PRP vs. Stem Cells: Dr. Aneesh Garg, DO, CAQ on Which One You Actually Need

Transcript

Speaker labels are inferred from the caption export’s turn markers (a short question is Nicole, the practice manager; the rest is Dr. Garg).

Hook: Should I get PRP or stem cells? It depends 0:04

Dr. Garg: Welcome to the Regen Doc podcast powered by DynamicAthlete.com. I’m your host Dr. Aneesh Garg. I’m Yale trained, Andrews trained, and a two sport US national team doctor here to help you make sense of regenerative medicine. Stem cells versus PRP. Which one do you actually need? Every patient asks me, “Should I get PRP or stem cells?” And here’s my honest answer. It it depends. And anyone telling you that you should always do this versus doing that maybe isn’t getting to the heart of the problem there. And this is what we’re going to break down. Let’s get into it.

Where they come from: peripheral blood vs bone marrow (BMA) and adipose (MFAT) 0:45

Dr. Garg: What’s the actual difference between PRP and stem cells? When you look at PRP the versus stem cells, the first big difference is where they’re coming from. The platelet-rich plasma. So PRP is taken from your peripheral blood. So think about when somebody takes blood for labs or you’re donating blood, they usually take it from your elbow, right? The inside of your elbow. And that’s where you take the blood and hyperconcentrate it and get platelet-rich plasma. Stem cells on the other hand generally there are two routes here. One is from your pelvis typically where they take the bone marrow and use that and the stem cells in the bone marrow and use that. The other option is lipos suction where we take adipose fat from your body. Typically we take it from the flanks so the sides of the the back where we’ll take some of the adipose and there’s significant amount of stem cells that are in there and and so those are the two differences in terms of PRP comes from the peripheral blood sign absolutely less invasive if you will versus bone marrow aspirate or micro fragmented atapost

Potency: stem cells are stronger, and why that isn’t the whole answer 2:21

tissue or we call bone marrow BMA or MFAT, right? There are some places that concentrate the bone marrow and you’ll hear the term BMA, right? And that’s a whole separate discussion on why we do bone marrow aspirate versus concentrate and you know when you concentrate you’re losing some of the things that are involved in it. So there that’s a whole different discussion. So that’s the that’s the big difference from how you harvest it. The second part of it is the potency. Stem cells are inherently stronger than PRP, hands down. And if we talk about in a vacuum where time and money and tissue pathology or whatever your injury, they’re they’re not really the factor. If you ask me which one PRP versus stem cell, I would pick the stem cell 100 times because it’s a more potent mechanism. But that’s not always the case, right? And there’s a lot of times where where money’s a factor, the tissue pathology is a factor, somebody doesn’t want to have an invasive component, they may not have enough atapost to take and there’s a lot of different factors that come into it. So I think that’s where the gap here is that understanding when to use which one and why. So I think people hear well I just want to get stem cells. I just want to get stem cells. And I think the other thing too the gap here is where is this coming from your own body or is this coming from an outside source? And I think that there’s a lot to to be said about getting it from your own body. So we we only do autotogus meaning it’s coming from your own body stem cells and we don’t do any sort of other type of either umbilical or placental or some somebody’s talking about Warren’s jail all this stuff. No, we take it from you and we inject it the same day back into you and our success rate is over 90%. which is a monster number in the world of regenerative medicine, right? In terms of what we do in totality in how we take care of people,

More expensive, so it must be better? Overkill and the family test 4:42

Nicole: stem cells are more expensive, so they must be better, right?

Dr. Garg: Yeah. I don’t I I talked about this where I think the expense component is just in terms of the the more work and invasiveness that these are. We have to go harvest these stem cells. We don’t, nobody ever says we’re going to go harvest PRP, right? There’s still work to be done on both sides. I think the component of why they’re more expensive is inherently the technical challenge more so when you’re doing the stem cells along with the intricacies that go along with that. Stem cells generally are used for bigger injuries. A lot of times somebody will come in and ask and say, “Well, what about stem cells here?” And I tell them, “I don’t think we need them.” I think we can go the less invasive route here. We can go the less financially costly route here. And I think you’re going to do fine. I think the stem cells might be overkill. you know, there’s there was somebody that wanted to get it and I said, “We’ll do it if you want to do it. I just, you know, if you’re in my family, I don’t I would tell you I don’t think you need it here.” Could I be wrong? Sure. But having seen a lot of these, you try to make the best call that you can make. And for me, it’s about finding out what the problem is, the the true diagnosis, and then figuring out how do I get this person back to what they want to be able to do in the most efficient and effective way. If I don’t need the stem cells, I don’t I won’t advocate for it. I’ll just give you my opinion. If you say, “No, I want to get the stem cells,” you’re not wrong in doing that. But these are certain things that that come into play here. So it really depends on the severity of your damage, how old you are, what are your goals, what’s the tissue, what are we trying to get right for and and sort of the timeline. And so there’s a lot of factors that kind of come into it. And I and and you know, when we do our stem cells, we actually combine PRP. So it’s really not an eitheror in that sense. It’s are we adding this or not? And and I think that makes a big difference. And if you guys are like, what is he talking about? I don’t understand stem cells or I don’t understand the PRP still because there’s a way to make lucasite rich and lucasite poor and you’re like, what is that? Go to DynamicAthlete.com, read about it, and educate yourself on it because there’s a lot of different factors that come into play here. And especially when you’re looking at PRP, not all PRP is the same. And and how much blood are they taking out? How many spins do they do? How many X multiples of the baseline platelets are you trying to get? Or how many billions of platelets are are your targets? So all these things where it may sound like I’m speaking a foreign language right now, but go to the website, read about it, and educate yourself and and really ask the right questions when you’re getting these treatments because, you know, it’s your hard-earned money that is going to be spent on this and I want to make sure that you get the best that you can possibly get. How do you decide which treatment to recommend?

