[Podcast] What Makes for a Good Patient to Receive Regenerative Injection Therapies?

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When considering Regenerative Injection Therapies like Prolotherapy, PRP and Stem Cells, patient selection does matter. As these therapies rely on the body’s own abilities to heal, it’s important that the patient’s overall health be taken into consideration. Factors such as nutritional status, muscle mass, hormonal profile, gut health and overall wellness all have a big impact on clinical outcomes. Listen in to find out more on what factors count and how to optimize your cell’s regenerative powers.

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You likely have questions. I have compiled a cheat sheet with all of the answers to all of the most common questions that I’ve encountered in the past decade of practice. If you want to know more, and would like to find a practitioner in your area, be sure to grab my Insider’s Guide to Prolotherapy and PRP within my PRP 101 School HERE!



Hello and welcome to Pain Free and Strong Radio. I'm Dr. Tyna Moore. And in today's episode, I'm going to be talking to you about something very near and dear to my heart. Which is regenerative injection therapies and who is good candidate to receive these therapies. And how can you optimize your stem cells and your regenerative medicine capabilities to become a good candidate to receive these therapies.

I'm hoping that in today's episode, I'm able to shed some light on some common questions that I get in clinic and questions that I get all the time from the public via e-mail and when interested patients are calling. And I also that this helps guide you in you're a patient of somebody else or if you're looking to become a patient of regenerative injection therapies anywhere in the world, that this hopefully arms you with some information so that you can make a better decision about going in to these treatments with realistic expectations. Understanding some of the factors that really will impact your outcomes. And how can you ... what are some things that you can do in your life, lifestyle, diet, etc. to really optimize your potential to get the best results from these regenerative injection therapies.

So the first thing I want to talk about is simply the idea of regenerative injection therapies, like prolotherapy, platelet rich plasma stem cells. And a little bit how they work, which I've covered in a prior episode, I went in to detail last week on how they work, what the differences are, how you can decide what might be best for you, what conditions respond to which treatment, etc. I really went in to detail for a good hour on all of that. And so you can go ahead and listen to episode two if you want to hear some of the details and go deeper there.

As for today, I want to just briefly surmise how these treatments so that you have an understanding of what I'm about to jump in to. Regenerative rejection therapies work by basically taking a joint, ligament or tendon, an area of soft tissue that's been compromised, and when injected appropriately ... and you can hear more about my beliefs on appropriate in episode two. When injected, regardless of the solution that's in the syringe, our main overall goal is to kick the body in to gear. We're asking the region that we're treating to wake up, to take notice, to get some blood supply in there and to basically create, if you will, a modulated immune response. So we're asking the body to wake up and take notice and come in and send in the troops, and send in the healing factors so that we can hopefully regenerate the tissues that are there.

Now, this might be a ligament that's been stretched out or injured, and causing a lot of pain. This might be tendon that's been compromised, or even a muscle. Most often, it's a joint and the ligaments and tendons surrounding the joint and then also inside the joint, which we refer to intra-articular.

These areas notoriously have a low blood supply, and so they don't heal terribly well. And we want to go ahead with our treatments that we're doing, with these regenerative injection therapies. And get the tissues kick up and take notice, activate the stem cells that are in the area, activate ... get the growth factors in there and basically create whole cell signaling cascade that gets everything to go.

So what is a cell signaling cascade? That's a great question, I get asked it often because I throw that word around a lot. Essentially, when you become injured, your body responds by creating a cascade of events that ultimately leads to 300 days or so later, collagen production. So you hurt yourself and the body responds by cell signaling with a whole bunch of different chemicals, we call them chemotaxic events. Cell signals, molecules, et cetera, platelets have growth factors, all of these things ramp up and you get ... sometimes you get blood clotting, sometimes you get blood flow to the area that simple leads to further healing. Essentially we're tying to get blood in to the area and we're trying to get things to turn on and we're trying to get the whole machine to go. That machine going leads to, about 300 days later, almost a year later, normal healthy collagen deposition, if everything is lined up, if everything is working. There are a lot of factors here that I'm going to get in to today so that you can understand how to get those things to line up best for you.

Now, if we only inject one area with one needle, one stick, one area, we're not really getting the full proliferative effect that we could. However, if we needle the area, we pepper it with our needle, regardless of what's in our syringe, we do a technique called prolotherapy, traditional prolotherapy is the act of really needling every ligament, tendon and soft tissue area that needs to get woken up. We're creating micro trauma with that needle, which induces more blood flow, which in turn gets the whole chemotaxic event rolling. We basically get the train rolling to collagen deposition.

As a side note, and a topic for another day, but what is the first thing that everybody is taught to do when they have an injury? We're taught to put ice on it and we're taught to use non steroidal anti inflammatory drugs like ibuprofen. We call them NSAIDs for short. So we're taught to take a non steroidal anti inflammatory drug and we're taught to ice it and we're taught to elevate it. And maybe we're encouraged to move it if we've got a good doctor on our team. And obviously rule out fracture, et cetera.

