APM SPINE AND SPORTS CLOSING THE VIRGINIA BEACH OFFICE

Dear Patient ad Friends of APM Spine and Sports,

As you may have heard, we are going through a transition period as two of our physicians leave to pursue other options. Like it or not, change is the norm in healthcare today.
That said, effective May 29, 2018, APM Spine and Sports Physicians will consolidate all clinicians into our Norfolk Office on a full-time basis. This means that for now, our physicians, PA/NPs and physical therapists will only be seeing patients in our Lowery Road location. We will continue providing a full range of services in the Norfolk Office.

Although this Virginia Beach office is closing, we recognize that many of our patients live in Virginia Beach and we do plan to re-open a satellite office in Virginia Beach along the First Colonial Road corridor by the end of the year, if not sooner.

It is our sincere desire to continue to provide each and every one of our patients with the outstanding care you have become accustomed to receiving. We hope that everyone will adjust easily to these changes, and we promise to continue to work very hard to provide you with the very best care.

We will certainly keep everyone posted about our progress, and apologize for any inconvenience this change may cause you or your family. If you need any assistance in rescheduling your future appointments, please ask our staff for help.
To assist you in getting everything you need during this time, we have set up a special e-mail address for our patients, this way we can address your concerns in a timely manner.

Please e-mail us at apmadmin@apmspineandsports.com if you need additional assistance or have any concerns you need addressed

Thank you for you loyal patronage!

Lisa Barr, M.D., Bonnie Nock, D. O. and Robert Spear, D.O.
The Staff of APM Spine and Sports Physicians




Non-pharmacologic management of peripheral neuropathy pain

Non-pharmacologic management of peripheral neuropathy pain

By Bonnie Nock, D.O.

Peripheral neuropathy is a disease or disorder that has damaged the nerves in the body. This disorder may impair sensation or movement of the body, but can also affect the glands and organs in the body. There are a multitude of causes of peripheral neuropathy but the most common are:

  • Diabetes mellitus
  • Medications such as chemotherapy
  • Excess alcohol usage
  • Trauma
  • Autoimmune disorders such as rheumatoid arthritis
  • Exposure to toxins/poisons and infections
  • Genetics

Frequent problems noted by persons with peripheral neuropathy are:

  • Muscle cramps
  • Weakness
  • Changes in skin and hair
  • Impaired balance and coordination
  • Burning, numbness, tingling, pins and needles
  • Stabbing pain
  • Abnormal heart rate and blood pressure control
  • Impaired bladder control
  • Increased sensitivity to touch and temperature

The majority of cases of peripheral neuropathy are not reversible, but can be managed. The pain related to peripheral neuropathy is frequently controlled with prescription medications such as Gabapentin, Lyrica and Cymbalta. Other non-pharmacologic prescription options are available to help people manage the pain and physical changes associated with the disease. These treatments have not been extensively tested, but there are some studies demonstrating benefit over placebo, as well as anecdotal evidence. Also, be aware there is a perception among most people that over the counter medications and alternative therapies are harmless. This is not always the case, so it would be wise to check with your physician.

Non-pharmacologic management of peripheral neuropathy can be divided into two categories. The first is lifestyle changes and alterations in the home environment and the second is alternative medicine.

Lifestyle Changes and Alterations in Home Environment include:

  • Exercise—studies have demonstrated the need to maintain ROM (range of motion), strength and balance. Activities such as aquatics, yoga and Tai Chi have been shown to be beneficial.
  • Eat a balanced diet and avoid excess alcohol.
  • Quit smoking—smoking decreases circulation to the nerves.
  • Massage—improves circulation and stimulates the nerves
  • Warm water—relaxes the muscles
  • Comfortable shoes with large toe box
  • Cotton socks with padding at the ball of the foot and heel
  • Semicircular hoop to keep bed covers off feet when in bed
  • Clean and inspect feet daily for sores or cracks in the skin to prevent infections and further pain
  • Avoid prolonged pressure on nerves—do not cross legs or lean on elbows
  • Splints for hands and feet to maintain range of motion and function
  • Mobility devices—canes, walkers, wheelchairs, scooters
  • De-clutter the home to allow for adequate room for maneuvering around the home
  • Remove throw rugs to prevent falls
  • Adaptive equipment—large handle kitchen devices and utensils, button/zipper aids, large button remote, key turner, reacher, elevated toilet seats, tub benches or seats

Alternative medicine:

