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While PRP is effective in stimulating new hair growth and thickening existing hair, its effect lasts up to 12 months. In order to sustain fuller hair, PRP needs to be given about every 9 months. With a successful hair transplant surgery, the effects are significantly longer in

duration. Properly done hair surgery transplants may last years. However, hair surgery is a complicated process that must be done with precision to have desirable outcomes. The final outcome may not be seen for a year. The effects of PRP on hair growth can usually be seen in 3 months with the duration of full effect for about 9 months. Think of PRP as a long acting fertilizer for your hair and scalp. Your lawn need fertilizer to be added at least twice a year to sustain a lush lawn. The same can be said about your hair needing PRP to sustain a dramatically better appearance. This helps patients to have a better quality of life.

female-hair-loss-slider-6Research published by Geoge Cotsarelis, M.D.has shown that the density of hair follicle stem cells is the same in bald areas of the head as it is in areas that are growing hair. Further research by Dr. Fabio Rinaldi has shown that platelet rich plasma can stimulate these hair follicles in bald areas (alopecia) to activate and grow new hair. Another study on patients affected with hair loss showed thickening of the hair shafts after administration of PRP, resulting in a fuller appearance of growing hair.  At this time, no other therapy has shown to more consistently stimulate new hair growth. PRP is FDA approved for use in human for treatment of a variety of medical conditions. Further research is being done to better understand the process. Hopefully, one day a medication will be able to be used to more effectively reactivate these dormant hair follicles.

There are many advantages of getting PRP for hair growth over conventional hair transplant surgery. The following is a chart comparing the two:

PRP Hair Surgery
Cost $1500 $6000+
Procedure Time 1 hours 5-6 hours
Recovery Time None 3 weeks for healing
Hair Growth 3-6 months 6-12 months
Risk of Infection <1% 1-2%

Learn More About Cosmetic PRP


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stem-cells

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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lower_back_painFailed back syndrome, or lumbar post-laminectomy syndrome, is the term given to patients who have had back surgery for back pain, but continue to have pain after surgery. Even worse, their back pain can be worse after the surgery. The main problem is the fact that low back pain is not an indication for back surgery – any more than neck pain is an indication for neck surgery (failed neck surgery: cervical post-laminectomy syndrome). Surgery done for the sole purpose of relieving neck or back pain is doomed to failure. Many spine surgeons make the false assumption that if a patient has back pain and there is a spine MRI abnormality – this is the cause of the pain and surgery to “fix” the MRI abnormality, and consequently the back pain, is necessary. In actuality, just the opposite is true. Most causes of neck or back pain cannot be identified and more importantly, do not require spine surgery.

Failed back syndrome (FBS) has many different causes. Some of these are a direct result of surgery: operating at the wrong level, failure to remove the entire herniated disc fragment, trauma to the exiting nerve root, continued pressure on the nerve root, scar tissue and inflammatory changes at the site of surgery. Back surgery typically involves removing some of the boney part of the spine. This can result in spinal instability. This causes additional spine pain. Predisposing factors to FBS include smoking, diabetes and obesity.

Persistent low back pain, following back surgery, may be due to any number of causes. The surgery itself causes scar tissue to form, which can cause more spine joint pain. Spinal hardware, such as screws put in to stabilize the spine, can cause pain. These screws are put into the vertebral bodies to secure metal plates or other hardware to stabilize the spine. This is frequently done plus inserting bone fragments, for a spine fusion procedure, to further add more stability. The screws can cause pain in and of themselves. They can be put in incorrectly or touch a nerve root. The spinal fusion can fail to take and therefore the spine is not as stable as it should be. All of these things combined can result in additional pain or worsening of existing pain. Taking the screws out does not always result in clearing the pain – plus this requires another back surgery, leading to a viscous cycle.

Back surgery fails for a number of reasons. The three main reasons for failed back surgery are:

1. Surgery was not indicated in the first place for pain treatment,
2. The surgical procedure performed never would have achieved the desired outcome,
3. Correct surgery performed but did not get the intended results.

The main message here is that there are many reasons not to have back surgery. Unfortunately, over 500,000 Americans undergo spine surgery annually. Over 50% will have little or no relief for of the symptoms. It is not unusual to find patients such as this who have had two or more spinal surgeries – both neck and back operations. The majority do poorly. Failure rate with second spine surgery is about 70%. Three or more spine surgeries experience greater than 90% failure rate.

FBS symptoms include persistent, dull back pain, which varies in intensity. Patients can have sharp back pains that may radiate down one or both legs – sciatica. In almost all cases of failed back syndrome, more surgery is the worst thing that can be done, as this only compounds an already bad situation. Most of these patients are disabled and are on narcotics for pain relief. Narcotics are addictive and surgery is not reversible.