So, let me just tell you real quick, icing it and taking NSAIDs completely shuts off the inflammatory cascade. Which sounds great, right? We don't want inflammation because that hurts. Well, that's actually incorrect. We do want inflammation, we want modulated inflammation, inflammation is about ... the inflammatory phase of the wound healing cascade is about 10 to 14 days give or take. And you need that phase for each subsequent phase to go to fruition. So the whole cascade itself will be shut up and compromised significantly if that first inflammatory cascade is shut off. Taking herbs like curcumin, fish oil, using hot and cold, alternating hot and cold therapy, I've got more about that on my blog post, over DrTyna.com ... using things like that will significantly help you reduce inflammation but we don't want to cut it off. We certainly want it to stay there, we do not want to cut it off, so I encourage patients to do quite the opposite. I actually ask them to heat it and then alternate that with cold, not just straight up ice, but cold. And I ask them to move it, so long as there's not a fracture, which there ... you know, you need to have that discussed obviously, so long as there's not a fracture there, to keep it moving and then to take something like Tylenol which is analgesic. Tylenol does not cut inflammation, it simply cuts pain. Or it reduces pain, so ... Be careful with Tylenol, it can be very dangerous to the liver and it can be even more dangerous when you start combining it with alcohol. But, just know that movement, alternating hot and cold and analgesia is actually a better route to go when you have had a soft tissue, acute injury, like a sprain or strain.

Okay, so back on line here. Cell signaling is so imperative for these therapies to work, that if you are unhealthy or your system is compromised in any sort of ways that I'm going to go through here, you won't get proper cell signaling and you won't get the most out of the treatment. These treatments are not covered by insurance. They are cash procedures, or payment at time of service procedures. Because they're not covered by insurance, some doctors will try to bill for them and that's essentially insurance fraud. So, if people are laying down cold hard cash for these treatments, I want to really ensure that they're going to get the best outcomes. And so often, I will turn people away, honestly. This is also why I prescreen and ask patients to apply, because I really don't want to give somebody false hope and I don't want someone to come in and expect treatment who is really not a good candidate and probably won't get much out of it.

These treatments are only as good as your body's ability to respond. They're only as good as your cells are and as healthy as your cells are. So, we're going to go through a couple high points over the next hour so that we can talk about those things and that you can have a better understanding of how you can optimize your own stem cells and your own body to have a robust healing response that is not too extreme, because that can happen as well, something that is modulated, regulated and therapeutic, so that you get the best out of your regenerative injection therapies. There's not point in spending thousands of dollars on a stem cell procedure, if your body isn't going to take to it well, and actually kick in and heal. So, we want all the cells talking to each other. The body's ability to respond to the treatment is everything.

So what are some things that make for a good candidate for regenerative injection therapies? If you're just joining us, I'm Dr. Tyna Moore, this is my whole lot in life, my entire practice is regenerative injection therapies, it's all I do all day long in practice, in clinical practice. Online I definitely talk about other things that are helpful, but I think that a health body and a healthy patient is really the best candidate for regenerative injection therapies. And right now I want to go in to some details for you.

So, I've got this listed on my website and I can share that link with you guys at the ... in the comments section of this podcast. But, the first thing is an active person. I need the person to be active if I'm going to take them on as a patient. The reason being, is that people who are inactive, there is a whole slew of reasons why being inactive is essentially, in my opinion, the kiss of death. I used to be very inactive. I know how that goes. I know how easy it can be to become inactive. And I've certainly had my fair share of pain and struggles and injuries and ... really debilitating injuries, actually. Where I was feeling fairly crippled. But motion is lotion and movement is medicine and it's everything. And so, to keep your hormones happy, to keep everything signaling, it's all about cellular signaling, you'll hear me say that repeatedly. All good health is about the ability of the body to cellularly signal. That means having your immune system, your microbiome and your hormones all in line and all talking to each other in a way that is moving you, as an organism, towards health. Not towards disease.

And of course, we're always in the middle somewhere, right? There's no perfection here. This is a journey and we're always just trying to go bigger, better and stronger. Sometimes we have setbacks, sometimes we drink too much, sometimes we eat too much junk food, sometimes we don't sleep enough, I totally get it. But the goal being is that we're moving towards wellness and that requires movement, so an active person. Preferably someone who's strength trained or lift weights. Anyone who listens to me knows I'm a total ... you know, I know I'm not a meathead, but I am a total buff for the strength training. I love it. It's changed my life significantly, I've done a lot of research in it, I've written articles about it, I've done podcasts about it and it's really ... if you want more information on that, I'm sure you'll hear that here on this radio show, but in the meantime you can go over to my website at DrTyna.com and I've got a lot resources there that you can read more about.

So strength training is important, one, because it gets your hormones to line up. Which is critical when you're looking at having, or receiving or regenerative injection therapies as a patient. You really want your hormones optimized, you want your human growth hormone and you testosterone, those your anabolic hormones, those are your hormones that actually help you regenerate tissue and build tissue. You want those working as best as humanly possible so I see a lot of women with low testosterone, I see a lot of men come in with low testosterone, I'm often the one who diagnosis the low testosterone just by looking at them. When no one's ever really talked to them before. But having chronic pain, one of the first things you really should look at is your testosterone levels.

