October/November 2020 - 34

Therapy
Dr. Mishra: They're actually radically different. Stem cells
are just a completely different animal than PRP.
Most PRP has a few stem cells in it. Within your bone
marrow are a variety of different types of stem cells. That
is within all of your tissues, including tendon tissues, there
are stem cells. They're just in small quantities. As we get
older, we have a diminished number of stem cells, and
that's one marker of aging.
If you're trying to collect or inject stem cells, you have
to have a way of harvesting them. That's much more
complicated than it is for PRP. You can get stem cells, for
instance, out of fat in some forms, you can get it out of
your bone marrow, you can get it out of different types of
tissues, but it's complicated.
Then the other side of the equation is PRP, which I'll
explain as if you were coming in to see me for tennis
elbow. You come in, you're an elite or a weekend warrior
kind of player. You've had this pain, and it can come from
playing tennis, golf, it can come from repetitive things
like too much time on the computer. You've tried a variety
of different options. PRP should not be used as a first
line, but if you've had (the injury) for, say, three months,
and you've been trying other things, PRP becomes an
interesting option.
I think this is one of the primary reasons why it has
exploded. Let's say we've tried everything else. What are
we going to do now? Well, let's take you to surgery. So
PRP has, for instance, in England radically decreased the
number of tennis elbow surgeries because PRP for tennis
elbow is about 85 to 90 percent successful at preventing
you from needing elbow surgery.
So I would say, 'I can operate on you, or I can inject you
with PRP. It may be slightly better if I operated on you and
added PRP, but I probably got between an eight and a nine
out of 10 chance that I could prevent you from needing
something further if we had treated you with PRP. And it's
a pretty easy discussion.
OK, well, how do we do it? We draw about the same
amount of blood that we would draw if we were going to
check your cholesterol. We do it in the office. I numb up
your elbow and it takes about 20 minutes to process the
blood into the Platelet-Rich Plasma, which is concentrating
out your blood - where we remove the red blood cells, we
remove most of the plasma and Platelet-Rich Plasma is just
concentrated platelets in a small amount of plasma.
If we take 30 cc's (cubic centimeters) of your blood
and we get down to about three cc's of PRP, then after
numbing up your elbow, we inject it into your elbow, I put a
big band-aid on your elbow. And you go.
TC: It sounds so simple.
Dr. Mishra: That is just a microcosm of what's happening
all over the place. n
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October/November 2020

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