image

Common Questions

Stem Cell Therapy

Do your treatments comply with FDA regulations

Yes. Our treatments involve only your own stem cells and involve no more than minimal manipulation of the cells so they are compliant.

What is JuvaStem Therapy

JuvaStem is a proprietary process that produces a unique blend of stem cells (mesenchymal stem cells) and plasma derivatives which are used to enhance your body’s healing mechanism. JuvaStem therapy involves harvesting your own mesenchymal stem cells from bone marrow and then carefully separating and concentrating them by centrifugation prior to injecting the concentrated JuvaStem product at the site of injury.

Our JuvaStem therapy harnesses and optimizes the regenerative capabilities of your autologous stem cells. Autologous cell therapy has the potential to become a new standard for non-pharmacologic and non-surgical treatment of osteoarthritis and other common orthopedic/musculoskeletal conditions. Autologous cell therapy supports the self-healing process of injured tissue through regeneration and signaling pathways, resulting in relief of symptoms.

What are stem cells and where do they come from?

Stem cells are the cells that control and ultimately divide and change into specific tissue types. In fact, they are called a ‘stem’ cell because the various tissues stem from this cell type. In adults, stem cells are present within different tissues and organ systems, the most common being bone marrow and fat tissues. At SRMC, we use only your own stem cells (autologous) harvested from bone marrow.

Why do you use bone marrow stem cells?

Bone marrow is easily obtained and can be processed with minimal manipulation, keeping our procedures in line with FDA guidelines. Importantly, stem cells from bone marrow are closer in cell lineage to cartilage and tendon than those found in fat, which means they require less differentiation to become the cells we want them to become.

What types of conditions are treated with JuvaStem Therapy?

At SRMC we treat any condition that is related to the mesenchymal cell line with JuvaStem Therapy. This includes bones, joints, nerves, spine, and skin.

Who is a candidate for JuvaStem Therapy?

In general, we recommend JuvaStem therapy for patients with moderate osteoarthritis or degenerative conditions of the hip, knee, shoulder, ankle, wrists or hand.

Who is not a candidate for JuvaStem Therapy?

Patients who are not good candidates for JuvaStem therapy are:

  • Patients with a recent cancer diagnosis who are undergoing treatment
  • Patients with blood-borne diseases or malignancies
  • Patients with current infections
  • Patients on high doses of blood thinner that cannot stop the medication due to a health concern
Does the JuvaStem treatment stay localized to the injection site?

Yes, the JuvaStem product primarily stays localized at the injection site.

Will JuvaStem regenerate the cartilage in my joints?

In some circumstances, it may and there are limited data that suggest the ability to regenerate joint cartilage. However, JuvaStem primarily provides pain relief and functional improvement by activating a cell signaling process that leads to healing and recovery.

Is the JuvaStem Therapy procedure painful?

Most patients report only mild discomfort during the procedure and mild tenderness at the needle puncture sites after the procedure. We do offer sedation by our board-certified anesthesiologist should you desire to have no awareness during the procedure.

Can I have sedation for the procedure?

Absolutely. Dr. Hostetter is a board-certified anesthesiologist who will provide IV sedation during the bone marrow harvest, the injection or both if you desire at minimal cost. Many patients prefer to be “unaware” during the procedure and for these patients, sedation is an excellent option. In the event that you choose to have sedation during your procedure, you will be monitored continuously during the procedure. After the procedure, we will observe you in our recovery area until you have fully recovered from sedation.

What happens during the JuvaStem harvest and injection?

On your treatment day, if you are having the procedure done with sedation, we will first place an IV in your hand or arm. If you choose not to have sedation, we will not place an IV. For the JuvaStem harvest, we will have you lay either on your stomach or your back and position yourself to your comfort. If you are having sedation, that will be started once you are positioned. Your skin will be washed and draped to keep it sterile. We will inject your skin with a local anesthetic. The bone marrow is then harvested using specialized equipment, including either ultrasound or fluoroscopy for visualization during the procedure. This process is usually not painful, with only mild discomfort. After the bone marrow is harvested, we then employ our propriety process of separation and concentration to produce the JuvaStem product. Once we have the final product, we will then inject the JuvaStem product at your site of injury. Following the procedure, we will briefly monitor you in our recovery area before discharging you home.

How long does the procedure take?

