Episode #9: Injections

Summary

In this episode, Dr. K and Coach Kyle discuss regenerative injections, including prolotherapy, platelet-rich plasma (PRP), and stem cells. They explain that regenerative injections aim to heal injured tissue and promote the growth of new, healthy tissue. Prolotherapy is the base treatment, while PRP is three times more effective and uses concentrated healing factors from the patient’s own blood. Stem cells, or mesenchymal signaling cells (MSCs), are even more potent and can be derived from bone marrow, adipose tissue, or birth products. The effectiveness of these treatments varies depending on the injury and the individual. In this episode, Kyle and Ben discuss the safety and risks of surgery compared to regenerative injections. They also explore the factors that affect the cost of regenerative injections and the wide range of prices in the market. The conversation concludes with a discussion on a full body stem cell makeover and plans for future deep dives into specific types of stem cells.

Takeaways

  • Regenerative injections aim to heal injured tissue and promote the growth of new, healthy tissue.
  • Prolotherapy is the base treatment, while PRP is three times more effective and uses concentrated healing factors from the patient’s own blood.
  • Stem cells, or MSCs, are even more potent and can be derived from bone marrow, adipose tissue, or birth products.
  • The effectiveness of regenerative injections varies depending on the injury and the individual. Regenerative injections can be a safer alternative to surgery, as surgery carries the risk of human error and potential complications.
  • The cost of regenerative injections varies depending on factors such as the quality of materials used and the expertise of the doctor performing the procedure.
  • Full body stem cell makeovers, where multiple joints and areas of the body are injected, can be a costly procedure.
  • Future episodes will delve deeper into specific types of stem cells and their applications.

Chapters

00:00 Introduction

01:28 What is a regenerative injection?

02:35 Types of regenerative injections

06:30 Prolotherapy

12:16 Platelet-Rich Plasma (PRP)

23:31 Stem Cells

30:18 Birth Products

35:05 Ethics of Stem Cell Use

35:57 Effectiveness of Stem Cells

36:16 Safety and Risks of Surgery vs Regenerative Injections

37:30 Factors Affecting the Cost of Regenerative Injections

39:09 Procedure-based Cost Variation

39:57 Full Body Stem Cell Makeover

41:05 Conclusion and Future Deep Dives

Sponsors

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People

Peak Performance 

Dr. K 

Coach Kyle 

Transcript

Kyle Hulbert (00:00)

Cool. Ladies and gentlemen, welcome to the Peak Performance Podcast. I’m Coach Kyle.

Ben Kosubevsky (00:04)

And this is Dr. K. Thank you everybody for joining us. While today we discuss regenerative injections, prolotherapy versus PRP versus quote unquote stem cells. Find out why I’m calling quote unquote stem cells. And then we’re gonna talk about quality, where to get them, how to get them done, and a few other things. Let’s get into it.

Kyle Hulbert (00:23)

Enjoy the episode.

The Peak Performance Podcast. Today we are talking about regenerative injections. I’m Coach Kyle.

Ben Kosubevsky (00:31)

and I’m Dr. K. Thank you for joining us today as we discuss prolotherapy versus PRP, which is platelet-rich plasma, versus that big buzzword, stem cells, and what are stem cells and what they really mean. We’re gonna cover some quality things. We’re gonna cover, you know, you should make sure the person you’re seeing is good at what they do, and a few other things. So let’s get into it.

Kyle Hulbert (00:53)

injections. So we’ve got a bunch of types of regenerative injections, but first can you explain Dr. K what a regenerative injection even is, and why would you

do it?

Ben Kosubevsky (01:03)

So the magic is in the name. Our goal is to regenerate injured tissue. So this is the exact opposite of Botox injections, that were the injections. Even it’s different than hyaluronic acid or gel or any of those other synvisc type things that people are injecting for issues. The whole point of these injections is that ideally they will actually heal your injury and regrow the injured tissue to an extent that you’re

have no more symptoms.

Kyle Hulbert (01:35)

Very nice. So injured tissue, like where do people inject these?

Ben Kosubevsky (01:40)

Yeah, so you, I mean, there’s a ton of uses for these. There’s cosmetic applications, there is musculoskeletal applications, there’s IV applications. So as a general rule, the idea is to restore and repair the natural tissue to basically how it was when you were born, I guess is the best way to put it. And let’s talk about musculoskeletal first.

Big thing with musculoskeletal is arthritis, tendonitis, ligament injuries, stuff like that. Things that have really bad blood supply and so the body’s not able to heal it. Most muscle injuries, if you tear a muscle, it’s gonna heal by itself pretty well because that’s really good blood supply. Whereas if you tear a tendon or a ligament, it really just can’t heal itself because it just doesn’t have enough blood flow to repair itself. Discs in the spine as well.

Basically have zero blood supply. Basically the top and bottom of it, get a tiny trickle down effect, and the inside just through, what’s the word, where it dilutes itself through.

Kyle Hulbert (02:48)

Osmosis?

