Gastroenterology

Gastroenterology

Rockville Internal Medicine Group’s team of gastroenterologists provide consultation and continuing care for patients with digestive issues and digestive system disorders.

*RECALL ALERT* “The FDA recently released several safety alerts on ranitidine formulations, including the brand-name drug Zantac,” that were found to contain low levels of carcinogen. Our gastroenterologists recommend, if needed, to take Famotidine (Pepcid) instead of Ranitidine (Zantac). Please note that 20mg of Famotidine (Pepcid) = 150mg of Ranitidine (Zantac).

Reference

GI Patient Center. (2019, October 6). Talking to your patients about ranitidine. [Blog post]. Retrieved from https://www.gastro.org/news/talking-to-your-patients-about-ranitidine?

PROCEDURES 

  • Upper Endoscopy
  • Colonoscopy (Hospital or Outpatient Centers ONLY)
  • Bacterial Overgrowth Test
  • Capsule Endoscopy
  • Flexible Sigmoidoscopy
  • Hemorrhoid Banding
  • Hydrogen Breath Test
  • H. Pylori Breath Test
  • Lactose Intolerance Test
  • Restech Pharyngeal pH Testing
  • Unsedated EGD

Note: These procedures can be performed in the office or at the hospital/outpatient center.

FORMS

PRE/POST PROCEDURE INSTRUCTIONS 

NOTE: The above documents available for download are in .pdf format.

Announcements:

March was colorectal cancer awareness month. Colorectal cancer is the second leading cause of cancer death in the U.S. when men and women are combined. And it doesn’t always cause symptoms. Please schedule an appointment with one of our Gastroenterology doctors today!

Providers in this Specialty:
Belen Tesfaye, MD
S. Grace Woo, MD

Behavioral Health

 

We are living in exceptionally stressful times, and the need for behavioral health care may be greater than ever. 

Please note:  Due to high demand, our Primary Care Psychologists can ONLY schedule consults with people who are already established patients with another RIMG provider.

Common Behavioral Health Concerns:

  • Depression
  • Worry, fear, anxiety
  • Insomnia
  • Loneliness
  • Stress
  • Grief
  • Relationship difficulties
  • Caregiving burden
  • Making changes to diet and exercise
  • Difficulty managing a chronic medical illness
  • Increased use of alcohol, tobacco, or other drugs

For immediate assistance:

  • Montgomery County, MD Crisis Line: 240-777-4000
  • National Suicide Prevention Lifeline: Call 800-273-TALK (8255)
  • Crisis Text Line: Text TALK to 741741
  • National Domestic Violence Hotline: Call 1-800-799-7233
  • Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746

Services

We provide short-term, evidence-based consultation & therapy focused on challenges you are dealing with right now. Episodes of care typically last from 2-8 sessions. Sessions are 45 minutes. For longer-term behavioral health needs, we provide referrals to community behavioral health providers.

Please note:  We can ONLY schedule consults with people who are already established patients with another RIMG provider.

To schedule a virtual visit with our Primary Care Psychologists: Please call 301-762-5020.

Prior to your visit, please review the Informed Consent Checklist PDF (click to download) for telepsychological services, sign it, and return it via the Patient Portal.

Providers in this Specialty:

Michal Moskowitz, PhD

Stephanie Park, PhD

Regenerative Medicine

Rheumatology

specialties-rheumatology2 Maintaining mobility and dexterity is important to continuing in an active, healthy lifestyle. A variety of conditions and diseases can cause joint and muscle pain or injury. By using diagnostic ultrasound, a non-invasive, non-radiation technique, Rheumatologists at Rockville Internal Medicine Group are able to diagnose and treat a variety of musculoskeletal conditions. The ease of use of this tool, as well as other cutting edge resources, allows for ongoing monitoring and re-evaluation when necessary, and that allows for your doctor to make any necessary changes in treatment more easily.

SERVICES

Rockville Internal Medicine Group also offers PRP Therapy, or Platelet Rich Plasma Therapy, a non-surgical treatment for joint injuries and arthritis that stimulates the body’s natural healing forces. PRP is a concentration of platelets, which can jump-start healing.