The harvest of cells takes only 20-30 minutes. Injection of the JuvaStem product takes 10-30 minutes depending on your site of injury. If you are having the procedure without sedation, you can expect to be at our clinic for 60-90 minutes. If you have sedation, expect to be at our clinic for 90-120 minutes.

How will I feel after the procedure?

If you had sedation, you may feel a little tired for a brief period after the procedure. We will monitor you in our recovery area until it is safe for you to go home. Once at home, you may feel tired for a period but should feel back to normal within a few hours. You can expect some tenderness at the needle puncture sites. You may have some mild pain and swelling at the site of injection.

Are there any risks/complications?

Anytime a needle is used to puncture the skin, there is a risk of bleeding, bruising, pain, infection, or nerve injury. We do all of our procedures using best practices for sterility and safety to minimize the risk of bleeding and infection. Because we utilize fluoroscopy and/or ultrasound during both the harvest and the injection procedures, there is a very low risk of injuring a blood vessel or nerve. That said, it is not unusual to have some mild bruising and tenderness at the needle puncture sites after the procedure.

Will I need someone to drive me home after the procedure?

If you have opted for sedation for the procedure, we require that you arrange for someone to drive you home. If you choose no sedation, then you will be able to drive home after a short period of observation after the procedure.

When can I return to work or my normal daily activities?

You will be able to return to work or full activity as soon as you feel up to it. Most patients return to normal activity within a day or two following their procedure.

When can I expect to feel better?

Every patient and every condition is unique, therefore there are no guarantees of what results will be achieved or how quickly they may be observed. Many patients report feeling better within a couple days of the procedure, others report results in 1-3 months, however, it can take as long as 6-9 months for maximal results.

Will I need a second procedure?

Many patients get relief after only one treatment. However, depending on the nature and severity of your condition, you may benefit from repeating or augmenting the treatment.

What is the success rate?

This depends on the exact procedure. Patients with disc pain in their low back had as much as 80% improvement in pain scores for as long as 2 years post injection in one study (International Orthopedics 40.1 (2016): 135-140.). Typically, we note that 70-80% of our patients see meaningful improvements with the procedure.

Is there a risk of causing cancer?

To date, there are no reports or any data to suggest that stem cell related injections promote the development of tumor growth.

Will my body reject the stem cells?

No. This is one of the advantages of JuvaStem over amniotic or cord blood type stem cell injections. Because JuvaStem is made up exclusively of your own blood-related products, there is no risk of developing an immune response and rejecting the JuvaStem product.

Are there any ethical issues related to obtaining stem cells?

No, because the stem cells are harvested from your own bone marrow, there are no ethical issues related to the JuvaStem product.

Is JuvaStem Therapy safe?

Yes. Adult stem cell therapies using bone marrow concentrate have a long history of safety. At SRMC, we hold ourselves to the highest standard to perform our procedures using best practices for safety and sterility.

Ketamine Therapy

How does it work?

Ketamine’s anesthetic effects are mediated by interactions with the NMDA, opioid, and dopamine receptors. Additionally, Ketamine interacts with the AMPA receptor, which is an important component of its antidepressant effects. Ketamine is thought to target gene expression and protein manufacture in certain brain pathways or circuits. Within hours of receiving an infusion, Ketamine starts a process of neuroplasticity which allows the brain to start healing itself, restoring brain synapses, structurally and functionally.

Is Ketamine therapy safe?

Yes, Ketamine has been used for decades and has a very high safety profile. There are multiples studies that demonstrate that it is both a safe and effective treatment for multiple disorders. At SRMC, we have a board-certified anesthesiologist (Dr. Hostetter) who will monitor you closely during your treatment to ensure that your vital signs remain stable and that you are safe and comfortable.

Do I need a referral from a psychiatrist?

We welcome referrals from psychiatrists and other healthcare providers, however, it is not necessary. If you are interested in discussing the benefits of Ketamine therapy and whether you are a candidate for the treatment, please feel free to schedule an appointment.

What should I expect during my ketamine treatments?

Before we schedule you for Ketamine treatments, you will be seen in a consult for evaluation of your disease and assess the suitability of this therapy for you and your condition. On the treatment days, you will be admitted and have an IV placed in your arm, hand or leg. You will be allowed to have a loved one with you doing your entire treatment experience. We will monitor your vital signs closely, including blood pressure, oxygen levels, and EKG. For the treatment of mood disorders, the infusion typically lasts about an hour. For the treatment of pain conditions, the infusion will be upwards of 4 hours. During the infusion, you will likely be awake, but you are welcome to rest and nap as you wish. You can watch TV, listen to music, use our virtual reality systems, or read a book or magazine as you wish. One of our providers will be readily available to meet any needs you have during the infusion period. After the treatment is complete, you will be taken to our recovery area where we will briefly monitor to you to ensure that you feel back to baseline and are safe to go home. There you will be allowed to have a drink of water, coffee or juice and enjoy a snack if you desire. Once your recovery is complete (typically 15-30 min), you will be discharged home.