Ben Kosubevsky (02:49)

not osmosis, there’s another word for it, but it doesn’t matter. So areas like that are really what benefit the most from these injections. So here’s, well let me dive into this. Here’s kind of how I help people visualize an injured tendon or ligament. Imagine it’s a boat rope. If you look at a tender ligament under a microscope, it’s gonna look, a healthy one’s gonna look like a brand new boat rope, bunch of fibers spun really tight into a rope.

Kyle Hulbert (02:58)

Okay.

Ben Kosubevsky (03:16)

an injured one is going to look like an old boat with a bunch of fibers fraying off. The body is going to pack scar tissue around it. And that’s the best they could do. So the idea with these injections, for example, for ligaments, is you inject them, it’s going to basically help the body grow new fibers to tighten that rope down again.

Kyle Hulbert (03:32)

So it’s like a boat rope, and as it gets injured, it frays. And so these injections, kind of what we’re trying to do is unfray it, build it back.

Ben Kosubevsky (03:42)

Yeah, proliferate the production of new tissue.

Kyle Hulbert (03:46)

Okay, so the production of new tendon ligament tissue to make sure that rope stays as new as possible.

Ben Kosubevsky (03:53)

Correct, or for cosmetics, you know, collagen in the face, or done IV for organs.

Kyle Hulbert (04:01)

Oh, very nice. So like if someone comes in and say, you know, I hurt my knee or whatever. So you can inject it with a bunch of different things all under this category of regenerative injections. So how would you go about like explaining the different types of injections, the levels, what they should do, what’s appropriate?

Ben Kosubevsky (04:02)

Um…

Absolutely. So in my office we offer all three, prolotherapy, PRP, and quote unquote stem cells. And I’m gonna explain why I keep saying quote unquote when I get to them. But you know, basically I have a discussion with patients about plus and minus of each injection option. From there it’s kind of up to them to choose what they want to do. So let’s start with prolotherapy. Prolotherapy is what I call the base one. This one, the first book was written in 1950s by a guy named, by two doctors named Hackett and Hemwall.

They experimented on dogs to prove this, where they would cut tendons in the dogs and then inject them and see that the tendons would regrow. And so that was the first time a book was written. But if you go back in history, basically old Greco-Roman warriors would take hot pokers and poke themselves in the tendons to repair things. That’s as far back as this base idea goes.

So, prolotherapy, its formulation has changed over the years to keep up with modern medicine and sterility and all that stuff. Back in the day, they used to use things like volcanic ash, pumice, and all sorts of crazy things. And the reason they were so caustic that when you injected them, they created a ton of inflammation irritation. Nowadays, we use dextrose, not as caustic. Still works pretty well, just not as good as that old stuff.

The other thing I’ve heard people using is hypertonic saline, 3% saline. That’s also pretty caustic. But what happens is when you inject that stuff, it creates a process called neovascularization or new blood vessel growth. The idea behind this is that those injured areas have really bad blood supplies, so when you inject them and make the body grow new blood vessels, it can now wash in more healing factors.

We don’t do prolotherapy IV, we don’t do it for cosmetics. We only do it for injured musculoskeletal tissue. Prolotherapy under the skin can actually cause necrosis of the skin, so don’t do that.

Kyle Hulbert (06:18)

Heh heh.

Oh, yikes. So no IVs of dextrose, ladies and gentlemen. Not a good idea.

Ben Kosubevsky (06:28)

You can do IVs of dextrose, but it’s going to spike your sugar crazy high. Yeah, but actually that brings up a good point I get. I get diabetics are scared of doing prolotherapy because they’re worried their sugars will spike. Locally injected dextrose will not affect blood sugars in a patient.

Kyle Hulbert (06:32)

That would just be a terrible idea.

Yeah, that makes sense because you’re not putting it in the blood, blood sugar. It’s actually the measure of the sugar in the blood. You’re actually putting it near tendons or in tendons or near muscles. And usually I would imagine that glucose would get absorbed into the nearby musculoskeletal system, where is it actually where you want to store your glucose for healthy glucose functioning anyway.

Ben Kosubevsky (07:07)

Yup.

Exactly. So I mentioned that they’re caustic. These injections hurt. Normally, prolotherapy hurts for about three to four days after injection. When I say hurt, I mean really stiff and sore. For example, if you, because the only part of me you can see is neck. If I injected someone’s neck, for the first day, this is all the motion they’re gonna have. And each day, they get a little bit more motion back. But it just creates a lot of stiffness in those tendons and ligaments.

Kyle Hulbert (07:41)

So it’s one of those deals that’s like, it’s gotta get worse before it gets better. Like, yeah, you’re gonna inflame it and then that’s gonna send the signal for the body to repair it. So it’s gonna suck for a few days, but after that repair starts going, it’s gonna get better than it was before the injection.

Ben Kosubevsky (07:43)

Yep. No pain, no gain.

Yep. And so now I bet this all sounds great, right? You know, why would I pay thousands for PRP or stem cells when I could do prolotherapy for price ranges for prolotherapy from like one to 500? The way we price it, for example, is by area, the more difficult the area or the more volume dependent the area, the more the price goes up. But really the unfortunate downside of prolotherapy is just not that strong. I typically save it for acute or minor chronic injuries.

Stuff that’s not too bad isn’t a big load on the body to repair.

