“Blood” (PRP) Versus “Gel” (Hyaluronic Acid) Injections: How to Choose
/The two most popular and common injections we offer patients for knee osteoarthritis are platelet-rich plasma (PRP), utilizing a patient’s own blood, and hyaluronic acid injections, commonly known as the gel, rooster comb, or viscosupplement injections.
Let’s compare the two and discuss pros and cons of each:
Both would be considered “natural“ injections with PRP obviously coming from your own blood and hyaluronic acid is a substance already in your joint, but depleted in joints that have osteoarthritis.
We often describe PRP as that big 100,000 mile service you do on your car, and hyaluronic injections are more like the oil change. Thus, PRP is more comprehensive.
PRP Injections
PROS
-most effective long-term injection we offer patients. Benefits typically seen for 6–24 months, and then PRP can then be safely repeated when necessary.
-very likely disease–modifying, meaning we are stopping or slowing the deterioration of cartilage in the knee. These give patients the greatest opportunity to either delay or avoid knee replacement.
-other than weight loss, probably the best long-term medical and financial nonsurgical investment in the health of your knee.
CONS
-not covered by insurance. See our blog regarding this here
-works gradually, with greatest benefit likely seen 4-6 months after the injections.
-anti-inflammatories of any type as well as blood thinners need to be stopped before and after the PRP procedure for a specific period of time.
Hyaluronic acid Injections
PROS
-authorized by most insurance plans, meaning the cost of these is fully covered, partially covered, or can be applied towards your deductible.
-excellent safety profile.
-the majority of patients see a benefit, often for 4 to 12 months.
-like PRP, injections are not particularly painful when given into the knee joint under ultrasound guidance and only require a few days of rest afterwards.
CONS
-may have an indirect benefit on the long-term health of the knee joint, but are not considered “disease–modifying” like PRP.
-benefits of pain and swelling reduction along with functional improvements do not last as long as PRP.
-although they work a bit more rapidly than PRP injections, typically it takes 6 to 8 weeks after the final injection to see the greatest benefit.
-most brands require a series of 3–4 total injections, given one per week.
Want to know more about PRP?
Learn about the key details of PRP here
How is PRP simple and not-so-simple? Read here
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
PRP For Knee Pain: Almost A No-Brainer
/Knee pain is often caused by a meniscus tear, osteoarthritis, patellar tendinopathy, low-grade ACL or MCL sprain or some combination of these.
Don’t want surgery, don’t need surgery or already had surgery with a less than satisfactory outcome?
Platelet rich plasma (PRP) has been a star in the world of orthopedics, particularly as it pertains to knee conditions.
Once considered experimental, this innovative, minimally-invasive treatment using your own blood and concentrated growth factors is now is becoming a standard-of-care treatment for many knee conditions.
Over 45 studies have demonstrated clinically significant benefit in the treatment of knee osteoarthritis (OA). The overwhelming majority of studies demonstrate that PRP is more effective in the long-term when compared to steroid or hyaluronic acid injections for knee OA.
Want something safe, natural, effective, and a disease-modifying intervention that will relieve pain, improve function, provide stability and/or healing for tissues that can be done in the office? Then PRP can be a great option for you.
I've been giving ultrasound-guided PRP injections for 15 years. I’ve spent countless hours on the educational process, training and fine-tuning of techniques to make this a excellent option for our patients. I’ve been a patient myself, receiving PRP for shoulder and knee conditions and I've experienced the success firsthand.
Want to know more about PRP?
Learn about the key details of PRP here
How is PRP simple and not-so-simple? Read here
If you think you may be a candidate or want to discuss further, then
come see us. We are always happy to help!
F. Clarke Holmes, M.D.
Orthopedic Injections: What Not To Do
/Injections are one of the most commonly used interventions in an orthopedic practice. Yet, where, how and what is injected is of vital importance, and certain approaches are just not in the best interest of the patient. Here are injections we prefer you avoid:
1) Injections for musculoskeletal conditions given in a chiropractic or primary care office. Both chiropractors, chiropractic mid-levels (NPs and PAs) along with PCPs all often do a great job in their respective specialties. However, giving injections optimally is just not in their wheelhouse. Therefore, if an injection is needed or suggested, then seek the expertise of an orthopedic specialist.
