Sunday, September 11, 2016

The Power to Heal Comes from Within

Powerful chemical weapons, also known as drugs, and sophisticated surgical procedures have dominated the practice of medicine for many decades.  For at least the last 15 years, maverick researchers and physicians have been exploring biologic alternatives to drugs and surgery.  Instead of searching the world for a novel chemical compound or engineering a sleek surgical device, they have looked in an unusual place--inside the body itself.  Could it be possible that the power to heal comes from within our own bodies?  The answer today is a qualified yes.  

Think about it for just a moment.  Next time your get a small paper cut, simply observe what happens.  You bleed a little.  It stops on it own.  You put a bandaid on it and magically it heals over the course of less than a week.  Similarly, if you sustain a simple fracture, it typically heals on its own with immobilization and a few weeks of time.  Your liver is your most amazing regenerative organ.  You can literally cut out a lobe of your liver and transplant it into someone else.  That missing lobe will then regrow on its own.  Skin, bone and liver are tissues that have excellent capacity to self heal. Other tissues need a helping hand.  Fortunately, within our own bodies are many tissues that can help heal other tissues.  Blood, bone marrow and adipose tissue (also known as Fat) are three examples.

To begin, let's explore platelet rich plasma, also known as "PRP".  PRP is a component of blood that can be prepared using a simple desktop sized centrifuge in about 10 minutes.  I have using PRP to treat chronic tennis elbow now for more than a decade with excellent success rates.  Multiple studies now confirm the value of PRP in the treatment of this common disorder.  A recent meta-analysis of randomized controlled trials noted PRP to be "of great clinical significance."  PRP has also been used to treat diabetic foot ulcers, knee arthritis and degenerative disc disease.  Overall, there are now more than 8600 published studies evaluating the basic science and clinically efficacy of PRP.   Importantly, in all of the areas studied, PRP has an excellent safety record.  That of course makes sense.  PRP is simply a component of your own blood.

Cancer immunotherapy is another example of using your body to help heal itself.  Cancer immunotherapy essentially reprograms your immune system to help fight nasty cancers.  Recently published data has found an "unprecedented" 94% of patients with a specific type of blood cancer achieving complete resolution of their symptoms.  The technique involves removing your own white blood cells, reprogramming them to attack tumors in the lab and then injecting them back into your body.  To quote one researcher, "This is really a revolution."

Finally, a therapy that sounds like it came out of a science fiction or horror movie is just beginning.  The idea of parabiosis involves merging the circulation of two animals.  The original research was done in young and old rats in 1956.  For the details please review a tantalizing paper entitled "Experimental Prolongation of the Life Span (Ref 1)  When their circulations were connected, the young mice started becoming "old" and the old mice started to appear "young".  Something in the blood of young mice was helping reverse the affects of aging in older mice.  The coats of the old gray mice were turning brown again.  Other research conducted at Stanford suggested young blood could boost brain cell growth in older mice.  (Ref 2, Ref Ref 4)  This research was so intriguing, it led to the development of a clinical trial focused on the transfusion of young blood to older patients with Alzheimer's disease.   Silicon Valley tycoons are also helping finance similar "treatments" for middle aged rich people who want to stay young or reverse the affects of aging.  A company has even been started and is presently conducting clinical trials.  Interestingly, the company is named Ambrosia after the mythologic Greek drink that was supposed to confer longevity or even immortality.  Peter Thiel, an iconoclastic venture capitalist , appears to be quite interested in this approach to combating the aging process.  This approach is clearly not yet proven but is intriguing.

If we are seeking transformative solutions to difficult problems, I suggest we look inside.  We might just find the power to heal.

Allan Mishra

Thursday, May 12, 2016

Tumeric for Tendonitis and Arthritis

The golden spice turmeric, commonly found in many tasty Indian dishes, contains an interesting and potentially valuable therapeutic component.  Curcumin, found in turmeric, modulates several cell signialing pathways and has been used as a nutraceutical supplement to combat inflammation.  Importantly, turmeric has been found to have a high safety profile.  This is consistent with its use for thousands of years in India and China.

