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HARNESSING THE BODY'S HEALING POWER A nonsurgica l or thopedic specia list, Dr. Galmer delivers treatment for a wide variety of musculoskeleta l concerns, including tendinitis, bursitis, arthritis, meniscal and partial rotator cu tears, and carpal tunnel syndrome. Indications for referral to a nonsurgical orthopedic specialist include pain and other symp- toms that persist despite the introduction of initial conservative treatments, such as NSAID management. " I believe referra l to a physiatrist is idea l for muscu loskelet a l issues, particularly if the patient has not yet been eva luated and if they are not yet considering surgery," Dr. Galmer says. "My role is to look at patients' pathology, functional status and goals, and either treat them nonsurgically or appropriately refer them to one of my orthopedic surgery colleagues. This ensures that surgeons are able to devote their time specifically to patients who need surgery." Dr. Galmer manages physical therapy, medications and injections. However, her expertise and clinical interests lie in integrative and regenerative medicine, a continua lly evolving specia lty that includes the use of stem cells, platelet- rich plasma (PRP) and other modalities to repair damaged tissue. At NewYork- Presbyterian/Queens, Dr. Galmer oers three regenerative medicine techniques: prolotherapy, PRP injection and bone marrow concentrate therapy (BMAC). Prolotherapy is an injection therapy that involves injecting a mild irritant such as a dextrose solution, which stimulates the regeneration of new or healthy tissue. In the realm of orthopedics, prolotherapy is commonly used to treat tendinopa- thies, knee osteoarthritis and low back pa in. During a prolotherapy session, Dr. Galmer uses ultrasound guidance to inject a concentration of 12.5 to 25£percent dextrose into the aected and immediate adjacent areas. "Prolotherapy usually requires several treatments to achieve pain and functional improvements," Dr. Galmer says. "From a patient perspective, prolotherapy is an attractive option because it's more cost eective than biologic treatments that utilize a patient's cells or derived cells." To prepa re a PR P injection, which is an autologous blood therapy, physi- cia ns obta in a blood sa mple a nd use centrifugation to isolate and increase the concentration of g row th-factor- containing platelets. The PRP — which contains five to 10 times more platelets than a normal blood sample, according to the American Academy of Orthopaedic Surgeons — is then injected into the injured area using ultrasound guidance. Stem cell therapy is the most inva- sive regenerative medicine technique. At NewYork-P resby t er i a n /Q ueen s , Dr. Ga lmer most commonly performs bone marrow concentrate therapy using undierentiated, pluripotent mesenchy- mal stem cells harvested from a patient's bone marrow because these cells have the potential to form bones, ligaments, tendons, cartilage and muscle. " Dur ing bone ma r row a spiration, which is performed under sterile condi- tions in the o§ce or in an ambulatory surgical center, bone marrow is taken from the iliac crest," Dr. Ga lmer says. " You then draw out the ma rrow a nd process it similarly to PRP using a spe- cialized centrifuge." PATIENT CANDIDACY AND FUNCTIONAL OUTCOMES The outcomes following regenerative injections are variable and highly patient specif ic. To ensure the best possible Hand X-rays Raymond Pahk, MD, an attending orthopedic surgeon who specializes in hand/upper extremity conditions and sports medicine, examines a patient. 0 7 M D N E W S .C O M /// M D N E W S L O N G I S L A N D ■ 2 016