How will I feel during my Ketamine treatment?

The responses to ketamine vary from individual to individual. The infusion experience is typically tolerable for most people, though it is commonly described as “weird.” You will be awake during your treatment, though some decide to close their eyes and rest. Others listen to music, enjoy our virtual reality experience, or interact with their loved ones.

Are there any side effects?

Many patients experience very few to no side effects during their ketamine treatment. Some experience some mild dizziness, nausea, visual hallucinations, disconnection from their body and mild space/time perception alteration. If you experience any of these sensations, they are transient and you will be back to your baseline within 30-60 minutes of treatment completion. We will monitor you in our recovery area and ensure that any side effects are resolved prior to discharge. There are no long-term side effects from ketamine.

How long does an infusion last?

Each patient is different and your treatment will be individualized to your needs, so there is no fixed infusion time. Typically, we will begin with a 1-hour infusion on the first day of treatment and then tailor the remaining treatments based on your response to the therapy. On average, the infusions will last between 1-2 hours.

How many treatments will I need?

The response of individual patient varies and there is no single defined protocol for ketamine therapy at this time. The clinical data do demonstrate that serial infusions are more effective than a single treatment and that the greatest success is obtained by closely spacing the infusions during the initial treatment phase (2-3 treatments per week).

For mood disorder patients (Depression, Bipolar), we typically recommend an initial treatment phase consisting of 4-6 infusions over a 2-week period. We will fine tune your treatment during this phase, based on your individual response to the therapy to determine an optimal treatment protocol designed specifically for you and your particular needs. After the initial treatment phase, most patients then require a maintenance infusion every 3-4 weeks.

For chronic pain patients (CRPS, Fibromyalgia), treatment requires more substantial dosing upfront. Therefore, we provide 4-hour long infusions, ideally done over 5 consecutive days. Following this initial phase, we will provide a maintenance program tailored to your individual needs. Many patients only require a couple of booster infusions following their initial treatment.

How soon will I feel better after a treatment?

Some people notice that they feel a difference by the evening or the day following their first infusion. Others require a couple treatments before they notice a change. Regardless of whether you feel better after the first dose or with subsequent doses, it is crucial that you complete the entire series of the initial treatment phase in order to maximize the therapeutic benefit. The response to ketamine is individual and therefore we will perform a careful assessment of you and your symptoms before and after each treatment to tailor the treatment protocol to you and your individual needs.

Will I need long-term treatment?

While many patients note they have a positive response to ketamine early on in the initial treatment phase, the changes can be gradual. Also, many patients find that the positive effects of ketamine may wear off with time. Clinical data support the implementation of a maintenance regimen to ensure the positive effects are sustained over time. We will assess your response to the initial therapy as well as your symptoms between therapy to design a specific maintenance schedule to meet your needs.

Will I be under anesthesia or asleep?

While Ketamine is an anesthetic, the doses that are typically used are considered “sub-anesthetic,” meaning they are such a low dose that they do not induce anesthesia. You may, however, feel relaxed enough during your infusion to drift off to sleep. This is not discouraged and we will monitor you throughout your infusion to ensure that you are comfortable and your vital signs remain stable whether you sleep or remain awake.

Will I need to stop my other medicines before treatment?

Most medications do not need to be stopped prior to Ketamine therapy. You will be able to continue your normal anti-depressant medicine regimen. Ketamine can be used safely with SSRIs, SNRIs, Lithium, Wellbutrin, and TCAs (with caution). If you are taking a benzodiazepine (Valium, Klonopin, Ativan) or Lamictal, these have been shown to blunt the effectiveness of the treatment infusion, therefore we recommend holding these drugs at least 12 hours prior to starting your infusion therapy and then waiting at least 6 hours after the infusion ends before re-starting.

Is Ketamine therapy dangerous?

