Here's How Orthobiologics Is Revolutionizing Pain Management | Conversations in Regen Episode 12

Here's How Orthobiologics Is Revolutionizing Pain Management—transforming the way we treat musculoskeletal pain and optimize healing naturally.

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Are you struggling to find safer, more effective solutions for chronic pain? Wondering how regenerative medicine could change your orthopedic practice? Or maybe you’re curious about how to get into regenerative medicine but don’t know where to start? In this episode of Conversations in Regenerative Medicine, I dive deep into here's how orthobiologics is revolutionizing pain management—a powerful shift happening in modern healthcare. Joined by Dr. Annu Navani, a leader in orthopedic regenerative medicine, we unpack how orthobiologic treatments like PRP therapy and platelet-rich plasma injection are changing patient outcomes and reshaping how clinicians approach musculoskeletal care. From understanding the science behind orthobiologics to exploring medical practice innovations and orthopedic innovation, we uncover the real-world applications, challenges, and opportunities awaiting practitioners ready to embrace this next frontier. Whether you’re searching for regenerative medicine training, regenerative medicine courses online, or the right PRP training or PRP online course, this conversation offers a roadmap for stepping confidently into the future of pain management.

Throughout this episode, Dr. Navani shares how her transition from traditional interventional pain management to regenerative medicine evolved through years of research, innovation, and patient-centered practice. We explore the integration of orthobiologics with cutting-edge digital therapeutics, biomarkers, and longevity-focused medicine—all designed to optimize healing from the inside out. You’ll hear how clinicians can balance ethics, regulation, and innovation while staying at the forefront of orthopedic practice management. We also discuss how to build an evidence-based practice that thrives without relying on insurance models, and how to communicate transparently with patients about results, research, and realistic outcomes in orthobiologic treatments.

If you’ve ever asked yourself how to bring orthopedic regenerative medicine into your clinic, how to launch a cash-based model successfully, or how to expand through a regenerative medicine training program, this video is for you. Expect actionable insights, behind-the-scenes strategies, and empowering takeaways from one of the most respected leaders in the field. My goal is to help you bridge science, innovation, and patient care—so you can create real impact with every treatment.

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

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Transcript

SPEAKER_02 0:00

We love injection-based therapy, but there's a human attached to the end of your needle. The way the innovation will work this day age is by embedding ethics and compliance early on in the planning phase and not as an afterthought.

SPEAKER_00 0:13

And I think it's worth considering how we best biologically optimize our patients for their orthobiologic injection-based therapies to give them optimal outcomes.

SPEAKER_02 0:22

We want the patients feeling their best, right? People feeling their best. Or would you say making people out of patients.