Kyle Hulbert (08:29)

So that’s kind of like, hey, I hurt my knee, but it’s really just like when I was playing pickleball last week and it’s just kind of annoying. It’s not really hurting.

Ben Kosubevsky (08:36)

Correct, you know, we’re just helping to touch up a sprain, because unfortunately, a sprain, for example, you sprain your wrist, you sprain your knee, elbow, whatever, it’s going to scar over a little bit. So if you inject prolotherapy before it scars over, you’ll actually reduce significantly the mass scar tissue that develops later.

Kyle Hulbert (08:54)

And then scar tissue is bad because of the reduced mobility or are there other reasons it’s bad?

Ben Kosubevsky (08:59)

Yeah, scar tissue, it’s reduced mobility, even less blood supply, it’s not flexible, and if it tears, it’ll tear over and over.

Kyle Hulbert (09:08)

Gotcha, so you don’t want scar tissue. Okay, avoid scar tissue. So, yeah, I mean, that’s pro-low. So you mentioned spending more money on PRP or stem cells because they’re more powerful. I like more powerful. So what is something like PRP gonna do for me as opposed to pro-low?

Ben Kosubevsky (09:10)

No, you really don’t. Yes. Um, okay.

Yeah, so we say that PRP is approximately three times as effective as prolotherapy, just based on our experience using these products. So let me rewind one thing. Prolotherapy is typically six to ten courses of injections every one to two weeks to resolve your symptoms, or hopefully resolve them. Talk to your doctor about your likelihood of symptom relief with your…

Kyle Hulbert (09:56)

Yeah, that’s a good point for our disclaimer. Uh, I am not a doctor coach coach. I am not a doctor. Dr. K is a doctor, but we are not giving you medical advice. Please talk to your practitioner for, uh, doing or trying any of this at all.

Ben Kosubevsky (10:11)

Yep. Okay, so PRP, it’s three times more effective. And why is it three times more effective? So platelet-rich plasma. So as a general idea, we take some blood out of the patient, and this is patient’s own blood, not someone else’s. We take patient’s own blood. We take usually 60 to 120 milliliters of blood, and we concentrate that down to about six to 10 milliliters of PRP.

So what we’re doing, there’s healing factors floating around in the blood all the time. There’s like 100 different ones that have been isolated. There’s probably more that we don’t know about, but they’re floating around in the blood all the time. The problem is they can’t get to the injured area. So when we pull them out of the blood, spin them down, hyper concentrate them, we’re doing direct injections of this hyper healing factor product. So we no longer have to wait for the body to grow blood vessels to the area. We’re just putting in directly and saying, get to work.

What’s wrong with that? You’re… I’m sorry?

Kyle Hulbert (11:09)

So it skips a step compared to Prolo.

Ben Kosubevsky (11:14)

Yes. Well, it doesn’t skip a step. It has the same step. PRP is actually more inflammatory than proliferative. So you get an even bigger immune response, more blood vessel growth, plus you have that base effect of what’s already been put in manually.

Kyle Hulbert (11:27)

Gotcha. So does that mean it hurts more?

Ben Kosubevsky (11:29)

It does hurt more. PRP, it is, if we were to classify all the injections, I would put like this, PRP is a 10 out of 10. Bone marrow stem cells are like an eight out of 10. Adipose fat is like a seven out of 10. Prolotherapy is like a six out of 10. Amniotic, which is values are exosomes or placental or Wharton’s jelly, that stuff’s like a three to four out of 10.

Kyle Hulbert (11:53)

Gotcha. Yeah. So I’ve done PRP injections. Well, I haven’t done them. I’ve had them done on me. Dr. K did them. And what did you inject on me, Dr. K? Maybe what didn’t you inject is probably a better question.

Ben Kosubevsky (12:04)

Let’s see, we’ve got Eric.

No, we haven’t done that much on you. We’ve done what? Your lumbar, both your hips, your thoracic, and your cervical.

Kyle Hulbert (12:16)

Yeah, so basically my entire spine and my hips, but I did multiple courses of each of those injections.

Ben Kosubevsky (12:24)

Yeah, PRP is normally three rounds of injections, about a month apart.

Kyle Hulbert (12:29)

Okay, so when I did it, the lumbar was my worst one. So you injected my lumbar. I actually didn’t even feel any pain for that. I just passed out. Straight up. That doesn’t normally happen though, right? I’m just a wuss.

Ben Kosubevsky (12:44)

Well, what we think is that we threw a bunch of mercury out of there. That was a running fury. Because you didn’t have pain reaction pass out, it’s like you got toxin bombed. And we’ll… Yeah. So, have I had people throw up and pass out? Yes, it’s not often. Most people get through this stuff just fine. In my office, for example, we do offer propofol only sedation just in case someone just wants to go sleep and wake up and it’s done. Valid option.

Kyle Hulbert (12:48)

Yeah.

Yeah, I woke up like drunk.

Not cheap though, right?

Ben Kosubevsky (13:15)

anesthesia they charge like two thousand dollars so it’s not cheap now but it depends you know if it’s worth it to you to not deal with it um

Kyle Hulbert (13:23)

Yeah, so if you have needle phobia or have a very bad pain tolerance, that might be something you consider.

