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Hi, I’m Dr. Mark Sanna. I’m the CEO of Breakthrough Coaching and a practice management consultant for multidisciplinary practices for 30 years. Welcome to the program. Special thanks to ChiroSecure for sponsoring this series of programs on multidisciplinary practice. Let’s go to the slides We’re gonna discuss in this presentation next-level regenerative medicine protocols for osteoarthritis, a chronic condition that can actually be stopped and reversed utilizing the procedures that we’re going to share with you today.
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I’m gonna give you a visual tour of regen med procedures for OA that actually took place in our Regenerative Medicine Academy training sessions that we perform here in Miami. These are sessions that are performed group and in individual sessions. And if you have an interest in attending one of them, please reach out, and we’ll be happy to connect you with the Regenerative Medicine Academy here in Miami.
So here are the regen med protocols that we’re going to discuss. For treating severe joint degeneration, osteoarthritis, cartilage defects, structural damage, the conventional treatments of PRP, certainly cortisone, which kind of does the opposite of PRP. Instead of regenerating the joint, it blows it up.
These fail to provide long-term regen and certainly not structural integrity. The best regenerative approach is a two-phase, twofold approach that actually reverses– stops then reverses osteoarthritis. So the first phase, we’re going to use something called A2M. And if you’re not familiar with A2M is alpha-2 macroglobulin.
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So macro being big, globulin being a blood protein. This is the largest circulating protein in our bodies, yours and mine right now circulating. And it is the cleanup crew in your body. Whenever there’s inflammation, body cleans it up with proteolytic enzymes, proteases, and that’s a really good thing unless they get trapped in a joint due to scarring.
And then what do they eat? They eat your good, healthy cartilage rather than just doing the cleanup. We heat the first draw of plasma. That’s platelet-poor plasma before it’s centrifuged to create something called bio scaffolding. We’re gonna talk about that in this presentation. Bio scaffolding of A2M provides immediate cartilage protection.
It neutralizes by binding with the proteolytic enzymes and also something called cytokines. Those are the pain-producing elements. And boy, people get immediate relief from A2M injections. You’ll call them the next day, they say, “I feel better than ever.” And you don’t normally hear that with, PPP or PRP I should say, platelet-rich plasma therapy.
Takes a little bit of time to regenerate the cells with PRP, but A2M, ’cause it binds with those cytokines, you get a great response right away. We’re also going to, in phase one, include some peptide therapies. Peptides are– talk about next level. Man, everybody’s talking about peptides now. You gotta know about them.
You gotta learn about them. BPC-157, that’s a great peptide body-protecting compound. They call it the Wolverine compound because Hugh Jackman in the movies heals up really quick all the time, so that’s the Wolverine compound. NAD+, incredible driver of energy production in the mitochondria. Speeds healing.
Fantastic thing. I should say BPC-157 actually helps in pain relief, but it also is a tremendous anti-inflammatory and stimulator of angiogenesis, new capillary formation. We do this in iontophoresis patch. We’re gonna talk about why we use iontophoresis patch versus injection therapies.
Patches are worn for three days in a row to get it to the therapeutic dosage, and then once a week thereafter, and the patient can go on to maintenance levels. Phase two, six weeks after administering the A2M, alpha-2 macroglobulin, we’re gonna hit it with some Wharton’s Jelly, and Wharton’s Jelly is a mesenchymal product.
We’ll talk about how it’s derived, where it’s derived from. It’s also called Supervesical Plus, and we also create a Wharton’s Jelly bio-scaffolding as well prior to injection. So Wharton’s Jelly restores the extracellular matrix, the ECM, provides long-lasting structural support, and it enhances regenerative healing.
Cool stuff. Little word about multidisciplinary practice compliance. Now, this program is for educational purposes only. It’s not intended to serve as a medical advice for patients or diagnostic guidance for providers. The procedures that are presented in this presentation must be performed by trained medical professionals, so you should consult with your consultant at Breakthrough Coaching and local legal counsel to ensure compliance with all legal and regulatory requirements.
So let’s take a little tour of the medical procedure room, the setup. I’m oft-often asked, you can see in the corner of the picture here up on the screen “Do I have to have a sink in my medical procedure room?” OSHA doesn’t specifically require that a sink is inside every room where a medical provi- procedure like joint injections are performed.
However, handwashing facilities must be readily available wherever there’s a reasonable likelihood of hand contamination with blood or other potentially infectious material. So important to know that pretty easy pieces of equipment. Doesn’t take a whole lot of space. Typically can be done in the size of a typical chiropractic adjusting room, 10 by 10, 10 by 12.
It involves an adjustable exam table that you can see in the middle. You’re probably familiar if you’ve ever had a physical exam in a doctor’s office with paper that covers the table. And on the right-hand side of the screen, you see a blood draw chair. That’s a great piece of equipment to have.