SPEAKER_00 0:47

And this is an exclusive series with pioneers of regenerative medicine, where we tackle controversial topics and cutting-edge insights that are really helping to shape the future of interventional orthobiologics. So we want to make sure that you have the success that you deserve in your practice. So welcome everybody. We're so glad you're here. I am so pleased to welcome Dr. Anu Nivani to the Conversations in Region. She has so many things that she's good at. She is the founder and chief medical officer for the Le Rev Wellness, Chief Medical Officer of Boomerang Healthcare, incoming president for ACIP, founder and chair of the World Institute of Regenerative Medicine and clinical faculty at Stanford for 20 plus years. She did residency in anesthesiology and fellowship in pain management. She's board certified in both anesthesiology, pain management, interventional pain, and regenerative medicine. And she's author and researcher of national guidelines on orthobiologics, spine care, and regenerative therapies, and a member of the editorial and professional boards in interventional pain and biologics. Man, I don't know how you get it all done. This is phenomenal. So for those of you who don't know me, I'm Dr. Ariana Demers. I'm board-certified fellowship trained sports medicine orthopedic surgeon and regenerative medicine enthusiast. I love to educate and train both in orthobiologics and ultrasound. And I've successfully moved my practice in rural Northern California away from insurance-based care. And I am passionate about helping physicians incorporate orthobiologics into their practices seamlessly. So I want to again thank you all for joining. And this is a little different. We're going to hear from obviously Dr. Ivani. She is a renowned regenerative medicine expert. And we're going to maybe explore some controversial topics both in regenerative medicine and orthobiologics and maybe even a little bit of business. And we're going to gain some actionable insights that you can implement in your practice. And we will have a QA session. We do have hardstop for Dr. Nivani at 5:30. So we will get started here shortly. And please put the questions in the chat and we'll go through all of those. After our question and answer, we have some extra special things for you. So stay tuned. And so we'll get started. So here's the deal. I think that orthobiologics treatments will be first line treatment for musculoskeletal care in the next five years. The train is leaving the station. And if you are not actively offering these treatments to your patients, you've got to get on the train. It's leaving the station. Now, I know people want to be successful in orthobiologic practice, but it's hard. We know orthobiologics is the best treatment for our patients, but how do you become successful? Maybe you've tried some things, maybe things are a little hard. Maybe you don't feel confident about the science, the techniques, cash business, marketing and sales. But here's the deal it's not your fault. You know, maybe you thought I'm just not good at business, but it's not true. You just didn't learn it in school. And so there is lots to do, lots to learn. I'm so glad Dr. Nivani is here. She is an expert in this piece of the world. And so the question is how do we win at ortho biologics and crash practice? And we're going to talk a little bit more about this. But we also need to consider how we talk to our patients. So we all win. So we all know how to move forward. So we do need a system, right? We're not going to go over all of this today, but we do want to get you a little bit further along in this journey to be wildly successful in your orthobiologic practice. So you do need a system, and we are going to start with some orthobiologic knowledge with Dr. Nivani. So let's get down to business. We're going to talk about her world beyond pain, building that regenerative medicine and interventional medicine practice. And you know, Dr. Nirvani, we have questions. So my first question to you is your vision. Obviously, you've spent decades at the forefront of interventional pain, and you're now leading the movement forward towards regenerative and wellness-based medicine. So, what does a truly integrated model look like to you? And what inspired maybe this shift from traditional pain management to where you are now?

SPEAKER_02 6:18

Thank you, Ariana, for having me first off. And it's really nice to meet everybody. And I love that we are all passionate about orthobiologics, regional medicine, and we are here. And I think that's the first step to get started, right? The fact that you are here after a full day of work and, you know, interested in learning about this. So I can just give you an example of how I got started. You know, I both certified in international pain management, and I would see patients with orthopedic, musculoskeletal, and spine injuries and do traditional radiofrequency ablations and spinal cord stimulators and steroid injections. One of the my patients actually asked me while I was recommending an epidural steroid injection to the patient for ridiculous pathy, actually asked me, doc, you're doing this cortisone injection. Is this going to really provide a solution for my condition or is it just a band-aid for pain? And that actually was probably about 18 or 15 years ago. And that got me thinking. That got me looking into options that were more regenerative and restorative for patients than just giving them something that would just decrease their pain. So at that time, there was not much going on in the United States. So I started looking outside the United States and connecting with world leaders who were actually pushing orthobiologics in different countries at that time. And I started, you know, researching myself. And that's how I entered the world of PRP for joints. I started with shoulders and knees, and then I did so much spine in my practice that automatically it was a natural inclination for me to get into spine. And I feel like it's a continuum, right? I mean, you get into PRP and then you look into MSCs, you look at acellular therapies and see what's out there and how you can best custom design the therapy for your patients, right? So when you talk about integrated approach, yes, it has got to be integrated, it has to be cutting edge, and it has to be, you know, it has to really be personalized, I feel, this day and age. So in addition to, you know, innovative cutting edge orthobiologics, we also marry that with digital therapeutics, right? So as you know, I practice longevity medicine along with Regenal Medicine, and you know, not only do we offer the orthobiologic injections, but we also offer them an application, an app that they download where they, you know, we track their biomarkers, they put in their lifestyle behavioral factors, we put in imaging studies, and then we trate injections or treatments we do, we track the changes in the biomarkers. So there is like a full closed loop where we start from a certain area of their condition and then we kind of do the treatment and come back and see how much difference have we actually made.