Ben Kosubevsky (13:29)

Yeah, I’ve had more piripides than almost anyone. I’ve had my cervical spine, my thoracic spine, I’ve had my lumbar, I’ve had my sacrum, I’ve had my foot, my shoulder, one knee, I’ve had, I think, both elbows, I’ve had my hand. And I get through most of it, now I feel great. But I get through most of it just fine. I don’t take any medicines after, no painkillers after. So most people are just fine.

Kyle Hulbert (13:47)

So how do you feel?

I’m sorry.

Yeah, when I did mine, the first round you did on each of the areas was by far the worst. And then the second round was just like cruising. It wasn’t nearly as bad.

Ben Kosubevsky (14:07)

Yeah, because it’s triggering your inflammation, injuries. The more injured you are, the start with the more response you get to it.

Kyle Hulbert (14:16)

Okay, yeah, that makes sense. So the PRP injections, you can put them just like Prolo in joints, ligaments, we’ve mentioned a lot of spine stuff. Where do you inject in the spine that helps?

Ben Kosubevsky (14:28)

So I’ll talk a little bit generally. You can inject the facets, which are the joints, the interactions between the vertebrae. You can inject the ligaments. You can inject the discs. You can inject the vertebral bodies. Pretty much anywhere in the spine you can inject. Some of those, you definitely want to be image-guided, either ultrasound or fluoroscopy, CRM-guided. Talk to your doctor, see what they recommend for you to do and how they want their stuff guided.

Kyle Hulbert (14:54)

Yeah, so that’s really dependent on basically your MRI or your diagnosis or what kind of issues you’re dealing with, where you specifically want to inject.

Ben Kosubevsky (15:02)

Correct. Okay, so PRP, like I mentioned, the way you make it is you take some blood and you spin it down and you inject it. There’s different ways to spin that blood. There’s all the way from what I call yellow top tubes. I think there’s a couple other colors that you can use, but basically that’s what we call dirty PRP. You make PRP in a test tube and then by hand you draw it out. It’s not that precise. Unfortunately, you do have a higher risk of infection because exposed surface, not a closed system.

And just overall the quality isn’t that good. All the way up to you can use kits. And there are a few different levels of kits and varieties and all that. Single spin, double spin, leukocyte rich, leukocyte poor, blah, blah. Things no one actually cares about besides the doctors doing it. In my office, I use an Emsite brand. There’s a couple of different brands. There’s Harvest, there’s Emsite. The other names are escaping me now. We use Emsite right now.

It’s a high quality closed system, significantly reduced the risk of infection, and it’s really precise. You know, you have these fancy centrifuge type bottles, and when you draw everything out, it’s really calculated and precise, and you get exactly what you need and not what you don’t.

Kyle Hulbert (16:15)

So, um, so dirty PRP though has benefits, right? Cause you’ve used dirty PRP on, on me before.

Ben Kosubevsky (16:23)

I’ve used it, so I’ve used it on my foot because I was too cheap to buy a kit for myself. And I only needed like two milliliters of it. I was like, I’ll just make this in test tube. Once again, that was on myself. I understand all the risks of doing this. I would never do that on a patient. The reason I used it for you, I only use test tube PRP in my office for one case and one case only. That’s to make what I call dirty PRF, which is platelet rich fiber. And I need that, actually it’s a clot a little bit. And I use that for…

repair of necrosis of the jaw, otherwise known as cavitations. Because I need to make a matrix for something for the bone to grow on top of.

Kyle Hulbert (17:00)

Okay, that makes sense. So there’s there are applications for test tube, but it’s far and few in between.

Ben Kosubevsky (17:06)

It should not, we should not be using test to PRP to do musculoskeletal injections, in my opinion.

Kyle Hulbert (17:12)

Yeah, because you just want that clean, closed system reduces the risk of infection. You get a higher quality product.

Ben Kosubevsky (17:16)

Yeah, so there’s something, the way we track PRP and how effective it is, or not how effective, how strong it is in basically measures of multiple. Anywhere from most doctors, we’ll start at 6x up to 15x, and that’s just how much we’re concentrating. If I take 120 cc’s of blood and concentrate down to 12 cc’s, we have 12x, or sorry, 10x.

Kyle Hulbert (17:38)

Okay, so PRP, you can do it basically in any musculoskeletal area, joints, things like that. It’s about three times as effective as Prolo. But what is the cost? Like, I’m sure it’s more expensive than Prolo.

Ben Kosubevsky (17:54)

For most practices, you go to a range between 1,000 and 2,500. And once again, the way my office does it is based on volume required, number of injections required, and difficulty of area to access. For example, cervical spines are most expensive because it is the hardest to inject, requires the most training, most skill, most precision. Whereas something like your hand, super easy, everything’s really superficial, it’s hard to miss your finger.

Kyle Hulbert (18:18)

Yeah. Okay. That makes a lot of sense. So, but there’s another level to this, right? We can go even higher and get something like quote unquote stem cells like you’ve been mentioning.

