Regenerative Orthopedic Options

By Shaun Lehmann, MD  prp, prolotherapy, and stem cells
Edited by Mila McManus MD


The body is designed to heal itself. As we age, our bodies start to lose the ability to focus a sustained healing response to musculoskeletal injuries. Injuries can occur from multiple sources including trauma, repetitive stresses, or medications. The body’s healing response can also be diminished due to nutritional deficiencies, hormone deficiencies, and genetic conditions.
The field of Orthopedic Medicine is rapidly changing to now include many regenerative options aimed at improving our ability to heal. We are now learning that some of the traditional ways that we have been treating musculoskeletal pain and injuries may actually be causing problems by negatively affecting the body’s ability to heal itself. Steroid injections, for example, are now showing in research to decrease the local stem cell counts and could actually damage cartilage. NSAIDS (non-steroidal anti-inflammatory drugs) also have been shown to accelerate cartilage loss.
Regenerative medicine aims to accelerate our natural ability to heal after injury occurs. The goal of regenerative therapy is to optimize the cellular environment by stimulating growth factors and repair cells.

Some of these treatments include:
Point of Care Therapies (same day procedures)

Nutritional Growth Factor Stimulation

  • Prolotherapy
  • Ozone Therapy

Personal Cell Therapy (Autologous)

  • Platelet Rich Plasma (aka PRP)
  • Bone Marrow Aspirate
  • Fat derived Mesenchymal cells – or VSF “vascular stromal fraction:”

Donation cellular therapy (Allogeneic)

  • Umbilical Allograft Cells
  • Amniotic growth factors
  • Placental growth factors

Cultured Cellular Therapies (not a same day procedure… takes weeks to grow)

Nutritional stimulation treatments such as Prolotherapy and Ozone therapy aim to focus the body’s healing energies on the location that needs repaired. They aim to wake up the body’s local healing mechanisms by refocusing and restarting the healing process. These treatments can work well as long as the body is healthy, and the repair mechanisms are in working order.

Personal cellular therapies do the same as above; however, they also bring extra cellular workers to the job site. These treatments are usually deemed stronger than Prolotherapy and Ozone and are deemed relatively safe since the workers are your own cells.

Donation cellular therapies are from a donor person, are more potent than Personal cellular therapies, and are tested for safety (e.g., viruses such as HIV, hepatitis); however, the tissues are not tested for every potential infectious disease, so there may be some theoretical risk.

Cultured Cellular Therapies are not legal to use in the U.S. at this time, but it is legal to process and store these stem cells in the United States. One has to travel to another country to have the stem cells injected or infused. Cultured stem cells can be either Personal (autologous) or Donated (allogeneic).

There is a large body of research done on the efficacy of Prolotherapy and Platelet Rich Plasma, but more is still needed. Stem cells show so much promise that they are said to be “the future of medicine”.

By |2019-02-22T08:55:43+00:00January 30th, 2019|Articles, General|

Could this help you?

by Mila McManus MD

If you are familiar with my practice and know that we work hard to heal and restore health in everyway possible without using prescription drugs, you may be wondering why I am excited to tell you about Low Dose Naltrexone (aka LDN).  For three reasons, I believe this is a great example of a very useful drug. LDN does not mask symptoms.  It addresses the issues of dysregulation of the immune system (and regulates it) and issues of inflammation (by reducing it).  And finally, LDN has no known side effects other than transient effect on sleep and vivid dreams.

Since inflammation and immune dysregulation are at the root of many diseases, especially autoimmunity, clinicians are using it for a whole range of conditions involving inflammation and immune dysregulation including Hashimoto’s, Grave’s, rheumatoid arthritis, lupus, psoriasis, MS, ALS, alopecia, chronic fatigue syndrome, and neurogenerative disorders such as Parkinson’s and Alzheimer’s.  LDN is also used as a complementary medicine by functional specialists for cancers, HIV/AIDS, as well as for post radiation salivary gland destruction, chronic allergic rhinitis, nerve damage, autism, shingles, weight management, infertility and migraines.

The original commercial prescription use of Naltrexone was approved by the FDA in 1984 in a 50mg dose and used for helping opiate addicts get off illegal and prescription drugs by blocking opiate receptors.  It’s also used to reverse opiate overdose (e.g., heroin, morphine).

Since that time, many doctors have pioneered the use of Naltrexone at very low doses, thus the name, Low Dose Naltrexone, or LDN.  One of the first was Bernard Bihari, MD, a physician in New York City who was interested in treating cancer and AIDS patients.  He discovered that low doses between 3 and 4.5 mg had very beneficial effects on the immune system.