What is PRP?
PRP, or Platelet Rich Plasma, is a substance made from your own blood to trigger healing.

Platelet Rich Plasma Therapy is a relatively simple, non-surgical treatment for joint injuries and arthritis. It merges cutting-edge technology with the body’s natural ability to heal itself.

The PRP is a concentration of platelets, which can jump start healing. Platelets contain packets of growth hormones and cytokines that tell the tissues to increase rebuilding of tissues to enhance healing.

When PRP is injected into the damaged area, it stimulates a mild inflammatory response, which triggers the healing cascade. This leads to restored blood flow, new cell growth, and tissue regeneration.

Because the blood is your own, there is no risk of rejection or acquiring blood borne diseases such as HIV or hepatitis.

What Are The Potential Benefits?
Patients can see a significant improvement in symptoms as well as a remarkable return of function. This may eliminate the need for more aggressive treatments such as long-term medication or surgery.

What can I expect during my treatment?
You will visit with the Doctor or Nurse Practitioner, who will ask about your medical history and give you a brief exam to determine that you are in good health to proceed.

The NP will obtain the blood sample and prepare the Platelet Rich Plasma.

The doctor will examine the joint which will receive the treatment, clean the area with an antiseptic soap, and apply numbing medicine.

Using ultrasonic guidance, the PRP will be gently injected into the joint space and joint support tissues.

After your treatment. you will stay for a short 15 to 20 minute observation period and we will review discharge instructions.

At check-out. you will schedule a follow-up appointment.

The process may be repeated 1 to 2 times over six to sixteen weeks.

What can I expect after the PRP treatment?
You may have mild to moder­ate discomfort which may last up to 1 week.

There may be temporary worsening of symptoms due to a stimulation of the inflam­matory response, which is necessary for healing.

Your doctor or NP will instruct you in the use of ice, elevation, reduced activity, and analgesic medications for comfort while the PRP is initiating healing. Also physical therapy or a therapeutic exercise program will be prescribed.

What should I do when I get home following the procedure?
Because Platelet Rich Plasma releases growth factors, it is important to not disturb the area of injection for at least 48 hours. We ask that you refrain from activities other than necessary walking or driving in order to receive the maximum benefit of the PRP growth factor stimulation. It is helpful if you can be sedentary for 48 hours, and refrain from any vigorous activity for up to 2 weeks following each procedure.

What Medications Can I Take?
Please do not take any anti-inflammatory medications such as Ibuprofen, Aleve, Motrin or high dose Aspirin. You may take Tylenol or homeopathic pain relieving medication if necessary, or you may be prescribed an appropriate analgesic. If you are on an 81-mg. daily dose of aspirin for cardiovascular reasons, please do not take it within the first 48 hours.

Your doctor or Nurse Practitioner will discuss your other medications and instructions prior to the procedure, and will review instructions again after the procedure is completed.

Stem Cells for Joints?
Millions of people develop osteoarthritis as they age. This process results in joint pain, swelling, instability, and loss of function. Current non-surgical treatments for osteoarthritis of weight bearing joints including weight reduction, rest, therapeutic exercise programs taught by physical therapists, non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin), naproxen (Naprosyn, Aleve). or analgesic medications such as acetaminophen (Tylenol). As the degenerative process advances, patients may be offered steroid (cortisone) joint injections, or Visco-supplement injections such as Synvisc, Hyalgan, or Orthovisc. Bracing and assistive devices such as cane and walker can be helpful.

Though these approaches may help in the relief of symptoms, they are pal­liative and do not correct the underlying problem of cartilage degeneration. Healthy cartilage is the ball bearing surface of bone that allows a smooth, gliding, friction free joint. When the effects of the degenerative process cause unremitting pain, inflammation, and dysfunction-the patient is referred to an orthopedic surgeon for consideration of joint replacement with man-made materials. There is no doubt that the advent of joint replacement surgery has been one of the great advances of medicine in our lifetime.

However, many patients are not candidates for joint replacement surgery due to medical conditions such as cardiovascular or pulmonary disease. Some younger patients may wish to postpone surgery-as artificial hips and knees can wear out in about 15 years requiring a second joint replacement over time.

