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Procedure report


Board Certified in:

Practice limited to:
Physical Medicine and Rehabilitation
Physical & Orthopedic Medicine
Neuromusculoskeletal Medicine
Osteopathic Diagnosis & Treatment
& Osteopathic Manipulation
Image Guided Spinal & Joint Injections
Orthopaedic Medicine Biological Regenerative Injection Treatment
Musculoskeletal Ultrasound Diagnostic Musculoskeletal Ultrasound
Depending on the area and the type of injections done typical y 2-8 sessions are necessary (less with platelet rich plasma injections, more without), spaced 3-6 weeks apart. If I suspect hormonal or vitamin deficiency, initial blood testing may be done before any injections, and any optimization of hormonal/vitamin levels to maximize healing potential will then be based on laboratory data. PRE-INJECTION
If on Coumadin (Warfarin) or any platelet inhibitors you must talk to the
prescribing physician to get approval to stop that medication for 2-3 days prior
to any injections. OK to resume the next day. If you are taking antibiotics due to
a sickness or infection you will not be able to have your procedure until you
have been on the antibiotic for 7 days.
(minimum of
3 days prior and at least 5 days after). This includes Advil (ibuprofen), Aleve
(naproxen), Orudis (ketoprofen), aspirin (if on mini-dose for your heart no need
to stop). Also prescription anti-inflammatories, such as Celebrex, Motrin, Relafen,
diclofenac, nambutone, Mobic etc.
Any herbal anti-inflammatory medications such as Wobenzyme, Zyflamend,
garlic capsules, bromelain (and other food enzymes taken between meals), as
well as oral/topical anti-inflammatories (including arnica) must be stopped for 3
days prior and at least 5 days post-injection.
Stop taking high dose (1/day is OK) fish oil for 3 days before injections. OK to start
again the next day.
Soreness, a bruised feeling, increased pain, local numbness at the injection
sites, swel ing (sometimes a lot) are typical post injection. Even for those who feel
early/rapid improvement, don’t fool yourself into thinking you’re al better and
overdo it.
The worst of it is usual y over in 24 hours, but it can last 4-7 days. Pain medicines
such as Tylenol (acetaminophen), tramadol, codeine, hydrocodone, or
oxycodone can be used / prescribed for post injection pain, but use for as short
a period as possible.
321 Main Street, Suite C, Winooski, VT 05404
(802) 859-0000 Fax (802) 859-0005
Try to use ice very sparingly, no more than 15 minutes at a time, and not when
injections are superficial such as the lateral elbow or ankle. Avoid heat for the

If injections were to the spine (thoracic, ribs, lumbar, sacral), avoid prolonged
sitting, at least for a few days, twisting, heavy lifting, and more than mild
pushing/pul ing for 3-4 weeks.
If to the neck, upper back or arms the same rules apply about being careful for
3-4 weeks, but also avoid weight bearing on the hands and any overhead
reaching or looking for at least 4 days post injection.
Platelet and fat graft injections done in the lower extremities require crutch use
and non-weight bearing post-injection for the day of the injection. PRP / fat
grafts done in the upper extremities require use of a sling or splint for 2-4 days.
Take Ligagenix (trace minerals and other co-factors needed in col agen
formation) 2 caps twice daily and MSM (elemental sulfur, found in all collagen)
750mg twice daily.
Make sure your getting 2,000-5,000 I.U. of Vitamin D3 daily.
If joints are involved, take Glucosamine Sulfate (with or without chondroitin)
2,000mg daily, with or without food.
Eat a high protein diet, preferably 5 small portions a day (every 3-4 hours,
including at bedtime). The body can’t store protein, and muscles, tendons,
cartilage and ligaments are made of col agen, which is made of protein and
Avoid al Trans (partial y hydrogenated) fats!!! These are toxic/poisonous to the
cel s of your body, and impede healing. They are in virtually all commercial
baked good, even those from local supermarkets.
It also helps joints greatly to take ultra purified and concentrated fish oil capsules
(each of which should contain at least 700mg. Omega-3’s) in order to get at
least 1500mg daily of EPA per day (stop 2-3 days prior to injections).
For those on cholesterol lowering drugs (statins), it is essential to take CoEnzyme
Q10 (or Ubiquinoe) 30-200mg. twice daily. Statins deplete this naturally occuring
substance, which results in depleted cellular energy. Healing is often quite
difficult without adequate CoQ10.
Al of the above supplements are available at this office in pharmaceutical
grade and at discounted prices.


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