And then a rolling stool. These are all readily available on amazon.com. They’re not expensive for you to have in the practice and they’re certainly gonna make life much easier for you when you’re in regenerative medi- in the regen med space. You want a refrigerator and there are certain things that can be kept at normal refrigerated temperature.
Warden’s jelly, BioScaff doesn’t require cryo therapy, but, … I’m sorry cryostorage. Other injectables such as injectable vitamins, MecB12 methionine and acetylcholine and B12, great for stimulating metabolism and weight loss. Procaine, that’s an anesthetic used in prolozone therapy.
We’re gonna talk about ozone therapy in the second part of this presentation, and those things can be stored at refrigerated temperature Cryogenic liquid nitrogen storage is something that Wharton’s jelly requires. These are live cells. They’re mesenchymal cells, and the liquid nitrogen storage container keeps them at minus 196 degrees C.
It offers many advantages over having them be in a regular freezer that gets to about m- minus 20 to minus 80 degrees centigrade, especially for long-term preservation and if we’re using them for clinical applications as we are. This cryogenic liquid nitrogen preserves viability, stability, the growth factors that are contained in Wharton’s jelly, the biomolecules activity in it.
Of course, if you’ve ever frozen a piece of meat in your refrigerator freezer, you know that they can form ice crystals, and that’s not so great for cellular damage. And the cryogenic liquid nitrogen storage keeps that cellular damage away for months and even years. The one, the unit that you see up on the screen, again, amazon.com.
And where– you say, “Mark, where am I gonna get liquid nitrogen?” Guess where? You get it from a welding supply store. They come, and they actually service the tank, and you can see how the Wharton’s jelly container is in the little medical metal cylinder that drops down inside the storage tank.
Pretty cool stuff, huh? Ethyl chloride in sterile ultrasound gel. Now, sterile conditions are absolutely important whenever we’re injecting the body and particularly when we’re injecting into a joint. Ethyl chloride, if you’ve ever used it for spray and stretch, it acts as a local topical anesthetic during injection procedures.
Sterile ultrasound gel also helps ensure seril- sterile conditions throughout the procedures. You should see when we do these procedures at the RMA in Miami. We go through more gloves, surgical gloves, piles of surgical gloves because of the importance of making sure that we maintain sterile conditions.
You’re gonna begin the process, just as you would in a chiropractic practice, with some orthopedic, also called provocative, testing prior to the injection procedures. You’ll do, of course, a thorough orthopedic eval in a multidisciplinary practice that’s typically done by the chiropractor in conjunction with the mid-level to confirm osteoarthritis and assess the suitability for alpha-2 macroglobulin therapy you’ll perform your differential diagnosis, you’re gonna review the patient’s history, and you’re going to assess candidacy for further diagnostic testing procedures.
While your orthopedic provocative testing is gonna lead you in the direction that we may have an issue here that could be helped with RegenMed, you’re gonna need some special testing procedures to confirm that diagnosis. You’ll use imaging procedures. Now, both X-ray and MRI can be used to diagnose osteoarthritis in a joint space.
However, MRI can directly vis- visualize cartilage, menisci, ligaments, other soft tissue structures in the knee, and it allows for assessment of cartilage degeneration, tears of the meniscus, bone marrow edema, inflammation, all the stuff that you can’t see on a plain film radiograph X-ray. X-rays are gonna show bone, and you can infer cartilage loss by observing joint space narrowing.
But if you’re– wanna be even further more thorough with your diagnosis, send them out for an MRI. If you have a local MRI center, you can negotiate a cash price for folks who aren’t insurance covered, typically somewhere between two fifty, three hundred bucks, something like that, and it really improves your diagnostic, tools toolkit, I should say.
MRI, of course, it’s much more sensitive to early subtle changes in OA, minor cartilage wear and tear, bone marrow bone marrow lesions, synovitis. These things might not show up on X-ray until the disease is more advanced, and early intervention is everything when it comes to osteoarthritis.
We prefer using ultrasound guidance versus landmark guidance when we do our needle injections. So ultrasound guidance joint injections, they demonstrate consistently higher accuracy compared to landmark, going off of the feel and landmarks when you’re guiding your neo- needles. Multiple studies, systemic reviews report that the ultrasound allows our clinicians to visualize real-time direct target to the joint space, especially if you’re doing a meniscus.
That s- I often say it’s important to not just to have the right material, whether it’s PRP, A2M, or Wharton’s jelly, but it’s also really important to put it in the right place, and you’re able to document the needle injection as well by screen capturing your ultrasound screen. So the accuracy rates in these studies, typically 90 to 100% when we’re doing ultrasound versus landmark guidance This is my favorite cool toy.
It’s the Butterfly iQ ultrasound unit, and that’s actually my hand right there, so you see how small it is, and you see how it connects right to an iPad, which is awesome. So it’s handheld, it’s portable, connects to your smartphone, connects to your tablet. You can project it up onto a big-screen TV. The images and data are stored on the cloud.