Fortunately, there is a growing body of scientific evidence indicating that autologous (from one’s own body) mesenchymal stem cells (a primordial regenerative tissue found in everyone) have therapeutic value for the treat­ment of painful osteoarthritis. Stem cells act as the body’s repair kit because they have the ability to become many different types of cells. A recent news article describes the use of stem cells in correcting Type 1 diabetes. Another article describes improved eyesight following stem cell placement in the retina of patients with macular degeneration.

For the past 3 years, the Rheumatology Department at Rockville Internal Medicine has been a leader in the medical community utilizing platelet rich plasma in the treatment of arthritis of the knee, hip, and shoulder-as well as for chronic tendinitis of the shoulder and Achilles tendon.

However, this approach has been found to be less effective with advancing age and diminished cartilage reserve in the affected joint.

Addressing this issue is impressive medical literature describing relatively painless office-based techniques which combine stem cells harvested from the patient’s own bone marrow or abdominal fat-with platelet rich plasma-to attempt a more robust regenerative cartilage repair response than can be obtained from platelet rich plasma alone.

It is known that there are 500 times more stem cells in superficial abdominal fat than bone marrow-per unit of volume. These fat derived stem cells are more resistant to aging and more anti-inflammatory than bone marrow stem cells. Fat is more comfortably removed than bone marrow. Therefore, the Regenerative Medicine Center at Rockville Internal Medicine is using fat derived from a modified liposuction technique in the office to obtain stem cells for use in the treatment of arthritis. Fat derived from the patient is safe and avoids ethical issues associated with embryonic stem cells.

The protocol being utilized at Rockville Internal Medicine is that used by Bio-heart, a biotech firm nationally known for regenerative medicine technol­ogy. The protocol consists of two therapeutic sessions: at the first session adipose derived stem cells and platelet rich plasma will be injected into the joint. Approximately 30 to 40 days later, a “booster” injection of platelet rich plasma will be in injected into the joint. All injections will be performed under ultrasound guidance for accuracy and optimal effectiveness.

If you feel you might be a candidate for the above office-based regenera­tive medicine approach for the treatment of disabling arthritis, please call the Regenerative Medicine Center nurse, at 301-762-5020 ext. 3141 for a consultation appointment.

Fibromyalgia and Myofascial Pain Center

We are a Center dedicated to the diagnosis, treatment and comprehensive care of patients with Fibromyalgia and related disorders. Our multi-disciplinary focus utilizes patient education and self-help to enable and empower the patient to better manage and control symptoms. Through these efforts, patients will acquire new skills, make lifestyle changes, and participate directly in therapeutic decision making.

    • Patient Education
      Education and self-help are important elements in the design of the Center and are integral to successful outcomes. Patients will be provided with handy brochures, pamphlets and teaching materials from mainstream professional organizations such as the National Fibromyalgia Association, Arthritis Foundation and American College of Rheumatology. In addition, patients will be given a list of websites and useful resources that are available on the Internet. Finally, they will be encouraged to join listservs, patient-oriented chat rooms, and various forms of social media to share their experiences and learn lessons from others.
  • Support Group
    In the planning stages is an RIMG-based support group, a forum for sharing best practices and success stories. We intend to assemble a small group of patients with the session being led by an RIMG provider, nurse or staff member who would act in part as leader and “coach”. The addition of a patient whose life has been changed dramatically and who has benefited greatly from the types of services provided by the Center would be highly desirable.

PROCEDURES

  • Platelet Rich Plasma Therapy
  • Stem Cell Transplant
  • Infusion Center: Certain diseases require the administration of intravenous medications for an ongoing period of time. In the past, this was usually done at a local hospital, which caused significant inconvenience to the patient. In order to provide a less stressful experience, RIMG has created a relaxed, friendly environment for patients requiring intravenous infusions at our clinical site. The unit provides comfortable recliners and a TV with DVD capabilities. All infusions are monitored directly by a Certified Nurse Practitioner under the supervision of the ordering physician.
  • Ultrasound guided joint injections

FORMS

NOTE: The above documents available for download are in .pdf format. Click here to download the free Adobe Acrobat Reader.

