Preparing For Your Regenerative Procedure

Bone Marrow Cell Therapy

Platelet Rich Plasma (PRP) Therapy

Whether you are undergoing a Bone Marrow Cell procedure or a Platelet Rich Plasma (PRP) procedure, it is important to recognize that both procedures are specifically designed to stimulate your body’s healing response in a specific area.  It is also important to realize that the first step in any healing process is an inflammatory reaction.  We typically refer to inflammation only in a negative context, however, considered from a different perspective, your initial inflammatory reaction after a Regenerative Procedure is vitally important to the eventual success of the intervention.  Therefore, it is critically important to avoid taking medications that have anti-inflammatory effects in the timeframe before and after your Regenerative Procedure.  Taking anti-inflammatory medications at the wrong time can sabotage your Regenerative procedure outcome by blunting the inflammatory reaction that must be provoked for success.

There are two classes of anti-inflammatory medications of which to be aware:  1) Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and 2) Steroids.  The crucial timeframe for NSAIDs is for 2 weeks before your Regenerative procedure and for 2 weeks after your Regenerative procedure (total duration is one month off NSAIDs).  The crucial timeframe for Steroids is for 4 weeks before your Regenerative procedure and for 4 weeks after your Regenerative procedure (total duration is 2 months off steroids).  Therefore, acetaminophen (Tylenol) can be used instead because it has no anti-inflammatory impact.  Dr. Terebuh can also provide you with a pain medication alternative during these crucial timeframes.

Most NSAIDs are pills that you swallow, but others are available through injection as well as in creams or patches that you apply to your skin.  It is important to account for every NSIAD that can get into your system and negatively impact your Regenerative Procedure outcome.

This is a list of prescription and over-the-counter Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) that should be avoided for 2 weeks before your Regenerative procedure and for 2 weeks after your Regenerative procedure:

Generic name in bold and (trade name in parentheses)

  • diclofenac (Arthrotec, Cataflam, Flector, Voltaren, Zipsor, Zorvolex)                        
  • diflunisal (Dolobid)                                                                                  
  • etodolac (Lodine)                                                          
  • fenoprofen (Nalfon)                          
  • flubiprofen (Ansaid)                                            
  • ibuprofen (Advil, Combunox, Dolgesic, Duexis, Genpril, Halpran, Medipren, Motrin, Nuprin, Pamprin, Q-Profen, Rufen, Trendar, Tab-Profen, Vicoprofen)                                     
  • indomethacin (Indo-Lemmon, Indocin, Indomethagan)                                                                                                                                          
  • ketoprofen (Actron, Orudis, Oruvail)                                                                     
  • ketorolac (Toradol)
  • meclofenamate (Meclomen)               
  • mefenamic acid (Ponstel)             
  • meloxicam (Mobic)
  • nabumetone (Relafen)                           
  • naproxen (Aleve, Anaprox, Naprapac, Naprelan, Naprosyn, Naproxyn, Vimovo)
  • oxaprozin (Daypro)
  • phenylbutazone (Cotylbutazone)
  • piroxicam (Feldene)
  • salsalate (Disalcid , Trilisate)
  • sulfasalazine (Azulfidine)
  • sulindac (Clinoril)  
  • tolmetin (Tolectin) 
  • celecoxib (Celebrex)

Steroids can be given in pills you swallow, but others are available through injection (muscle, IV, epidural, joint, bursa, tendon, etc.) as well as in creams that you apply to your skin.  It is important to account for every Steroid that can get into your system and negatively impact your Regenerative Procedure outcome.

This is a list of prescription and over-the-counter Steroids that should be avoided for 4 weeks before your Regenerative procedure and for 4 weeks after your Regenerative procedure.  If you have a medical emergency that requires Steroids then that emergency certainly takes precedence and Steroids should be used under those circumstance:

Generic name in bold and (trade name in parentheses)

  • betamethasone (Celestone)                         
  • cortisone (Cortone)                          
  • dexamethasone (Decadron) 
  • hydrocortisone (Cortef) 
  • methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
  • prednisolone (Hydeltra, Orapred, Prelone)
  • prednisone
  • triamcinolone (Aristocort, Aristospan, Kenalog)

Using IceHealing relies on blood flow and ice restricts blood flow.  For that reason avoid applying ice to your Regenerative procedure injection site for at least the first 2 weeks after the procedure.