It’s shared via HIPAA compliance platform, and it has a significantly lower cost than traditional systems. If you’ve actually purchased an ultrasound unit in the past, you know that they used to be $20,000, $30,000 some years past. This unit under $5,000. We’ll talk about our group purchasing organization for Breakthrough Coaching.
You get a discount of $400 off that. So this is an amazing tool, and it can do some great things in terms of viewing changes of contrast, changes of color. It can turn the needle blue. Cool stuff that helps you in guiding your needles. So let’s hop into A2M for a little bit. As I mentioned, it’s a naturally occurring protein in your blood circulating throughout your system doing cleanup.
It’s a powerful inhibitor of enzymes that break down the cartilage, the proteases, and it helps to protect and preserve your joint tissue. I like to say that when you have osteoarthritis, it may begin with wear and tear, physical wear and tear, but over time, that scar tissue of the joint capsule prohibits the naturally occurring A2M from getting into the joint to denature or bind with those proteolytic enzymes inside the joint.
It’s like having termites eating up your house. You can paint the house. You can try and fresh it up. You don’t get rid of the termites first, you’re gonna be in a real situation in a short period of time. So think of A2M as our termite insecticide getting in there, preparing the ground before we then can add our regenerative products We have lots of different kits.
The kits are the tubes the connectors that are utilized to create alpha-2 macroglobulin. When I say create, I mean filter it from the plasma. Now, there’s lots of kits out there on the market. They are certainly not all created alike. I prefer the advanced A2M Plus kit. First of all, it concentrates the A2M protein.
It also really importantly removes 99% of the proteases. Most A2M kits do not remove the proteases, and you gotta remember, it’s the proteases that are the cause, the perpetuating cause of osteoarthritis. This kit also allows for use of smaller gauge needles, as small as a 27 gauge needle, and that certainly helps with patient comfort if you’re going into a joint.
A quick note on regulatory compliance for kits, both A2M and if you do PRP as well, these kits’ regulations depends upon their ingredients and their intended use, and they require compliance with device and biologic standards. They have to meet strict manufacturing and safety requirements, and unauthorized marketing can lead to enforcement action.
So make sure you have a very reputable source. In Breakthrough Coaching, we vet all of our vendor and manufacturer sources for you. In wrapping up, let’s start. Here’s the A2M blood draw. You’re looking at that screen saying, “Man, that’s a lot of blood.” The amount of blood drawn for A2M, it’s only about 120 cc’s, and after we filter it for red and white blood cells, that’s gonna result in about 60 cc’s of plasma.
The first five cc’s of the platelet plo- poor plasma at that point in time are set aside before the first centrifugation, this is a double spin process, for bio scaffolding. We set aside the first five cc’s. After the second spin in the centrifuge, the A2M is then filtered for the proteases, and it’s ready for mixing with the bio scaff and injection There we go.
That’s a picture of the blood draw kit for A2M. You can see there’s 12 vials, right? 10 mLs per vial. And next step, isolating the plasma. That’s, of course, the liquid portion of the blood, and you can see it being drawn up inside in our photographs here. That golden yellow plasma is what we’re looking for.
We don’t wanna suck up any of the RBCs or WBCs. Remember, we want a nice anabolic environment inside the joint, and putting in RBCs or WBCs are gonna continue the cat- catabolic process. We don’t want breakdown, we want build-up. So we carefully separate the liquid plasma from the other components.
We utilize, in the tube in the doctor’s left hand, holding the smaller tube, the right hand is the golden plasma. These kits also utilize filtering beads, and those are beads to filter out the WBCs and RBCs and separate them from the plasma. Want you to know, it’s much more effective than a gel layer.
You’ll see some kits that are out there that have a gel lay- layer that actually end up pulling out and withdrawing the materials, whether it’s A2M or PPP, that you are trying to get the most of in your filtering process. So we wanna make sure that we’re not losing any of those important materials.
Final note, as I mentioned before Breakthrough Coaching has group pricing organization. We have a GPO. Our members participate in our GPO, and it provides discounts of really up to 50% of the products and the services that are featured in this program. All of our vendors and manufacturers are vetted for FDA and FTC compliance.
They undergo regular testing to ensure that they are in adherence to all required regulatory and industry statutes. Our Next Level Regenerative Medicine Protocols, part two, we’re gonna cover the next steps in the injection of A2M. We’re gonna talk about Wharton’s Jelly preparation, injection of Wharton’s Jelly.
I’m gonna talk about ozone and prolozone therapy. We’re gonna also discuss peptides and some of the cool stuff that you can do to stack, some stacking therapies that help bring your regenerative medicine procedures to the next level. If you’re interested in learning more, please join us in our next session.
This is Dr. Mark Sanna from Breakthrough Coaching. I hope you make today an exceptional day, and a shout-out to ChiroSecure. Thanks again for making this program possible.
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