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In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh discusses Platelet Rich Plasma  and Regenerative Medicine.

Regenerative medicine is a new, exciting branch of medicine which deals with healing injured or damaged tissue with the body’s own natural healing mechanism. To do this, Platelet Rich Plasma (PRP) is extracted from the patient’s own blood. Using blood from the patient eliminates the risk of transmission of blood born disease, viruses and other infectious agents. PRP is then injected into the area of the body that needs intensive healing and tissue regeneration.

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PRP therapy works especially well for injured tendons and ligaments, and is uniquely suited for those difficult knee and shoulder injuries. Even patients who have had knee or shoulder surgery but still have pain can have dramatic benefit and pain relief from PRP therapy.

PRP is revolutionary therapy in that it avoids surgery. It is done as an outpatient procedure, so there is no recovery time or rehabilitation to deal with. If you have joint pain, you may be an excellent candidate for PRP therapy. Call now to schedule an evaluation to see if you would benefit from PRP therapy.

To schedule an appointment, please call (941) 955-5858 or you may request an appointment here.


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Sarasota Neurology is proud to announce the addition of Nora Davis, ARNP to the practice. In addition to her medical experience of 20 years, she has had extensive training and interest in dermatology to enhance patients’ facial appearance. Nora brings to Sarasota Neurology her expertise in skin health and rejuvenation. Additionally, with her medical experience and interest in neurology, she is seeing neurology patients as well. Dr. Kassicieh has had over 20 years of experience in performing Botox therapy for many different medical conditions. As a bonus, doing Botox for cosmetic purposes came naturally. Since 2009, he has been doing platelet rich plasma therapy (PRP), the first Sarasota platelet rich plasma doctor doing non-surgical neuro-orthopedics. Platelet rich plasma therapy is done in the office, using your body’s own natural ability to heal itself. PRP therapy can also be used for cosmetic purposes in hair growth and natural, non-surgical face lifts.
Nora is a Board Certified, Advanced Registered Nurse Practitioner, who has been practicing medicine for over 25 years, trained in dermatology aesthetic procedures and most recently joined an Osteopathic specialist, Sarasota neurologist Dr. Daniel Kassicieh. She has her Master of Science Degree from the University of South Florida. Nora is a member of the American Academy of Nurse Practitioners, Southern Gulf Coast Nurse Practitioner Council, Board member of the American Cancer Society of Charlotte County and Certified American Heart Association CPR instructor.
Five years ago Nora entered the dermatology field of Medical Aesthetics. In primary care Nora found a passion in dermatology. Beauty in treating and preventing skin conditions such as acne, rosacea, and skin cancer became her main focus. She has had extensive education and training in aesthetics for facial skin care, laser therapy, Botox, Juvederm and other treatments to reduce or eliminate facial wrinkles and other signs of aging. The goal is to avoid She is an educator and clinician with the Obagi® skin care systems. Additionally she does chemical peels, and performs facial injectable procedures. She focuses on tissue regeneration for wrinkles, laxity, brown spots, dryness and dullness. This, combined with platelet rich plasma therapy to replace facial collagen is the ultimate in facial skin care. Nora promotes wellness and beauty for health management in all ages. She is dedicated and committed to providing the best possible care to her patients to feel and look their best. It is all about quality of life – if you look better, younger – you feel better. Call Sarasota Neurology now for your appointment for a new youthful look and start to reverse the effects of aging.


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How I Avoided Knee SurgeryI remember it like it was yesterday. While playing racquetball in December 2011, I felt a sudden click in my right knee. I just knew that I had torn my right knee medial meniscus. The knee MRI  proved it. The pain was excruciating, and it was compounded by the thought that this happened 9 weeks before my annual Rocky Mountain ski trip.

The misery did not last long though. I’ve been through this scenario before. I did the exact same thing to my left knee in 2010. (I have the MRI for that one, too!) So, I turned to the revolutionary treatment that got me back up on my feet and on the slopes last time this happened.

If I had gone the surgery route, my trip would have been cancelled, as surgery and rehab can take 3-6 months – with no guarantee of outcome. But I was on the slopes as planned! — Not just any slopes, but the “Expert” slopes! I skied for three gorgeous days in a row without pain or problems! No surgery. No downtime. No rehabilitation. Just a simple injection and then my body did the rest.  I was completely healed, completely pain free by the time I left for my trip. All this only eight weeks after treating my right knee.

Sound too good to be true? Well it’s not…it’s PRP – platelet rich plasma. PRP is the cutting-edge therapy that even professional athletes have turned to when faced with career-limiting injuries.