Ketamine is a dissociative anesthetic that is sold illegally on the street for recreational use. Abuse of ketamine can be very dangerous and potentially lethally, similar alcohol and opioid medications. In the hands of trained clinicians, particularly anesthesiologists, ketamine has a very wide safety margin. It is one of the safest anesthetics on the market and is often used by anesthesiologists when a patient’s condition is unstable enough that other anesthetics are unsafe. The doses used at SRMC are “sub-anesthetic doses,” meaning that they are a very low dose, much lower than is used when ketamine is given as an anesthetic.

Who should not get Ketamine therapy?

Ketamine therapy is not appropriate for patients with schizophrenia, psychosis or seizures. Patients taking aminophylline for asthma or COPD should avoid ketamine therapy as this can increase the risk of seizures. Patients with serious medical conditions including uncontrolled high blood pressure, heart disease or pulmonary problems will need medical optimization and clearance from their primary provider before undergoing ketamine therapy.

Can I become addicted?

No. There is no risk of addiction associated with Ketamine therapy.

Do I need to bring someone with me during my treatments?

We do not require that you bring someone to sit with you during your actual infusion, but you are welcome to do so if it would make you more comfortable. Because Ketamine is an anesthetic and can cause some mild sedation at the doses we administer, we do require that you have someone available to drive you home after your treatments.

Can I eat or drink before my treatments?

We require that you do not eat solid food or consume any non-clear foods for at least 6 hours prior to your appointment. You may have clear liquids, including water, clear broth, apple juice, black coffee (NO DAIRY) or clear tea up to 2 hours before your appointment.

How much does it cost?

For treatment of mood disorders, such as depression and bipolar disorder, we recommend an initial treatment phase consisting of 6 treatments administered over a 2 week period, followed by occasional maintenance infusions, typically spread out over weeks to months.

For mood disorder treatments, the costs associated are as follows:

Consult -- $300

Basic Labs -- $250

Initial 6 treatments -- $4000

Maintenance Booster, each treatment -- $600

For the treatment of neuropathic pain conditions, such as CRPS and Fibromyalgia, we recommend five 4-hour infusions given daily for symptomatic relief. Occasionally, the treatment period may need to be extended beyond the initial 5 days, depending on your condition. A booster treatment may be required a few weeks after your initial treatment.

For CRPS and Fibromyalgia treatment, the costs are:

Consult -- $300

Basic Labs -- $250

5-Treatment Series -- $1000/each day ($5000 total)

Maintenance Booster -- $1200

Can I drive myself home after my treatment?

We require that someone drive you home after your treatment. While you may back to normal shortly after your treatment, without much or any grogginess at all, we strongly advise that you avoid driving, operating machinery or doing anything strenuous or mentally taxing for at least 12 hours after the infusion.

Will insurance cover the cost of Ketamine therapy?

At this time, insurance does not cover Ketamine therapy.

Do you offer financing?

Yes, we offer financing through a 3rd party medical financing company. Don’t hesitate to inquire about this option.

Dermafrac

Is Dermafrac only for the face?

No, Dermafrac can be used on the face, the neck and the decollete. These treatments can be done all at the same time or scheduled separately as you desire.

How many treatments are recommended?

For best results, we recommend a course of 4-6 treatments on a monthly basis. This is typically followed thereafter by maintenance visits, either quarterly or half yearly depending on your results.

What is the pre and post treatment care?

We recommend that you avoid the use of any exfoliative skin care product for at 3 days before and 3 days after treatment. These include products containing retinol, lactic acid, glycolic acid, etc. Additionally, we recommend that you apply a sun protectant daily and avoid prolonged exposure to direct sunlight. For best results, we recommend you follow a daily, gentle skin care regimen alongside your course of treatments.

How are PRP or stem cells used with Dermafrac?

The Dermafrac handpiece includes a cartridge insert for application of various serums. At SRMC, we have the capability of administering your own PRP or stem cells (using our revolutionary JuvaStem Therapy) at the time of your Dermafrac procedure to deliver your own concentrated growth factors and/or mesenchymal stem cells into the dermal-epidermal layer and optimize the collagen and fibroblast proliferation to produce a very effective facial rejuvenation.

How long does the procedure last?

A typical procedure lasts about an hour depending on how much area is being treated. Usually, facial treatment alone takes less than an hour and adding the neck and decollete will make it slightly longer.

Is the treatment painful?

No. The microdermabrasion process will feel slightly abrasive on the skin, like a gentle sandpaper. However, because the microneedles are very fine and only penetrate to the dermal-epidermal junction (above the nerve endings) this procedure is not considered painful by our patients. Your skin may feel slightly sensitive and dry for 1-3 days following treatment.