2) Receive a series of steroid injections for soft tissue conditions, such as plantar fasciitis, tennis/golfer’s elbow or gluteal tendinopathy (often mislabeled as “hip bursitis”). We often use the statement, “better in the short term, worse in the long-term.” This really applies to situations when multiple steroid injections are given in a short period of time, as they ultimately can lead to further breakdown and tearing of these tendons/fascia.
3) Receive a steroid injection for Achilles, patellar or quadriceps tendon problems. These tendons are much higher risk for rupture, especially if exposed to a steroid injection. If anyone suggests a steroid for one of these conditions, then RUN (figuratively)!
4) Pay top dollar for an orthobiologic injection such as platelet-rich plasma (PRP) without ultrasound guidance. It’s your choice to have this injection if it’s non-guided but just realize that accuracy is so important with this type of injection. There is no way to ensure the solution is making it to the intended area without ultrasound.
5) Receive “stem cell” injections that do not come from your own tissue. If a stem cell injection is being suggested, it should be derived from your bone marrow or your adipose (fat) tissue. Most of these products "ordered for you” do not actually contain any live stem cells, and at this point, are not approved by the FDA for usage in musculoskeletal conditions.
As always, let us know if we can help you!
F. Clarke Holmes, M.D.
PRP: The Details Matter. Give Us 3 Minutes
/More practices than ever are offering platelet-rich plasma (PRP) injections to their patients, especially those with osteoarthritis, tennis and golfer’s elbow, partial rotator cuff tears, Achilles and patellar tendonopathy and plantar fasciitis, just to name a few.
We often say, “not all PRP is the same.” There are so many details that go into the success rate of the injections. On that subject, how do you define success? Less pain, better function, healing of damaged tissue and/or the slowing of the deterioration of cartilage, especially in osteoarthritis. PRP can truly be a disease-modifying treatment, not just something to make you temporarily feel better.
Now, what details really matter?
Experience of the physician: how long has he/she been giving PRP injections
Accuracy of the injection: ultrasound-guidance is paramount
Amount of blood used to produce the PRP: we’ve learned that a higher volume of blood is likely necessary to produce the optimal number of platelets
Creation of the PRP: constructing the optimal amount of PRP to inject for each condition. Creating a mixture either rich in leukocytes (white blood cells) or poor in leukocytes
Providing the best recommendations regarding what medications and supplements should be temporarily stopped before and after the injections
Providing the best recommendations regarding restrictions (use of a boot, crutches, bracing, type of rest) after the PRP
Deciding upon the optimal number and frequency of injections to give
Working with a physician who is frequently involved in medical education on the topic of orthobiologic injections, including PRP
Working with a physician who is transparent and communicative regarding outcomes, expectations and cost
If truth be told, only a few physicians in Middle Tennessee implement all of these details when it comes to PRP injections.
So, if you think you are candidate for this very natural, quite effective, and minimally-invasive treatment, then come see us!
F. Clarke Holmes, M.D.
Do I Need a Knee Replacement?
/Your 55 year-old knee is hurting and your brain immediately asks the question, “Do I need a knee replacement?”
An x-ray demonstrates moderate to severe osteoarthritis and thus, it’s time for a knee replacement, right? Not necessarily. It’s amazing how many patients have severe findings on their x-rays but minimal to mild pain and excellent function. Therefore, we always say, “Treat the patient, not the x-ray.”
Ok, now your pain has been running 5-7 out of 10 for weeks to months. Therefore, it’s time for a knee replacement, right? Well, pain is certainly a factor in this decision; however, we have many nonsurgical tools in the toolbox that will reduce or eliminate pain for extended periods of time.
Finally, you’ve been episodically limping now for several weeks. You suppose it’s time for a replacement, right? Persistent dysfunction is another reason to have a knee replacement, but function can often be significantly improved without the need for surgery.
To overcome the symptoms and dysfunction of knee arthritis, three factors can be addressed: the environment, the biomechanics and the structure. Only surgery can change the structure, yet significant improvements in the environment and biomechanics can often delay or eliminate the need for knee replacement.
How do we do this? The environment is best changed by injections such as platelet-rich plasma, an anti-inflammatory pattern of eating, supplements and occasionally medications.
The biomechanics can be improved through physical therapy, certain forms of exercise, bracing and changes in footwear.