How I decide: imaging, tear size, scaffolding, and sleeping at night 8:08

Dr. Garg: For me, it’s about what we see either on ultrasound or MRI and look at their function and what their goals are. if it’s a smaller injury in terms of a tear. So I I look at this from a tear standpoint where is this is this a small enough tear where the PRP should be able to help heal given the proper rest or how we’re going to do with with the recovery post procedure or is this tear bigger than what can be done with the PRP and do I need now a scaffolding something that’s thicker than the the PRP? Do I need something that can create this web if you will or scaffolding between the injured areas and help that heal almost like creating a blood patch. And so that’s where that’s a lot of times is dependent on that tissue structure. If something’s thickened like a tendinosis, right, where where the tendon is thickened, can you can you get away with the PRP first and then if you needed to do the stem cells afterwards? So, those are the discussions you have. We use EMTT and shockwave in combination with our biologics and I think that has a lot to do with why our success rate is so high. And also we we tend to cherrypick patients. And what I mean by that is I want to make sure that when I go to sleep at night that I feel really good about the decision we made. So if I don’t feel really good about the procedure, I won’t do it. There’s no point other than from a financial standpoint, but that’s not what drives us. If I don’t feel good about a procedure, I won’t do it. Right? And and I think that’s a big big thing where I want to make sure my guys are looked after and and my people are looked after and and so that’s we that’s how we go about it. And that’s why it really depends on on where we are. If it’s arthritis where you sort of look at timeline where do you want to have the potential of having this last longer but it’s going to be more expensive investment or are you okay with a shorter term and seeing where you are from a PRP and hyaluronic acid combination with EMTT and shockwave. Do we do the dynamic mind plus? Do we do the dynamic core plus in combination? So there’s a lot of these factors that kind of go into play to help support it. But at the end of the day, it’s really about having a really good understanding of what PRP is and what the capabilities are. What bone marrow aspirate and microfgment atapost tissue, what they are, what their capabilities are, why are you using what you’re doing, why are you using them in combination? So that’s where you’re really trying to figure out, okay, if this person’s in my family, what am I doing here? Right? and and that’s how we structure everything in in that component. And that’s why we combine them when we do our stem cells, we do PRP with it. So it’s not like you’re missing out and and it creates this enhancement and you know that’s why we get the outcomes that we get.

Three patients: tennis elbow, bone-on-bone knee, early arthritis 11:25

Nicole: Can you give me an an example of when PRP was the right call versus stem cells?

Dr. Garg: Yeah, there’s a lot of times when we do PRP. We’ve had a woman who had lateral epicondylitis, so tennis elbow and we ultrasounded her. We actually had an MRI and we ultrasounded her in real time and she had thickening of that tendon that’s causing her pain and it was months. She was having this pain for months and we used the combination of the EMTT and the shockwave with the PRP where I thought the stem cells would have been overkill. I thought that the return on investment and paying the difference between the PRP and the stem cell wouldn’t have been worth it. And she did fantastic. And and that’s where having the experience and looking at some of these things and knowing how the tissue responds to PRP versus stem cells matters because if you don’t know what you’re doing and you’re like well just do the most expensive thing because I don’t know what I should do here and it’s the default and it’s the best option like I said before like [amount] on [amount] times if nothing else mattered I would just pick that. But there are other considerations to sort of make. And I think for me the biggest thing is do I need this or do I not need this? That decision’s got to come from me first irrespective of can this person afford it. That’s not my call. That’s I they’re here for me to give them my best judgment and then we go from there. So I have to think about what’s the best way to get this person back first and foremost. If I think it’s do nothing, then we do nothing, right? But that’s where that’s sort of where that comes in. Now, the flip side to this, we had a woman who had severe knee arthritis, bone on bone, has been she’s been told many times, and I told her, I said, I don’t think PRP is going to be enough here for you. I said, I think this is going to be something that we need to do the micro fragmented atapost tissue. She was her age was a little bit higher than I typically like to take the bone marrow. And so we take the adipose and we did PRP with her and the same thing we do EMTT and shockwave and in its entirety as a whole treatment protocol. And she actually did the dynamic core plus along with it to help her with her pelvic floor and her core strength. so she would actually be able to take some of that pressure off of those knees. And she did fantastic. She’s back hiking and doing these things where she was told she needed a knee replacement and and we got her back and and we were we were she’s now doing her yoga and she’s now doing all the things that she wants to do specifically hiking and steep terrains in that in that space and she feels great. So both patients here got the appropriate treatment and you know and I’ll give you another example like we’ve had somebody with earlier arthritis where he said I don’t know if we necessarily need to do the stem cells here. So for that patient we did the PRP and the hyaluronic acid combination along with the EMTT and focused shockwave in totality. We didn’t have to do the dynamic core plus because she was in she didn’t need to do it. She was actually demonstrated that she was pretty pretty solid there. So, and then she’s back into running where would she have done well had we done stem cells for her? Absolutely. I don’t have any doubt about it. I think the the fact that we could get there with the PRP and the hyaluronic acid and then we’ll see how long her body responds to it. She could get two years, maybe longer of relief there. So, if that’s the case, then fantastic. Then now we’ve saved those resources and if we need to apply them in the future, so be it. But at least we’ve gone that route and I think that’s that’s what’s pretty encouraging kind of in that space. What should I ask during a consultation to make sure I’m getting the right one?