  • Biofeedback/relaxation techniques
  • TENS units—application of electrical current to the skin over the painful or adjacent body region. Studies have shown a 44-52% reduction in pain after 3 weeks of daily use.
  • Acupuncture—involves insertion of thin needles into various parts of the body. Studies have shown that 50% of patients have a 50% reduction in pain after 6 sessions.
  • Magnet therapy insoles for shoes—more effective than placebo but only show a 25% reduction in pain.
  • Low intensity laser therapy—demonstrated a 50% reduction in pain for a month
  • FREMS—modulated electromagnetic stimuli. Has been shown to decrease pain after 3 weeks.
  • Capsaicin—cream made from hot chili peppers—must be used regularly. You must get used to the heat before experiencing any pain relief.   Must be careful not to touch eyes, nose or mouth after applying to feet and hands, until you have thoroughly washed hands.
  • Vitamins—vitamins B1, B6 and B12 are essential for nerve health
  • Herbs and oils—all may interact with medications and patients should discuss these with their physician prior to starting them.
  • Alpha lipoic acid is an anti- oxidant that has been used in Europe for many years for peripheral neuropathy. It may affect blood sugar levels.
  • Primrose oil and botanical oils
  • Fish oil—acts as an anti-inflammatory and may increase blood flow

Non pharmacologic strategies work best when combined with prescription medications in managing pain related to peripheral neuropathy. Neuropathic pain can be difficult to manage and generally requires multiple approaches to control.




Regenerative Medicine for Tennis Elbow

WHAT IS TENNIS ELBOW?

By David Levi M.D.

Tennis elbow is a troubling condition, not just for athletes, but for many individuals struggling with elbow pain.  Tennis elbow occurs when the tendon which attaches to the outside part of the elbow mildly degenerates and develops small tears.  This tendon attaches to the top forearm muscles which lift your wrist and fingers.  Activation of these muscles will transmit forces through the degenerated tendon and cause pain.  Simple activities such as turning a key or lifting a carton of milk can cause pain when the tendons of the elbow become worn.

STANDARD TREATMENTS FOR TENNIS ELBOW

Treatment for tennis elbow, also called common extensor tendinosis, include: bracing, physical therapy, dry needling, medication, icing, and, in difficult cases, injections.  Steroids into or around the tendon have been the injection of choice for the last 25 years.   More recently, however, studies have shown that patients who undergo steroid injections for this issue tend to do worse in the long run than those who did not have the steroid injection.  This is because when steroids are injected directly into the tendon, they can weaken the tendon.  Additionally, ongoing use of nonsteroidal anti-inflammatories can interfere with tendon healing and prolong recovery.  NSAIDS also interfere with the effectiveness of PRP injections.

NEW TREATMENT FOR TENNIS ELBOWElbow PRP Injection

The ideal approach to treating tennis elbow is to implement an intervention that helps heal the degenerated tissue. Regenerative treatments, such as platelet rich plasma (PRP), have shown great promise in this area. A high concentration of growth factors is easily obtained from the patient’s own blood sample.  This concentrate is then injected directed into the damaged tissue as visualized under ultrasound.  Platelet rich plasma (PRP) treatment has been shown in multiple studies to be highly effective for tennis elbow.  And while the healing process does not occur immediately (often requiring several months for significant improvement) and the injections can cause some immediate discomfort, the benefits of PRP appear to be very effective and long lasting, often resulting in a true “cure” for this troubling condition.   Several of the physicians at APM Spine and Sports have a great deal of experience using this biologic healing therapy as well as a high level of expertise in using diagnostic musculoskeletal ultrasound to target injection sites.  The combination of expertise and experience make APM Spine and Sports a great choice when you are faced with a nagging painful elbow.  We look forward to helping you or your friend in need.

 




Helping people get back to a healthy lifestyle !

APM Spine and Sport Physicians is the premier Physical Medicine and Rehabilitation practice in the Hampton Roads area and is the only PM&R practice in the area with six board-certified physiatrists, including several fellowship trained spine specialists. APM is also accredited through the Accreditation Association for Ambulatory Healthcare, the only practice of its kind to achieve this distinction in Virginia.

 
 
 
 

Founded in the early 90s by Lisa Barr, M.D., APM prides itself on the quality of its services. We constantly research and seek training in the newest proven treatment modalities.  Because we keep on the cutting edge of treatment innovations, APM physicians are often tapped to lecture and train other physiatrists in educational conferences around the country.  Dr. Barr was the first physician in the area to offer prolotherapy, the forerunner of PRP (Platelet Rich Plasma) therapy, an increasingly popular treatment for athletes of all levels.

