Pain and Regeneration with Dr. Timmermans, ND (NMD, Arizona)
Q: Can you tell me a little bit about what your practice looks like?
A: Approximately 70% of my practice is a traditional medical practice where patients come to our clinic, but the other 30% is telemedicine. Being able to practice Telemedicine has allowed me to help patients outside of my immediate clinic area, and provide healing solutions to more people. In terms of modalities, 60% of my current practice is pain management with 40% endocrinology (which also encompasses athletic and cognitive performance).
Q: Can you explain the difference between prolotherapy, PRP therapy and stem cell injection therapy? And when you may use one over the other?
A: Within the realm of regenerative injections, there are three main injections, Prolotherapy, PRP, and stem cell therapy. The goal with each of these injections is to stimulate a healing response from the body in order to regenerate connective tissue such as ligaments, tendons, muscles, and cartilage. Prolotherapy uses a simple sugar solution that acts as a local irritant where it is injected, and the body responds by sending growth factors to lay down new and stronger connective tissue in that area. PRP is a portion of a patient's blood that is highly concentrated in platelets, hence the name platelet-rich plasma. When injected into an injured area, these platelets secrete proteins and growth factors that helped trigger healing in that area and also trigger the release of mesenchymal stem cells from the local tissue. This results in a stronger response when compared to Prolotherapy. The strongest form of regenerative injections is stem cell therapy, where either bone marrow or adipose is extracted from the patient, spun down in a centrifuge and processed in order to isolate the layer that contains the most stem cells. When the final product is injected back into the injured area, a high number of growth factors, proteins, and exosomes are secreted from the stem cells, resulting in a much stronger response from the body in regards to healing. There's also new research showing that the stem cells can transfer micro-RNA into the local tissue, which helps the cells in that area to heal. This is not something that is seen with Prolotherapy or PRP.
In general, I use prolotherapy when a patient’s main concern is just ligament laxity, PRP when there is mild to moderate osteoarthritis with or without any partial tears in the surrounding muscles, and stem cells for older patients (above 40 years old), with moderate to severe osteoarthritis and significant tearing or tendinosis.
Q: What conditions do you usually treat?
A: For pain management, I treat a lot of chronic musculoskeletal pain, specifically low back pain, neck pain and headaches, shoulders, knees and hips. Most of these areas have osteoarthritis or old injuries that have resulted in tendinosis.
In regards to hormone therapy, I work with a lot patients with hypothyroidism, premature ovarian or testicular hypofunctioning, and menopause/andropause.
Q: What other naturopathic modalities do you use alongside treatments for pain, regeneration, and helping athletes achieve their peak performance?
A: For pain and regeneration, I also do quite a bit of acupuncture, cupping, gua sha, and TCM herbs to help modulate the meridians in the body and achieve a more balanced state in the body.
In regards to athletes achieving peak performance, I work a lot on nutritional and lifestyle counseling in order to help balance our their neuroendocrine system so that they are able to recover more efficiently and therefore perform better.
Q: When it comes to athletes, how do you explain the connection of their hormones, to lifestyle and athletic performance?
A: Within the realm of athletic performance, hormones have a very large impact. That being said, we are sometimes limited by what we can directly do with the hormones because of doping guidelines. This means that we typically need to focus more on nutrition, lifestyle, and herbal medicine in order to put the body in an optimal place to restore balance to the system. When an athlete has low cortisol or testosterone levels, a very large decrease in performance can be seen, and this can result in overtraining syndrome.
Q: What fuels your passion to work in Naturopathic Medicine?
A: I think a lot of my passion comes from being able to help people who feel lost with their health, and those who have lost faith in the medical system. Being able to help people who have been suffering for years bring a great amount of satisfaction and passion into my practice.
Q: What have you learned from your patients?
A: To be honest, I don’t know if I can count how many things I have learned from my patients. Each week I am humbled by them, either indirectly through researching for them, or through direct interactions. I think the most valuable lesson that I have learned from my patients is to listen more than I speak. Many patients that come to see me feel like they haven’t been heard by their past physicians, even if some of them don’t vocalize this. A significant portion of healing occurs for my patients just by the fact that they are feeling heard.
Q: Is there something else you would like to share with our readers?
A: Never stop working towards being your true self.
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