This post will be about an incredibly successful method of treating inflammation in multiple different areas of the body. I will do my best to make is as free of “medical-ese” as possible, while still explaining how it works and the various ways to do prolotherapy. I have personally had multiple prolotherapy treatments over the past 5 years, and I can tell you it is truly a revolutionary therapy.
I decided to blog about this because perhaps some of you might benefit from pursuing this treatment. Additionally, some aspects of prolotherapy are available in veterinary medicine. Perhaps you have a dog or a horse that could experience substantial improvement in their quality of life after receiving prolotherapy.
My personal story
Let me begin by providing some background information about how I was introduced to this procedure. In 2001, I trained for and completed the Avon Breast Cancer 60-mile walk. We walked from Kenosha, Wisconsin to downtown Chicago over a 3-day period. During the six months I trained for this event, I walked between 20 and 45 miles per week.
I wore a fanny pack while training. Apparently, the presence of a belt around my waist combined with the repetition involved with walking so many miles created a neuropathy (neuro = nerve, pathy = suffering) in the area of my quadriceps muscles. Over the years, the unhappy nerves have shared their unhappiness and my sensory neuropathy now affects almost all of both of my legs. I have no motor issues, only sensory.
In addition to that, I’m no spring chicken! I have, like many adults my age, lower back pain. Horseback riding, long trips in the car, long periods of standing, and other “normal” activities can easily aggravate my back.
Referral to Dr. Dean Reeves
I have tried different medications and even a stint at the Mayo Clinic in Minnesota to address the buzzing and pain associated with my neuropathy. Some approaches helped to some extent, but nothing provided significant and lasting relief.
One year, after meeting my substantial insurance deductible, I suggested to my family doctor that I’d like to see what options were available to treat my expanding neuropathy. He referred me to a pain doctor… a medical professional whose entire practice focused on the alleviation of pain.
I dutifully saw that doctor and told him my story. He listened carefully and said,
You need to go see Dean Reeves. He can actually help you, while I can only mask the pain.
My initial appointment with Dr. Dean Reeves was a 2-hour evaluation. He determined that the only normal sensory feeling on my legs was a small strip down the very back of each leg. I began treatment with him, which I will describe in more detail shortly.
Thinking outside the box
Before I move on to describing prolotherapy, I want to share my family doctor’s reaction when I told him where I was going for treatment. He is a great guy, about my age. He was a neighbor when we first moved to Kansas and that is how he came to be our family doctor.
However, he isn’t very familiar with PRP therapy. He questioned the wisdom of me pursuing this treatment, and he wasn’t very supportive of my decision.
Now remember, I was referred to Dr. Reeves by the professional that my doctor referred me to! I share this part of the story because sometimes it is necessary to find a medical professional who can and will think outside the box. Many medical professionals are afraid of or skeptical about that which they don’t understand. Find a different doctor if need be!
Dr. Dean Reeves is one of the most intelligent and phenomenal physicians I have ever encountered. He’s also a deeply spiritual Christian and that is reflected in his approach to medicine and patients.
What IS Prolotherapy?
The term “Prolo” comes from the word “proliferate.” Prolotherapy is a medical intervention that causes cells to proliferate and grow, thus promoting healing. Another description of this therapy is “regenerative injection therapy.” A key word here is “injection.” This is not a surgical procedure, but rather one that involves the injection of various types of substances into tissues. Therefore, the injection of a substance that causes new cell growth is prolotherapy.
In my own personal experience, Dr. Reeves has injected me with both dextrose 5% solution and PRP. Dextrose is a dilute sugar solution. The dextrose creates a mild inflammatory reaction. This inflammation signals the body to “send in the army” to repair any abnormalities, stabilize any unstable areas, and clean up any residual issues.
PRP stands for “Protein Rich Plasma.” Dr. Reeves draws my own blood. He spins it down in a centrifuge which separates it into 3 layers. The red blood cells are on the bottom. The plasma is on the top. The thin layer in the middle is PRP. PRP contains a plethora of cells that promote healing, including some stem cells. Dr. Reeves mixes the PRP layer that came directly from me with an extender. He then injects that material back into tissues that are in need of repair. Like dextrose, PRP signals the body that there is a problem that needs some attention.
Prolotherapy in veterinary medicine
I am going to explain more about the various forms of prolotherapy in human medicine, but first I will explain the primary use in veterinary medicine. This article written by South Mountain Equine veterinary practice states that:
Prolotherapy treatments are done by injecting the ligaments and tendons that support the joints with a prolotherapy solution which causes growth of new connective tissue to stabilize the affected joint(s) and relieve pain.
They recommend it for chronic musculoskeletal pain. Note that the tissue that is injected is soft tissue, the ligaments and tendons.
An article in Innovative Veterinary Care, written by Carvel Tiekert, DVM, describes the use of prolotherapy in small animal practice. This article is geared towards veterinary professionals. Dr. Tiekert admonishes veterinary practitioners interested in this form of therapy that they must know the anatomy of their patients! I will touch on that later when I return to how Dr. Reeves treats me.
Dr. Tiekert primarily uses prolotherapy to treat cruciate tears and lumbosacral spinal issues. However, he has used it in other areas of the body with ligamental inflammation or damage. Interestingly enough, in his description of prolotherapy and his explanation as to why and how he uses it, he references a study co-written by my very own Dr. Reeves.