Stay Hydrated:  Make certain to drink extra water during the 48 hours before your Regenerative procedure.  This will make the blood draw much easier if you are undergoing a platelet rich plasma (PRP) procedure, but being well hydrated significantly helps your body better tolerate any procedure it is experiencing.

What to Wear:  On the day of your Regenerative injection please wear very loose fitting and comfortable clothing.  This allows easy access to the targeted area without requiring you to disrobe.  Loose exercise clothing or lounge clothing is ideal.  Avoid zippers, buttons, belt buckles or draw strings with metal grommet holes because these dense objects block x-ray visualization.  If your Regenerative procedure is in the neck make sure to leave at home jewelry such as necklaces, ear rings and tongue studs.  Just before the neck injection procedure you will be asked to take of your glasses and any removable dental appliances (bridges, dentures, etc.).  Keep your shoes on during the procedure so you have traction on the tile floor when you stand up after the procedure is complete.

Driver Required:  It is always necessary to have a driver take you home after a Regenerative procedure.  Numbing medicine can sometimes slow your foot pedal reaction time even if your legs and feet don’t feel numb.  For that reason you must have a driver bring you home after your injection and you should not drive your vehicle for at least 4 hours after the injection.  This policy is for your safety as well as for the safety of other drivers on the road.  As you make plans for yourself and your driver please schedule 90 minutes total time (from check-in to check-out) which will cover all the steps involved including the after Regenerative injection observation and monitoring period.

Procedure Related Anxiety and Mild Sedation Options:  If you would benefit from mild sedation in order to go through with your Regenerative procedure, a medication can be prescribed to you in advance during the office visit to schedule your procedure.  This prescription should be filled enough in advance so can swallow the tablet at home two hours before the scheduled time of your Regenerative procedure.  If any type of sedation is used during your procedure then you should not drive until the following day after you have had a full night sleep.  An additional option to make you more comfortable is the use of Nitrous Oxide “laughing gas” during your procedure.

Injection Safety & Risk Management:  When you and Dr. Terebuh decide to move forward with plans to perform a Regenerative procedure, he will ask a detailed series of questions with your safety in mind.  The risk of any medical procedure is never 0% but working together with Dr. Terebuh you can reduce the risk as low as possible.  Each category of safety is discussed below:

Blood Thinners:  There are many over-the-counter and prescription medications that are designed specifically to thin your blood and there are many others that thin your blood as a side effect.  All of these medications make injections more risky because they cause you to bleed excessively in and around the treatment site after the injection needle is removed.  When planning your Regenerative procedure Dr. Terebuh will go through a long list of these medications to make the injection as safe as possible by minimizing your bleeding risk.  You can help by reviewing these lists beforehand and notify Dr. Terebuh if you are taking any of these over-the-counter or prescription medications:

Aspirin containing medications thin the blood up to 7 days:

  • Aspirin (ASA - acetyl salicylic acid)  
  • Adprin                                                        
  • Aggrenox
  • Alka-Seltzer
  • Anacin
  • Ascriptin
  • Aspergum
  • Bayer
  • Bayer Back & Body
  • Bufferin
  • Doan’s Pills
  • Easpirin
  • Ecotrin
  • Endodan
  • Equagesic
  • Excedrin
  • Fiorinal
  • Fortabs
  • Gelpirin
  • Genacote
  • Goody’s Extra Strength
  • Halfprin
  • Magnaprin
  • Norwich
  • Norgesic
  • Orphengesic
  • PC-CAP
  • Percodan
  • Robaxisal
  • Roxiprin
  • St. Joseph’s
  • Supac
  • Sureprin
  • Synalgos-DC
  • Soma-compound
  • Talwin-compound
  • Vanquish
  • ZORprin
  • Willow Bark Extract

Prescription Blood Thinners all work differently and for different lengths of time:

generic name in bold and (trade name in parentheses)