Providers in this Specialty:
Lawrence Schainker, MD
Mandana Hashefi, MD, FACR
Rachel Glaser, MD


External Content Disclaimer

*Please note that pages of this site may be linked to other websites, which may have different terms of use and privacy practices than Privia Medical Group. Privia does not own, control, manage, supervise, direct, or otherwise have involvement in such other websites or the content of such websites. Privia is not responsible for the content of any linked websites. Privia is not acting as an agent for these websites, nor does Privia endorse or guarantee, in any way, their websites, content, or products. Privia makes no representation or warranty regarding the accuracy of information contained in linked websites, takes no responsibility for the use of copyrighted or otherwise protected materials on such linked websites, and has no control over the privacy practices or use of user information at such linked websites.

Cardiac & U/S Testing

Cardiac & U/S Testing

PROCEDURES

    • Stress Echocardiogram
    • Exercise Stress Test
    • Echocardiogram
    • Carotid Ultrasound
    • AAA Screen
    • Lower Extremity Arterial Exam
    • Holter Monitor
    • 24 Hour BP Monitor
    • Metabolic Test
    • Thyroid Ultrasound
    • General Abdominal Ultrasound
    • Venous Ultrasound to Rule Out DVT
    • TAG ECG (7 day heart monitor)
    • Remote Patient Monitoring

Patients with Blue Choice insurance will need to go to an outside radiology facility for the following procedures:

  • AAA Screen
  • General Abdominal Ultrasound
  • Thyroid Ultrasound

Provider in this Specialty:
Shishir Khetan, MD

Sleep Medicine

SLEEP APNEA DEVICE RECALL ALERT: If you use a Philips Respironics machine you may be affected. Click here for more information.

Sleep Medicine

SleepMedicine

Premier Sleep Center, Rockville Internal Medicine’s four bed unit of private rooms providing overnight sleep studies (polysomnography and C-PAP titration), as well as daytime studies (MSLT, PAP-NAP, Home Sleep Studies), opened in January 2004 to provide customized medical care with a professional and personal touch. The Center is dedicated to improving the quality of life for people with sleep/wake disorders. The center is staffed by experienced certified and registered polysomnography technicians.


PROCEDURES

  • PSG, PSG w/Oral Appliance, CPAP, MSLT, PAP Nap
  • Oral Device Fitting
  • CPAP Mask Fitting
  • Nasal Function Study
  • Laryngoscopy

FOR MORE INFORMATION

PHONE: 1.877.TRY.SLEEP
EMAIL: sleeplab@priviamedicalgroup.com

Providers in this Specialty:
Asefa J. Mekonnen, MD


External Content Disclaimer

*Please note that pages of this site may be linked to other websites, which may have different terms of use and privacy practices than Privia Medical Group. Privia does not own, control, manage, supervise, direct, or otherwise have involvement in such other websites or the content of such websites. Privia is not responsible for the content of any linked websites. Privia is not acting as an agent for these websites, nor does Privia endorse or guarantee, in any way, their websites, content, or products. Privia makes no representation or warranty regarding the accuracy of information contained in linked websites, takes no responsibility for the use of copyrighted or otherwise protected materials on such linked websites, and has no control over the privacy practices or use of user information at such linked websites.

Pulmonology

Pulmonology

Pulmonary Rockville Internal Medicine Group’s team of pulmonologists’ provide consultation and ongoing routine care to patients with respiratory issues.

SERVICES

Pulmonary Function Lab

A cough and shortness of breath are troubling symptoms that sometimes indicate the presence of a serious underlying condition. In order to diagnose and treat these conditions, the pulmonary physicians at Rockville Internal Medicine Group have developed a state of the art Pulmonary Function Lab. By performing these tests, your physician can determine lung functions as simple as how forcefully you can blow air out, or as sophisticated as how efficiently your lungs extract oxygen from the air. This testing, as well as X-ray and endoscopic evaluations when necessary, will help your physician determine the cause of your symptoms. Once that is determined, your physician can direct you to therapies to preserve and restore your health.