So, I want them strength training because strength training actually helps you increase your hormone growth hormone levels and your testosterone levels. Now, the studies they're doing out there right now, I'm not in love with because they're looking at gains in these hormones specifically following strength training, but I'm looking at the long term for a person. And so I can tell, there's good science to support that your health is very much dependent on how much skeletal muscle mass you have. In fact, cancer patients, it's imperative that they keep their skeletal muscle on. The minute they start losing muscle, something cachexia, or wasting, is honestly when they start going down. And when they start moving more towards death. So, strength training keeps the muscle on, the muscle is what's going to help feed a healthy human. So, we want muscle, we want you strength training, and lifting weights several times a week. That could be two or three times, certainly not every day, more is not better with just about anything, so two to three times week, for 40 to 60 minutes, strength training, lifting weights, building muscle, it's imperative.

Another factor that is critical is having a healthy body composition. And body composition is your bone to muscle to fat. You can change all of these things with how you live your life and how you move your body. What we want is obviously low fat, higher muscle, good quality bones. Your bones are not just bricks of dust that live in your body, they're active, they're their own organ system. Your muscles are an active organ system with their own ability to manipulate your immune system, manipulate your hormones and your fat is the very same thing. Fat actually ... it's almost the opposite of what muscle does. Fat can really create a lot inflammation in the body. Excess fat, it can create ... it can really skew and screw up your hormone and your hormonal milieu and it can effect ... it is effected by and can effect your microbiome. So we want ... obviously, not everybody who comes to me is super lean, that's not what I'm looking for, but I am looking, if somebody's going to be carrying around excess adipose tissue, it's really imperative that they have healthy muscle tissue under there, and bone.

So one of the side effects, unfortunately, of having extra weight is often diabetes, type two diabetes. And type two diabetes over time will lead to muscle wasting. For a variety of reasons. So you end up with more of a protuberant belly and significant wasting in the arms and legs. That of course is going to lead to chronic pain. But more importantly, it's really not going to help us if we're trying to inject those regions and ask those regions to wake up and do something regenerative. Because the body is actually in a catabolic state, meaning it's in a wasting state, it's in a state where tissue is being dissolved. It's not in an anabolic state. We need the patient, or the person receiving the treatments in a more anabolic state.

So, healthy body composition is really critical. If people are just ... it's the chicken or the egg though, right? Because people are packing around a lot of weight will often have knee and hip problems and chronic pain issues, and that's inhibiting their ... I know this more than anything, I've had a hip issue really barking at me the past six months in particular and I've gained weight myself. I get the chicken and egg thing. So often we have to cut the pain so the patient can start moving, but if you're going to receive one of these more expensive therapies like PRP or stem cells, often starting with prolotherapy is a wonderful, affordable way to start. It'll get the pain down and the patient can start moving and once the patient starts moving, the weight will start to come off. Just note, 90%, at least, of your fat and muscle and bone composition is dependent on your diet. Not on how much you can move, so, that said, you cannot outrun your fork. Your diet is everything in this battle of ... you could call it weight loss, or fat loss, I call it healthy body composition. I'm always going for more muscle and more strength, which will in turn lead less fat mass on my body.

Another really important factor is diet. So I just mentioned that. Consuming an anti inflammatory type diet with adequate protein is critical for regenerative properties in the body. So, if you're a vegetarian or vegan, that is fine, I don't see them respond nearly as well as omnivores, or people who eat vegetables and meat. But, getting adequate protein, whatever that form means to you, a complete protein is really critical when it comes to joint health and joint regeneration and ligament and soft tissue regeneration. And then keeping that diet anti inflammatory. I think the quickest way to do that, and something that I share with my patients often, is just keep it simple. Cut your grains way back, your grains and your carbohydrates, those refined carbohydrates and grains are super inflammatory in many people. So cutting those way back, cutting your alcohol intake way back and cutting your sugar intake way back. If you do those things, you are bound to be leading a more anti inflammatory lifestyle. Obviously, consuming healthy fats and healthy protein sources are critical. That's, again, a topic for another day.

But, getting the grains and refined carbohydrates, the sugars and the alcohol, down or out of your diet is probably the best thing you can do for healthy body composition, for one. That is often a sure fire way for people to immediately start losing weight. But more important, it creates an anti inflammatory environment. If I'm going to take somebody's blood, concentrate down their platelets, which have the growth factors, or concentrate down their adipose tissue, which has the stem cells, and re-inject that in to their joints, if that blood is inflamed, we're going to have a hot mess on our hands, quite literally, because chances are the joints are inflamed.

Your joints are not just degenerating because of wear and tear, there's a systemic, metabolic, hormonal, immune driven process going on there, effecting that joint, because joints are an organ system in and of themselves, so eating an anti inflammatory diet is everything. And for many people, when I even suggest, like hey, why don't you just cut the sugar out and the alcohol back and start really focusing on how much carbohydrate, refined grains, breads and pastas and all that, that you're eating, cut those way back, and by the time they come in for treatment a few weeks later, they always report how much better they feel. And that their joint pain is significantly reduced.

I know for certain, when I have too much alcohol, like when I'm traveling, if I'm at a conference, I was just at a conference in Phoenix, Arizona and you know, a drink or two a night with the colleagues, eating more gluten than I'm used to, eating more grains than I'm used to, we can talk about gluten another day, this is not an anti gluten rant, but it is an anti inflammatory rant. Eating those foods and then trying to go work out or trying to receive treatment, boy, do things hurt, so ... and I've done both, I've had PRP in the midst of something like that and it was the most painful procedure. Versus PRP when I've been eating really well and taking good care of my diet is not such a big deal at all. And in fact, it's very therapeutic, so, I know first hand, I've lived his. I just worked out with my coach yesterday and my hip, which has been barking at me recently, is killing me right now and I completely blame it on all of the inflammatory food that I ate over the weekend. And the alcohol. So, just a little bit of alcohol, it's not a lot, but just a little bit, what people consider normal, one drink a night or one drink every couple of nights, even that's enough to inflame a lot of people, so ...