APM was also among the first in the nation to achieve Meaningful Use status. The MU program was established by the Center for Medicare and Medicaid Services to incentivize physician practices to utilize electronic medical records in a way that promotes quality measures, easy and efficient communication between patients and providers, and information gathering and reporting.

 

We do all this because helping people get back to a healthy lifestyle where they can fully enjoy work and play is important to us. 




PrimePATIENT® Portal

We are very pleased to announce our newest innovation to make communicating with APM easier than ever; a secure and encrypted web portal for easy e-mail access between patients and the practice. The PrimePATIENT® Portal will allow patients to communicate directly with the practice through a secure web portal. Individuals who sign up will be sent an e-mail invitation to open an account. The e-mail will contain a link to the PrimePATIENT® site. Once there, you will be asked to answer some basic questions to confirm your identity. Once confirmed, you’ll be given access to the portal, through which appointments and prescriptions may be requested and a message may be sent to the provider or the provider’s assistant.

Further benefits of the portal are in development, so stay tuned. Soon, patients will be able to enter information directly into the site and it will be inserted into their chart. Also, the patient will be able to open and view their chart documents from the site.

 

As always, APM welcomes our patient’s comments and insightful feedback regarding our services.

Now there is another way to communicate: Use the PrimePATIENT® Portal!

 

Click here for a brochure explaining how it works.




Achieve Positive Changes

 

It has been said that “you have no idea what you are capable of until you try.”  I say this because I decided to learn to dance in my mid 50s, after suffering many different injuries and after two neck surgeries.  Needless to say,  I have had my own struggles with pain and limitation and “taken some of my own medicine.”  To paint a realistic picture–in spite of all of these challenges, I get around pretty well.   I had no prior dance experience and I was certainly no Ginger Rogers.  I just had a dream.

 

Dr. Lisa Barr, APM Spine and Sports Physician


I have been a fan of the show Dancing with the Stars for several years.  Little did I know that I would one day get the chance to really try my hand at this sort of thing.  I am not talking about the ABC TV show. I am referring to a local fund raising event that was held August 15th at the Sandler Center to benefit the Arts in Virginia Beach, Dancing with the Hampton Roads Celebrity Stars.  

Thanks to the help of a good friend, I signed up for the local show and was assigned an amazing partner, Brent Dunn of Shall We Dance.  We started rehearsals several months before the actual performance.  First, we selected a song, “It’s Raining Men,” by the Weather Girls. Every week I showed up after work with my dancing shoes on and we worked together to choreograph our 4 count hustle routine. As we progressed, I realized that Brent was expecting more of me physically.   I became keenly aware that dancing well required me to improve my balance, timing, rhythm and foot work and, needless to say, learn to follow Brent’s lead.   Showing up each week to rehearse wasn’t going to be good enough, so I started to learn how to move more consciously.  I enlisted the help of friends in the fitness arena to help me become more “dance ready.”

After several months of trying different types of exercise, working on muscle re-education and learning different functional movement strategies, I was indeed learning to dance.  Yet, the greatest gift I was giving myself was the benefit of setting a goal that challenged me to truly change!  Over the months before the performance, I pushed myself to step outside of my prior comfort zone. Once I did it consistently, it was an amazing feeling.

On the evening of the show I got all dressed up in my fancy ballroom competition dress, donned fish net stockings, false eye lashes and some great costume jewelry, and did my thing.  How do you say razzle dazzle!?!   Being on the stage at The Sandler Center in front of a sold out crowd was invigorating.  Did I dance the best dance? Nope.  Did I take home the mirror ball trophy? Nope!  Honestly, it really didn’t matter.  I was so proud of myself for doing something just a little “crazy-pushing my mind, body, spirit out on a limb.   Leading up to the big performance I realized that I inspired myself to set a goal which was outside of my reach at the time.  The epiphany, as Dr. Seuss says: “You have brains in your head, you have feet in your shoes, you can steer yourself in any direction you choose.”

We see patients every day who fail to push themselves to change or to choose something different.  I say, just try something new. Start where you are, use what you have, ask for help when you are unsure, and do what you can. We are here to help you achieve positive changes!




Regenerative Medicine for Hip Pain

Regenerative Medicine for Hip Pain

by David Levi, M.D.