PRP is short for platelet rich plasma. With PRP, a patient’s own blood is drawn and the platelets are extracted into a small amount of your own blood plasma. Platelets contain numerous beneficial, natural growth factors and chemical messengers that initiate and aid in healing and tissue regeneration. As the PRP is derived from the patient’s own blood, there is no risk for rejection or disease transmission. The PRP is then injected into the injury site. In my case, my knee. It’s that simple. Still not convinced? Let’s compare PRP therapy versus traditional arthroscopic knee surgery, which would be the usual prescribed course of treatment for an MRI proven torn meniscus.

Risks associated with Surgery may include:

  • Possible complications due to anesthesia
  • The surgical procedure itself – with no guarantee of pain relief
  • Increased knee pain during recovery process
  • 3-6 months rehabilitation after surgery
  • 3 hours or more of lost work per week due to therapy plus drive time to appointment
  • Use of narcotics to manage pain
  • Possible risk of addiction to pain killers

Risks associated with PRP:

  • Essentially zero

Pretty startling contrast between the two, don’t you think? Oftentimes, patients may complain PRP is not covered by traditional insurance and therefore too expensive to pay out-of-pocket.  If you look at it a different way: Add up the co-payments associated with both the surgery and 3-6 months of rehabilitative therapy plus the missed time at work, you could have easily covered the cost of PRP therapy. That does not even include the downtime that you will have before and following surgery.

Remember, with PRP therapy there is no recovery time, no anesthesia, no narcotics, no downtime. You have one shot on Friday and are back to work on Monday.

PRP may not be right for every situation, but if you have an injury or condition that you’ve been told requires surgery, it’s definitely worth checking out! This is true not only for knee problems (not limited to a torn meniscus) but also for shoulder pain, rotator cuff injuries, hip pains, ankle injuries and plantar fasciitis (foot pain.) Remember: surgery is irreversible and narcotics are addictive. Surgery never comes with a guarantee and frequently patients have more pain after the surgical procedure. Avoid them if at all possible! For more information on the non-surgical treatment of joint pains and learn more about Sarasota PRP here.

I remember discussing my knee with my physical therapist friend who marveled at my rapid, complete recovery. He looked at me and said, “Why isn’t there a line out your door right now of patients waiting to get PRP instead of surgery?”  I thought to myself, “He’s right. Too many patients are getting knee, shoulder and foot surgery who could do extremely well with PRP therapy.”

Ready to make your appointment today and start living pain free?


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Platelet rich plasma (PRP) has been used medically since the late 1990’s. Dentists were the first to use this natural healing mechanism to improve outcomes of dental procedures. PRP has been used since 2000 for intraoperative (in the course of surgery) therapy following orthopedic, thoracic and cardiac surgical procedures. PRP has found wide use in non-surgical orthopedic treatment of knee pain and other joint injuries.

Platelet rich plasma also can heal injured tendons, ligaments, muscle, cartilage and bone. Major league sports has discovered the incredible natural healing effects of PRP. Many national and international sports leagues have adopted PRP therapy as one of the first line treatments of their injured athletes. Professional sports has recognized the economic value of PRP in that one PRP treatment costs $1500-2000 as compared to the typical orthopedic surgery which can range from $20,000 – 40,000. Additionally PRP has virtually no down time and does not require months of physical rehabilitation.  Platelet rich plasma has become an early treatment option in the treatment of professional athletes that have suffered muscle, joint, tendon and ligament injures.

NFL Players Who Have Received PRP

Hines Ward: Multiple PRP Treatments

Hines Ward: Multiple PRP Treatments & 2 Super Bowl Wins!

Hines Ward, the Pittsburgh Steelers wide receiver, has use platelet rich plasma therapy on at least two occasions  for a torn medial collateral ligament — a knee injury. The use of PRP allowed him to go on and win two Super Bowls. Mr. Ward has attributed his ability to play to receiving PRP.

Other NFL players have successfully been treated with PRP for various injuries. Troy Polamalu, a Steeler’s defensive safety, has had his share of traumatic injuries. As one of the top defensive players, Polamalu has had repeated trauma to his knees. He had one significant MCL injury for which he had PRP therapy.

Donald Jones of the Buffalo Bills and Andre Dixon of the Hartford Colonials have also had PRP therapy for their injuries -all with excellent success.  Houston Texans wide receiver Andre Johnson suffered a high ankle sprain. To expedite the recovery process, Johnson underwent platelet rich plasma therapy.