So in summary, knee replacement can be the right option for many patients and produce successful outcomes in most patients, yet in 80-90% of the patients that walk (or limp) into our office, nonsurgical treatment will be quite effective.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
When It Comes to Osteoarthritis, PRP is the Winner!
/Although platelet-rich plasma (PRP) injections remain innovative and the science behind and techniques when using them are evolving, they are trending towards the injection of choice, especially in the case of osteoarthritis. Once considered “experimental,” there are now at least 45 studies validating the success of PRP in the treatment of knee osteoarthritis. So simply put, why would you choose PRP over a steroid injection or hyaluronic acid for knee osteoarthritis?
-Safer and more natural
-Longer-lasting relief of pain with often 6 months to 2 years of benefit for knee OA
-Most likely PRP is disease-modifying, meaning it is slowing the deterioration of cartilage in your knee
How about a study or two demonstrating these points made above:
PRP and Knee OA- Article 1
PRP and Knee OA- Article 2
Want to know more? Here are a couple of our previous blogs on the topic:
https://www.impactsportsnashville.com/blog/2024/2/16/7826kg4vvyebmp8bt2aph72i704hmc
https://www.impactsportsnashville.com/blog/2023/6/17/insurance-companies-say-prp-is-experimentalwe-sigh
As always, we are here to help! Let us know if we can be of assistance to you.
F. Clarke Holmes, M.D.
Proactive Versus Reactive: Which One Are You Choosing?
/We strongly encourage our patients to be proactive with their musculoskeletal health over just being reactive.
Let’s list some examples of the two different approaches:
Proactive
You’re trying to remain in great shape, yet your knee is starting to ache due to mild osteoarthritis. No surgery is necessary, but you want to do something that not only reduces symptoms, but also protects the knee in the long term that is likely disease-modifying. Thus, a series of platelet rich plasma (PRP) injections will meet those goals. PRP injections are one of the best treatment options for the management of osteoarthritis.
You’re starting to have heel pain when you first get out of bed. You suspect plantar fasciitis. Instead of ignoring the symptoms or simply relying on Dr. Google, you decide to consult with a sports medicine physician, so a comprehensive diagnostic and treatment plan can be constructed and customize for you. You realize an inexpensive ultrasound in the office can confirm this diagnosis, determine severity and help with prognosis. At that visit, you’ll be given numerous treatment options and successfully guided on your ability to continue exercising to maintain good health.
You have daily aches and pains, early arthritis and stiffness, but really don’t want to go on daily medications to manage the symptoms. However, you need some help making lifestyle choices as a pertains to diet, supplements and exercise choices. You understand that friends, family, and the Internet are not the optimal resources. Therefore, you decide to move forward with a physician consult so you may receive advice in great detail regarding the best supplements to choose for your particular situation, how to approach exercise and dietary choices. You understand that it is your physician’s to help you decide between what is fact and what is myth.
Reactive
Your heel starts to hurt after some longer walks, especially when you first get out of bed. You talk to friends who recommend rolling the heel, stretching the toes and obtaining non-customized orthotics. You continue to walk, but three months later your heel pain is worse and you limp into the doctor’s office wondering what happened. Bottom line, you now have advanced plantar fasciitis. Unfortunately, the advice you’ve received from well-intentioned others has not been the best for you. Presenting to the doctor when the symptoms first developed would’ve given you a much better outcome, as an entirely different set of treatment options would have been suggested.
Your arthritic knee starts to hurt and you see a bit of swelling, but you decide to keep going to the gym, rubbing Biofreeze on it and you add in some heavy yardwork over several weekends, Ultimately, you can barely bend your very swollen knee, and you’re thinking about canceling that trip to see grandkids. Of course, we are here to help you, but we could’ve avoided this major flare if we would have proactively started some treatment as soon as your knee started to ache.
So we ask the question: are you going to be proactive or reactive? Not every little ache or pain that last hours to a few days should prompt a visit to the doctor. However, do not ignore symptoms and instead, do realize that early treatment usually provides better outcomes than waiting until symptoms rise to a moderate or severe level.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
Our 5 Best Pieces of Advice for You
/Some specialty medical practices see you as a “knee,” an “ankle,” a “hip replacement,” or “that person with too many aches and pains.” At Impact, we see you as a whole person. We see you from head to toe and do our best to advise you on long-term lifestyle choices to keep you, your joints and soft tissues as healthy as possible.