There is an excellent article in the Journal of Prolotherapy titled A Case for Prolotherapy and Its Place in Veterinary Medicine. In the opening abstract, the author states:
It is concluded that Prolotherapy is an excellent medical option that diminishes pain and resolves clinical signs of lameness. Prolotherapy is a viable alternative to surgical options and curative in many cases of ACL [cruciate] and HD [hip dysplasia] pathologies. Prolotherapy is also a marvelous tool in conservative treatments in animals with unresolved pain, osteoarthritis and lameness issues. Prolotherapy is a great post surgical option to eliminate chronic pain and accelerate rehabilitation in our animal community.By Babette Gladstein, VMD
If you are considering this treatment modality for an animal or even for yourself, I would encourage you to read that article. It is not too technical and it is loaded with great information. The article references many, many researchers, including Dr. Reeves once again.
Pin-firing or blistering horses
This Wikipedia reference to pin-firing horses describes a practice that is no longer used in veterinary medicine. However, the principle of “blistering” a leg is similar to the concepts behind prolotherapy. Blistering or pin-firing was accomplished by using caustic chemical agents or thermal agents to create an inflammatory response. The hope was that the inflammatory response that resulted from purposefully applied damage would ultimately result in a healthier leg. The brief Wikipedia reference suggests that you should also see “prolotherapy.”
Dr. Reeves taking it to a new level with PIT
Up to this point, I have described prolotherapy in terms of injecting dextrose, a mildly irritating sugar solution, or PRP into inflamed soft tissue. The mechanical impact of a needle, the potential leakage of a few red blood cells, and the irritating solution all work together to alert the body to a problem that needs repair. The use of prolotherapy in veterinary medicine appears to be primarily or exclusively used in soft tissue or joint disease.
My personal issues include the “standard” lower back pain, which is essentially interverterbral joint disease, as well as nerve damage. To be sure, my lower back pain has a neurological component, and I have experienced sciatica as well. Dr. Reeves has used a variation of prolotherapy known as PIT, or Perineural Injection Treatment, to treat my nerve pain.
In this article differentiating Prolotherapy and Perineural Injection Therapy, Dr. Reeves defines them as follows:
Prolotherapy: Injection with the goal to repair weakened or stretched ligaments or tendons or stabilize joint surfaces affected by arthritis.
Perineural Injection Therapy (PIT): Injection close to nerves with a goal to restore normal function in nerves that cause chronic pain and degeneration.
I have put together a brief video that shows the ultrasound-guided needle injecting fluid around my unhappy nerves. It is frankly amazing. As you can hear my husband say, I am asleep. I subjected you to a shot of my tush as I climbed on the helicopter in my last installment about our amazing Grand Canyon rafting trip. I will spare you the photos and videos my husband took that show way more than the helicopter view…
I firmly believe that when Dr. Reeves looks at me, he primarily sees a map of nerves! His knowledge of anatomy and his use of ultrasound allow him to carefully place a needle exactly where he wants it to go. What I want you to see in this video is the needle going in, followed by the push of the injected fluid. The fluid goes around the angry nerves, separating the nerve from binding connective tissue and bathing it in healing fluid.
I agonized over whether or not I could show any photos that help you understand the procedure without sacrificing my modesty. I finally settled on this one… My head is to the right and you can see my sports bra.
Note the white bumps. Those are injection sites. Each time I get this treatment, I receive between 300 and 500 injections. A couple of days after the procedure, I have tiny scabs all over my treatment areas.
Final thoughts… pain, payment, progress
Pain… I take oral meds and I am, for the most part, oblivious to what is going on. There is minimal pain after the meds wear off and I don’t even need to take a Tylenol. About two weeks after the procedure, my nerves are a bit angrier than before treatment. Hopefully, the reason for that is clear after I have described how this therapy works. A few weeks after the slightly worse period, I suddenly realize that I am feeling much better.
Payment… The major downside to this treatment is cost. Some insurance companies still want to call it “experimental.” We have submitted it to Medicare but have not heard if any part of it will be covered. I am sure if we get any coverage, it will be in the “out of network” category. I only recently hit Medicare eligibility, so before that I didn’t even bother to send it to my insurance company… I knew the answer.
Are you ready for what I am going to say next…? Dr. Reeves charges $500 per hour! And yet, his practice is so overwhelmed that he is no longer taking new patients. Current patients are booking over 3 months out.
Progress… Nothing I can write will adequately convey how much better I am because of this therapy. When Alan and I first met, my aching legs kept me awake at night. My back was so bad I could not stand up straight when I crawled out of bed. After a half-dozen treatments, I rarely take pain medications.
My lower back is not constantly sore. Certainly, after driving 660 miles to Kansas, I might have some minor discomfort. Still, I rarely take even an Aleve. In fact, when I had my Medicare-initiated bone density scan, they asked if I knew that I had arthritic changes in several of my lower vertebrae! Yes, I was very aware of that a few years ago, but not so much anymore!
I realize this is a lot to absorb. I wrote this post because perhaps you or someone you know need to realize that this treatment exists. Hopefully, insurance companies are fighting it less and less. It is also an option for your animals, although I don’t know if animal insurance plans will cover it. I’m happy to answer any questions that you might have!