SPEAKER_00 9:07

So don't miss out. Please subscribe to our newsletter now to stay ahead of the world of orthobiologics. You can find the link below. Additionally, if you're ready to start this journey with me in my orthobiologics masterclass, come join us. And you've been tracking this for how long now with your integrated clinic, with the app and all of the biomarkers.

SPEAKER_02 9:30

Yeah, so that has been ongoing for a few years. I was just thinking the other day, last weekend, I was doing a talk in Miami, and I was going back as to when I did my first orthobiologic injection. And I remember my first publication came out in 2015, and that was a series of patients that I reported on. And so I must have done at least three more, three prior years to that, where I was practicing regenerative medicine. So yeah, it's been as early as that. The app wasn't existing at that time, but I tracked my outcomes. That's how we started publishing in 2015 and ongoing. But the application has been around for about four or five years, so if we have a good amount of data in there, and we are modifying that to fit the conformity of more longevity medicine-based practice, in addition to orthobiologic practice now.

SPEAKER_00 10:19

Amazing, amazing. So that brings you to my next question. So there is a challenge with regulation and data, rigorous data collection and responsibility. So regenerative medicine is advancing maybe faster than regulation and public understanding are. And so, how do we balance innovation with safety and ethics? And, you know, should it be on the practitioner? Should we have world-based organizations who are playing a role in setting these global standards?

SPEAKER_02 10:55

Yeah, a really great question, Ariana. Actually, you know, it almost seems a little nerve-wracking to take the word innovation alongside regulation right in the same sentence now, just because just recently the CMS, Medicare, actually came up with this LCD of eliminating peripheral nerve blocks from their codes, right? And that's affecting multiple MACs all over the country. And I'm at the front of it through a society that I'm going to be the incoming president for. We are doing advocacy and comments and lobbying against it, of course. So it almost seems like when we talk about innovation and cutting-edge therapies, here there is a time-label therapy of peripheral nerve blocks that's been ongoing for years that's been taken away, right? So you almost feel like, you know, what's the point of innovating if this is what's the going to happen with the regulations? But given human nature and given that we are disruptors and we want to bring only the best to our patients, innovation is inevitable. I feel the way the innovation will work this day and age is by embedding ethics and compliance early on in the planning phase and not as an afterthought. You know, working with CMS and FDAs of the world to make sure that we are doing, even under their guidance, some studies showing robust data and then being transparent with our patients in terms of the efficacy and safety and collecting enough data that we make a compelling case for not just orthobiologics, any innovation that we really think of, including digital therapeutics, including AI, or even like nanotechnology, bioprinting, and there's so much coming our way along those lines.

SPEAKER_00 12:36

Right. I know that's so exciting. So I wanted to ask you because you know, when you look at your clinic, your wellness clinic, this is a premier regenerative longevity clinic, and really the offerings that you have are so varied. Would you kind of walk me through how somebody can really get a good idea of all of the opportunities that you're able to offer, blending that technology, that innovation to maybe redefine modern health and rejuvenation?

SPEAKER_02 13:13

Yeah, absolutely. You know, the concept is simple. We want patients feeling their best, right? People feeling their best. Or would you say making people out of patients? It's as simple as that, right? And it is not just limited to their spine, musculoskeletal, and orthopedic injuries, because that's where I started, but it's about their overall health span, right? You know, and I learned this the hard way as I would do these orthopiologic injections if they didn't get better, or you know, somebody, two people like having the same exact pathology, one being on the healthier side, another one having chronic diseases, didn't respond as well as the first patient, healthier patient did. It got me thinking, what is that missing piece that's changing the outcome of the injection? That's how I started looking into this. So, for example, if I have a patient with high hemoglobin A1C or you know, a hypothyroid patient who is just not optimized, or you know, somebody who has an active infection happening and I'm doing orthobiologic injection and it's you know it's not gonna work. So then I started looking at okay, what are the things I can fix? What are the modifiable risk factors? What are non-modifiable risk factors? And as we are progressing more and more into health spans and looking into the biomarkers and longevity medicine, I'm realizing even age is a modifiable risk factor this day and age. So I think this is how the natural transition has been. And we have a variety of services. We have, you know, starting from IV infusions to hormones and peptide balancing. You know, of course, we do, you know, regenerative medicine. I'm looking into bringing in some gene therapy into the clinic, looking into therapeutic plasma exchange. I mean, those are all on the verge of getting launched, but we are doing, you know, stem cells and PRP and you know, overall health management, so to speak, with biomarker, full body imaging, and epigenetic clocking and testing and so on and so forth.