Here are our current 5 best pieces of advice for you:
1) Use food to your advantage, not as a detriment: many think only of food as calories, but instead, let food be nutrition…something that can nourish your body. Choose wisely with lean meats, some plant-based protein sources, numerous fruits and vegetables and healthy fats. Really limit fried foods, fast foods, processed foods, foods high in sugars and artificial sweeteners. Don’t forget about healthy beverage choices: more water than anything, adding green tea or black coffee but keep soda and alcohol very much in moderation. Why is this important? Proper nutrition allows for healing and recovery. Poor food and beverage choices lead to more inflammation and pain.
2) Being at a healthy weight is very important for your joints and soft tissues: every 1 pound someone is overweight equals 4 pounds of extra force going through his/her lower body joints. On the positive side, you lose 10 pounds, you have 40 fewer pounds of force on your knees and other joints. Osteoarthritis of the hips and knees, plantar fasciitis and insertional Achilles tendonitis are the most common conditions we see in overweight individuals.
3) Make cost-effective medical decisions: did you know that seeing a physician employed by a hospital or one associated with a larger group practice is more expensive than seeing a physician in a smaller private practice? Why is this? It is because insurance companies and these larger organizations have negotiated higher reimbursement rates. Is this based on a higher quality care? Absolutely not! It’s just the behind-the-scenes business of medical economics, and not many patients are aware of this. An office visit at “Hospital/Large Practice X” may cost you $300. A similar and possibly even more comprehensive visit at our practice may cost you $200.
4) Stay moving, as “motion is lotion”: whether your knee or low back hurts, or you are just stiff quite often, staying mobile will help your musculoskeletal system. Don’t sit for too long. Don’t keep your hips, knees or spine in one position for too long. Set a goal for a certain number of steps each day, even if you are not classifying this as formal exercise. Walk while you talk on the phone. Choose an adjustable or standing desk if possible.
5) Find your sweet spot when it comes to exercise and activity: perhaps 2 miles of walking is too much for your arthritic knee, but 1.5 miles feels good, both during and after the walk. 25 minutes of the bike is great, 30 minutes creates pain. 2 sets of bench press with 30 pound dumbbells feels right, but 3 sets with 40 pounds causes shoulder pain. “Sweet spot” exercise is essential, especially for us middle-agers and older.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
PRP: The Simple and Not So Simple
/Many of you are either very familiar or somewhat familiar with platelet-rich plasma injections commonly known as PRP. These are great options for osteoarthritis of a joint, a chronic tendon problem as well as some ligament and fascia problems. Our top conditions treated with PRP include knee osteoarthritis, tennis & golfers’ elbow, plantar fasciitis, rotator cuff tears and Achilles tendon conditions.
When it comes to PRP, here are the simple and not so simple :
Simple
-This is an office procedure, that from start to finish, only takes 45 minutes or less
-A simple blood draw from an arm vein is typically painless
-For a joint injection, pain afterwards is typically very mild
-Risks are exceedingly low as abnormal bleeding, infection, a blood clot or nerve damage are basically nonexistent.
Not So Simple
-We have been performing PRP injections for nearly 15 years. Literally hundreds of hours have been poured into training and fine-tuning the knowledge and skill set it takes to be highly competent to perform this procedure
-Some of our patients have very small veins. Fortunately, we have developed a skill set of ultrasound-guided venipuncture, making blood draws much more successful and less painful on those more challenging patients
-Ultrasound guidance, in our opinion, is a must when giving PRP injections. If you want these growth factor rich platelets to make it to the intended location with great accuracy, then ultrasound guidance is necessary. This is a skill set we have developed over the past 16 years
-With some soft tissue PRP injections, such as partial tears of tendons, we have to prepare our patients that there will be a spike in pain after the procedure, often for one to two weeks. Fortunately, the pain is typically not as significant as it would be if you had a surgery
-Finally, patients have to be patient! PRP exerts its positive effects very gradually. Most patients are seeing a benefit within one to two months, and the maximum benefit often is seen between 6 and 12 months. Thus, we have to advise our patients that with many orthopedic conditions, there is no “quick fix”
Ultimately, PRP can be simple and not so simple, depending on your perspective. Generally speaking, we leave the simple part up to the patient, and we will handle the not so simple aspects of the procedure.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
I Have Knee Arthritis. Can I Still Run?