Over the last 25 years or so, there have been increasingly more clinical trials with very favorable results. Additionally, clinical and anecdotal experience is showing improvements for a wide variety of conditions. So far, two main mechanisms of LDN have been identified.

First, LDN modulates the immune system by helping the T regulatory cells balance immune function without suppressing the body’s ability to regenerate and repair.  T regulatory cells are responsible for turning inflammation on and off in the body.  Patients with overactive immune systems (such as asthma, allergies, and autoimmune conditions) have immune systems that get “stuck in overdrive”.  LDN helps to get the system balanced again.

Second, LDN reduces inflammation in the Central Nervous System which is thought to play a significant role in fibromyalgia, other forms of chronic pain, and depression.  In the Central Nervous System there are receptors found on certain brain cells called microglia.  These cells can become chronically activated, resulting in neurotoxicity, which causes a cascade of symptoms that are associated with chronic pain, fatigue, mood disorders, and cognitive problems.  LDN reduces inflammation and quiets the microglia, which slows or stops the cascade of symptoms.

Another important advantage is that LDN is safe for almost everyone. People who regularly use opioid drugs or medication should not take LDN (however, there is a new FDA approved morphine that has a VERY low dose of LDN combined with it).  LDN is not addictive and can be stopped abruptly without harm or withdrawal.

While most conventional healthcare practitioners are not familiar with LDN, it’s gaining popularity in the functional medicine realm. At TWIHW, we’ve been prescribing LDN for several years for all sorts of health issues.  Because it’s specially compounded, it’s not covered by insurance.  Dosing is very personalized for each patient. In our practice, dose varies from 0.5mg per day, up to 4.5mg twice daily.  It can be formulated into capsules, sublingual drops, topical cream, nasal spray, and eye drops, depending on the purpose or need.

Studies with LDN have been especially encouraging for treating Crohn’s with over a 70% remission rate, and even complete mucosal healing as evidenced by colonoscopy in some cases.

Because naltrexone has been without patent protection for many years, no pharmaceutical company will bear the expense of the large clinical trials necessary for FDA approval of LDN’s new special uses.  There are at least 2 new FDA-approved and patented combination drugs (one mentioned above, and a new weight management drug called CONTRAVE®) which include LDN.  They always find a way!!



By |2018-06-11T08:37:08+00:00May 5th, 2018|Articles, General|

All About Pain-Causes and Solutions

By Mila McManus MD and Nancy Mehlert, MSchronic pain

Chronic or intermittent pain, whether it is a headache, tummy ache, or joint ache, and whether it is dull and long-lasting or short term and shooting, it can really drag you down and take the joy out of your life. It can seem difficult to resolve and frustrating to control or eliminate.

Pain is difficult for many reasons.

One reason it’s difficult is because the main person you are counting on to resolve it knows very little about it! Did you know that over the course of a doctor’s long medical study, less than four percent of medical schools require a course in pain and many offer no dedicated courses at all? ¹

Not only are most doctors grossly undereducated about pain, but pain can also be very mysterious. Pain can be caused by a specific area of dysfunction or inflammation (kidney stones, pinched nerve, imbalanced hormones, leaky gut) but it can also be a nerve memory caused by negative plasticity of the brain. Dr. Datis Kharrazian, in his book Why Isn’t My Brain Working?, describes this characteristic of the brain in this way: “Many individuals develop chronic pain thanks to negative plasticity.  These are conditions in which a person’s neuronal pathways that perceive and generate pain signals become more developed and efficient. ² For example, a person’s herniated disk could cause pain for years.  The pain further activates the pain signal, in essence making these pathways very efficient in generating pain.  Additionally, pain-receiving fibers increase in number and branch out to further activate pain perception. Over the years these new pathways heighten the pain response, even though the tissue injury is no longer sufficient enough to actually generate pain. “³

In the U.S., more people suffer from chronic pain than from diabetes, heart disease and cancer combined. ⁴ There are many causes, and one thing we know here in our practice from observation and experience is that nutritional deficiencies, food sensitivities, hormonal imbalances, and dietary/lifestyle choices are often the main triggers of pain.