Another important factor is hormones. And so, on my blog post I talk about having a relatively intact and balanced hormonal milieu and gut function. Those are huge topics and we'll cover those another day in detail, but for now, just know that if your hormones are not in orchestra, they're really an orchestrated event, if they're not in orchestra and your gut function skewed, which many peoples' are, you can end up with a lot more inflammation and pain than you would otherwise. And you can also have an inhibition of ability to regenerate, so if your testosterone's low, if your thyroid's low, if your estrogen's too high in relationship, if your progesterone's low, if your adrenals are tanked out, et cetera, you could really have a very different signaling response, very different pain response, and very different regenerative abilities than if things were sort of working in a moderated ... they don't have to be perfect, again, nobody here is perfect and we're not looking for perfection, but we are looking for things to be somewhat balanced out.

Balanced is an overused word, and I know many of my colleagues are sick of hearing women come in and say, "I need my hormones balanced," but you honestly just feel like crud when your hormones are out of whack. So really, a lot of crud. Men and women. And as we age, I think everybody over the age of 40 should go have their hormones checked out by a good naturopathic physician or functional medicine doctor who has good experience in these things. And just have a look, because more often than not, there's something that can be helped. And often it's thyroid, often it's testosterone, often it's progesterone, adrenals, those are the big ones.

Now, your gut function, that's a huge picture. We can talk about microbiome, again, we're going to cover that in detail on another radio episode. But microbiome is critical for healing, it's critical for inflammation response, it's critical for regeneration, pain, et cetera, so having ... if your gut's really messed up, if you're having a lot of constipation, if you're not using ... if you're not having a bowel movement at least every day, if you're not ... if you're having too much, too robust, and you're having loose stools, gas, bloating, that kind of thing, you're probably looking at some disturbed gut function, meaning your gut microbiome or the organisms that live in your gut are skewed. And that can definitely lead to subpar results and increased pain.

My patients who come in to have their ... well, let's back up a second. I've seen a lot of correlation between irritable bowel syndrome and low back sacroiliac pain. I've just seen it over the last 10 years, I've seen thousands of low backs and I see a high correlation there.

Interestingly, if they come in and their IBS has been flaring on them, their pain is usually ramped up, and the procedure is a lot more uncomfortable than otherwise. So if they can get their gut function under control, meaning, again, working with a good naturopathic physician or functional medicine doctor, if they can get that handled, then ... or at least dialed down in to something that's a little bit more user friendly, so to speak, often their procedure will be a lot more comfortable, their pain will be reduced and they will actually get a better result. That's what I've seen clinically.

A huge, critical component, and this is not negotiable in my practice, is that they be a non smoker. I won't even take smokers in my practice, or tobacco users at this point. I'm not trying to ... I used to be a smoker, I smoked for 10 years, if you can believe it I smoked a pack a day from the time I was 14 years old until I was 24. And I was not joking around about it, I smoked. Sometimes I smoked more than that. I don't know why. I grew up in a family full of smokers and both my parents smoked for a long time, on and off, and I ... I don't know, I did it and I can tell you with absolute conviction, I didn't heal well at all during that time period. A little cut, a bruise, any kind of injury was just really not going to make it. The healing ability that I had was terrible. And I see this in smokers.

One of the reasons is that your capillaries start to die back away from your distal extremities, so meaning your fingertips. Your blood vessels and capillaries start to die away. So you end up with a significantly reduced ability to get blood flow to the area and to get healing. The tiny capillaries surrounding your spine actually start to die away, so the spine actually starts to degenerate at a much faster rate than if the person was a non smoker, because they literally don't have the blood flow to get to the spine to heal it. The arteries and vessels taking blood to the discs start to die away.

So being a smoker is bad news, and it's not just about looking haggard or lung cancer, it's literally about your body degenerating at a significantly reduced rate, and you not having the ability to heal. So imagine ... that's why the skin gets pallor to it when people smoke, you can tell, you can tell when somebody smokes. And just like you can tell when somebody eats copious amounts of vegetables, this is not a judgment by any means, just know that if you're a smoker, your ability to heal up are terrible and if you're dealing with chronic pain, that's probably the first place you should look. Is getting a handle on that. This isn't about nicotine, necessarily. This is just about the act of smoking chronically.

And please don't ask me about marijuana. Because I have no idea, there's no studies on any of that to show. And that people who smoke marijuana are often smoking far less substance than people who are smoking tobacco products, so ... but, I don't know any more than that.

Another important factor is that they have contributing systemic, inflammatory processes or autoimmune disease. That doesn't mean that I won't treat people who have systemic inflammation or autoimmune disease, because I have autoimmune disease and I sometimes have some systemic inflammation because of that autoimmune disease. Autoimmune disease is simply the idea that your body ... your cells are being identified by your immune system as foreign and so they are being attacked. But having a lot of systemic inflammation, having a lot of ... having a robust autoimmune process going on, will really not lead to good results with regenerative injection therapies. This is not something that most any doctor I know screens for that does regenerative injection therapies, but it's worth looking at, it's worth asking the patient about, it's worth knowing. If you don't know that you have that as a patient, you can look at some autoimmune conditions and guess.