Ben Kosubevsky (18:25)

Yeah, we can. I just want to point out one more thing with PRP and that’s testing. Blood work. Because I get this question on time, should we test my platelets before we do it? And I will use a CBC on someone, as long as they have no medical issues and take no medications, I’ll use a CBC a year old. I have no problem with that. Now someone that has a history of anemia or platelets or chronic infection or whatever other thing, I would like a recent CBC to make sure platelets are a good count. Just make sure that the PRP we’re using is actually effective.

Kyle Hulbert (18:56)

That makes sense. So like my sister has, um, ITP, um, she has a low plate and accountant has dealt with that most of her life. So she probably wouldn’t be a great candidate for PRP injections.

Ben Kosubevsky (19:06)

Well, two asterisks. One, keyword had, not has. I believe we fixed that issue for her. And then two, actually, so I don’t know how much she wants us talking about her.

Kyle Hulbert (19:13)

We did.

It’s okay. I’ll have her sign a release.

Ben Kosubevsky (19:22)

There you go. We did PRP on there. We did a cosmetic PRP on there when the platelets were lower than I’d like and still worked extremely well.

Kyle Hulbert (19:30)

Okay, well there you go. So it can work. It’s just, so it’s probably far-of-view scenarios where people’s blood renders them not effective. Not very common.

Ben Kosubevsky (19:37)

Yeah, as effective, but still effective.

Kyle Hulbert (19:42)

Okay, yeah, that makes sense, because you’ll still get the inflammation response. Regardless.

Ben Kosubevsky (19:45)

Yep. Yeah. And then there’s one huge contraindication that there are no ifs, ands, or buts on. It’s cancer. Cancer or a history of cancer within the last 10 years. I will not use a patient’s own products if they have cancer because if you pick up a circulating cancer cell and inject it somewhere, you just gave it all the healing factors it needs to steal and grow.

Kyle Hulbert (20:09)

That sounds kind of scary. So no cancer, no history of cancer. Would it be beneficial for people to screen for cancer before they come do injections?

Ben Kosubevsky (20:18)

I don’t actually know anyone that is. Honestly, the risk of a circulating cell is so low. If they’re not symptomatic and the risk of circulating cell, it’s so low that it’s not really a risk. But if we know about the cancer, it’s just, we’re gonna be more careful.

Kyle Hulbert (20:36)

Yeah, that makes sense. Makes a lot of sense. Anything else on PRP?

Ben Kosubevsky (20:41)

That’s all I’ve got for PRP, besides cosmetic applications, but we’ll kind of lump that all together at the end.

Kyle Hulbert (20:47)

Yeah, we’ll probably do an episode on cosmetic applications of things like this. It’d probably be a good separate episode for the audience.

Ben Kosubevsky (20:55)

Yeah, okay, so let’s talk about stem cells. And the reason I keep putting stem cells in quotes. So a stem cell by definition is a pluripotent cell. It’s a cell that has the ability to turn into any other cell. What we’re talking about in this case are not true stem cells. So a little bit of history, the guy that discovered stem cells, his name was Dr. Arnold Kaplan. He discovered them in the 90s. He first called them stem cells and then changed name, and has changed name like five more times.

Um, the current name is mesenchymal signaling cells, right? Or is it medicinal? It’s MSC is I just never remember the M stands for.

Kyle Hulbert (21:30)

MSC’s, yeah.

It’s me as a condom. You got it.

Ben Kosubevsky (21:37)

Um, no, it’s midisinal now.

Kyle Hulbert (21:40)

It’s how they changed it, because it was Mezzenkaman.

Ben Kosubevsky (21:42)

It was, that’s why I say it keeps changing. Mesenchymal signaling cells, medicinal signaling cells, it’s all the same thing. MSC is really the keyword of that. So signaling cell, that’s exactly what we’re looking for. It is a beacon cell that when injected will tell your body how to repair an area of injury. And it does have some potency. It’s not fully plastic and the idea that it can turn to anything. There’s just certain things it can turn into.

But the way I kind of explain it is, imagine you’re building a house. It’s like the architect and engineer. They’re gonna tell all the other cells where to go to build this house. Doesn’t do it itself, it just, you know, instructs. And, yeah. So they exist in a few, they exist in high concentrations in a few areas. They’re in our bloodstream all the time, just low concentrations of it. So the high concentration areas are fat, your adipose tissue,

Kyle Hulbert (22:19)

That makes sense. Amazing.

Ben Kosubevsky (22:35)

Two is your bone marrow, and three is birth products, placental, umbilical cord, and amniotic. So let’s start with bone marrow. Bone marrow, the way most people do this, there’s a couple other places you can pull this from, but the most common is you go on the back of your hip to what’s called your PSIS. It’s that bone on the back of your hip that sticks out. When I say back, I mean like your back back. It’s that little bone that sticks out. You put a needle through, you pull it out. There’s two ways to do it. It’s…

I saw you making that face. I’ve had it done myself. It’s deeply uncomfortable. It’s not painful, truly. You feel a vacuum, you feel some vibrations, it doesn’t hurt. We numb you up really well.

Kyle Hulbert (23:14)

mildly disturbing. Yeah. More mental than actually physically painful.