These professional athletes were able to get back to playing football in only a few short weeks, instead of the normal 2-4 months of healing and rehabilitation time it take for more conventional therapies. Surgical treatment would sideline these highly trained athletes for a whole season. NFL physicians have discovered that PRP is the answer to getting these players healed quickly, with needing to resort to surgery. Platelet rich plasma regenerates new, stronger tissue in these injured players.

Major League Baseball and PRP

 

Alex Rodriguez: 5-time PRP Recipient

Alex Rodriguez: 5-time PRP Recipient

Alex Rodriguez, one of Major League Baseball’s most famous players used five PRP treatments to accelerate healing and recovery following hip surgery that left him in pain. His trainers were amazed to see how much faster A-Rod was able to get back into playing baseball.

Takashi Saito suffered an elbow injury in his pitching arm while playing as a Pitcher for the LA. At 38, surgery was not a good option, as recovery could have taken as much as 9 months. He had PRP therapy and was able to resume pitching in only a few weeks. Saito credited his unlikely recovery from a partially torn ulnar collateral ligament to PRP therapy.

Takashi Saito in his 2009 Season with the Boston Red Sox

Takashi Saito in his 2009 Season with the Boston Red Sox

In one year, Major League Baseball’s 30 teams had 519 players who spent 28,602 days on the disabled list for injuries sustained while playing baseball. This represented $455 million in total salary sitting idle, as these athletes were sidelined. PRP therapy can and does have a major effect in reducing recovery and down time.

National Basketball Association and PGA

One of the most famous basketball players, Kobe Bryant, has had several arthroscopic knee surgeries for right knee pain. He went to Germany to receive platelet rich plasma therapy. Being in his 30’s, he did not see more surgery as a good alternative. The promise of non-surgical, more rapid improvement with PRP therapy for his knee pain convinced this basketball legend to undergo therapy. Similarly professional golf star, Tiger Woods has undergone platelet rich plasma therapy more than once following ACL reconstructive surgery. His knee pain continued after surgery and he went with PRP with beneficial results.

National Tennis and World Soccer

Rafael Nadal: PRP Recipient

Rafael Nadal: PRP Recipient

Other major national and international sports have recognized PRP therapy as an outstanding alternative to “standard” conservative therapy and certainly its benefits over surgical intervention. World tennis star, Rafael Nadal underwent PRP therapy after injuring his knee. His physician, Dr. Mikel Sanchez, described platelet rich plasma as a miraculous regenerative treatment. Indeed, that is what PRP does, regenerates new tissue. Major League Soccer players have also discovered the potential for better, rapid healing with PRP therapy.

Jonathan Bornstein, one of the top new young stars in soccer, twisted his knee resulting in a torn ligament. Facing the prospect of being out of playing soccer for 10 weeks, Bornstein elected to have PRP for his knee injury. He was back to running in 3 weeks and was ready to resume playing soccer only 2 weeks later. The list of professional athletes in a broad range of Major League sports, who have undergone platelet rich plasma therapy is growing every week. This list is beyond the scope of this article. The conclusion though is that PRP therapy is here to stay in the treatment of these injured, highly trained athletes.

PRP therapy is considered to be acceptable medical therapy by the International Olympic Committee, World Anti-Doping Agency and most professional sports association. Platelet rich plasma therapy is distinctly not blood doping and has been ruled on by the IOC and WADA as well as professional athletic associations.

Platelet rich plasma is a novel, non-surgical therapy to heal injured tissue. The platelets contain growth factors, cytokines and other agents that trigger the healing cascade. The difference is, is that with PRP therapy, a massively concentrated amount of platelets and supporting proteins are injected directly into the damage tissue. The body uses the same natural healing process for injuries but not in this high concentration. With this high concentration of healing platelets and growth factors, injured tissues can be regenerated and healed in only a few weeks. Many patients can have pain relief in 3 weeks. Many other painful conditions can be treated with PRP. If you suffer from joint, muscle, tendon or back pain – contact Sarasota Neurology for PRP therapy in Sarasota.

Photo Credits: tomcoolinmiami (Hines Ward) Keith Allison (Alex Rodriguez) Keith Allison (Takashi Saito) Francisco Diez (Rafael Nadal)


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Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery.

PRP works to heal painful joints by using the patients’ own natural biological healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically and molecularly attach to the damage tissue and trigger the natural healing process of making new collagen. This process takes six weeks to have a full effect although actual healing can continue for up to three months.