What will my skin look like after the procedure?

Dermafrac treatment typically results in minimally visible redness and mild swelling. Many people who have had Dermafrac treatment return to work right after their procedure.

Is there any downtime after the procedure?

This procedure is very well tolerated and there is little to no downtime required at all. Many patients go right back to work the same day after having the procedure done. After the procedure, you may feel as if you have a mild sunburn over the area that was treated but that sensation should subside within a day or two.

When will I see results?

You will typically see results after the first treatment, though more significant and longer lasting results will be seen after 4-6 treatments, spaced about 4 weeks apart. After your series of 6 treatments, your skin will continue to improve over the next 6-12 months, especially when combined with the recommended post-treatment care.

Is Dermafrac safe?

Yes, Dermafrac is very safe. This is a shallow depth treatment that is safe and effective for many skin types and conditions.

Can I combine Dermafrac with other cosmetic procedures?

Yes, this is a versatile, non-surgical treatment that you can combine with other cosmetic regimens. Dermafrac is a great treatment for maintaining skin health and keeping your skin looking fresh and rejuvenated.

Are there any contraindications?

While Dermafrac is very safe, there are some instances where we advise against having the treatment. These include open sores or wounds in the treatment area, HIV/hepatitis, high doses of blood thinners, uncontrolled brittle diabetes, sunburned skin, dermatitis, fungal infections, active rosacea or active acne, skin cancer, easily bruised skin.

Platelet Rich Plasma Therapy

Why should I consider a PRP injection?

Injecting a patient’s own PRP into damaged tissue is an effective, safe, and minimally invasive treatment option. By enhancing the body’s own natural healing abilities, patients are able to enjoy a faster and more thorough healing process that relieves symptoms, allowing them to return to their regular activities.

What happens during a PRP procedure?

During the PRP procedure, initially, blood is drawn from an IV in your arm. This blood is first separated via centrifugation into the platelets, white blood cells, plasma and red blood cells. The platelets and plasma are then isolated and concentrated via centrifugation. The end product is a plasma with a high concentration of platelets. This solution is loaded into a sterile syringe, ready for injection.

The PRP injection is performed the same day, as part of the same outpatient procedure. The whole process from blood draw to injection typically takes less than an hour to complete, sometimes more depending on the site of injection. During the injection procedure, either ultrasound or fluoroscopy will be utilized to visualize the site of injury and ensure that the solution is injected right at the target site.

How does PRP differ from JuvaStem Therapy?

PRP is derived from your blood, not bone marrow. Therefore, PRP does not contain stem cells, only the growth factors and platelets found in plasma.

Is JuvaStem Therapy better than PRP?

JuvaStem includes bone marrow derived stem cells and higher concentrations of growth factors than conventional PRP.

Is PRP safe?

Yes, PRP has minimal risk because the treatment utilizes your own blood platelets and plasma. This eliminates the risk that the injection will transmit disease or be rejected by your body.

What are the common conditions treated with PRP?

We use PRP for a number of mild to moderate conditions involving the hips, legs, knees, arms, shoulders, and feet. To date, the only condition that is covered by insurance providers is lateral epicondylitis of the elbow.

Am I a candidate for PRP treatment?

PRP is recommended for patients with mild or moderate injuries, or those patients whose symptoms aren’t relieved by conservative treatments, such as rest, medication, and physical therapy. Our physicians will review your medical records to let you know if this procedure is right for you.

Does PRP treatment hurt?

There may be some mild discomfort when the PRP is injected. It is also common to feel some soreness and swelling for the first 2-3 days after the procedure. This discomfort can be treated with over the counter Tylenol.

How much downtime is required after PRP treatment?

There is typically no downtime required at all. We encourage patients to return to their normal and full activity as tolerated.

How many PRP treatments are usually needed?

This varies as it depends on your specific condition. Most patients require only on PRP injection, but a small number of patients will experience partial improvement and request to have another injection performed.

When can I expect relief following PRP treatment?

This is somewhat unknown and impossible to predict. PRP itself does not provide immediate relief, rather it sets into motion a repair mechanism that takes time and varies depending on the individual patient and their specific condition.

Are there any risks to having a PRP injection?

As with all procedures that involve puncture of the skin, there is always a risk of bleeding and infection, though these risks are very rare. Not all patients will experience pain relief, and symptoms may recur over time.