/The answer is, “yes,” “maybe” or “no.” Thus, it really depends on your situation, and fortunately, a period of relative rest may only need to be temporary.
Here’s the really good news: several recent studies have indicated that running a reasonable number of miles does not cause knee osteoarthritis and may actually have a protective effect.
If you are a runner and your knee is symptomatic, then our role is to help you reduce or eliminate your symptoms and safely return to running. We know that running has numerous health benefits, not only including protection of the joints, but also calorie burning, weight control, improvement of cardiovascular health and many mental health benefits.
As a patient though, it’s sometimes difficult to know when you need to stop running for a while, what’s a reasonable amount of running for your body and what treatment options may be available to not only reduce your symptoms, but also to protect your knees on a long-term basis.
That’s where we come in! We love treating runners and understand how you think. We typically focus on a nonsurgical and minimally-invasive approach to your care.
Physical therapy, bracing, footwear changes, custom orthotics, medications, supplements, and various injections can all play a role in the treatment of knee osteoarthritis. One of the best long-term treatment options, especially for those with mild to moderate osteoarthritis, would be platelet plasma (PRP) injections. These can have a very protective effect for the knee, and not only by reducing symptoms, but also by slowing or stopping the deterioration of the cartilage within the joint. Only a couple weeks of rest are typically required after these PRP injections.
Check out a few blogs on PRP as well as running as it relates to knee osteoarthritis:
https://www.impactsportsnashville.com/blog/2023/8/5/our-top-5-treatments-for-knee-oa
https://www.impactsportsnashville.com/blog/2023/5/12/five-keys-to-successful-outcomes-with-prp-injections
https://pubmed.ncbi.nlm.nih.gov/36875337/
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
I Don't Want Surgery But What Else Can I Do?
/Fortunately, 90% of problems that come into an orthopedic clinic do not require surgery.
Approximately 80% of those conditions treated nonsurgically can be treated with traditional treatment measures: rest, activity modification, physical therapy, medications, supplements, lifestyle changes, brace, splint, a boot walker, steroid injection, etc. This is “bread and butter“ treatment administered by an orthopedic/sports medicine physician.
Now, what about that last 20% of non-surgical treatment? That’s often where we have to think “outside the box.” Let’s say in the case of osteoarthritis and tendon problems, that’s where treatment like platelet-rich plasma (PRP) injections can be very helpful. For example, in the case of knee osteoarthritis, how would you like to have less pain, less stiffness, less swelling and better function? What if we could accomplish that with a treatment that is minimally-invasive, safe, proven and natural? As a bonus, this treatment has preventative benefits, meaning we likely are slowing down the cartilage breakdown in your knee. These are the benefits seen with PRP injections.
In the case of tendon or fascia problem like a rotator cuff partial tear, tennis or golfer’s elbow or plantar fasciitis, PRP is designed to be a healing agent. We are using these growth-factor rich injections to accomplish healing, not just make you feel better like a steroid injection might.
Check out a few of our previous blogs, and let us know if we can help you!
https://www.impactsportsnashville.com/blog/2023/12/8/prp-the-gift-of-health
https://www.impactsportsnashville.com/blog/2023/9/23/5-things-you-have-to-know-if-you-have-knee-pain
https://www.impactsportsnashville.com/blog/2023/8/5/our-top-5-treatments-for-knee-oa
F. Clarke Holmes, M.D.
Why Me? Why So Many Tendon Problems?
/If you are 40 years old or above, it’s probably not “if” but “when” you are going to have a tendon problem. Tendons connect our muscles to bones, but as we age, they become problematic. Common tendon problems include/involve the rotator cuff, tennis and golfer’s elbow, Achilles tendon, posterior tibialis tendon and then the plantar fascia, which behaves like a tendon but technically is a ligament.
Thus, these conditions are usually a disease of the middle-aged and older. What are the causative factors for what we call tendonopathy?
-acute injury to the tendon
-overuse activities
-genetics
-inflammation
-diet
-biomechanics
-weight
So, to treat tendonopathy, we have to address these factors with genetics being an exception, as this can’t be changed.
Thus. we have to modify activities, either temporarily or permanently, especially avoiding overuse situations.
We want to reduce inflammation, and this can be achieved multiple ways: medications, steroid injections, supplements and an improved diet can all play a role. Medications and steroids can be very helpful in the short term but are not always a long-term solution. Platelet-rich plasma injections can be a great option to promote long-term management of inflammation and the actual healing of a tendon.