Platelet rich plasma and bone marrow concentrate for hip pain

Regenerative medicine is expanding rapidly in the area of joint pain treatment. Through the use of harvested growth factors and stem cells from the patient’s own blood and bone marrow, regenerative medicine assists the body’s healing process. Platelet rich plasma (PRP) is a growth factor concentration of the patient’s own blood and bone marrow concentrate (BMC), as the name implies, is derived from the patient’s own bone marrow.  BMC has a great quantity of growth factors like PRP,  but it also contains a high number of the patient’s stem cells.  Growth factors and stem cells are your body’s key to repairing itself.

Can these regenerative treatments be used to help my hip joint? 

When we discuss the hip joint, we are typically referring to the ball and socket joint called the femoral acetabular joint.  This is composed of bone, cartilage, a sealing “gasket-like” structure called a labrum, all surrounded by a thin but very strong enveloping capsule.

The most common problem with the hip joint is wear and tear type degeneration called osteoarthritis.  Although research for regenerative medicine is just beginning on the hip joint, there is some evidence that PRP is effective for osteoarthritis. One published study in the journal Orthopedics in 2013 showed improvement of hip pain and function with ultrasound guided PRP injections.  This study also showed improvement with hyaluronic acid injections, which is a primary component of your joint fluid.   Although there is little research to date testing PRP for hip osteoarthritis, we do know that PRP has been shown in multiple research studies to significantly help a similar type of osteoarthritis, that of the knee.

Bone marrow concentrate (BMC) may be even more effective for more severe degeneration and other conditions of the hip because, in theory, the stem cells in BMC might be able to reverse the degeneration.  At this point it is not known how well BMC works, but research is currently underway to answer this question.

What if my pain is coming from outside the hip, such as bursitis?

There are numerous structures around the hip that may be the source of pain.  Sometimes small lubricating sacs near tendons may become inflamed and fill with fluid.  This is called a bursitis and can be very uncomfortable.  Research has shown, however, that most often it is the tendon itself, not a bursitis, that is the pain culprit.  Tendons (which attach muscle to bone) commonly become very painful near the hip.  A tendon may degenerate, losing its normal strong structured fibers and become very thick and partially torn.  This is referred to as tendinosis.

PRP has been shown to be effective for tendinosis.  Most of the research of PRP on tendons has been for tennis elbow.  Although this is a different joint than the hip, the type of abnormality of the elbow tendon has been shown to be the same problem as the tendons near the hip.   Although tendinosis of the hip has not been as well researched, a recent study presented at a major orthopedic conference (AAOS | 2014) did show long lasting effectiveness of PRP for this condition of the hip as compared to a steroid injection.

For very large tendon tears, some physicians feel that bone marrow concentrate may be even more helpful than PRP with the idea that the stem cells can help regenerate the torn tissue.  Research is ongoing in this area as well.

The goal of these treatments is self-repair of degenerated or injured structures.  Using the body’s own natural healing mechanisms, we may be able to achieve results greater than any other type of treatment.




Non-Pharmacologic Management of Peripheral Neuropathy Pain

Non-Pharmacologic Management of Peripheral Neuropathy Pain
By Bonnie Nock O.D.

Peripheral neuropathy is a disease or disorder that has damaged the nerves in the body.  This may impair sensation or movement of the body, but also can affect the glands and organs in the body.  There are a multitude of causes of peripheral neuropathy, but the most common are:

  • Diabetes mellitus
  • Medications such as chemotherapy
  • Excess alcohol usage
  • Trauma
  • Autoimmune disorders such as rheumatoid arthritis
  • Exposure to toxins/poisons and infections
  • Genetics

Frequent problems noted by persons with peripheral neuropathy are:

  • Muscle cramps
  • Weakness
  • Changes in skin and hair
  • Impaired balance and coordination
  • Burning, numbness, tingling, pins and needles
  • Stabbing pain
  • Abnormal heart rate and blood pressure control
  • Impaired bladder control
  • Increased sensitivity to touch and temperature

The majority of cases of peripheral neuropathy are not reversible,  but can be managed.  The pain related to peripheral neuropathy is frequently controlled with prescription medications such as Gabapentin, Lyrica and Cymbalta.  Other non-pharmacologic prescription options are available to help people manage the pain and physical changes associated with the disease.  These treatments have not been extensively tested, but there are some studies demonstrating benefit over placebo, as well as anecdotal evidence.  Non-pharmacologic management of peripheral neuropathy can be divided into 2 categories.  The first is life style changes and alterations in the home environment and the second is alternative medicine.
Life Style changes and Alterations in Home Environment include:

  • Exercise—studies have demonstrated the need to maintain ROM (range of motion), strength and balance.  Activities such as aquatics, yoga and Tai Chi have been shown to be beneficial.
  • Eat a balanced diet and avoid excess alcohol.
  • Quit smoking—smoking decreases circulation to the nerves.
  • Massage—improves circulation and stimulates the nerves
  • Warm water—relaxes the muscles
  • Comfortable shoes with large toe box
  • Cotton socks with padding at the ball of the foot and heel
  • Semicircular hoop to keep bed covers off feet when in bed
  • Clean and inspect feet daily for sores or cracks in the skin to prevent infections and further pain
  • Avoid prolonged pressure on nerves—do not cross legs or lean on elbows
  • Splints for hands and feet to maintain ROM and function
  • Mobility devices—canes, walkers, wheelchairs, scooters
  • De-clutter the home to allow for adequate room for maneuvering around the home
  • Remove throw rugs to prevent falls
  • Adaptive equipment—large handle kitchen devices and utensils, button/zipper aids, large button remote, key turner, reacher, elevated toilet seats, tub benches or seats
  • Alternative medicine:
  • Biofeedback/relaxation techniques
  • TENS units—application of electrical current to the skin over the painful or adjacent body region.  Studies have shown a 44-52% reduction in pain after 3 weeks of daily use.
  •  Acupuncture—involves insertion of thin needles into various parts of the body.  Studies have shown that 50% of patients have a 50% reduction in pain after 6 sessions.
  • Magnet therapy insoles for shoes—more effective than placebo but only show a 25% reduction in pain.
  • Low intensity laser therapy—demonstrated a 50% reduction in pain for a month
  • FREMS—modulated electromagnetic stimuli.  Has been shown to decrease pain after 3 weeks.
  • Capsaicin—cream made from hot chili peppers—must be used regularly.  You get used to the heat before experiencing any pain relief.   Must be careful not to touch eyes, nose or mouth after applying to feet and hands until you have thoroughly washed hands.
  • Vitamins—vitamins B1, B6 and B12 are essential for nerve health
  • Herbs and oils—all may interact with medications and patients should discuss these with their physician prior to starting them.
  • Alpha lipoic acid is an anti- oxidant  that has been used in Europe for many years for peripheral neuropathy.  It may affect blood sugar levels.
  • Primrose oil and botanical oils
  • Fish oil—acts as an anti-inflammatory and may increase blood flow

Non-pharmacologic strategies work best when combined with prescription medications in managing pain related to peripheral neuropathy.  Neuropathic pain can be difficult to manage and generally requires multiple approaches to control.




“Sounds” Like a Great Idea

“Sounds” Like  A Great Idea!

By Dr. David Levi.

Over the last 10 years, ultrasound  (US) has become an invaluable tool in making proper diagnoses and in providing greater accuracy in performing injections into joints, tendons, ligaments and nerves.  The US image allows us to directly visualize anatomic structures in the office setting.  Sound waves generated by the crystals contained in the US probe are placed and directed by holding the probe over a targeted area of the body.  As these sound waves reach the different tissue planes or layers of tissues, echoes are produced.   Using the same technology as sonar, the Ultrasound ‘s computer interprets the echoes and converts them into images that are a very accurate representation of the underlying tissue structures.  We can really see everything  including arteries, veins, nerves, tendons, bursa, joints, muscles, cysts and lastly,  bone interfaces.   Diagnostic Ultrasound used in settings like ours is referred to as MSK US.   Needless to say , we use our US machines daily to help us determine the cause of someone’s pain, as well as to guide injections to alleviate their pain.

Studies performed over the last decade confirm that US guided injections are more accurate than what is commonly referred to as “blind injections.”   These studies show the miss rate with “ blind” injections varying greatly between 10-75 %.  Basically, blind injections rely solely on identification of surface anatomy  and bony landmarks, which vary from patient to patient as well, as palpation, which varies from provider to provider.   Certainly, this could explain why some patients don’t get better with “ blind” injections.