SPEAKER_00 15:09

Now that, you know, I agree. And I've kind of gone the deep dive into that as well from an optimization standpoint. But a lot of doctors that I talk with, they're like, you know, I that seems so overwhelming. Where do I even start? Like, am I in charge of their diabetes? And what, like, what do I do? Where what are like a two or three things that are like the low-hanging fruit that anyone could improve their orthobiologic outcomes by paying attention to uh just a couple of easy things?

SPEAKER_02 15:48

Yeah, I think a couple of things that are really important when it comes to orthobiologic injections is the level of inflammation. So I would track CRP and ESR, depending on if it's chronic inflammation. I would look into the blood counts. That's really important to track before and after. So, you know, just making sure your platelet counts what they're looking like, how much of leukocyte and RBCs you have in your final solution, that's really important to track. And then I think, you know, just the metabolic status is really important to track, you know, especially, you know, diabetes or thyroid dysfunction, because a lot of these pathways are very closely related to DNA repair and, you know, just overall healing and endantal process, which we really count on with our orthobiologics. And lacking that, I don't think we'll get the responses we are looking for in the patients.

SPEAKER_00 16:40

Yeah, absolutely. Yeah. Thank you so much for giving, you know, our listeners here some really nice actionable steps that anybody can take to boost their outcomes. So, when we're talking about, you know, now this world of interventional regenerative medicine congress, how are you now hoping to fill a gap? How do you envision this platform, the shaping our global collaboration among physicians, scientists, polymet policymakers? How are you? What's your kind of framework for this new Worm WIRM conference or Congress that's happening in April of this year?

SPEAKER_02 17:23

Yeah, thank you for bringing that up. So, you know, I'm sure everybody on this call recognizes the fragmentation in our healthcare system. You know, just meeting with the people who are really passionate in this field realized everybody wants to try their best to bring, you know, the best therapies to their patients at the point of care, but not always is it possible, depending on which geographic location you're on, you're in, or what regulatory guidance you are following in whichever country. So the goal of the World Institute of Regental Medicine is to bridge that gap with scientific evidence, with clinical efficiencies, and with you know, just accelerating the clinical applications and clinical research. The World Institute of Regental Medicine, Worm, has been established with that intent to bring scientists and clinicians of the world and connect them with technologists, biotechnologists, and you know, entrepreneurs to accelerate regenerative medicine. So, as you said, we are doing our World Congress in April in San Francisco, and everybody is welcome to attend. We really want people to be passionate in this field. And so please register early. As I often say, early bird catches the worm.

SPEAKER_00 18:32

So speaking of technology, I think that you know you spoke about AI and biologics evolving. So, where do you see the biggest breakthroughs coming? Where, how can clinicians kind of be at and continue to be at the forefront as we prepare for this next era of medicine in regenerative and interventional medicine?

SPEAKER_02 19:00

Yeah, I mean, you know, healthcare is really getting disrupted in a really big way. And for you and I who are sitting here in Silicon Valley, I mean, we are seeing new startups come on every single day, and so many of them are focused on healthcare. So, you know, the biggest areas of disruption, of course, everybody's talking about AI that's integrating and inserting itself into every single process that we have in place. So I feel like that's gonna be huge. Digital therapeutics is gonna be very big, nanotechnology incorporates and integrates really well with orthobiologics. In fact, I'm looking at a couple of lot studies that we are going to start doing where we are going to be able to track the stem cells as they as we're injecting them to see where they are actually landing in the body, right? Because to make a positive correlation about healing with the cells, we need to be making sure that they're getting to the right place and doing what they're supposed to do. So those kind of things. So, in fact, I'm writing a book on emerging technologies that's consumer-facing and physician-facing, and I'm happy to, you know, tell people about that. It's coming in 2026. Forbes is partnering with me in getting that book out, and it's all about emerging technologies because I feel like we all need to stay ahead of it. So please, you know, I'll put my email in the chat box. So please reach out to me if you're interested, and I can send you more information about the book.