Ben Kosubevsky (23:16)

Yep, that’s exactly it.

It really is. If you go on my Instagram, there’s actually videos of me doing it, if anyone wants to see what it looks like.

Kyle Hulbert (23:29)

Yeah, that’d be cool. Check them out at the osteodoc.

Ben Kosubevsky (23:32)

Yup. So we pulled out, there’s two ways to pull it out. There are people that tap in the big needle, there are people that drill. Not a big fan of drilling, we think the heat from it destructs some of the good cells that you want. So we basically just corkscrew a needle in. Best way to bluntly put it. It takes about 10 minutes, we do it right in the office. We put down sterile drapes, sterile gauze, all that stuff. The localized area is sterile and that’s pretty much all you need.

The other option is adipose. An adipose is, it’s fat tissue, so we do a mini liposuction procedure, either from the belly, the side, or the back. I also know people that use the side of the legs. Wherever you can get enough fat deposit, you suck it out, takes about 30 minutes. It is not enough fat for a cosmetic difference. I know people get real excited when they hear that. We’re only taking about 100 cc’s of fat. It’s not a lot. If you go to liposuction plastic surgeon, it’s gonna take like a thousand.

So you won’t really notice, occasionally it can dimple, but for the most part you just don’t notice. Adipose we mix with PRP because adipose only has those MSCs and have other healing factors, whereas bone marrow has all the healing factors all in one place, because everything in their blood comes from our bone marrow. So either of those we will inject into whatever area that we need, either cosmetic or musculoskeletal.

Kyle Hulbert (24:52)

Yeah, so I’ve had a head oppose done years ago before I actually knew you. And I had it on my shoulder and actually had pretty good results with it. I had issues with my shoulder when I was bench pressing and he injected me. And honestly, in six months it kind of went away. But the liposuction, at the time I was very, very lean. It was brutal because I didn’t have very much fat on my stomach and he was just like going for it. I mean, I…

It didn’t, it wasn’t like you said, it wasn’t necessarily painful. It was just disturbing. Like it was like, I don’t like this, like take the needle out of me type deal. Um, but it was quite the process.

Ben Kosubevsky (25:29)

Yep. Yeah.

If I had to pick 10 times out of 10, I would rather do bone marrow on the patient than adipose just because it’s honestly easier to get. It’s a much simpler procedure to pop into the bone, pull out the bone marrow, and inject it compared to pulling the fat.

Kyle Hulbert (25:44)

Gotcha. Yeah, that makes sense. So like in terms of effectiveness compared to like PRP or Prolo, can we measure it? What have you seen in your practice?

Ben Kosubevsky (25:56)

Roughly it’s three times more effective again than PRP or six times more than prolotherapy. The big difference I found is that labrums. Labrums are the big difference where you need these MSCs. PRP, just out of the dozens, hundreds, whatever, we’ve done the PRP on labrums, it doesn’t work. It’s just not strong enough. Whereas if you add the MSCs, we usually get much better results symptomatically.

Kyle Hulbert (26:19)

Yeah, I mean, I’ve seen this. You did the labor on my hip and you did a lot of injections in my spine and my spine dramatically improved and my hip didn’t change at all. So I actually later went and did stem cells in my hip and it’s still, I mean, I’m probably six to eight months down the road from that and it still is causing me issues. So it doesn’t work all the time, does it?

Ben Kosubevsky (26:47)

No, so as a general rule, prolotherapy is roughly, and when I say percent likelihood, I mean percent likelihood of being 100% symptom free. Prolotherapy usually sits about 60%, PRP sits about 70, MSCs from you, which are bone marrow and adipose, sit about 80, birth product, amniotic, placental, umbilical, those sit about 85%. That means eight out of 10 people will get better. Two out of 10 will not.

Kyle Hulbert (27:15)

Yeah. So, I mean, I’ve kind of seen this like on myself because I’ve done injections on, um, basically my whole spine and my hips and my spine is radically improved across the board, but my hip is nearly the same. And it actually makes a lot of sense because the cause of my hip issue is a deformed, um, deformed bonehead in my femur. So it’s not quite the right shape. So it’s always going to be beating up against that labrum.

Ben Kosubevsky (27:41)

Yeah, and I think part of the problem is, I wish I had been the one to do the stem cells on you, because part of the problem is when you went to that place, they just did one shot into your hip, right? So they just injected the joint, they didn’t re-stabilize your hip by injecting all the surrounding tendons, ligaments, muscles, which are also getting affected all the time, because the labor is unstable.

Kyle Hulbert (28:01)

I’ll probably have to come do that with you soon then.

Ben Kosubevsky (28:03)

Yep. Okay, so let’s get into everyone’s favorite birth product,

So let’s break there are three there’s placental umbilical cord and amniotic Placental is the one that’s kind of whoo-hoo in America. It’s not used often The only thing we really get from placental in America is exosomes They’re basically the protein the inside of the MSC. They take it They concentrate it like crazy up to three billion per milliliter And that’s what we get as a fluid a lot of growth factors really good for cosmetics really good for joints

Kyle Hulbert (28:10)

Yeah.