  • apixaban (Eliquis)                                        
  • betrixaban (Bevyxxa)                       
  • cilostazol (Pletal)
  • clopidogrel (Plavix)                                                      
  • dabigatran (Pradaxa)                       
  • dalteparin (Fragmin)                       
  • danaparoid (Orgaran)                               
  • dipyridamole (Persantine)          
  • edoxaban (Savaysa)
  • enoxaparin (Lovenox)                               
  • fondaparinux  (Arixtra)                    
  • heparin
  • low molecular weight heparin (Lovenox) 
  • pentosan polysulfate sodium (Elmiron)  
  • pentoxifylline (Trental)                                    
  • prasugrel (Effient)                                        
  • rivaroxaban (Xarelto)                       
  • ticagrelor (Brilinta)                           
  • ticlopidine (Ticlid)                                      
  • tinzaparin (Innohep)                         
  • warfarin (Coumadin)   

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) interfere with Regenerative procedure outcomes (as documented at the top of this page) and should be avoided for 2 weeks before your Regenerative procedure and for 2 weeks after your Regenerative procedure.  They also each thin the blood (as a side effect) for different durations:  some as short as 24 hours and others as long as 10 days.  To plan appropriately Dr. Terebuh needs to know which of these prescription or over-the-counter NSAIDs you take regularly, occasionally, or even rarely:

Generic name in bold and (trade name in parentheses)

  • diclofenac (Arthrotec, Cataflam, Flector, Voltaren, Zipsor, Zorvolex)                        
  • diflunisal (Dolobid)                                                                                  
  • etodolac (Lodine)                                                          
  • fenoprofen (Nalfon)                          
  • flubiprofen (Ansaid)
  • ibuprofen (Advil, Combunox, Dolgesic, Duexis, Genpril, Halpran, Medipren, Motrin, Nuprin, Pamprin, Q-Profen, Rufen, Trendar, Tab-Profen, Vicoprofen)                                     
  • indomethacin (Indo-Lemmon, Indocin,Indomethagan)                                                                                                                                        
  • ketoprofen (Actron, Orudis, Oruvail)                                                                     
  • ketorolac (Toradol)
  • meclofenamate (Meclomen)               
  • mefenamic acid (Ponstel)             
  • meloxicam (Mobic)
  • nabumetone (Relafen)                            
  • naproxen (Aleve, Anaprox, Naprapac, Naprelan, Naprosyn, Naproxyn, Vimovo)
  • oxaprozin (Daypro)                                     
  • phenylbutazone (Cotylbutazone)
  • piroxicam (Feldene)
  • salsalate (Disalcid , Trilisate)
  • sulfasalazine (Azulfidine)
  • sulindac (Clinoril)                                        
  • tolmetin (Tolectin) 

 

Supplements can thin the blood for varying lengths of time:

Fish Oil, Garlic, Ginkgo Biloba, Ginseng, Willow Bark Extract

Blood Clotting Disorders:  Notify Dr. Terebuh if you have a blood clotting disorders hemophilia, low platelets, etc. to avoid bleeding complications from the spine injection.

Infection:  You should not get a Regenerative injection if you have an infection anywhere in your body – even a cold or flu!  Whether or not you are taking antibiotics there is a chance of moving that infection into your central nervous system causing meningitis.  Make sure to tell Dr. Terebuh if you have had a recent infection – even if you are taking antibiotics and no longer feeling the symptoms of the infection.

Recent Dental Work:  Bacteria can enter your bloodstream during routine dental cleaning even if you have healthy teeth and gums.  Make sure that you notify Dr. Terebuh if you have had any dental work in the 2 weeks prior to your scheduled Regenerative procedure to avoid infection complications in the central nervous system such as meningitis. 

Dye Allergy:  Notify Dr. Terebuh if you have an allergy to or x-ray dye (contrast).  It is possible to perform injections without x-ray dye (contrast).

Pregnancy:  Notify Dr. Terebuh if you are or could possibly be pregnant because your fetus should not be exposed to x-rays from the fluoroscope.

 

Are you a candidate for The Discseel® Procedure?