SPEAKER_00 20:25

Oh, that's amazing. What if you had to pick one thing that's currently fascinating you that keeps you kind of like thinking about things in your free time? What is the one thing from an either an AI perspective or nanotechnology perspective that's so interesting that may, you know, help people to kind of go deeper or or go down the rabbit hole a little bit? What is the one thing that you're really excited about?

SPEAKER_02 20:55

You know, I think one thing that really has been exciting me and continues to do so because there is so much out there is how can we make the ortho biologics work better, like enhancing the cells in a way. So they go out and really create this huge cascade of healing process, right? And there are simple things that actually we can do to the cells. Now we have limitations, as you know, because of the FDA guidance here in the United States, but I have a few ideas that I want to try out. Actually, there are three studies that I'm doing overseas that actually are along those lines, but that's what I want to do. You know, I want to see even if we do autologous cell therapy, how can we enhance it to work the best it can in humans, right? And that also ties into the biomarkers and how we can track before and after and make sure that we really are making the difference in people and keeping the promise that we are making to them in terms of regenerating or repairing or restoring those tissues.

SPEAKER_00 21:58

Yeah, you know, that is. Is something that really I think everybody who's offering orthobiologics or regenerative type therapies or even precision medicine, how do we keep that promise? Or how do we not oversell it? I think that's a fine line. And I think, you know, number one, having transparency about the fact that we don't know everything. Here's what we do know. Here's what we still don't know. But there's some, you know, maybe some other types of studies, either from other nations or animal studies, those kinds of things, bench top studies that are helping to guide us, but that we don't have all the answers. What would you tell someone who says, well, you know, there's no research to show that any of this helps?

SPEAKER_02 22:53

Yes, so people who are questioning the research, and that comes up often, Ariana, but I just wanted to comment on the comment you made earlier. Absolutely, I think, in terms of transparency with our patients, I think our duty is first to our patients to make sure that we are offering honest care to them and bringing only the best to them and not making promises we can't keep. So currently, you know, we cannot promise regeneration of tissues to them based on what we have currently available to us in the United States, right? We can repair some tissues, of course. That brings us to the data that you're talking about, right? Yes, we are currently lacking in some data, but we also are, you know, quite well endowed with data in some of the indications. For example, NEOA has been very well studied. It's a level one indication. Lateral epicondylitis has been very well studied, and it's level one indication. Discs, I feel, in the spine realm have been studied quite a bit, and we have some really good RCTs that actually speak to really high quality, effectiveness, and safety. So, of course, more is welcome, and we really need to do more in terms of the studies, and and they probably never will be enough. But I think we are at a comfort point where we feel we can have an open conversation with the patients, give them the studies. I typically do give patients the studies, I have them, you know, read through it, answer any questions before I embark on treating them with those therapies.

SPEAKER_00 24:19

Don't miss out. Please subscribe to our newsletter now to stay ahead of the world of orthobiologics. You can find the link below. Additionally, if you're ready to start this journey with me in my orthobiologics masterclass, come join us. Of course. Dr. Nirvani, you've been so generous with your time. I really do appreciate it. And it's so fun to be able to kind of just pick your brain. I know because you're so connected to not only what's happening in this country but around the world. You have multiple studies going in in different locations, but also, you know, you are in that hotbed of technology in Silicon Valley and new startups happening all the time. So do you think we're at an inflection point right now where this is really starting to kind of accelerate?

SPEAKER_02 25:13

Yes, I think so. People are more open to it. I remember 10 years ago, I offered traditional therapies and then telling people about hey, by the way, there is this new thing called PRP that is a constellation of growth factors that I can do, but now people come asking for it. And even if you want to divert them into you know surgical options, and of course, not to say that there are patients who are candidate for surgeries or other traditional treatments, they steer you away and they want something that's non-pharmacological, non-surgical, something that's meaningful in terms of getting to the root problem and trying to fix it. So people are smart, and I feel like, yes, people are ready, and so is technology and science, and I think this world to take on something that you know will help them in a meaningful way.