Biomechanics are often improved through changes in movement patterns, improved flexibility and strengthening. At times, footwear changes and orthotics can play a role as well.
As we often preach, early treatment of a tendon problem usually produces better outcomes than late treatment, but either way, we’ve got you covered. Don’t be discouraged if you have one or more tendon problems, knock on our door and we’ll be more than happy to share our expertise!
F. Clarke Holmes, M.D.
PRP: The Gift of Health
/As we near the major holiday gift-giving season of the year, consider one the best gifts you can give to yourself: the gift of health! Platelet-Rich Plasma (PRP) injections are a great option for you in 2024 if you are looking to boost your orthopedic health and longevity. Here are 5 great adjectives that apply to PRP injections:
1) Safe: adverse effects and complications associated with PRP injections are exceedingly rare.
2) Effective: 80-90% of our patients that receive PRP injections have very good outcomes and are satisfied with their results.
3) Natural: these injections use your blood, specifically your platelets and your growth factors to exert their positive effects.
4) Proven: once considered experimental, there are now hundreds of studies that demonstrate clinical benefit with PRP injections.
5) Preventative: PRP injections are touted in their ability to prevent many degenerative joint and soft conditions from further deterioration.
Want to know more? Check out some of our blogs:
Insurance Companies Say PRP Is Experimental…We Sigh — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)
Five Keys to Successful Outcomes with PRP Injections — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)
PRP And The Three "Es" — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
Three Roadblocks to Your Health: Time, Fear and Money
/
Time: we’re all so busy, at least we think we are. Let’s be real, going to see the doctor does take time. Driving, parking, filling out forms, waiting, talking, testing and deciding. The average visit from start to finish. meaning door-to-door is in the range of 2 to 3 hours. Yet, that 2 to 3 hours could be the difference in you getting a diagnosis, relieving anxiety, feeling better, promoting better function and doing something that can help your body long-term. Are you willing to binge watch a show for 2 to 3 hours? Are you willing to go to dinner for 2 to 3 hours? Are you willing to surf social media and watch videos for 2 to 3 hours? Are you willing to go to the mall for 2 to 3 hours? Are you willing to go to the gym for 2 to 3 hours? If the answer to these questions is “yes,” then you definitely have time for a doctor’s visit.
Fear: so many patients skip that doctor’s visit because of fear of a frightening diagnosis, a recommendation that surgery is necessary or because of potential expenses that come with that visit and subsequent treatment. Here’s the good news: often that fear fades away once you get into the doctor’s office and actually are able to learn why you have certain symptoms and then are able to develop a plan of action. I’ve seen it for decades, as many patients, even when given news that they did not want to hear, find a sense of relief. Frequently though, we are able to provide good news and reassurance, calming the patient’s fears. In a nutshell, fear of the unknown is often much greater than the fear of the known. More good news here… 95% of patients that present to our office do not require surgery!
Money: sometimes the most expensive course of medical treatment is the one that was developed late in the game. Meaning, if a patient would have sought treatment earlier, a much less expensive plan of action could have been developed. There is no greater investment than the one in your health. We are all willing to spend money on trips, hobbies, clothes, restaurants, cars, etc. While all these can have value, they don’t hold a candle when compared to your health. So, make sure that you are budgeting enough money to pay for your necessary healthcare. Finally, when making financial decisions about your health, attempt to think long-term, not just short-term.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
Five Financial "Must Knows" Relating To Your Healthcare
/Not too long ago, it was considered taboo for physicians to discuss money issues with patients. Now, it’s irresponsible not to do so. Therefore, let me share 5 quick considerations pertaining to the blending of your finances and your healthcare:
You must save additional money for your healthcare. Deductibles are rising, fewer procedures are being covered and overall, all costs in healthcare are rising. You can’t just save enough money to pay your insurance premium each month. You must plan with an additional reserve.
A Health Savings Account (HSA) is a great tool to have. Either you can contribute to this periodically and use it for your out-of-pocket medical expenses as they arise, or you can choose to invest this money in your HSA account and allow it grow to tax free while saving it for later. Either way, your contributions are tax deductible.