Ben Kosubevsky (28:39)

Not so good for tendons, ligaments. Next is Wharton’s jelly or umbilical cord. This is once again, really highly concentrated growth factors. You take a ton of growth factors, you inject it. It’s gonna be like doing bone marrow injections, but like way better because they’re fresher. As we age, our concentration of MSCs and healing factors decreases. But, you know, newborn products won’t. The other option is amniotic.

amniotic fluid or amniotic sac. And for those that don’t know, amniotic is, you know, it’s a sac the baby’s in inside the mom. So the company I use and my preferred benefit is they harvest the sac itself, so it actually acts as a micrograph, it’s actually a piece of sac, it’s tissue. The other option is amniotic fluid. Most of those companies shut down. Amniotic fluid just wasn’t as effective as umbilical.

Kyle Hulbert (29:33)

Okay, so does it matter? Because you said they’re fresher. The stem cells from the birth products are fresher. So say someone comes in, like myself, it’s high in heavy metals or even high in something like lead. Would you like to avoid a bone marrow because lead is often stored in bones? Or is that not an issue?

Ben Kosubevsky (29:54)

That’s a difficult question. And you know, I get lots of people, a lot of my patients that are in for chelation get injected, and I get a lot of people that just wander through and have no idea what heavy metals are. And most of the time the injections work regardless of if they’re high in metals or not, unless they’re really, really sick. Sometimes those people don’t do well. But in general, it seems like the metals don’t affect the treatments.

Kyle Hulbert (30:15)

Okay, so, but you mentioned metals when you injected my lumbar. What was our theory, our operating theory that we were going on?

Ben Kosubevsky (30:22)

So when you get an injury and you’re really high in mercury or lead or whatever, your body’s going to end up packing that into the injury because the thing is the mineral is trying to heal that injury so it packs it into there and because it has bad blood supply, when we keylet you we can’t get it out. So when I injected you and flooded a bunch of blood towards that area, we’ve washed out the mercury and straightened the bloodstream.

Kyle Hulbert (30:43)

Yeah, so if you’re really high in heavy metals and you have an injury probably around the time or around the time that you’ve already accumulated those metals, sometimes those metals can be packed in. Possibly this is a theory we’re going on. And yeah, it’s a working theory. We’ll maybe one day we’ll try to prove it somehow. But all I know is I passed out when he hit my old injury.

Ben Kosubevsky (30:57)

It’s a very raw theory, don’t hold us to it.

I’ve got to throw Kyle under the bus on this. We’re going to prove it. We’re going to do a mercury challenge test before and after injecting his back and someone messed up the test.

Kyle Hulbert (31:19)

Yeah, I did mess up the test. I forgot. I forgot to pee. I forgot to pee in the bucket. So it happens, you know? Sometimes the biohacker extraordinaire I am, didn’t take my nicotine or something like that and just totally forgot. Okay, so birth products.

Ben Kosubevsky (31:36)

Well, you brought up ethics. Hold on, you brought up ethics. We’ve got to jump on ethics. So ethics. I can’t speak for all companies. Talk to your doctors. Make sure they’re comfortable with the company that they’re using. Ideally, they’ve toured the company that they’re using. There was a whole scandal about 15 years ago with a company called Libyan where they were basically making stem cells in the basement. Not good, not good. Lots of issues.

Nowadays, personally, as a practice, we always tour. Most of the owner, the practice mat, tours the facilities that we’re using just to make sure everything’s above board. But ethics, live birth, C-section, baby has to be born. No complications, no abortions, no fetuses, nothing like that. Comes from a hospital in America, not an overseas country. Mother has to agree to donate it, not allowed to be paid for, prevents trafficking. Tested to the same extent as an organ transplant, so steroid implants are 100%. No loud communicable diseases, no drugs that could pass through. It gets processed, shipped to us.

That was fast, but it’s also kind of boring.

Kyle Hulbert (32:34)

So it’s clean and

it’s ethical. No dead babies. Okay, good. We don’t wanna be doing any sketchy stuff like that. And again, that was outlawed many, many years ago and is highly, highly illegal and should no longer be associated with the use of stem cells in modern day medicine at all. Now.

Ben Kosubevsky (32:36)

Yep. Correct.

Well, I’ll put a key point on that, in America. Key word, America. Overseas, we cannot speak for what happens overseas.

Kyle Hulbert (32:56)

in America.

Okay, so in America, you know that if a doctor is doing stem cells and they are, I mean, I assume we can basically assume that they’re not using like fetus based stem cells. Okay, so I just want to make that clear for everybody that this is not a thing anymore in America. Okay, so stem cells, you said probably 85% effective.

Ben Kosubevsky (33:14)

No.

Yeah.

On average, yeah, you know, talk to your doctor. You know, I give my patients specific percents based on their injury and the products we’re doing. Sometimes it’s high. Sometimes it’s high as 85%. Other times it dips because their injury is so severe. And we’re doing this more as a Hail Mary to try and push off a hip replacement or a knee replacement or whatever for as long as possible.

Kyle Hulbert (33:46)

Yeah, that’s kind of my strategy with my hip because of my deformed femur. I’m just going to have to like inject it every few years and just kind of keep it. Together.