SPEAKER_00 26:00

Yeah, so I do have a question here. So the question is: have you seen any disc infections or facet joint or sacroiliac joint infections associated with PRP?

SPEAKER_02 26:11

Thankfully, not yet. I know you know, disc infections are not that uncommon. Facet and SI joint infections are very uncommon, sort of rare, I would say, but disc infections can happen, and sometimes it's just discoitis, which is chronic inflammation with you know multiple different pathogens that have been isolated. I haven't seen personally any, but I have, you know, read case reports of it. There's a lot of work that Greg Lutz did in that space, and then there are protocols that are established to preemptively treat the discs with antibiotics prior to the injection.

SPEAKER_00 26:44

Yeah, I would second that, you know, the risk of infection in both facet and SI joint is very rare. We do know that PRP is a somewhat antimicrobial, and I think what people are asking and getting at is this thought process that the disc space is maybe not sterile, and there may be a microbiome inside the disk space de novo. So that always makes me take pause. I'm like, oh, yeah, and Greg Lutz and et al. did a lot of work on this. So yeah, you're exactly right. There are protocols. It is true that there are risk factors anytime that you break the skin, anytime that you introduce anything from an injection-based standpoint, that does have a risk factor. But I think you're exactly right that there are protocols for that. All right, so we'll go through. I know we have basically our time is up with you, and so I wanted to thank you so much. We do have a little bit more to discuss going forward, so everybody else gets to stay on with me, and we can have another QA session at the end. But Dr. Navani, thank you so much. I know you have to run. You have like a thousand companies you're running. So thank you so much for your expertise. For anybody who's wondering how to connect, her email and the WIRM website are in the chat. And thank you for your generous time. I really appreciate it.

SPEAKER_02 28:13

Thank you, Ariana, for having me. And thank you, everyone, for listening and being a part of this. I really appreciate it. Thanks.