What to ask at your consultation: the why and the imaging 15:41

Dr. Garg: Yeah, a lot of the things that I talked about here, I think in our in our space, why are we doing this treatment and why are we not doing the other one? What does the imaging show? I said this on a different podcast of ours that if somebody doesn’t go over your MRI or imaging, just walk out. Just leave. Find a place that’s going to take the time to go over your imaging. It’s important. It’s important for you to understand what’s going on, why you have it, what we’re going to do about it. Ask these questions. How far along is my injury? Why do you feel confident about this? What’s your success rate on something like this? So, for me, it’s it’s a lot about the why. I mean, I can tell you what the injury is, and that’s that’s pretty straightforward. the the part about why we’re doing what we’re doing is more based on experience and knowing how tissue generally responds to things and timelines. If we’re trying to get our athlete back in a certain way or we have more time, it can help us dictate a little bit of where we have leeway. Right? We had we had Olympic athletes said, “Hey, I’m hurt. I’m leaving for the Olympics in 10 days. We had to augment some of the things we were doing. We had we had a college gymnast who had his last collegiate meet in 10 weeks, right? So, one I’m giving you is 10 days. One I’m giving you is 10 weeks and we’re counting days for him in the terms of okay, here’s how we’re going to do this. Here’s how we’re going to do that. and then this is how we’re going to get you to train and this is how we’re going to get you ready for that meet in 10 weeks. And so that’s why and all of it’s met with here’s why we’re doing what we’re doing. I think I think when you walk into a situation, it should feel like two people with the same common goal trying to get you there rather than feeling like we’re trying to sell you on something or sell you on something different in general. I think it’s really more a conversation about why we’re doing it and how do we visualize you getting back to the activity that you want to do. It’s a conversation. It’s never a dictatorship. It’s about it’s about how do we work together to get you back. And I think that’s the biggest thing. So for people that are listening, I think the biggest thing to take away really is that PRP and stem cells are fantastic and they have utility in the right situations. the most expensive doesn’t mean it’s the most appropriate in terms of should we do stem cells or should we do PRP. Having a really good understanding of what the problem is and what we’re going to do about it and how the tissue responds to PRP versus stem cells is a really important component. If you’re seeing someone, they should be able to explain you this. If they can’t explain the why, then just walk out and go find somebody that can. Because the last thing that I want you to do is spend your money on a place where they can’t explain to you why they’re doing what they’re doing and why this is a better option for you. at at the end of the day, I think it comes down to what’s going to be in your best interest and that’s what we always try to do. So, if you know your stuff and you’re educated and you can ask these questions. So, go to DynamicAthlete.com. There’s a wealth of resources there. You can read about

Who’s doing the injection: do your homework 19:32

stuff, get yourself educated and making sure you’re asking the right questions, but make sure whoever you’re seeing, you’re asking why are we doing what we’re doing? And the other thing too is who’s doing the actual injection. That’s another thing that I would say to look out for because if you have somebody that is not your physician doing the injections, I would tell you to pause and ask them what’s their experience, how many times have you done this, what what complications have you seen, how do you respond to that stuff, all these things that go into it. Right? in our clinic, I do all these injections because of that reason, because I have all that experience and and I want to make sure that we’re trying to get after this in the best way possible. So, there’s a lot of different things where not all PRP is the same, not all stem cells are the same. Do your homework because just because somebody calls it PRP or somebody calls it stem cell doesn’t mean it actually is. Do your homework on who is doing these procedures and why they’re doing it. I hope this helps and we’re going to see you next time.