I had a patient come in today and she was wondering if she was autoimmune, but she has suffered from a condition called Grave's disease, which is excess thyroid. And Grave's disease is an autoimmune process, so we now know she's on the autoimmune rainbow, systemic inflammation, although she's working with a really great naturopath and so she's getting that handled and that modulated and she's dialing her diet in to get a hold of her pain, so just know if you're dealing with a systemic inflammatory process or autoimmune disease, that could be driving your pain and that may effect clinical outcomes. That doesn't mean you won't get clinical outcomes that are fantastic, but it also means that we could flare you. You could really end up in a flare, it could makes things worse, frozen shoulder is a great example. We could really ramp things up and make the patient uncomfortable. So these are just all factors that change and effect the outcomes.

A condition I will not treat anymore, I have tried repeatedly with many, many different patients, is fibromyalgia. Fibromyalgia is not a condition that is great to have needles put in to you. It can make the patient feel much worse, it can flare the fibromyalgia. Fibromyalgia, if you want to read a great book, David Brady, Dr. David Brady, he is also a chiropractor and a naturopath, he has written a great book called The Fibro Fix, and I'm hoping to get him on the show and interview him about it. Awesome book, he describes fibromyalgia perfectly and simply and gives you great ideas, a lot of which is very similar to the information I share about diet, lifestyle, movement, et cetera, so awesome book. But fibromyalgia patients are not good for prolotherapy. I get a lot of people reaching out to me asking me, "Hey, I have fibromyalgia, would prolotherapy or PRP be helpful?" And the answer, in my opinion, is no. After seeing thousands of patients over the past decade, working with my mentor for a long, long time, the answer, in my opinion, is no.

Also, centralized pain syndrome is another condition that often gets misdiagnosed or missed completely. It's kind of in the same family. Not exactly, but in my head, the way that I see these patients, it's that fibromyalgia, chronic fatigue, centralized pain syndrome picture, not good for getting needles put in them.

Another thing that makes somebody a good candidate is someone who does not take NSAIDs regularly. So patients who are taking the non steroidal anti inflammatory drugs regularly have ... and this is not proven, but we do know how NSAIDs work, we know how they effect soft tissues, and we know how they effect bone. And the bottom line is they're bad news for cartilage and for bone, we know that with certainty, and they're bad news for ligaments. So if people are taking them regularly, that's probably part of the reason that their joints are degenerating more quickly. And this creates a lot of anger for people when I tell them, because they were never told this before, they were never warned about this, the companies that make these drugs make it sound like they're super safe over the counter and you're only told you should be worried about your kidneys or liver depending on which over the counter pain medicine you're using. But, I'm here to tell you that we studies that show that cartilage and bone ... it's so terrible for bones that orthopedic surgeons will tell you not to take it because it will inhibit bone healing, if you've had a fracture. So ...

And in fact, my boyfriend just recently had his distal biceps rupture and he had it tacked down, they drilled a hole through his bone to tack it down and the orthopedic surgeon told him to take ibuprofen because sometimes with this condition you get a little excess overgrowth of bone. And to inhibit that he said to take the ibuprofen. So there you go, proof positive that it actually inhibits bone regeneration, but most people need bone regeneration, right, because most people are walking around osteoporotic. So we don't ... especially thin Caucasian women, seems to be scorn of thin Caucasian women is osteoporosis, like myself, light eyes, pale skin. We need our bones to be strong and so taking NSAIDs regularly is not a great idea. And we do know that it effects cartilage and soft tissues in various ways, so ... taking NSAIDs regularly is kind of ... it's something to definitely look at getting off of and again, working with somebody who knows how to manage pain, who's a functional medicine doctor or naturopathic chiropractor, somebody that can help you with that. Absolutely worth it. But taking 15 ... I'm sorry 1600 milligrams, even 800 milligrams, even 200 milligrams on a daily basis is really bad news for a lot of reasons besides just your bones and your soft tissues. So cardiovascular risk goes way up, meaning heart attack, stroke, that kind of thing. Kidney issues, not good, so ...

Patients who have cancer. I don't treat patients who have cancer or active cancer, they need to be cleared. The reason being, and we don't have any studies to prove this, but if I'm putting something regenerative with growth factors in to their joints, and they have cancer that may have seeded those areas, because cancer likes to metastasize and move, I certainly don't want to throw growth factors at it. This is one of the reasons I have a big concern over the vampire breast lifts, you've heard about this maybe. This treatment where you actually inject the breasts with platelet rich plasma and, or stem cells in order to get that tissue to become more robust and have more heft in the breast tissue, and I just ... it's always sort of put me off because of the regenerative properties of these stem cells and these platelets. I certainly don't, if there's any dormant cancer in there, or if there's even seedlings of cancer, I don't want to give them growth factors. I don't want to give them lighter fluid to pour on the fire. So, just my thoughts there. Again, nothing to prove any of this, but ... and people like to dispute me, and that's fine, I don't need a lot of hateful comments at the end of this, I just ... be leery because we know how growth factors work and putting them near cancer is probably not the best idea.

