Sometimes It’s Tough Being a Good Doctor…

By Chris Centeno, MD /

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If you read this blog you know that I often write about what I experience. Yesterday I had two patients that in most other clinics would have been treated with stem cells, but not at our clinic. Let me explain.

Purpose over Profit

We’ve all interacted with professionals who seem to place their purpose over profit. It’s that mechanic who tells you not to fix a car and to get a new one, even though he could have raked you over the coals for thousands of dollars over years trying to fix a car that was a lost cause. Or we once had an architect who advised us to sell a home we were trying to remodel because he knew our local historical board would never approve a design that we would be happy with, in the process giving up tens of thousands of architectural fees for himself.

My First Patient with Low Back Pain

A phone review in the morning introduced me to a patient with chronic low back pain that wanted to go to the Cayman Islands to get cultured cells. In looking at his MRI and getting a history, it was clear that that treatment was overkill from a cost standpoint. Heck, even a same-day bone marrow stem cell procedure wasn’t warranted. In fact, a far cheaper platelet-based approach to his degenerative disc disease would likely work just fine. Why? Watch my video below to learn more:

In this patient’s case, he had no disc problem requiring stem cells. He just had garden-variety, mild degenerative disease, so this is the procedure I recommended, using his own blood platelets:

However, by doing that, his cost went from about twenty thousand dollars to a few thousand. This is despite many other clinics that would have told him he needed a much more expensive stem cell procedure.

My Second Patient with Upper Neck Issues

We perform a novel upper neck ligament injection that I developed years ago called the PICL procedure. It’s used in patients who have damaged upper neck ligaments, and it’s helped many patients recover who have responded to little else. Watch my video below to learn more:

Yesterday I saw a patient for follow-up before this planned procedure that day who had an interesting history. Basically, he had an occipital nerve block for a hair transplant, and that ended up giving him complete relief of his symptoms for a week. Given that he had yet to try that less invasive procedure and that the PICL procedure was much more invasive, I was ethically required as a good doctor to tell him that we had to cancel that procedure and try using platelet lysate to hydrodissect the occipital nerve instead, to see if that gave him longer relief. To learn more about what a nerve hydrodissection looks like, see my video below of that procedure on the median nerve in the wrist:

However, by making that decision, we had to cancel his bone marrow draw, cancel the anesthesiologist for this PICL procedure later in the day, and then collapse several hours of time into 20–30 minutes to perform the occipital nerve procedure. Meaning, all of this was an exercise in destroying my schedule for the day because it was the right thing to do.

The upshot? Doing the right thing with both of these patients affected many people so was tough, but the best thing to do in each case. While I know clinics that would have soaked both patients for as much as they could pay, I’d prefer to be more like that architect who told us to sell our house than the mechanic who decides to fix a car he knows will become an annuity.

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2 thoughts on “Sometimes It’s Tough Being a Good Doctor…

  1. Mark

    When having upper cervical issues,is it still possible to have symptoms,ringing in the ears,brain fog,dizziness,even when my chiropractor tells me my atlas is in- balance?
    The symptoms are more pronounced when my atlas is out,but still present after Atlas adjustment is made…
    Are these symptoms usually improved with PICL procedure?

    1. Regenexx Team

      Hi Mark,
      Yes. Unfortunately, if you have true CCJ Instability, there isn’t a chiropractic adjustment that can keep the area stable. That said, dizziness, brain fog and ringing in the ears can be symptoms of other things, which is why there is such a strict criteria for the PICL (CCJ Instability) procedure. Please see: https://regenexx.com/blog/candidacy-for-ccj-instability-procedure/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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