SPEAKER_00 28:20

All right, so have a great rest of your day. And then the question is what's the next step? How do we take all of the things that Dr. Nivani has shared? And really, you know, it's so exciting that we're really at an inflection point. But how do we bring this back to our practice, right? And so, really, you need a system. And right now we are able to have our practice launch system help to figure out, you know, this knowledge, but also how to attract the right patients to our clinic, how to create a cash-based business, how to have high-converting consultations, and of course, getting putting it all together for success. So we are offering this practice launch system and through the business of orthobiologics. Speaking of the business of orthobiologics, I have a business of orthobiologics express course that is a hands-on workshop and lab workshop on Saturday, which is the business piece lab, cadaver lab on Sunday. This has been, you know, generously sponsored through Apex Biologics. There is no registration fee, and we have dates still available for November and December and coming January and February as well. Stay tuned for that. Uh, as we go forward, I want to just give you a couple of dates. Number one, please save the date for our Orthobiologic Live, our Bob Live event. This is going to be in February. It's a two-day event. We believe it is gonna be that first weekend, that 6-7 in February. We're not we haven't locked down those dates yet, but please scan the QR code to get on the wait list for the most recent information as soon as we lock down those dates. And you can come hang out with me, learn how to make your practice thrive, and hang out in Arizona in the middle of winter, which is not a bad way to spend the time. As far as the World Institute of Regenerative Medicine World Congress in 2026, that is in San Francisco, April 23rd through the 25th. And that's gonna be clinicians, scientists, innovators. We're gonna be right alongside tech and really to start delving into biologics, precision therapies, technology-driven healing, and learn from the world's experts what's going on outside the United States that can continue to spur on success at home. So scan the QR code or the chat has the website. And I just wanted to thank you all so much for tuning in. Please make sure that you look forward. We have ever an exciting guest next in two weeks, Dr. Don Buford will be joining me and talking about some quite controversial things for our future. So, with that being said, I just want to make sure that we have time for questions. So, if anybody has any further questions about business, about science, any comments, I welcome all of them. Pop them in the chat, or you can just raise your hand and I'm happy to get those questions answered for you. So, any questions about what the future holds, any questions about why these things are so exciting, not only the technology, the precision medicine, the optimization, I will tell you that I have gone down that rabbit hole for patient optimization, not only with metabolic optimization, but making sure that the inflammation profile is optimized prior to injections of autologous therapies like platelet-rich plasma or cellular therapies such as BMC or adipose. So that has been a very rewarding trip to be able to help come alongside my patients to enhance health. Not only joint health, but there's some very surprising things that happen when you start enhancing health from a metabolic profile, from an inflammatory profile, the joints feel better too. And then when we track our long-term outcomes, our data, we actually are able to see better outcomes than when we did injections without biologic optimization. So I hope that Dr. Nivani has provided some easy things with, you know, checking the inflammation markers, CRP, sed rate, making sure that we know what our platelet levels are looking like, what our leukocyte levels are looking like, and then hemoglobin A1C, thyroid panel. I think those are really important to make sure that you have the optimized biology to have our outcomes be as good as possible. I always tell my patients the reason I'm checking all of these labs is to be able to stack the deck in their favor to enhance healing and repair. So with that being said, I'm happy to answer any questions about what we talked about, not only from a technology standpoint, but from an interventional type practice that also is doing optimization, personalized medicine optimization. Oh, good. Let's see here. There's a question about, yeah, is there any good articles or studies showing how well a PRP works other than lateral chondylitis studies or knee arthritis studies or even intradiscal? Yeah, so there are a collection of studies. I though the one that I know that's been helpful for me is a blog by Dr. Kristen Tenno listing out, he does this every one to two years, and he lists out all of the randomized control trials for each body part. So we know that in 2024 there was 41 randomized control trials showing efficacy for knee arthritis with PRP. There's the lateral bocondylitis has been well studied as well as intradiscal. There's been some very robust data outside the US with culture expanded cells for a number of treatments. That's just not inside the US, and so it's not currently being done here in this country without you know an IND or a trial that is registered with the FDA. So I think that's the best place to get that, and we can see if we can't get that up and share that with all the registrants. We have specific allowances to be able to share that data with physicians specifically. So, but if you wanted to search on LinkedIn, he does post his blogs, and you can probably just search Dr. Chris and Tenno, PRP evidence 2024 PDF. And I think you'll be able to find it. It's a beautiful blue PDF, and inside that PDF is interactive dots, and each dot is a study that is showing the outcomes, and these are all randomized controlled trials. So I do agree with Dr. Navani that there is quite a bit of data out there to support, and hopefully, I'll be able to also present that data on LinkedIn here in the next one to two days. So, any other questions based on what we're talking about? Thanks so much everybody for tuning in. This has been so good. Yes, there's a question Have you ever used PRP for plantar fibromas? So I don't use PRP for plantar fibromas. I do use PRP for plantar fasciitis, especially if you're measuring the plantar fasciitis, the thickness, the increased thickness of the plantar fascia. That has been shown to have darn good outcomes for plantar fasciitis. Plantar fibromas, I'm not sure we'd have to kind of consider what the mechanism of action or the disease causation for plantar fibromas is. I'm not sure that PRP it would be the ideal treatment. I just I don't have enough expertise with plantar fibromas to say whether it would be something that would be ideal or not. Alright. Any other questions? Well, I really appreciate the attention and the time that you've taken away from your day. I hope this has been helpful and inspiring. Oh, yes, Sandish, you have a question.

SPEAKER_01 37:53

So my question is, you know, when I do the PRP, I always put some numbers in like the combination of the lidocaine and dextros so that you know I can take some pain away. But one of your guests, I believe it was Dr. Torlin, he was telling, don't put anything, we're just diluting the PRP. Uh, what do you do? I mean, one time what happened when I did the PRP in my patients, she was so uncomfortable, and I feel so sorry I didn't put that, and then I actually put that some lidocaine later on because he was so uncomfortable. Do you regularly put some numbing as in with it or just let it be? I'm just concerned that they would go home and then it would be so painful. But then I'm concerned that I'm just diluting the PR.