 


PROCEDURES

    • Bronchoscopy
    • Laryngoscopy
    • Thoracentesis
    • Pulmonary Stress Testing
    • Plain spirometry
    • Plain + post Albuterol
    • Full – DLCO, Lung Volumes
    • Exhale Nitric Oxide
    • 6 minute Walk Test
    • 24 Hour Pulse Oximetry

Procedures Performed in office, or at the Hospital.


FORMS

Health Record Information Updates
Pulmonary Questionnaire (October 2010)
Notice of Privacy Practices (April 2011)

NOTE: The above documents available for download are in .pdf format

Providers in this Specialty:

Internal Medicine

Internal Medicine

Dedicated to your overall good health, Rockville Internal Medicine Group’s team of physicians, board certified in Internal Medicine or Family Medicine, are focused on preventive and primary care. Our physicians and staff look forward to being lifelong partners in your good health.

SERVICES

Procedures and Laboratory Services
InternalMedicine1
The Rockville Internal Medicine Clinical Laboratory is open Monday through Friday from 8:00 am – 4:00 pm. All laboratory tests must be ordered by your physician. A lab appointment is required. For more information on our laboratory services, click here.

Hospitalist Available 24 Hours/Day

To provide 24-hour hospital coverage, Rockville Internal Medicine participates with Inpatient Specialists. This allows for a physician to be present and available in the hospital at all times. The Inpatient physician will be in contact with your doctor during your hospital stay, and all details of your hospital stay will be communicated in a timely manner after your discharge.

What you can expect at your physical exam

Your annual physical exam is an opportunity for you and your doctor to update your medical history, make note of any changes in your family medical history, and reconcile your medications. It is also a time for your physician to assess safety concerns and focus on lifestyle habits such as diet, exercise, alcohol and tobacco use. Your doctor will make sure that you are up to date on preventive health items such as immunizations, and age-appropriate health screenings such as colonoscopies, pap smears, mammograms and PSA tests. Usually, fasting blood work is done prior to the annual exam so that you and your doctor can review the results together at the time of the visit. We realize that sometimes other medical concerns arise during your annual physical exam. It is important to keep in mind that those issues may not be part of the annual physical exam. Your physician may ask you to schedule another office visit to address those concerns. If your doctor is able to address those concerns in the allotted time for your annual physical exam, please be aware that you may be billed for an office visit in addition to a physical exam. We are simply saving you another trip to the office by addressing all of those issues at one visit.


SERVICES

  • Birth Control
    • IUD (Paragard/Mirena) – Dr. Allison Hockman
    • Implant (Nexplanon) – Dr. Eleanor Tanno or NP Christina Schrack
  • Cardiovascular Testing
    • Stress Echo
    • Exercise Stress Test
    • Echocardiogram
    • Carotid Ultrasound
    • AAA Screen
    • Lower Extremity Arterial Exam
    • Rule Out DVT
    • Abdominal US
    • Thyroid Ultrasound
    • TAG ECG (7 day heart monitor)
    • Remote Patient Monitoring
    • Holter Monitor
    • 24 Hour BP Monitor
    • Metabolic Test
  • Department of Transportation (DOT) – NP Kathy Kemper-Dean (Olney)
  • Diabetes Retinopathy Screen (IRIS)
  • Medical Cannabis Card – Dr. Kelly Cowen and Dr. Kharia Holmes

FORMS

Health Record Information Updates
Patient Request Form (October 2010)
Patient Intake Form (October 2005)
Notice of Privacy Practices (April 2011)

NOTE: The above documents available for download are in .pdf format.


CDC IMMUNIZATION SCHEDULES

Adult Schedule
Indications
Precautions

Providers in this Specialty:


External Content Disclaimer

*Please note that pages of this site may be linked to other websites, which may have different terms of use and privacy practices than Privia Medical Group. Privia does not own, control, manage, supervise, direct, or otherwise have involvement in such other websites or the content of such websites. Privia is not responsible for the content of any linked websites. Privia is not acting as an agent for these websites, nor does Privia endorse or guarantee, in any way, their websites, content, or products. Privia makes no representation or warranty regarding the accuracy of information contained in linked websites, takes no responsibility for the use of copyrighted or otherwise protected materials on such linked websites, and has no control over the privacy practices or use of user information at such linked websites.