So, what are some factors that might prevent these treatments from working well? Well I'm going to recap some of these things and some of these just mentioned and others are a bit new. People who do not strength train regularly, and I mentioned earlier why. People who do extensive cardio exercise. A lot of reasons for that, people are who in a chronic cardio kind of picture tend to have a little bit more of a a catabolic hormonal picture going on instead of an anabolic, meaning they're in more of a break down sort of phase instead of a build up sort of phase. People who strength train moderately, not excessively tend to have that more anabolic picture that we're looking for. And there's studies to show all of this. Excess cardio also creates a lot of cortisol and cortisol is a hormone that can wreak havoc in your system but it also can cause wasting and muscle loss. And chronic cardio tends to tank out people's testosterone. So those are all things we don't want happening if we're going to be doing regenerative therapy.

Another reason is that people who do intensive cardio regularly don't want to stop that, of course, none of want to stop the activities we love and to get somebody's hip or knee or foot to regenerate, I've got to take them off of running, or I've got to take them off of chronic cycling. I've got to take them away from the activity that caused it. And I know this. I hurt my hip, I believe dead lifting, and I continued to push through for it for a year and now I'm paying the price and my hip isn't responding as well as I'd like and I can't dead lift. So I know what it feels like not to be able to do the things that you love, and it can make you a bit crazy. But chronic cardio, for a lot of reasons, is not my favorite exercise when it comes to a regenerative milieu in a person.

Someone who has systemic inflammation, on lab work or to the palpation of tissues, meaning somebody who has skill in palpation has palpated you or touched you or felt the region and said, "Well this his very inflamed." Those people don't tend to do well. So I'll get women who come in, and I use women as an example a lot, women between the ages of 45 to 65, tend to be that sort of hormonal shifting phase and they are ... it's like playing Russian Roulette on whether these women will respond well. And it's a tough crowd, that's a though group, I'm in it, I'm walking right in to 45 here, I'm 43 but, I'm almost walking in to that, but that 45 to 65, it really is. It's a crapshoot as to how they're going to respond to treatment. Because often there is systemic inflammation and there's hormonal shifts et cetera. Stress, whathaveyou, but often you can even just palpate it, their knees will be boggy. A boggy knee is probably not the ... well, in fact I've never had a boggy knee respond beautifully to these treatments. Some have done okay. But when someone comes in that's a female, that has puffy tissues, it's not just swelling of the knee joint itself, but actual really puffy tissues, those patients don't tend to do great.

Patients who have fibromyalgia or central pain syndrome, I've already mentioned why. Patients who have an autoimmune condition. That depends on what state they're in, and I talked about that prior, but depending on what state they're in. Are they really, really, really autoimmune and is it kind of out of control and it's not being managed well, or is it really minor and mellow and they're under the care of a good doctor who can help them and they're getting what they need and so ... like, in my case, I'm mildly autoimmune. I used to be a raging autoimmune mess when I was in my younger years, so something to consider there.

Somebody who has hormonal imbalances or unmanaged post menopausal symptoms. This fits right in to that 45 to 65 year old female picture and I see it a lot. When they come in and they're post menopausal and it's unmanaged and it's a mess, it's a mess of hormones, it's a mess of inflammation, it's a mess of pain, they feel like a mess. I am not calling anyone a mess, because I'm talking in to perimenopause and I know what that feeling feels like when your hormones start to get crazy. But they often come in as a mess overall and pain is their driving symptom, and they come to me first, and I simply won't treat them. I send them off to somebody who can help them get that under control, they come back feeling much better, much more stable emotionally and also physically.

And so that's where wen want them, we want them in a managed post menopausal state. Again, not looking for perfect, just looking for somebody who's not going to flare on us or not get good results. Because we don't want to ask somebody to pay cash money for a procedure that isn't going to give them at least some, you know, 20, 30, 40% improvement is what I'm going for. If I can't look at them and know with certainty they're going to get that, then I really don't want to put them through it, I don't think it's fair to the patient, I don't think it's ethical. If we know the cells are not going to signal right, then I think that it's not an ethical decision to treat them.

Someone who regularly consumes sweets, soda, wheat products and other inflammatory foods. Talked about this a little bit already, but when you're eating a lot of sugar and soda's just ... if you're drinking soda and you have pain, you've just got to stop. Whether it's diet ... especially if it's diet soda. Lots of reasons why, but you are not doing yourself any favors by drinking soda. And again, no judgment, I understand, and in fact I think diet soda's probably a bit addictive and really hard to get off of. So, my heart goes out to you, but if it's one thing that you do after listening to this radio show, this podcast, is to cut soda out of your diet, I gave you some time on your life and I did my job, so ... But sweets and soda, wheat products in particular, it's not just gluten, it's how the gluten is grown, it's the glyphosate that's sprayed on almost all gluten, all wheat in this country. Monsanto's Round Up is all over everything and glyphosate has been show to be, especially in recent years, it is a very dangerous chemical and it's on virtually everything. It's in our tampons. I mean, it's everywhere. So, wheat products are inflammatory for various reasons and specifically wheat, but most grains can be quite inflammatory for many people, especially if they have that boggy kind of pain. That boggy kind of joint pain.