PRP may be used in some patients as an alternative to having surgery on their knees, rotator cuffs or in cases of plantar fasciitis (foot pain). Beginning in early 2011, Sarasota Neurology will be offering a new and innovative uses for PRP. This highly effective treatment is ideal for patients who would prefer to avoid the cost, pain and time involved in having surgery for the same problem. Check back with us in February to get more details of this exciting treatment with PRP in Sarasota.


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A recent report in the Journal of the AMA (De Vos, et al JAMA 2009) reported that platelet rich plasma therapy was no more effective for chronic Achilles tendinopathy than standard, conservative therapy. This study was inherently flawed in its design resulting in incorrect conclusions. Platelet rich plasma is the healing component of blood. It is derived and concentrated from a patient’s own blood and then injected into the affected area. Not all PRP is the same. Blood processing is the key, levels of growth factors are of utmost importance and successful outcomes will vary with the technique, protocol and level of expertise the clinician possesses. Different PRP extraction equipment and how the blood product is handled during this process is also critical.

De Vos et al commented “A limitation of the study was that the amount of platelets and quantity of activated growth factors that were present in the PRP injections were unknown.” This introduces several variables that would invalidate the data and the study’s conclusion:

1. What PRP processing system was used?

2. Were the levels of Growth Factors therapeutic? Therapeutic level ranges  are usually 4-5  times the baseline.

3. No levels or PRP concentrations were taken or reported.

All of these are significant study design flaws that will result in invalid study conclusions. Additionally the study stated “Platelets are slow to activate by exposure to tendon collagen, but it might be that therapeutic pressure within the tendon, a large amount of PRP diffused rapidly out of the tendon thereby reducing its effect.” Additionally thrombin – a critical component in PRP therapy – was not used to activate the platelets. PRP and growth factors will not activate or be as effective if thrombin is not used in this procedure.

Perhaps most significant study design error was that only one PRP injection was given. The study patients, by design criteria, were required to have chronic Achilles tendinopathy that had responded poorly to prior therapies. Chronic tendon injuries, particularly those in the Achilles tendon, heal poorly due to inherently poor blood circulation. The standard PRP technique in this type of injury would be a series of three injections over a period of 3-4 months. A study that specifies treating a patient with a chronic tendinopathy with a single PRP injection is setting up the patient unnecessarily for failure. Lastly, the study had a low number of subjects in it to make any clinically significant conclusions. Only 27 subjects were treated, each with a single PRP injection and there were 27 control subjects.

Regenerative medicine – Platelet rich plasma – has been FDA approved for medical use for 20 years. It has been used widely in dental, cardiac, orthopedic medicine to assist in and improve medical outcomes. The professional horse racing associations widely use PRP therapy to heal leg injuries in their million dollar race horses. Major league sports such as the NFL and MLB consider platelet rich plasma therapy an important treatment option to get their elite athletes “back into the game” in as short of time as possible. PRP healing typically takes six weeks, particularly when combined with rehabilitation. In conclusion, PRP is a highly effective medical treatment for ligament, tendon, muscle and other knee/shoulder injuries as well as lower back pain. Even patients with post-operative knee pain or shoulder pain can benefit from PRP therapy.  Outcomes are entirely dependent on the preparation and handling of the blood, equipment used and experience as well as skill of the treating physician. Additional information on PRP can be found at PRP Stops Pain. Excellent clinical study references can be found by clicking here.


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As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. Tendons attach muscle to bone and ligaments attach bones to bones. Platelet rich plasma (PRP) is the concentrated healing components of the blood. Only one percent of the blood contains the bioactive proteins and platelets that are involved in healing. Through a specialized process, we can take the patient’s own blood and concentrate the platelets and bioactive proteins up to 500%. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The PRP graft is then activated with thrombin and the healing process begins. Using the patient’s own blood eliminates the risk of transmitting disease and prevents graft rejection. PRP also has the benefit of being antimicrobial, killing off bacteria thereby limiting the risk of infection. David Crane, MD published an excellent overview of platelet rich plasma.

Platelet rich plasma works by first being injected into the affected area and activated. The activated platelets attach themselves to the damaged tissue, whether that be tendons, ligaments, muscle or bone. The platelets release alpha granules and dense particles. The small packets contain powerful bioactive proteins that begin the healing process. The alpha granules contain clotting factors, growth factors, cytokines and adhesion molecules. These substances allow the PRP graft to attach to the damaged tissue and start recruiting other healing cells to migrate into the area. The dense particles contain proteins that allow the platelets to clump together, forming the structural matrix of the PRP graft.

(more…)


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