Dermatology

Dermatology

Dermatology Dermatology is the medical specialty which deals with conditions of the skin, hair, and nails. Our board certified dermatologists, Dr. Sara Brooks and Dr. Yamini Saripalli are available for general skin checks and treatment of skin conditions. They are fellowship trained in the expert identification and treatment of melanomas and other skin cancers.

SERVICES

Dr. Brooks and Dr. Saripalli treat all medical dermatology conditions, in people of all ages (from infants to senior citizens). Some common dermatologic conditions include (but are not limited to):

    • Acne
    • Rosacea
    • Psoriasis
    • Warts and Molluscum
    • Melasma
    • Hives
    • Skin Manifestations associated with internal diseases such as Diabetes, Mellitus, and Lupus
    • Contact Dermatitis
    • Eczema and Dry Skin
    • Vitiligo
    • Blisters
    • Skin Infections (such as boils and folliculitis)
    • Hair Loss
    • Nail Disorders including Nail Fungus
    • All types of Skin Growths (such as Skin Tags, Cysts, Moles, and Keratoses)
    • Skin Cancer (Basal Cell, Squamous Cell, Melanoma)

PROCEDURES

MEDICAL

RIMG offers the following dermatology medical procedures:

  • Botox for Increased Sweating in the Armpits
  • Liquid Nitrogen (Cryotherapy)
  • Removal of Skin Growths
  • Biopsy of Atypical Moles
  • Photodynamic Therapy (Blue Light) for Pre-Cancerous Lesions and Acne
  • Patch Testing

COSMETIC

  • Products
    • We offer our own anti aging RIMG product line as well as the Glyderm product line available for purchase. 
  • Botox
    • Injected medications used to relax certain muscles of the face, resulting in fewer wrinkles, and a more youthful appearance.
  • Juvederm
    • Volumizing and wrinkle reducing injectable natural materials which are used to restore the facial contours seen in younger skin. They are mostly used in the cheeks, the angle of the jaw, temples, and lips, as well as areas of deep wrinkling such as the nasolabial folds and marionette lines. They can also be used for filling depressed scars as well.
  • Chemical peels
    • These are peels, usually consisting of salicylic, glycolic or lactic acid, which is applied directly on the face (or affected areas) for the treatment of conditions such as hyperpigmentation, acne, and skin rejuvenation. We currently offer the GlyDerm peel and the VIpeel. 
  • Microneedling
    • Microneedling is a self-pay procedure that helps to treat fine lines, hyperpigmentation, and acne scars. It is a resurfacing technique that helps the skin to build new collagen. With very little down time, this is a popular anti-aging procedure. For more information, visit: www.inductiontherapies.com/collagen-pin-micro-needle

FORMS

Health Information Update
Dermatology Patient Intake Form (November 2011)
Notice of Privacy Practices (April 2011)

NOTE: The above documents available for download are in .pdf format.


RESOURCES

Please visit the American Academy of Dermatology for more information about specific skin conditions.

Providers in this Specialty:
Sara Brooks, MD
Yamini Saripalli, MD

Rheumatology

Rheumatology

specialties-rheumatology2 Maintaining mobility and dexterity is important to continuing in an active, healthy lifestyle. A variety of conditions and diseases can cause joint and muscle pain or injury. By using diagnostic ultrasound, a non-invasive, non-radiation technique, Rheumatologists at Rockville Internal Medicine Group are able to diagnose and treat a variety of musculoskeletal conditions. The ease of use of this tool, as well as other cutting edge resources, allows for ongoing monitoring and re-evaluation when necessary, and that allows for your doctor to make any necessary changes in treatment more easily.

SERVICES

Rockville Internal Medicine Group also offers PRP Therapy, or Platelet Rich Plasma Therapy, a non-surgical treatment for joint injuries and arthritis that stimulates the body’s natural healing forces. PRP is a concentration of platelets, which can jump-start healing.

What is PRP?
PRP, or Platelet Rich Plasma, is a substance made from your own blood to trigger healing.