Research studies have shown turmeric can modify tendon inflammatory pathways.  (Ref)  One study found "curcumin can improve the quality of tendon rupture healing, and thus represents a promising strategy in the management of injured tendon tissue."  (Ref)

Tumeric / Curcumin may also be of value in the treatment of osteoarthritis by decreasing inflammatory pathways.  "Short-term supplementation with curcuminoids attenuates the systemic oxidative stress in patients with osteoarthritis.  These antioxidant effects may account for the reported therapuetic effects of curcuminoids in relieving osteoarthritis symptoms.  (Ref)  Some clinical studies suggest using Tumeric / Curcumin may result in better improvements in pain and walking when compared to using chondroitin and glucosamine supplements alone.  (Ref)  Finally, some formulations of curcumin have been specifically found to reduce the pain associated with knee arthritis.  (Ref)  (See chart below)

Bloodcure's take home message for turmeric is to consider it for tendonitis and arthritis symptoms.  The data suggest the supplement is safe and it may be a natural way to treat these very common disorders.  Consider a dose of 500 mg to 1500 mg per day.  As always, check with your personal physician prior to initiating any new supplement as each of us is unique.


Sunday, February 28, 2016

Leg Power Predicts Brain Power

Save your brain by strengthening your legs.

Here are a few bullet points from a recently published study by Claire Steves et al from Kings College in London about leg power and brain function.  

1.  Leg power is correlated with cognition over a 10 year period

2.  Leg power also correlated with total gray matter in the brain.

3.  Fasting blood glucose and diabetes status were other variables associated with cognition.

So, if you want to maintain your brain function over time, stop eating donuts and get your legs in shape.

One simple program is to walk more often and more vigorously.

The other is considering starting the PowerKnee Program.  This is a simple program that activates your primary leg muscles, stretches your hamstrings and uses an exercise bike to strengthen all of your lower extremity muscles.  I have been recommending it to strengthen knees but now the data is clear.  Strengthen your knees and you will also strengthen your brain.

The QuadCrunch helps to activate the quadriceps muscle.   (From the PowerKnee Program)

The results of Steves' study are important because they were conducted in twins over more than a decade.  This means that it is more likely that improved leg power results in better cognition because they controlled for genetics in addition to a variety of other factors.

Total Tendon

Wednesday, February 24, 2016

Tiger Woods is getting better

Check out Tiger Woods' swing.  It looks like he is feeling a lot better after multiple back surgeries.
Best of luck for a full recovery.  

Video of my own back surgery.

Total Tendon 

Sunday, February 07, 2016

Signing of the Stars and Coach Jim Harbaugh

What I learned from the University of Michigan Signing of the Stars and Coach Jim Harbaugh

by Allan Mishra

Seek a unique perspective.
Harbaugh and his expert production team took a rather mundane event (signing of high school football players) and turned it into an Oscar-like event.  The day inspired not only the Michigan football program but the entire university.

Embrace diversity.
The crowd supporting the newly signed Michigan players included Tom Brady, Derek Jeter, Denard Robinson, Jordon Kovacs, Charles Woodson, wrestler Rick Flair, world champion poker player Phil Hellmuth, rap group Migos, Owen Wilson, Vince Vaughn, Coach Mike Ditka, and many others.  The collective value of the group to the signees and audience was staggering.

Sometimes you just have to ask.
Former Notre Dame Coach Lou Holtz helped carry the event with excellent one liners.  Why did a coach from another school come to a Michigan football event?  Simply because Jim Harbaugh asked him.  To the new Michigan players Holtz said:  "You didn't just make a four year decision, you made a 40 year decision"  He understands and articulated how the new players would be part of Michigan for the rest of their lives---a powerful message.

