Prioritizing Your Best Interests
“When choosing a physician to provide you treatment they need to put your interest ahead of theirs. The procedure is not the endpoint. The endpoint is your wellness” –Steve Mora MD.
When Dr. Mora was a child living in Peru he was struck by a bus and his life was forever changed. The bus mangled and crushed his legs. After surviving complications and many surgeries into his early adulthood Dr. Mora recovered. Recovery was not easy. He had to undergo numerous procedures including bilateral open femur fracture fixation, osteomyelitis treatment, distal femoral osteotomy, tibial tubercle osteotomy for maltracking, multiple knee arthroscopies, lateral release, epiphysiodesis, and femoral leg lengthening. Because of his personal experience as a patient with post-traumatic arthritis, he has been at the forefront of cutting edge Orthopedic Surgery and Regenerative Medicine.
The foundation of successful medical treatment is based on an accurate diagnosis. Your pain can be caused by a multitude of factors. Beware of ‘stem cell injection centers”. Many clinics emphasize a particular procedure rather than understanding why you have pain.
Dr. Mora uses Regenerative Therapies such as PRP and Adult Mesenchymal Stem Cells as an adjunct and not as his only tool for treating pain. He understands that the most important aspect of treating pain is to first understand what is causing the pain (correct diagnosis) and only then can the proper treatment be carried out. He will listen, examine, order appropriate tests, read the MRI and X-Ray images on his own and do the injection.
The Needle Cannot Find What the Mind Does Not Know or Has Never Seen
If you are going to spend money on procedures not covered by your insurance your injection treatment needs to be accurate. The best person to do this is a trained physician ( M.D. or D.O) with residency training. A one week or one month certification course does not accomplish what a 5 year residency program does in terms of learning the anatomy inside and out and understanding what works and what does not work.
Over the last 15 years Dr. Mora has performed thousands of surgical procedures. He knows the anatomy inside and out. He knows what is normal and what is abnormal. Your injection will be done with the accuracy of a surgical procedure.
What are Regenerative Therapies?
Regenerative therapies merge cutting edge medical technology with the body’s natural healing abilities. These minimally invasive options are used chosen for treating sports injuries and arthritic conditions.
Bone Marrow Concentrate
Lipogems Adipose Tissue Transfer
Platelet Rich Plasma (PRP)
Birth Tissues- Umbilical blood, amniotic tissue
Bone Marrow Concentrate (BMC)
Indicated for moderate to severe arthritis and soft tissue injuries requiring high concentrations of cells. Invasive procedure requiring a harvest of bone marrow from pelvis bone.
The procedure involves aspirating bone marrow with a special bone needle. It is a very comfortable and nearly painless procedure. Dr. Mora has perfected a technique which allows this procedure to be performed in his office without general anesthesia. The bone marrow aspiration is filtered and put through multiple centrifugal spins. The laboratory equipment is cutting edge and provides the highest concentration of bone marrow cells possible including adult mesenchymal stem cells. The resulting concentrate is injected into arthritic joints or soft tissue injuries. Additionally the BMC is mixed with platelet rich plasma (PRP) to maximize regenerative potential.
The procedure takes approximately 2 hours from check-in to discharge. Patients go home same day. A ride home is recommended. Dr. Mora performs the procedure from start to finish. No corner is cut. You will not be injected by a nurse or a assistant.
After the BMC all patients will be recommended to participate in a physical therapy program. This will be prescribed after the procedure. Movement and exercise are essential to stimulate a healing response.
Expect improvement within 6 weeks. Positive effects can be greater than one year.
Patients with a history of bone or marrow cancers should not have this procedure done.
Lipogems Adipose Transfer
Cutting edge treatment which utilizes the healing potential of fat and its surrounding cellular matrix . This treatment can be used for all grades of arthritis including severe bone on bone disease. This is an option for patients who have been diagnosed with bone marrow or bone cancers.
Adipose tissue has been shown in clinical research to have a much higher concentration of adult mesenchymal stem cells and regenerative pericytes. I The science behind Lipogems has been studied in detail by Professor Arnold Caplan PhD, from Case Western. He is considered the Father of the Mesenchymal Stem Cell. Search him out on YouTube for more info regarding this highly intriguing science.
The procedure is usually done under IV sedation by an anesthesiologist or alternatively local anesthesia. The sedation is necessary only for the fat harvest. Patients who are interested in “local anesthesia only” can be accommodated. Once the harvest is done the patient can be woken up to watch the painless joint injections.
The entire process also takes about two hours depending on the final injection sites. The patients go home the same day.
Patients who are done under local anesthesia can drive home.
The procedure is scheduled similar to a surgery therefore patients will be scheduled for an appointment after the initial evaluation.
The fat is obtained by first doing a simple fat harvest from the patients belly just under the belly button or the flank. The harvest is similar to a mini liposuction. A small amount of fat is taken and then processed with the Lipogems system by removing non-essential components. The remaining lipoaspirate is injected into the joints or injury site.
After the procedure patients are recommended they limit activity for 2-3 days. They can expect some belly tenderness and some discomfort at the injection sites. Multiple joints can usually be injected. The main limitation is the amount of fat harvested. Patients who have super low fat percentage may not be good candidates.
Platelet Rich Plasma (PRP)
Platelet-Rich Plasma therapy is a revolutionary treatment which uses your body’s own platelets to heal injury and decrease pain from arthritis. Platelets release numerous growth factors including TGF-β1 and PDGF which stimulate mesenchymal cells and collagen production leading to healing of soft tissue injuries and pain reduction. Platelet Derived Growth Factor has a role in activating regenerative cells such as pericytes.