Platelet Rich Plasma Therapy is a relatively simple, non-surgical treatment for joint injuries and arthritis. It merges cutting-edge technology with the body’s natural ability to heal itself.

The PRP is a concentration of platelets, which can jump start healing. Platelets contain packets of growth hormones and cytokines that tell the tissues to increase rebuilding of tissues to enhance healing.

When PRP is injected into the damaged area, it stimulates a mild inflammatory response, which triggers the healing cascade. This leads to restored blood flow, new cell growth, and tissue regeneration.

Because the blood is your own, there is no risk of rejection or acquiring blood borne diseases such as HIV or hepatitis.

What Are The Potential Benefits?
Patients can see a significant improvement in symptoms as well as a remarkable return of function. This may eliminate the need for more aggressive treatments such as long-term medication or surgery.

What can I expect during my treatment?
You will visit with the Doctor or Nurse Practitioner, who will ask about your medical history and give you a brief exam to determine that you are in good health to proceed.

The NP will obtain the blood sample and prepare the Platelet Rich Plasma.

The doctor will examine the joint which will receive the treatment, clean the area with an antiseptic soap, and apply numbing medicine.

Using ultrasonic guidance, the PRP will be gently injected into the joint space and joint support tissues.

After your treatment. you will stay for a short 15 to 20 minute observation period and we will review discharge instructions.

At check-out. you will schedule a follow-up appointment.

The process may be repeated 1 to 2 times over six to sixteen weeks.

What can I expect after the PRP treatment?
You may have mild to moder­ate discomfort which may last up to 1 week.

There may be temporary worsening of symptoms due to a stimulation of the inflam­matory response, which is necessary for healing.

Your doctor or NP will instruct you in the use of ice, elevation, reduced activity, and analgesic medications for comfort while the PRP is initiating healing. Also physical therapy or a therapeutic exercise program will be prescribed.

What should I do when I get home following the procedure?
Because Platelet Rich Plasma releases growth factors, it is important to not disturb the area of injection for at least 48 hours. We ask that you refrain from activities other than necessary walking or driving in order to receive the maximum benefit of the PRP growth factor stimulation. It is helpful if you can be sedentary for 48 hours, and refrain from any vigorous activity for up to 2 weeks following each procedure.

What Medications Can I Take?
Please do not take any anti-inflammatory medications such as Ibuprofen, Aleve, Motrin or high dose Aspirin. You may take Tylenol or homeopathic pain relieving medication if necessary, or you may be prescribed an appropriate analgesic. If you are on an 81-mg. daily dose of aspirin for cardiovascular reasons, please do not take it within the first 48 hours.

Your doctor or Nurse Practitioner will discuss your other medications and instructions prior to the procedure, and will review instructions again after the procedure is completed.

Stem Cells for Joints?
Millions of people develop osteoarthritis as they age. This process results in joint pain, swelling, instability, and loss of function. Current non-surgical treatments for osteoarthritis of weight bearing joints including weight reduction, rest, therapeutic exercise programs taught by physical therapists, non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin), naproxen (Naprosyn, Aleve). or analgesic medications such as acetaminophen (Tylenol). As the degenerative process advances, patients may be offered steroid (cortisone) joint injections, or Visco-supplement injections such as Synvisc, Hyalgan, or Orthovisc. Bracing and assistive devices such as cane and walker can be helpful.

Though these approaches may help in the relief of symptoms, they are pal­liative and do not correct the underlying problem of cartilage degeneration. Healthy cartilage is the ball bearing surface of bone that allows a smooth, gliding, friction free joint. When the effects of the degenerative process cause unremitting pain, inflammation, and dysfunction-the patient is referred to an orthopedic surgeon for consideration of joint replacement with man-made materials. There is no doubt that the advent of joint replacement surgery has been one of the great advances of medicine in our lifetime.

However, many patients are not candidates for joint replacement surgery due to medical conditions such as cardiovascular or pulmonary disease. Some younger patients may wish to postpone surgery-as artificial hips and knees can wear out in about 15 years requiring a second joint replacement over time.