A typical case:

Recently, a gentleman in his 50s came to see us about his shoulder.  He plays a great deal of golf and developed shoulder pain over the last few months, which he believes started after painting his grandson’s room.  It was especially painful when he engaged in overhead activities. He had some improvement with physical therapy, but the pain continued to be an issue and affected his golf game.    We performed a diagnostic ultrasound of his shoulder, which showed that his main shoulder tendons (rotator cuff), was not torn.  During what we refer to as dynamic US testing, we were able to watch the tendons “live” with the ultrasound as he raised his arm.  The ultrasound showed pinching (impingement) of one of his tendons as his arm elevated.  It also showed an increased amount of fluid in a small sac above the tendon called the bursa.  We diagnosed him with a shoulder bursitis caused by a tendon getting pinched or “impinged.”  Injection options were discussed.  We explained that a “blind “ injection (without ultrasound)  can  be only 60% accurate.  This means that 40% of the time the needle is not within the bursa—and neither will be the delivered medication.  In contrast, when the injection is performed with ultrasound guidance, studies show the needle position to be 100% accurate.  We also explained to him that further research proved that, on average, patients obtain much better pain relief when physicians use ultrasound guidance.   Additionally, because of the increased accuracy of delivery, we can use less volume and sometime less steroid.  We chose to use ultrasound guidance for his injection.  He did well and is back on the golf course.

At APM, we strive to provide the highest level of care to our patients.  Ultrasound has become an invaluable tool, improving the accuracy and effectiveness of many of our treatments.  In addition,  the US has also expanded our ability to perform nerve blocks and other nerve related procedures which provide relief from neuromas and nerve entrapment syndromes, as well as nerve scarring from surgery and trauma, which can cause burning pain and numbness.

Lastly, with our growing interest in the use of biologic injections including PRP, fat derived stem cell grafts and bone marrow derived stem cells, we know that using  the US machine  allows us access  to treat a greater array of conditions that were previously just outside of our reach.

APM Spine and Sports Physicians is only practice in Norfolk or Virginia Beach to be accredited in Musculoskeletal Ultrasound by the American Institute of Ultrasound Medicine.




Is Fat in your Medicine Cabinet?

Is Fat in your Medicine Cabinet?

By Lisa Barr M.D.

Last month we introduced the concept of regenerative medicine  as the use of the body’s own resources to promote real healing at a cellular level.    This burgeoning “body eco- friendly” approach can be carried out using different adult stem cells and growth factors from different tissue (whole blood, fat, skin and bone).  This month’s newsletter will focus on the use of fat derived stem cells or adipose-derived stem cells (ADSCs).    Fatderived stem cells can be added to PRP (platelet rich plasma) when PRP alone does not adequately heal the condition or when there is the need for additional “tissue matrix.”

Fat derived stem cells are considered mesenchymal stem cells, found in a specific layer of fat called the stromal –vascular fraction (SVF).  These stem cells are similar in some ways to bone marrow derived stem cells, but are easier to extract and are more abundant.  What makes fat derived stem cells so interesting is that, in comparison to blood and bone, fat yields millions of stem cells per treatment.  Furthermore, ADSCs can be induced in vitro (outside of the body) to differentiate into many different tissues including:  osteoblasts (bone), chondroblasts (cartilage), myoblasts (muscle), and neurons (nerves), as well as others.   Thus, the possibilities are endless as a cure for disease and injury.  Needless to say, optimizing the use of these potent cells is the new frontier of medicine.  Current restrictions enforced in the USA by the FDA limit any modification of stem cells to certain research facilities.  In time, as more standardized protocols are developed, these restrictions should be loosened.  It is still unclear how we will be able to best optimize stem cell function.  Some studies suggest ADSCs are “locked in” to the fatty tissue and require enzymes to release the actual stem cell.  In vivo (in the body) studies regarding optimal use of fat derived stem cells are in the early stages, but results look very promising.

As previously stated, fatty tissue serves as a reliable, accessible and abundant source of adult stem cells with the ability to develop along multiple pathways.   Unlike bone marrow derived stem cells, fat provides a biomaterial scaffold, as well as specific growth factors that modulate inflammation, which can be used to repair and regenerate tissue.   ADSCs can also stimulate the recruitment of stem cells to the site of injury and promote their differentiation along specific cell lines.    It is also believed that ADSCs are “immunoprivileged” cells, providing the injured tissues with antioxidant chemicals and free radical scavengers.  They also suppress immune reactions.  Since fat (adipose) derived stem cells are  stromal cells which are “ multipotent progenitor cells,”  they are also believed to even  help failing heart muscles.   Current studies are underway worldwide using ADSCs in patients with heart damage after a heart attack to repair damaged myocardial tissue.  One observation in these studies is that these cells contain VEGF, a growth factor that promotes the development of new blood vessels, which are crucial in carrying oxygenated blood to the injured tissue.   Studies are also underway using fat derived stem cells in treatment for leukemia, spinal cord injury, stroke, liver damage and Alzheimer’s.   With all of the amazing possibilities in sight,  various medical centers are looking for standardized and streamlined approaches to extract the fat, process it  and in some cases “bank the fat”  for future use as people age.