Platelet Rich Plasma are effective for tennis elbow, early arthritis, hamstring tears, elbow tendinitis, partial tears and patella tendinitis.
Platelets are also used to augment surgical repairs.
The PRP is done in the clinical area and in most cases same day as consult. A simple blood draw is performed and the platelets are concentrated harvested and injected.
Patients are recommended to drink plenty of fluids so that the blood draw can be readily performed.
Anti inflammatory medication needs to have been stopped preferably 2 weeks prior.
The PRP injection will be targeted into the areas causing the pain. It is done with the patient fully awake with no sedation. The procedure takes approximately an hour. The patient is usually able to drive home. The body part is rested and iced for the next 24 hours.
2 injections are usually recommended, 4-6 weeks apart.
Better pain outcomes for arthritis can be obtained by adding hyaluronate. The Hyaluronate is a gelatinous substance which helps the PRP remain in the joint for longer periods of time and on its own has shown positive results for the treatment of arthritis.
An MRI is usually recommeded to evaluate arthritic joints prior to the injection. Some patient with arthritic knee pain may need to have loose cartilaginous and meniscus fragments washed out of knee prior to doing PRP or MSC injections. Regenerative injections are not successful in the face of loose bodies or fragments in the joint.
The PRP injection usually takes an hour and is performed on an outpatient bias. Positive effect is experience 3-6 weeks after the injection. In some cases more than one joint can be targeted with one blood draw.
Conditions commonly treated with PRP
Shoulder: Rotator Cuff Tendinitis or partial tears, Rotator Cuff Impingement Syndrome or Bursitis, Bicipital Tendinitis, labrum tears, arthritis, instability
Wrist/Hand: DeQuervaine’s Tenosynovitis, arthritis, other wrist or finger tendinitis, ligament tears or dysfunction of the fingers.
Elbow: Medial and lateral epicondylitis (tennis & golfers elbow)
Hip: IIliotibial Band Tendinitis (ITB Syndrome), Psoas Tendinitis and bursitis, Greater Trochanteric Bursitis, Hip labrum tears, Piriformis Syndrome, arthritis
Knee: Patellar Tendinitis, Patellar Femoral Syndrome, chondromalacia patella, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, arthritis, patellar instability
Ankle/Foot: Achilles Tendinitis, Peroneal Tendinitis, arthritis, recurrent ankle sprains, other foot or ankle tendinitis.
Frequently Asked Questions
What is the difference between Platelet Rich Plasma (PRP) and Adult Stem Mesenchymal Cells?
In general, PRP is appropriate for mild to moderate osteoarthritis or tendon injuries. Bone Marrow Concentrate and Adipose derived cells may be reserved for more challenging cases such as moderate to severe osteoarthritis or when more potent effects are desired. BMC and Adipose derived cells are done if the effects of PRP where a limited or if the degenerative condition is on the moderate to severe side.
Is PRP or Adult Stem Cell Treatment Right for You?
That depends on your diagnosis and the cause of your pain. It is in your best interest to be evaluated by a physician focused on getting your diagnosis correct and then giving you the best options. This usually requires an office visit. Once it is decided that you are a good candidate for this treatment we can do PRP on the same visit. Bone Marrow Concentrate stem cell injections are scheduled on a a different day.
How to prepare for your injection?
Patients should schedule an evaluation to determine if PRP is a viable treatment option. An X-ray, MRI and/or musculoskeletal ultrasound may be done prior to the injection to insure a proper diagnosis. Prior to the procedure, patients are restricted from taking all corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) for a minimum of 2 weeks as these medications inhibit platelet function.
What do I do after the injections?
Patients are encouraged to take multi-vitamins, Glucosamine/chondroitin, !0,000 units of Vit D/day and Turmeric supplements.
Activity modification and icing is recommended for the first 1-3 days.
NSAIDs (Anti inflammatory drugs) such as Advil is stopped 2 weeks before and 6 weeks after. Tylenol may be taken for pain.
Patients who had BMC can expect mild swelling and mild bruising at the pelvis harvest site. Lipogems patients will have belly tenderness for about 3 weeks. Icing will diminish the pain.
You will most likely be given a prescription for physical therapy or physician guided exercises. Some patients experience pain and swelling at the injection site. Activities are slowly re initiated as tolerated.
What Are The Significant Side Effects?
Although uncommon, the risks include those signs/ symptoms associated with an injection including: pain, injection, never injury, skin discoloration calcification, scarring, loss of fat to the affected area and allergic reaction. If you experience any of the above side effects, please contact your doctor.
After the injection, it is expected to experience pain and possibly bruising at the injection site.
Lipogems patients can experience belly tenderness up to 6 weeks.
Bone marrow aspiration can cause a hematoma at the aspiration site.
Who Should Not Have Bone Marrow Concentrate Done?
Bone marrow derived cancer (such as lymphoma), non-bone marrow derived cancer or metastatic disease (should be checked with your oncologist), and active systemic infection are all contra-indications. Blood thinning medications such as Coumadin must be discontinued and managed appropriately by your cardiologist or primary doctor prior to the procedure. Coumadin and Platelet Inhibitor medication will need to be managed by a patient’s cardiologist or internal medicine physician.
Is PRP Or Adult Stem Cell Treatment Covered By Insurance?
At Restore we will optimize utilization of your insurance benefits to cover acceptable services however, the PRP, Adipose Derived Cells (Lipogems), birth tissue and BMC are the patient’s responsibility. Patients are fully responsible for the payment at the time of service. While there are currently several publications in peer-reviewed medical journals showing the positive effects of BMC, LipoGems and PRP therapy they are still considered investigational and not covered by insurance. These treatments are rarely included within the Worker’s Compensation Medical Treatment Guidelines.