Fortunately, there is a growing body of scientific evidence indicating that autologous (from one’s own body) mesenchymal stem cells (a primordial regenerative tissue found in everyone) have therapeutic value for the treat­ment of painful osteoarthritis. Stem cells act as the body’s repair kit because they have the ability to become many different types of cells. A recent news article describes the use of stem cells in correcting Type 1 diabetes. Another article describes improved eyesight following stem cell placement in the retina of patients with macular degeneration.

For the past 3 years, the Rheumatology Department at Rockville Internal Medicine has been a leader in the medical community utilizing platelet rich plasma in the treatment of arthritis of the knee, hip, and shoulder-as well as for chronic tendinitis of the shoulder and Achilles tendon.

However, this approach has been found to be less effective with advancing age and diminished cartilage reserve in the affected joint.

Addressing this issue is impressive medical literature describing relatively painless office-based techniques which combine stem cells harvested from the patient’s own bone marrow or abdominal fat-with platelet rich plasma-to attempt a more robust regenerative cartilage repair response than can be obtained from platelet rich plasma alone.

It is known that there are 500 times more stem cells in superficial abdominal fat than bone marrow-per unit of volume. These fat derived stem cells are more resistant to aging and more anti-inflammatory than bone marrow stem cells. Fat is more comfortably removed than bone marrow. Therefore, the Regenerative Medicine Center at Rockville Internal Medicine is using fat derived from a modified liposuction technique in the office to obtain stem cells for use in the treatment of arthritis. Fat derived from the patient is safe and avoids ethical issues associated with embryonic stem cells.

The protocol being utilized at Rockville Internal Medicine is that used by Bio-heart, a biotech firm nationally known for regenerative medicine technol­ogy. The protocol consists of two therapeutic sessions: at the first session adipose derived stem cells and platelet rich plasma will be injected into the joint. Approximately 30 to 40 days later, a “booster” injection of platelet rich plasma will be in injected into the joint. All injections will be performed under ultrasound guidance for accuracy and optimal effectiveness.

If you feel you might be a candidate for the above office-based regenera­tive medicine approach for the treatment of disabling arthritis, please call the Regenerative Medicine Center nurse, at 301-762-5020 ext. 3141 for a consultation appointment.

Fibromyalgia and Myofascial Pain Center

We are a Center dedicated to the diagnosis, treatment and comprehensive care of patients with Fibromyalgia and related disorders. Our multi-disciplinary focus utilizes patient education and self-help to enable and empower the patient to better manage and control symptoms. Through these efforts, patients will acquire new skills, make lifestyle changes, and participate directly in therapeutic decision making.

    • Patient Education
      Education and self-help are important elements in the design of the Center and are integral to successful outcomes. Patients will be provided with handy brochures, pamphlets and teaching materials from mainstream professional organizations such as the National Fibromyalgia Association, Arthritis Foundation and American College of Rheumatology. In addition, patients will be given a list of websites and useful resources that are available on the Internet. Finally, they will be encouraged to join listservs, patient-oriented chat rooms, and various forms of social media to share their experiences and learn lessons from others.
  • Support Group
    In the planning stages is an RIMG-based support group, a forum for sharing best practices and success stories. We intend to assemble a small group of patients with the session being led by an RIMG provider, nurse or staff member who would act in part as leader and “coach”. The addition of a patient whose life has been changed dramatically and who has benefited greatly from the types of services provided by the Center would be highly desirable.

PROCEDURES

  • Platelet Rich Plasma Therapy
  • Stem Cell Transplant
  • Infusion Center: Certain diseases require the administration of intravenous medications for an ongoing period of time. In the past, this was usually done at a local hospital, which caused significant inconvenience to the patient. In order to provide a less stressful experience, RIMG has created a relaxed, friendly environment for patients requiring intravenous infusions at our clinical site. The unit provides comfortable recliners and a TV with DVD capabilities. All infusions are monitored directly by a Certified Nurse Practitioner under the supervision of the ordering physician.
  • Ultrasound guided joint injections

FORMS

NOTE: The above documents available for download are in .pdf format. Click here to download the free Adobe Acrobat Reader.

Providers in this Specialty:
Lawrence Schainker, MD
Mandana Hashefi, MD, FACR
Rachel Glaser, MD


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