And then other inflammatory foods. So, what are some other inflammatory foods? Nightshades come to mind, that's a big one. So a lot of people I know who have arthritis, especially in my parent's generation or before, they know to stay away from nightshade. Dairy can be very inflammatory for people. Dairy in and of itself can cause a lot of pain, specifically, so keep that in mind and that can be any kind of dairy, I've seen that with goat dairy, cow dairy, you name it. Fermented goat dairy. But it's a ... dairy is dairy and I'm sure it's different from different parts of the country and how the cows are raised obviously has everything to do with it, different parts of the world, but dairy overall can drive pain and there's literature to support that. So, cutting dairy out can often by very helpful.

Sweets, I've mentioned, so basically any kind of sugar, but keep in my mind that refined carbohydrates turn in to sugar, alcohol turns in to sugar. These things are carbohydrate heavy and they can turn in to sugar, so it doesn't just have to be directly cane sugar products or high fructose corn syrup sugar products.

And then other inflammatory foods that pop to mind is just alcohol. And that's the next thing on my list is moderate to excess alcohol consumption is really something that will inhibit these treatments from working well. There's a lot of reasons for that. Most notably, alcohol is a poison. And your body handles alcohol just like a poison, so there you have that. I know that alcohol can drive a lot of pain for people. Drinking consistently can cause a lot of pain, so even if it's just a low amount but it's consistent, that low grade inflammation being created in the body can really lead to a lot of joint pain. I experience that firsthand myself, and I've seen that with countless patients.

Wine tends to make joint pain worse. I have no idea why wine in particular but wine seems to ... red wine seems to be a ... a lot of women love red wine, I love red wine, but red wine seems to be a big trigger for people's pain. Certain grain alcohols like whiskey. Whiskey has pretty much zero carbs, not to say that that's okay to be drinking regularly on a low carbohydrate diet because again, it is a poison, but grain alcohols, they are ... the way that they are processed, you end up without the grain in it, so, if you want to get really persnickety, tequila or a potato vodka some people say are maybe better. But I don't have anything to support that. I just know that excess alcohol consumption leads to a lot of inflammation in people, it makes them puffy, it makes them hurt, it makes their joints cranky and crotchety and dried out, so ...

Somebody who is dehydrated chronically, and that is a lot of people, is not a good candidate for these treatments. Chronic dehydration, just in a nutshell, let's look at cartilage for one second. Cartilage is a glycoprotein layer, meaning it's basically a gel. It's a cushioned, proteinaceous gel and that get needs need water. And without water, it's not a gel, it becomes dried out and cracked, so think about a kitchen sponge that you let dry out on your countertop, that's a lot more prone to flaking and crusting and breaking apart than is a nice wet, squishy sponge, right? So the top of your cartilage is slick, almost like when you're making jello and you get that slick layer on top before it hardens. We want that slick. And that slick requires water.

And in fact, studies have shown that cartilage that's degenerating and breaking down will actually break down fast if the patient's chronically dehydrated. So, it's a chicken and egg with that one, but keeping you hydration levels up is something everybody can do, it's simple, it's easy, you just have to remind yourself. There's a fun little app that I found, there's a couple of them actually, where you mark off how many water glasses you've had. A really simple thing to do is buy a 30 ounce bottle, like a hydro flask or a clean canteen or some kind of metal bottle, we don't want plastic, plastic is bad news and I'll talk about that another time. But you take the clean canteen or the metal bottle, 30 ounces, and you fill that up three times over the course of a day. That'll give you roughly 90 ounces, that's an excellent marker point. Not everybody makes it to 90, but that's a great way to do it, so ... having one at home, having one in your desk at work or at work, wherever you are and being sure to fill that up and drink that down.

Again, I've already mentioned somebody who's a smoker is not a great candidate and why. I've mentioned why people who frequently take NSAIDs like Advil, someone who follows a vegan or long term vegetarian diet. Again, not judgment, and I absolutely understand the value of a plant based diet. I also know that if you don't eat collagen, it's difficult to make collagen. You can eat the building blocks to build collagen, but actually ingesting collagen in a collagen supplement form or in a bone broth form can be very helpful of alleviating joint pain and helping us with these regenerative treatments, so ... No judgment, I sometimes can get vegetarian patients on like a cartilage, chick cartilage type supplement in pill form and their pain will significantly reduce.

Especially in the knees. I see a lot of vegetarians with knee pain. And I'm wondering if those are the joints to start to go first for vegetarians. Hips and knees tend to be something that I see, again, I don't know why in particular, but eating collagen can be very helpful. So if you're in to eating collagen, there are a lot of collagen products that are great, I've got some on my website, through the store on my website. Lots of good options there. I really like different forms, so there's pills, there's powders, however you can get it in you. But if you're vegetarian and you are willing to do some kind of collagen supplement, chances are that will start to help your joint pain just alone, by taking it. And then it certainly should help us, theoretically, in getting these treatments to work better.

And then the last thing that will detour will from these treatments working well is obesity. So the patient being overweight. And again this varies and there's no judgment here, but fat is a known inflammatory organ. It's actually it's own organ system and it is a little factory of inflammation, so ... that's not great, that's not going to help anybody with regeneration, it's certainly not going to help with pain. But more importantly, that chronic inflammatory state is catabolic and you start to get muscle wasting from it, so it's a really vicious cycle. We want more skeletal muscle mass, we want more muscle on the body, we try to build it even, we try to lift weights and even build it, we're eating all the right ways, but if we're packing on too much fat on our body, and we've got too much obesity happening, it can be very counter effective. So, really trying to get health body composition in line is critical. And not absolutely necessary, but very helpful.