Ben Kosubevsky (33:55)

Well, it’s a much safer alternative than surgery, because once you have surgery, you can never go back. And here’s what people don’t realize about surgery. Sure, it’s the quality of the materials used. And look at cobalt hip replacements 20 years ago. Everyone said that they were great, and all of a sudden people are coming up with cobalt poisoning, and had to have their hip replacements redone. But it also comes down to, is it a Tuesday and your surgeon just had a terrible case right before you, and now he’s upset, and now he’s doing your hip replacement? Is it Friday afternoon and he wants to go home? So.

Some things to keep in mind is there are human error in everything. Your biggest downside to doing regenerative injections is that they don’t work. Barring some catastrophic injury that happens to result in injections, which, you know, that’d be a difficult scenario to imagine, you don’t have much risk.

Kyle Hulbert (34:42)

Not much downside at all. So, I mean, cost of stem cells, this is all over the board. I mean, like I’ve seen crazy high prices and I’ve seen crazy low prices, which makes me think something’s up. So could you speak to cost a little bit?

Ben Kosubevsky (35:01)

Yeah, so cost, so a big part of the cost comes down to two main factors. One is the quality of the material. For PRP, it’s whether or not they’re using a kit versus test tubes and the kit that they’re using. Some kits are a lot more expensive and better quality than others. For bone marrow and adipose, it comes down to, once again, so for example, the kit I use is expensive to draw bone marrow because it gives better quality bone marrow. Same thing with adipose. And then stem cells.

biggest price range. Stem cells, they start in the thousands, plural. Cheaps I’ve seen is $3,000 all the way up to, you name it, by house. And the biggest differences with that is the quality of the person doing your injections and the quality of the material. You know, especially for amniotic versus exosomes versus umbilical versus whatever.

They’re not all created equally, they’re not all processed as well, they’re not all in the same concentrations. So I’ve had people come to me and they said, oh, well, you know, I went somewhere else after I talked to you and the doctor told me they get 10 cc’s of umbilical cord for $1,000. I’m like, you can’t even buy 10 cc’s of it for $1,000. So I don’t know what they’re doing. I don’t know any company that’ll sell it that cheap. So I don’t know what you’re getting when you go there.

So we are definitely on the higher end of the cost spectrum just because we do tend to use high volume injections because we tend to cover, just like I mentioned, your hip, we’re not gonna cover just the joint because you’re arthritis. We’re gonna cover the glutes, the tendon, the ligaments, everything that’s unstable.

Kyle Hulbert (36:40)

That makes a lot of sense. So, I mean, it really is, it’s procedure based. I mean, you can go as low as 3000 up to, if you had something really complicated and needed a ton of materials and a highly, highly qualified doctor, tens and tens of thousands, even hundreds of thousands of dollars. Yeah, there’s a guy out in, I think, Park City, Utah, that does a whole body stem cell makeover. And they knock you out and they inject like every joint in your body or something crazy like that. And it’s like hundreds of thousands of dollars.

Ben Kosubevsky (36:54)

Yep. Yeah.

Yeah. 200,000.

Kyle Hulbert (37:10)

Hey, but they put you up in the Waldorf Astoria for two nights.

Ben Kosubevsky (37:13)

and they give you some IV vitamins as well.

Kyle Hulbert (37:16)

There we go. It’s a bargain folks. Honestly, like that is like the, um, in the biohacker world, that’s like the, like creme de la creme of preventative injections.

Ben Kosubevsky (37:28)

Yep. Well, actually, to be fair, the owner of the practice I’m at, Dr. Sean Goddard, he went to sleep and myself and another doctor that worked there, we injected literally his entire body. Pretty much his whole back, both knees. I think the only thing I didn’t do was his left elbow. Let’s put it like that. Yeah, we did his whole spine, both legs, both arms, everything. So it’s definitely doable. It’s something we could easily offer someone.

Kyle Hulbert (37:44)

We’ll have to end this.

Yeah, I imagine that doesn’t feel great for a few days.

Ben Kosubevsky (37:59)

Oh god, he was sore.

Kyle Hulbert (38:02)

Yeah, that’s a lot. Everything hurts. That’s funny. Okay, so we’ve talked about basically just about everything I know to talk about stem cells. You got anything else for us?

Ben Kosubevsky (38:16)

Um, I think that’s enough for today. You know, we covered how, how the different kinds, how they work, um, sort of where the injecting, especially quality, uh, we covered the ethics of them. I think that’s it for today. And then we’ll deep dive some more of that stuff as we go on.

Kyle Hulbert (38:35)

Yeah, we’ll do deep dives and like specific types of stem cells. We’ll probably do deep dives and IV stem cells and what that can be used for and a few other things. But for now, I think this is a good general overview. So thank you, ladies and gentlemen, for listening. This is the Peak Performance Podcast. I’m Coach Kyle and you can find me at Toxin Free Kyle on Instagram.

Ben Kosubevsky (38:55)

And this is Dr. K or at the osteo doc on Instagram. Thanks everybody for joining us and we’ll see you next time.