What does a consultation with Dr. Silva include?
Dr. Silva provides an extensive/comprehensive consultation. We schedule out at least 60 minutes of his time for your initial consultation. Your consultation will include:
- Medical history
- Physical exam
- Review of imaging (MRI/X-Ray, CT) Dr Silva will review the actual images from your CD as well as the report to educate you regarding your pathology
- Review of pertinent medical records such as Op reports, EMG, etc (if appropriate)
- Ultrasound examination of peripheral joints (if appropriate)
- Discussion of Dr. Silva’s findings, assessment and diagnosis
- Discussion of treatment options
- Education regarding medical condition
- Education of regenerative medicine and healing process
- Provide education and tools to optimize your health through:
I live out of state or out of the country – how do I get a consultation and treatment with Dr. Silva?
A significant number of patients travel from other states and internationally for consultation and treatment with Dr. Silva. You are of course welcome to schedule an in-office consultation with Dr. Silva. However, we work to accommodate our traveling patients by minimizing their travel time and financial resources.
We offer phone consultations as a starting point. This consultation will include everything that an office consult does, except of course the physical exam and ultrasound exam. Typically, Dr. Silva can develop your treatment plan during this consultation. This enables us to appropriately schedule you for a physical exam, ultrasound exam and treatment in the same trip.
What can I expect at my initial consultation?
At the completion of your consultation Dr. Silva will discuss your diagnosis, as well as the treatment options and recommendations he has for you. Following that, Deb, our procedure coordinator will review your case with the doctor and then send you a packet that summarizes what your treatment would include, as well as provides you with all pre-procedure instructions and protocols and the fees for the proposed procedure.
What are the fees for the initial consultation?
The initial consultation with Dr. Silva ranges from $350-$550. There are several factors that determine the fee, including actual time utilized, records reviewed, ultrasound exam and complexity of the case. The consultation does not include treatment.
Do I need an MRI before my consultation?
Dr. Silva does not require imaging (X-RAY, MRI, CT) for your initial consultation. If he deems it necessary, he can order it for you. However, if you already have imaging, he requests that you bring the report along with the images on a CD to your appointment. You can easily acquire these records by contacting the facility that provided the service and requesting it.
Do you accept insurance?
Dr. Silva has opted out of all insurance contracts, including Medicare. He has done this for your benefit. He does not want your insurance company dictating what he can and cannot do for you, as they are often very limiting. In addition, eliminating a billing department enables him to pass those financial savings on to you. Dr. Silva accepts Visa, MasterCard, Discover, Debit and Cash/Check for all services performed at IOW. Cryptocurrency is accepted as a form of payment for all services as well. At this time he only accepts Bitcoin, Ethereum, or Litecoin. The address to send these payments will be provided at the time of service. All typical taxes and fees are still applicable and any 3rd parties transfer fees are of the responsibility of the payee.
What is regenerative medicine?
Regenerative medicine is a nonsurgical approach to heal damaged tissue and disease that contributes to pain and dysfunction. This can include Prolotherapy, PRP and/or Stem Cell Therapy. We attempt to address underlying problems that are creating the patient’s complaints. This is in contrast to the majority of medical treatments that are designed to address symptoms without addressing the underlying cause of those symptoms. To regenerate a joint, we must strengthen all of the tissues that make the joint work appropriately for optimal function and then the proper biomechanics will lead to a better working joint in the long run.
Typically, the stages of healing are inflammation, proliferation and then maturation. By using various orthobiologics, these stages of healing occur over several weeks to months. In order for this process to occur, the orthobiologics must be precisely placed under image guidance into the degenerative tissue. You cannot get this result of healing by just blindly injecting it into the knee joint. Always choose a doctor who specializes in regenerative medicine, or interventional orthopedics, and who does this as their specialty for best outcomes.
What is prolotherapy?
Prolotherapy is short for proliferative therapies which are various types of injectates which stimulate an inflammatory response which encourages the body’s healing process with the intent of repairing injured tissue such as ligaments and tendons. The end goal would be to stabilize and strengthen joints to reduce your pain and improve their function.
There are multiple types of prolotherapy, from mild to very strong, and this should be customized to the patient’s pathology.
What is PRP?
PRP is Platelet Rich Plasma which is created by drawing the patient’s blood and removing all of the red blood cells from the plasma and then concentrating the platelets within the plasma to various concentrations necessary to treat various structures such as tendons, ligaments, bones, muscles, nerves, and joints. We use platelets because they contain a vast array of growth factors and other cytokines which stimulate the bodies healing process. PRP is not a stem cell injection.
What is stem cell therapy?
Stem cell therapy is derived from bone marrow concentrate where a variety of immune cells, including mesenchymal stem cells, are concentrated to be used in regenerative medicine procedures. This is one of the strongest types of orthobiologics and is typically used for more severe cases of tears, osteoarthritis and degeneration. Stem cells act as a general contractor to organize the repair through a variety of cytokines and exosomes, but they may also become the brick and mortar needed for tissue repair. The end result is stronger tissue and an improved ability to handle stress which will result in better biomechanics and decreased pain.
What is the difference between your autologous stem cells and the amnion/cord products that others are offering?
Amniotic/placental/Wharton jelly products are quite popular right now. They are acquired from a variety of donors around the world, sterilized and dehydrated into a powder, or cryopreserved. This is then packaged sold to doctors for their patients. Many doctors are selling amniotic tissue as stem cells but these are dead tissues and are regulated as such by the FDA. Therefore, any doctor who calls these therapies as “stem cell therapies” is practicing fraudulent medicine. In fact, these products may have some variety of growth factors which may be appropriate in specific cases. I will use these products only in combination with other autologous PRP or stem cell treatments to improve the desired result. Autologous (PRP and stem cells derived from your own body) products will always yield the best result.
What is your follow-up protocol after regenerative procedures?
There are a variety of things that need to be done before and after injections to improve the overall outcome. Unfortunately, many doctors are not aware of all of the protocols and precautions necessary to support the optimal outcome.
Many times, this includes lifestyle modifications, rehabilitation exercise, changing /reducing/discontinuing medications, optimizing disease, and utilizing a brace. I recommend a PREhab protocol to prepare for the procedure and then a rehab protocol for a minimum of 6 weeks after injections. Your PREhab and rehab and should be customized to you, and we will talk about this in length at your evaluation in order to maximize your results.
How much does PRP cost?
This is of course a common question. The good news is that our fees are typically lower than what patients expect. We strive to keep the fees as low as possible for the quality of care you will receive.
Dr. Silva will tailor your PRP treatment plan for you, and there are numerous variables that he will take into account as he does this. For example, the degree of pathology, the specific regions he will be treating, and the number of regions that will be addressed in a single intervention are all variables that will be different for you than another patient.
We always want you to know the fees prior to your procedure, and will provide you with a breakdown following your consultation.
How much does Stem Cell therapy cost?
Due to the increased technology and nature of the acquisition of the stem cells, stem cell prices are slightly higher than PRP. Once again, the fees are typically lower than what our patients expect. Many of the same variables as for PRP apply in determining the actual fee for the stem cell procedure.