different
cycles it's based on a lot of different
factors how healthy you are for instance
some people have low platelets some
people have excellent platelets we don't
typically get blood tests on people to
determine their their platelet count but
that's an area that that could be
explored that's we're gonna talk about
it later but that's what's so exciting
to me about the amniotic membrane
therapy because it bypasses your own
using your own blood and and it saves
the blood draw as well so once once you
have a patient and you take out the
blood you spin it down you get this
magic gold where would you want to
inject it why this type of treatment and
not
different type of the treatment I may be
like cortisone or something else like
that
yeah and in today's day and age people
people are very leery about chemicals
being put into them or anything that's
going to be damaging or toxic to the
body cortisone is wonderful it's an
anti-inflammatory so it it stops the
inflammatory process it can help reduce
localized inflammation and it can help
with symptoms there's no doubt about it
the problem is it also delays natural
healing it actually interferes with the
body's natural healing response
platelets are what promote the body's
healing response we want platelets to be
called into the area because we want
platelets to bring their growth factors
there there are special healing
properties they release their own stem
cells and stem cells are cells within
your body that can become other types of
tissues
they're called multipotent stem cells so
they can become bone tendon fashio
ligaments joints nerves they can't
become organs not in not in our not in
today's day and age not yet hopefully
never are hopefully someday with the
organs but yeah so you take this this
special platelet-rich plasma and and
then you inject it into is it attendant
is it a bone what area of the body
specifically do you use it for so if you
have plantar fasciitis it can be put
right into the source of the plantar
fasciitis and nowadays it's really
exciting we have a diagnostic ultrasound
at the office so we can we literally see
the area of concern whether it's plantar
fascial whether it's a tendon tear
whether it's achilles tendon we can
literally see the structure and we could
see the diseased part of the structure
we can see the needle going in to the
structure a little later we'll show you
an Achilles tendon where there's
actually amniotic tissue going in but we
can do the same thing with platelet-rich
plasma or PRP
so it's any of the tissues you need it
to go into we can we can put it into
those tissues and is this something
that's done in the operating room is it
something that's done in your office and
what's the recovery like afterwards you
have to be out of work yeah you can do
it anywhere we actually do a rade in our
office we have the ultrasound machine in
our office MRIs are typically the gold
standard diagnostic study where you can
see tissue disease you could see tears
in tendon you can see splits you can see
inflammation you can see cracks and bone
but the diag Knox diagnostic ultrasound
gives you real-time imaging capabilities
and and and we have it in our office so
you can do it right in the office it's a
blood draw the the spin on the
centrifuge is about five minutes so the
blood draw
it's me drawing the blood so if you're
an easy stick it's pretty quick
sometimes it takes a little longer if if
you have a difficult vein the spin
itself is about five minutes sometimes
we use a local anesthetic to the area to
limit any discomfort that might occur
from injecting it if it's a larger area
if there's multiple areas within the
Planner fashion or the Achilles then PRP
is a really nice choice because you
usually get we draw 15 cc's of blood so
that's it's about three teaspoons of
blood and that gets spun down typically
we get anywhere from three to five cc's
of plasma of the PRP which as we
mentioned that we call liquid gold
because it's a golden color and that
gets injected into the area so if
there's a larger defects that's a really
nice option to have and the procedure
itself takes if we're doing it under
ultrasound it might take a little longer
but you know from thirty Seconds to
three minutes afterwards you get a
band-aid or a soft wrap depending on the
structure involved you might go into a
soft cast and a walking boot for up to
two weeks and and as you're walking out
you might need a ride if it's your right
foot because you might need it you might
need to be in a walking boot on your
right foot and is there anything you
can't do after can you take motrin
ibuprofen things like that
you shouldn't because again those are
anti-inflammatories you could take
tylenol you could use hi ice or heat but
we generally don't like the use of the
anti-inflammatories because it will
interfere with the with the function of
the platelets and the other thing I
might add is the disease structures the
the tissue tears fascio sis fasciitis
achilles tendonitis tendonosis they're
just conditions of pathology within
these structures the reason they they
become problematic in the first place is
they don't have a great blood supply and
platelets get called into action to heal
but they need to come through the
bloodstream they need to come through
capillaries and if these structures
don't have a really powerful ER or a
strong blood flow to them you're not
going to get nearly the quantity of
platelets there that are needed for
healing platelets release fibrin and
they also release factors that help with
new blood vessel formation so they
actually promote blood vessel formation
from within these tissues to increase
your body's own ability to heal itself
and that's one of the real exciting
features and that's something that the
shockwave therapy also does which we'll
talk about I think it's a good segue
doctors have anything else to say about
plate rich plasma
well first doctor Pelt oh thanks for
having me on the show much appreciated
big fan good post a lot of a lot of
videos about the platelet-rich plasma
therapy you know the people who in the
general population who have probably
heard of it the most are the people who
are sitting at home on their couch on
Sunday watching football and you hear
about you know Martellus Bennett shout
kit and platelet-rich plasma therapy
into his shoulder or Vince Wilfork had
it into his Achilles tendon after in
with ruptures these elite high level
athletes they these guys obviously
sometimes they have an infinite amount
of resources to do anything to heal
themselves but you know some of these
things they they make sense to look at
the guys that want to get back out and
participate a little faster you know so
maybe avoiding surgery in the past if
you have one of these tendon injuries
surgical option
what you were doing in the past sooner
these that athletes who were flying to
Germany because the initial work was
done over in Europe Italy Germany and
they were the tiger Lance Armstrong you
know in addition to other things
probably but these yeah these president
Worcester Massachusetts not the stuff
Lance was on yeah we had that we don't
do that well good I think it's a good
segue now to talk about our next topic
is something called shock wave therapy
and dr7 yet and he's kind of researched
just a little bit and he's kind of at
the forefront of shock wave therapy so
I'd like you to start talking a little
bit about in shock wave therapy yes
absolutely so I've been a big fan of
shock wave therapy for several years
have done multiple presentations and
research projects on it myself and been
pretty much up to my eyeballs in it for
a few years now so it was excited to
join a practice where shock wave was a
component of the practice
so what shock wave therapy is it's not
somebody just in there whacking away on
you with a mallet or anything like that
it's it's a way to manipulate some of
your soft tissues be it a tendon or
wound or a bone or ligament injury to
try to stimulate a physiologic response
that's innate and kind of already within
your body to get it to respond to an
injury that might be there
so let's we're going to show a picture
right now of an actual shock wave
machine that we use and could you
explain a little bit how it works what
are the mechanics of it yeah
so for there are several different types
of machines but the machine we use in
our office it has a handheld it's a
handheld device essentially that's
connected to a machine and then the
machine provides a pneumatic flow of
high pressure and low pressure and what
that does is it moves a projectile
within the handpiece slow piece of metal
it's a little yeah basically a little BB
that oscillates back and forth within
the handpiece and you keep that
handpiece in contact with the skin and
the projectile will hit the tip of the
the device and then
creates a basically a concussive wave
that goes through your tissues and
that's the the very easy explanation of
it yeah it and so those waves you put a
gel ultrasound gel on there to conduct&l

Author Central Massachusetts Podiatry

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