Fortunately there is non-surgical, non-narcotic treatment for patients with post-surgical neck or back pain. Platelet rich plasma (PRP) therapy is a simple, in-office procedure that can naturally provide dramatic, lasting relief. PRP (platelet) therapy does not require anesthesia, rehabilitation or any down time. Platelet rich plasma (PRP) is derived directly from your own blood. PRP is blood plasma with a high concentration of platelets. Contained within platelets are the active healing proteins and growth factors that promote new tissue regeneration. Growth factors are necessary to initiate tissue healing and regeneration. With concentrated amounts of these proteins in an injured area, healing and tissue repair is started and accelerated. Stem cells, respond to the growth factors, into the area, further aiding in healing. Healing can occur in various tissues including tendons, ligaments, muscle and bone – as stem cells will change into whatever damaged tissue is needed. Along with tissue repair, the regeneration process also stimulates new blood vessel growth to promote healing process.

Here in Sarasota, platelet rich plasma therapy is available. At Sarasota Neurology, Dr. Kassicieh, a Sarasota PRP doctor, has been doing platelet rich plasma therapy for tissue regeneration (regenerative medicine) since 2009. He has successfully treated several hundred patients with back and joint pain – all without surgery. Our success rate in treating failed back syndrome, knee pain, shoulder injuries and even plantar fasciitis is over 80%. Many patients become pain free. If you have persistent cervical (neck) or back (lumbar) spine pain, call now for a consultation for platelet rich plasma (PRP) therapy with a board certified neurologist and PRP doctor.


Posted in Back Pain, Pain, Platelet Rich Plasma and tagged , , , , , , by

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?


Posted in Pain, Platelet Rich Plasma and tagged , , , , , , , , , , , , , , , , , , by

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.


Posted in Back Pain, Pain, Platelet Rich Plasma and tagged , , , , , , , , , , , , , , , , , , , , , , , by

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.

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Posted in Back Pain, General Medicine, Nerve Pain, Pain, Platelet Rich Plasma and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , by

Carpal tunnel syndrome is the most common “pinched nerve” condition that neurologists see. It is a form of compression neuropathy The typical patient comes in with complaints of hand or arm pain associated with one or more numb fingers. There is usually sparing of the little finger. This painful numbness will frequently wake affected patients from their sleep. They will complain of a swollen feeling in their hand (or both hands) associated with painful numbness affecting all but the little finger.

Carpal tunnel syndrome is caused by compression of the median nerve (the “carpal tunnel nerve”) as it pass under the carpal tunnel ligament. The carpal tunnel is located at the wrist. There is a small band of tissue across this to hold down the median nerve and vein. When the carpal tunnel becomes too narrowed, the median nerve becomes “pinched” and the vein is compressed. This combination of events results in the hand becoming numb and swollen. Carpal tunnel symptoms frequently occur only at night, during sleep. This is because we all have a tendency to sleep with our wrists slightly flexed. This position further narrows the carpal tunnel, causing symptoms. As the carpal tunnel narrows further, with time, patients will develop daytime hand numbness. Holding a newspaper, magazine or steering wheel can bring on symptoms. In more severe cases hand grip weakness can occur. Patients find that they have difficulty removing jar lids or may drop objects. Carpal tunnel syndrome occurs in both hand about 50% of the time.

CTS is diagnosed, most commonly by a neurologist, on the basis of the patient’s symptoms and detailed neurological exam. Electrical diagnostic testing, nerve conduction studies (NCV), are necessary to confirm carpal tunnel syndrome – particularly if surgery is being considered. Many patients can have carpal tunnel symptoms and have normal NCV studies. These patients are not candidates for surgery. The standard of care medical treatment for CTS is wearing a cock-up wrist brace. These braces prevent wrist flexion, thereby reducing the pressure on the median nerve. Frequently patients can “cure” their CTS with wearing a brace. For more severe symptoms with abnormal NCV studies, surgical decompression may be indicated. This is a procedure done under local anesthesia. A small incision is made at the wrist and the carpal ligament is cut. This relieves the pressure on the median nerve. Success rate for this surgery is approximately 90%.

If you feel that you have carpal tunnel syndrome, you should see a neurologist and have diagnostic studies performed. Most patients will do well with conservative, non-surgical treatment. For more detailed information click here.


Posted in Nerve Diseases, Nerve Pain, Neuropathy and tagged , , , , , , , , , , , , , , , , by