Insurance companies’ mantra: “Deny, Deny, Deny.” We are seeing more procedures and valuable interventions such as MRIs, physical therapy visits and certain injections get denied by insurance. Now, some of these can eventually get approved, but not without a lot of extra work put in by the physician and his/her office staff. Insurance denials are a cost-containment measure for these for-profit companies. There’s nothing wrong with being a for-profit business, but you have to realize this as you approach your relationship with your insurance company.
Some of the best procedures in orthopedics are not covered by insurance. This includes innovative procedures such as PRP injections and certain surgeries. Insurance companies are often slow to catch-up with the latest and most effective treatments in medicine.
Except for those with Medicare and Medicaid, we really need to consider insurance coverage as “catastrophic” medical coverage. Meaning, we have insurance to help cover the majority of the expenses in the event of a major surgery, a hospitalization or cancer treatment as examples.
In summary, we have to shift our thinking regarding how we budget for our current and future healthcare. I want all of us to receive the best medical care possible. To do that, we have to be prepared financially.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
5 Things You Have to Know If You Have Knee Pain
/1. Three factors play a role in knee pain: structural, biomechanical and environmental. Structural means damage, biomechanical means abnormal tracking or loading within a joint or tendon because of misalignment, weakness, and/or inflexibility. Environmental typically means inflammation within the joint or tendon. When formulating a treatment plan for you, we typically want to address one or two of these factors initially. Unless you have major damage, we’re normally not treating structure initially, as that results in a surgery.
2. Age often plays a role in these different factors: in the absence of injury, in patients under 20 years of age, the problem tends to be biomechanical. In patients ages 20 to 40, the problem tends to be biomechanical and inflammatory. In patients older than 40, structural, biomechanical and inflammatory are typically all playing a role.
3. Being proactive in the care of your knee problem usually produces better outcomes than being reactive. This means integrating treatments early on and not waiting until you have major pain or disability to see a physician. We term this “PIO,” Proactive Interventional Orthopedics.
4. Meniscus tears are commonly found on MRIs and may or may not be a source of pain. For decades, the trend was to treat these surgically, typically arthroscopically, removing the torn piece of meniscus. There’s now a trend towards repairing the meniscus tear when possible, but only about 10% can be successfully repaired. Thus, surgery for meniscus tears, especially those age 40 and above, is falling out of favor. On occasion, surgery is the better choice, but treating these initially nonsurgically is usually the best way to start. We often tell patients “a little torn meniscus is better than less meniscus,” especially long term. Less meniscus often equals greater arthritis.
5. Three types of injections can be used for most knee problems: steroid, hyaluronic acid, and orthobiologics. Orthobiologics include platelet-rich plasma (PRP) and stem cell injections. Each of these injections can be reasonably good choices, but for long-term success, PRP is likely your best option in terms of producing favorable outcomes, modifying the disease process, and these are often the most cost-effective option. Stay away from “stem cell” injections that are ordered by physician’s or chiropractic offices and do not come from you own bone marrow or fat. These are often being used inappropriately, and patients are charged exorbitant amounts of money to have these injections.
As always, let us know if we can be of assistance to you!
F. Clarke Holmes, M.D.
You Turned 50 and Now Have Pain. You Are Not Alone!
/Yes, so many of our patients reach the harsh reality that their body doesn’t feel “normal” when they reach those glorious middle ages. For many, this can be a lonely feeling, as they feel like they are unique with their aches and pains. Well, we are here to tell you, you’re not unique, and you’re not alone. And that’s a good thing.
Although there is a reality check that has to occur with an understanding that those aches and pains will often be there, that doesn’t mean that you have to “give in” to these. Some of these conditions can be effectively cured while others can be managed to the point where symptoms are mild, tolerable and do not significantly inhibit you. The good news is that the large majority of these conditions do not need surgery. More than ever, we have a large number of tools in the toolbox to manage chronic tendon problems, arthritis as well as ongoing strains and sprains.
Don’t just rely on “Dr. Google” for your health care. We can provide cost-effective, but very sound advice and treatment interventions to help you feel better, function better and have a greater quality of life.
Typically, when a patient presents with a pain or injury, we will cover all of these aspects of care:
what forms of exercise can still be utilized
what “relative rest” looks like for you
appropriate use of medication
supplements that may benefit you
the potential for physical therapy or a rehab program
various types of injections that may help manage or overcome your condition
lifestyle modifications including weight loss, improvement in ergonomics & sleep habits and stress reduction
only surgery if we feel it is absolutely necessary