"Some people think less is more, I believe more is more."---Jim Harbaugh
Jim Harbaugh doesn't like meetings and discusses strategy on the field with this players and coaches during marathon four hour practices.  We all should have less meetings and execute instead of engaging in perpetual discussion.

"Those who stay will be champions"-----Coach Bo Schembechler
Harbaugh added a corollary to that famous Michigan axiom.  "Try hard and you will stay".  He has written this above the exit sign from the Michigan locker room.  The implication is clear.  Work as hard as you can and you will stay.  Stay and you will be a champion.  Embracing this mindset could help all of us in our chosen professions.

"Attack each day with an enthusiasm unknown to mankind."---Jim Harbaugh 
Harbaugh and his team gave a swag bag full of gear emblazoned with his motto to all the presenters.  After the star-studded event was over around 1 pm, Harbaugh, true to form, was quoted by the Michigan daily as saying:  “We’ll be back to work at 2.30.”  Translation---have some fun but then return to the relentless pursuit of being one of the leaders and best.

Video montage of the event produced by VisionVideo360


Tuesday, January 26, 2016

Platelet Rich Plasma beats Surgery for Tennis Elbow

Treatment of tennis elbow using platelet rich plasma (PRP) resulted in an average of 83% improvement in pain scores at one year compared to baseline in a recently published study of 110 patients by Karaduman et al.  The surgery group had 46% improvement in pain scores.   Mayo elbow scores were also higher in the PRP group.  (See graphs below)  

The study used the Biomet GPS PRP device and the Nirschl surgical technique

This is an interesting study comparing the value of PRP versus a commonly recommended surgical procedure.  The data suggest PRP is a safe and effective alternative to the much more invasive and expensive surgical procedure.

See abstract and reference below:

Karaduman et el 2016



To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique.


A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements.


VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength.


The PRP seems to be better for pain relief and functionality in the short and mid-term periods.


  • Nirschl surgical technique
  • Platelet rich plasma (PRP)
  • Chronic elbow tendinosis

Sunday, January 03, 2016

Biologic Orthopedic Society passes 5000 Member Mark

The Biologic Orthopedic Society (BOS) recently passed the 5000 member mark.  (Link to join)

The society was started in 2012 with the simple goal of connecting what I thought would be 200-300 people interested in biologic orthopedics.  The group has dramatically exceeded those expectations. We now have members from six continents spanning many different orthopedic, musculoskeletal and business disciplines.  As 2016 unfolds, the BOS will hopefully continue to grow and help advance this rapidly expanding field.


Saturday, December 19, 2015

Brave Thinking

Seek the distance and difficult shore. 

Earth "Rising" from NASA
The data suggests almost no chance of reaching the distant destination.  Think bravely and embark in spite of the data.  As you progress on your faithful journey, you will become more efficient with your efforts.  Productive currents could also land you ashore beyond your previously imagined target.  By setting insanely lofty goals, you distinguish yourself from the fearful masses pursuing objectives they know they can accomplish.  Yes, you may not achieve your stated objective.  You may be disappointed, discouraged or even collapse.  Only by failing, however, will you know the limits of what you can accomplish.  

Landing of SpaceX Falcon 9 Rocket

Thoreau stated it well: 

“In the long run men (and women) hit only what they aim at.  Therefore, though they should fail immediately, they had better aim at something high”.   


Saturday, September 19, 2015

Tiger Woods Spine Surgery

Tiger Woods just had surgery on his back for the second time and will be out for a indefinite amount of time.  Apparently, something was pinching on a nerve and causing him significant pain.

(ESPN Story)

Below is a video of my own spine surgery from several years ago.  Thankfully, I have done very well.
Let's hope his second surgery will allow Tiger to return in 2016 to an elite level of play.


Saturday, August 01, 2015

Respect Your Future Health (#BodyIRA)

Body Individual Retirement Account (BodyIRA)

When I was in medical school and about 22 years old, an erudite 50-year old professor made a claim that the warranty on the human body wears out at age 45.  As I fidgeted in my uncomfortable back row seat in a packed classroom, I thought to myself---what an old man.  I couldn't even contemplate what it would feel like to be 45 or 50.  I can now attest to the validity of my professor's claim because I have seen friends, family members and patients endure unexpected medical issues in their 40s.  I have a suggestion:  Open a BodyIRA.