Causes of pain include:

  • Poor gut health, nutrient deficiencies and food allergies/sensitivities caused by poor diet, excessive grains, sugar, alcohol, chemicals, excessive antibiotic and steroid use and brain injury.
  • Poor Sleep – during sleep the body recovers, restores and resets. Deep sleep is critical for tissue growth and repair, which is, therefore, essential for getting pain relief.
  • Vitamin D deficiency – this can causes achy bones. Vitamin D also inhibits inflammatory pathways, so having a deficiency can lead to trouble.
  • Magnesium Deficiency – one primary role of magnesium is to block your brain’s receptors of glutamate, a neurotransmitter that may cause your neurons to become hypersensitive to pain. Both stress and prescription drugs can deplete magnesium stores which may explain why an estimated 80 percent of Americans are deficient in magnesium.
  • Prescription drugs – a side effect of many drugs can be pain. For example, statins are known to cause muscle and joint pain.
  • Lyme Disease – Borrelia burgdorferi, the bacteria that causes Lyme disease, and all its co-infections may start with flu-like symptoms including fatigue, achiness and stiff neck, but can linger chronically and look very similar to many diseases such as multiple sclerosis (MS), arthritis, Parkinson’s, chronic fatigue syndrome, and fibromyalgia. Even though many people cannot recall a tick bite, it is worth considering since a tick will numb your skin before the bite, making it difficult to remember or feel the bite. Also, the size of the tick can be as small as a pinpoint and easily be missed.
  • Sedentary Lifestyle, including too much sitting, lack of stretching, and too little exercise.
  • Excessive exercise
  • Hormonal imbalance-can cause headaches, as well as body aches.

Natural Therapies for Pain Relief

  • Ondamed Energy Therapy is offered here at TWIHW and reduces and/or eliminates pain through reducing inflammation, oxygenating the body and supporting the body with energy frequencies that help with balance, healing and repair. Call for a free demo today!
  • Movement -Stretching and Exercise – a great deal of our current aches and pains are a result of a sedentary life. Too much sitting at desks, hunching over computers and sitting on the couch can lead to chronic disease and pain.  We are designed to be active all day. Aim for sitting no more than 3 hours a day. Consider ways to stand while working and keep moving and stretching throughout the day. Even an aggressive exercise schedule cannot compensate for sitting 8-10 hours a day.
  • Infrared Sauna is offered here at TWIHW. Check out this link to see how infrared sauna can help a great deal with alleviating chronic pain.
  • Chiropractic, Massage Therapy, Acupuncture and Physical Therapy are all familiar methodologies for pain relief.
  • Ice remains an age old, simple and local anti-inflammatory treatment for pain.
  • dōTERRA Deep Blue Rub cream made with cooling and pain relieving essential oils (available at our office)

Supplemental Painkillers from Mother Nature

There are many very effective supplements available to relieve many types of pain.  Talk to our healthcare providers to determine which combination might be right for you.  Since we are all unique, we find that effectiveness varies with individuals so it can take several attempts to find the ones that work best for you.  Here are many to consider:

  • CBD Oil –available at our office
  • Protease– when used between meals, these enzymes get into the bloodstream and seek and destroy inflammation, scarring and other “garbage” that needs to be removed from the body. In a sense, they are scavengers, gobbling up materials that obstruct optimal function. They promote improved circulation and immune function, resulting healing. Also available at our office.
  • MSM (sulfur), Curcumin, Boswellia, Ginger and Bromelain are all plant compounds with powerful anti-inflammatory and pain relieving effects. ⁵
  • Evening primrose, Black Currant and Borage Oils all contain the fatty acid gamma linolenic acid (GLA) which is useful for treating arthritic pain. ⁵
  • Capsaicin Cream is formulated from dried hot peppers and alleviates pain by depleting the body’s supply of a chemical component of nerve cells that transmits pain signals to the brain. ⁵
  • Krill Oil provides Omega 3 fatty acids which are precursors to mediators of inflammation and thus are beneficial for pain relief.

Dietary Adjustments for Pain Relief

Click Here for the Nutrition article today about dietary adjustments for Pain Relief.

It is important to remember that solving ongoing pain will require a multi-pronged approach where the impact of addressing diet, lifestyle, hormonal imbalances, supplements and movement cannot be under estimated. Let us help you get some relief. Call 281-298-6742 today for a free consultation.


¹ J Pain. 2011 Dec;12(12):1199-208.

² Mercier C, Leonard G. Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome. Physiother Can.2011 Summer;63(3)305-14

³ Kharrazian, Datis. (2013) Why Isn’t My Brain Working?. Carlsbad, CA: Elephant Press LP.

⁴ Rodale News, May 12, 2014, American Academy of Pain Medicine, Facts and Figures on Pain.



By |2017-08-05T13:25:52+00:00August 5th, 2017|Articles, General|
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