SPEAKER_00 38:32

Yeah, so here's what we know. Number one, I do think that it's important to consider the patient experience, especially in treatments that are cash-based and reliant on word of mouth. So that I think is important, and because we like our patients and we want them to not be tortured. Number two, there's been a couple of really good studies that show that dilute lidocaine and dilute ropivacaine do not appear to cause any problems with degranulation or changing the pH. So when we use it, I dilute by volume. So I'm using 0.125% dilution of either of lidocaine or ropivacaine. So that ends up being like a half to a quarter cc in a four to five cc syringe. And I do also use, I'm very liberal with our blocks. So regional anesthetic and also using numbing the skin. Yes, absolutely. That's I think all appropriate and definitely doable.

SPEAKER_01 39:48

Thank you, thank you.

SPEAKER_00 39:49

You're welcome. So, what there's a question about what specific instructions do you give your patients pre and post PRP to optimize the outcomes? Okay, yeah, so this is this is a work in progress, but currently my protocol is to evaluate all of their lifestyle, so these modifiable pieces of the puzzle, including stress, including sleep, including blood work. Um, so I include hemoglobin A1C, I include thyroid panel, I include a lipid panel, I include an inflammatory panel, and depending on their symptoms, depending on anything else that's going on, we may include a GI map for those people who are having trouble with the GI system. And then we map out a program for them. We use supplements, common supplements that can help with all of the things that from a metabolic profile. We use things like berberine to help with blood sugar control. We use L-glutamine for helping with gut lining stability, because we know that when we have inflammation or leaky gut, we can have inflamed joints. We also consider improving the GLP1 status either with fiber or improving the gut motility or using a GLP1 medication, which has been shown to help with not only inflammation, blood sugar control, but also with cellular health and the cellular health pathways. So those are the main things. We usually get started up to four weeks before and then continue to optimize for eight to 12 weeks at minimum afterwards, based on all of the things, all on all the initial blood work and findings. As far as post-PRP, we do use laser therapy. So class four laser therapy has been shown to enhance healing, giving additional energy to the mitochondrial system for cellular health and metabolism. It speeds up that flare or that pattern of healing as we go through that standard way that cells heal and improve, that it compresses the time frame. And when we look at our six-month data, patients who have used laser therapy after PRP have better outcomes from a functional and pain relief standpoint than patients who have not used laser therapy after their PRP. So I hope that helps a little bit to kind of give you an idea. Some of these things are super simple, you know, the CRP, the hemolytone A1C thyroid panel, a TSH at least, can help. We know that the sex hormones, estrogen deficiency specifically, is massively important in musculoskeletal health as well as musculoskeletal pain. So I think that's worth considering in that age group for your female patients. And in your male patients, if they're androgen deficient, it may be helpful to go ahead and manage and monitor that as well. So don't forget that we love PRP, we love injection-based therapy, but there's a human attached to the end of your needle. And I think it's worth considering how we best biologically optimize our patients for their orthobiologic injection-based therapies to give them optimal outcomes. I hope that helped, Ramona. Was that is that some of the question you were working for? Anything else that people are wondering about, about orthobiologics, about this precision style integrated medicine, anything about technology, AI. These are all my these are all my favorite words. I love talking about that. Alright, so we are going to wrap up. If no one else has any questions, if you do put them in the chat really quick, like or QA. And then we will see you in two weeks for an amazing chat with Dr. Don Buford. And you'll have to keep stay posted for the topic. We're gonna keep it a little secret. We don't want to unveil it right away, but I promise you this is definitely outside the box thinking, a little bit controversial, and something that is really cool and exciting, and I think bears talking about to be able to look towards the future. Okay, so hopefully we'll see you soon. If you wanted to come to the Clearwater Workshop, I think it's next weekend for the November dates, and December, I think, is that second weekend in December as well. Maybe it's the first, I can't remember, but just scan the QR code and we'll see you there. This is the QR code for the World Institute of Regenerative Medicine Congress in April of 2026 in San Francisco. And then if you are looking to join us for the Business of Orthobiologics live event wait list, this is the QR code. It's gonna be a great event. It's a two-day event, and it's gonna be fantastic to really learn how to be successful in the practice that you so dearly want to succeed. Check it out. I'd love to have you have massive success. Thanks, guys, for tuning in, and we will see you next time on the Conversations in Regenerative Medicine.