And my patients who have a health body composition, that doesn't mean you need to be super lean. I don't even believe in being super lean, I used to. I'm not completely convinced that's the best way. I think having a little bit of fat on your body is healthy and that varies from person to person, and obviously men to women. But women need a little bit of fat to have healthy hormones, I believe, and having a little bit of fat on you can be protective, too much can inflammatory, so ...

So while this whole list that I've gone through is very general and I'm not saying if you don't fit the bill that you won't respond well to regenerative therapies, I just want you to have all of the information. I want you to have all the pieces, and a lot of this comes from the scientific literature, and a lot of it comes from my clinical experience, and I've seen a lot of patients, I've injected a lot of patients over the years. I used to take anyone who walked in my door, I've gotten significantly narrowed down to who I will agree to see, only because again, these are cash procedures and I want my patients to get the best clinical outcomes, and I certainly don't want to promise the moon to somebody who I know by looking at them, and looking at their labs, and having a conversation with them and taking their health history, that they're probably not going to do great. I would much rather get them on a program, or to a good doctor who can help them out.

Finding a good naturopath in your area, you can do that by going to www.naturopathic.org. And you can find a naturopath in your area, if you don't have one, you can go to the Institute For Functional Medicine and look for a well trained functional medicine doctor, I think that's a great institution that trains them. And you can find somebody there than can help you who is in your area. If you can't find either, sometimes there are nutritional therapists that will work from long distance and online and I've actually, I'm looking for somebody right now to do that in my practice, but somebody you can work remotely that can help you with some of these things. And their scope is limited but they can be very helpful because the front line of all of this is your diet. And how you eat.

Finding a good strength training coach in your community can also be very helpful to get you on the right track for that. I will tell you, what I say a million times a day, please do not try to learn to lift weights without help. It's a really great way to hurt yourself and I think it's worth every penny, tremendous value in finding a good strength and conditioning coach. You can do that by going to functionalmovementscreen.com, I believe. And then looking up also anybody who's gone through the Strong First Kettle Bell certification is probably worth their weight in gold when it comes to training. At least from a strength and conditioning standpoint, I'm not saying that they have the nutritional and diet stuff handled, that's a whole different beast, find a good nutritional therapist. The Nutritional Therapy Association is a great resource for that, to find somebody that you can work with in your area or remotely. And hopefully that's helpful for you.

So, anyway, I wanted to throw this all out there. I do have actually a couple programs online you can check out. Not trying to push them, but they were designed specifically to help people get themselves dialed in for regenerative injection therapies. The first one is just a 30 day overview of my favorite tips and tricks to really optimize your health well, and that can be found through my website, it's called The Start Somewhere 2017 Challenge and it's really a brilliant 30 day package that ... it's the top 30 things I say to all my patients, my friends, my family, my loved ones, these are the 30 most important things that I could possibly think of after a decade in practice that I know will help optimize your health and wellness. And then if you want to dive deeper, if you want, if you really want more of this and you want to go deeper in to the science, and you want to go deeper in to the facts, then I've got a four week program, it's a four week jumpstart program, and it's an hour's worth of content, plus an exercise and rehabilitative program, and that's called The Pain Free and Strong Program, you can also find that on my website. And both of those are really nice resources and laid out in a very user friendly manner to get you moving in the right direction.

The Pain Free And Strong is all video, webinar format and the Start Somewhere 2017 is written content, video content, it's really ... I tried to do a little bit of everything, because I know people learn different, so check those out on my website, www.drtyna.com, that's D-R-T-Y-N-A. And also there you'll find a ton of free content and a lot of blog posts, podcasts, videos, interviews, lots more to dive deeper in to this if you're interested.

So, I hope you found that helpful. I hope that you take this with you, really own this information if you're looking to get regenerative injection therapies. You can check out my website if you want to come see me, but there's other doctors, you can go to getprolo.com and find regenerative injection therapists in your area. And make sure that you ask them about some of these things. If they poo poo you or sort of blow it off, I wouldn't see them. I wouldn't actually believe that they had your best interests in mind, to be honest, because any good regenerative injection therapist that I know, and I know a lot of them, they really all talk about this. All of these things are important to them as well, in their practice, and they will hopefully get you in the right hands of somebody who can help you. Whether it's themselves, somebody in their practice, or somebody they can refer you to, so once you become their patient. Please don't call their offices and ask them for this information off the bat. Go in, see them as a patient, see what you think and see if these things matter to them, because it really does matter to your clinical outcomes.

So with that, I will say goodbye. Thank you so much for listening. Again, check out my website www.drtyna.com, that's D-R-T-Y-N-A. Check out the podcasts there and check out the free resources and also please check out the programs that I have that are webinar and e-course online formats, I think they'll really help you out.

Thank you so much.


You likely have questions!

I am legally unable to answer individual health questions for non-patients without an online consultation or in-person visit.

Due to the high volume of requests, I am unable to answer individual requests for specific doctor referrals in your area. To find a doctor in your area who offers these therapies, please refer to my PRP 101 Insiders Cheat Sheet and Free Academy.

There is a tremendous amount of information on my website about these therapies, so please have a look around and see if you can’t find answers to your questions there. We have testimonials on every page and even a Research page with supporting studies. Enjoy!


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