What is a BodyIRA?  It's not a financial investment, but an investment in good health practices. Think of a BodyIRA as a bridge to your future health.  Just like a retirement savings account, a BodyIRA is a gift you give to yourself, by taking care of yourself now so you can be healthy far into the future.  And just like retirement savings, the sooner you begin to contribute to your  BodyIRA, the more benefits you will reap later in life.

Request to join the BodyIRA LinkedIn Group 
(Goal:  share ideas about health and fitness)
Four Starter Recommendations for your BodyIRA

1.  Maintain or work toward your ideal body weight (Keep a daily record of your weight)

2.  Stretch your hamstrings and develop strong legs  (See the PowerKnee Program)

3.  Focus on your posture (Sit up and Stand up straight)

4.  Get 7-8 hours of sleep per night or more

Consistent exercise, a healthy diet coupled with stable sleep patterns are like buying index funds for your future health.  In our twenties, we are told to begin contributing to a retirement savings plan like a 401k or an individual retirement account (IRA).  Put away a little money each month and you will see it grow into millions of dollars over the course of the next 40 years.  We need to emulate that sage advice and translate it to our health.

BodyIRA leads to dramatic dividends later.  One profound example is bone density in women.  Women in their teens and early twenties are building their bony framework.  In their thirties and beyond, they will make withdrawals from this bone bank.  If they do not deposit enough early on, they pay a heavy price later in the form of osteoporosis.

We have all heard this type of advice before but let's make it actionable.  Don't just take it from a friend or a medical professional.  Take it directly from your future self.  What would your ten-years-older self have to say to your current self?  If that older you limped in the door and looked at what you were doing, he or she might just scream at you to get your butt off the couch, stop bingeing on Netflix and get some exercise.  Begin by committing to writing down your weight daily and doing some simple leg exercises.  (See PowerKnee Program)  If you can initiate the habit of contributing to your BodyIRA for two weeks, you will experience some immediate benefits and also be contributing to your future health.

Importantly,  it's never too late to open a BodyIRA.  Don't worry if you are in your 30s, 40s, 50s or even beyond 60, you can still work toward a better physical and mental situation.  Much like a "catch up" contribution to your 401k or IRA, if you start later, you will need to pay more.  Also, as we age, the body requires more maintenance.  Don't get mad about it and neglect your aging engine and wheels.   Respect your future health and start your own BodyIRA today.  You will reap the priceless reward of future well-being.  


Thursday, June 11, 2015

Will Biologics Revolutionize Musculoskeletal Care?

The economic costs of musculoskeletal care in the United States is approaching $800 billion or about 5.7% of annual GDP.  (Ref)  These costs are expected to increase significantly as our population ages.  This is clearly not a sustainable path.  A recent article published by the American Academy of Orthopedic Surgeons (AAOS) suggests the "early evidence is promising" for biologics to revolutionize musculoskeletal care.  (AAOS Article in full)

Biologic therapies represent a rapidly evolving frontier similar to arthroscopy in the 1970s and 1980s.  There will always be a need for continued research and development but the data supporting treatments such as platelet rich plasma (PRP) and stem cell treatments for tendinopathy and arthritis is increasing significantly.  PRP is now a recognized treatment for chronic tennis elbow that has been shown to be better than surgery.  (See Ref)  The number of PRP articles on PubMed now is over 8000 and the Google Trends for PRP is rising rapidly. (See Graph)

Biologic orthopedic procedures are in the process of revolutionizing the options available for patients for difficult problems such as arthritis.  It is an exciting time to execute on these point-of-care biologic treatments.   Continued progress will demand hard work and innovation by elite motivated teams in order to produce transformative outcomes for patients.


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