Interview with Dr. Reeves

[ Transcript ]

Interview of Dean Reeves M.D. by Nathan Wei, M.D.

July, 2009
Dr. Nathan Wei is a rheumatologist and fellow of the American College of Rheumatology and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine.
Dr. Wei:  Today I am  speaking with Dr. Dean Reeves. Dr. Reeves is a Clinical Associate Professor of Rehabilitation at the University of Kansas. He has served as the primary researcher in several clinical trials in the area of regeneration of ligament, tendon and cartilage and offered a number of articles in regenerative medicine in med line journals and current textbook in pain management.   He’s on the Board of Directors at the American Academy of Orthopedic Medicine.  His primary interest in research is in helping design, implement and interpret research in collaboration with physicians from multiple countries and in bringing affordable, regenerative medicine into academic settings around the world.  So today I’ll be asking Dr. Reeves questions specifically about prolotherapy. So let’s go ahead and begin. Dean as you know there’s a tremendous amount of interest in the topic of regenerative medicine. Sort of the how can I continue to feel good for as long as I can and one of the techniques that people are very curious about is prolotherapy. I mean if you go to the internet and go to any of the arthritis forums this is a hot, hot topic. So I guess a good starting question is "What is prolotherapy and why is it called prolotherapy?"
Dr. Reeves: Prolotherapy is a method of injection treatment designed to stimulate healing. The term "prolo" comes from the term proliferate which means to make new cells. Because prolotherapy involves making new cells grow or regenerate, another description of the treatment is regenerative injection therapy. There are other ways to make things regenerate of course but the key word in prolotherapy is injection. This is a nonsurgical treatment. Therefore, injection that causes new cell growth can be termed prolotherapy.
Dr. Wei: How long has this been around? I mean how old is prolotherapy?
Dr. Reeves: The concept of creating or stimulating new growth and repair has been around since the time of the Pharaohs. Nearby the tomb of Amenhotep III is a pictorial description of how he tarried to treat his lame horses by applying heat to their foot ligaments. Much like foot aches in humans, if horse foot ligaments became week the horses become lame and may have to be put down. Heat was used to irritate the ligaments in the foot of the horse and stimulate repair. That was the early history of using irritation to promote healing. Another example was from the 1600s on the French battlefield when oil was dripped into a wound to stimulate more rapid healing by irritation. If you could not lift your sword you could not defend yourself. The key was speed of healing. If it was not for the process of inflammation, none of us would heal even the smallest cut. It is life-threatening if we lose the ability to react to injury by inflammation In about 1930 several physicians, primarily in the United States, began to use various solutions to create a temporary stimulation for repair. One of those solutions used years and years ago was simple dextrose solution. So the use of dextrose dates back at least till then.
Dr. Wei:  What does prolotherapy actually do to ligaments and tendons that are damaged?
Dr. Reeves: Those that use prolotherapy realize that the typical repair process after an injury leads to approximately an 80% repair. In other words, the original strength of the ligament or tendon or integrity of the cartilage has some damage that is not completely repaired or made fully normal. Over time, with additional injuries, large or small, the amount of total injury becomes enough to start creating pain. We can’t force someone to repair by causing actual injuries because they don’t fully repair. The advantage of prolotherapy is that you don’t tear anything and you don’t stretch anything. Instead, you simply inject something that makes the body sense that repair needs to occur and then the process begins. A tendon or ligament is much like a rope. If you’re going to strengthen a rope you can’t just pull on the rope to make it stronger. A rope will fray when you do that. To make a rope stronger you need to add strands to the rope. After a solution is injected, called a proliferant solution, new rope material or new "strands of rope" are laid down along the weak area. This new rope material thickens the rope that is already there but it is important to know that the new rope material is immature and filled with water molecules. It is called procollagen. The term pro means immature. As the baby collagen or procollagen matures it loses the water in its structure and, as it does that, it naturally tightens This is how a stretched out and weakened rope in sprain and strain can be changed back into a thicker and tighter rope. The body does not appear to allow over-tightening, so it has not been the experience of those doing prolotherapy that ligaments and tendons become too tight Cartilage is a different structure type but has its own way of responding.
Dr. Wei:  Fascinating.  I can picture it in my mind how you’re adding these new strands, new ropes to help strengthen this. Are there different methods used in prolotherapy?
Dr. Reeves: Well, as mentioned, the initial way that prolotherapy was done to create an inflammation and this can occur by simply using a needle. When a needle touches a cell it disrupts the lining of cell. That lining is called a cell membrane. The cell membrane is made up of little fats called lipids and these are released into the fluid around a cell. These lipids create inflammation which is a signal for repair cells to begin their work. A needle can also cause a little bit of bleeding. There are tiny veins and capillaries all over our body and you can stimulate a little bleeding with needle contact. Blood has many thousands of things called platelets. When these are released into an area they are also inflammatory and stimulate a repair effect. This is one reason why bruises are actually good. So even a little bitty needle can do this without injecting anything at all. If you inject something that creates an additional repair effect, that will result in a more powerful response. Dextrose is the most natural and most common solution injected in prolotherapy. We have all heard of glucose which is what we measure in our blood when we have diabetes. Glucose comes as a right or left mirror image. Dextrose is the right mirror image of glucose and is the one that humans use. So when I say dextrose, listeners can substitute the term glucose. Dextrose is a simple sugar that has six little carbons. It’s like a hexagon and is what our cells use for energy. Injecting dextrose appears to be somewhat like piling raw materials outside a factory. Having an abundance of raw materials is a signal for the factory to turn on and start producing something. When you inject dextrose around a cell it makes ligament, tendon and cartilage cells produce special proteins that are potent stimulators of repair. In summary there are needle effects and bleeding effects that stimulate healing and an effect of the solution itself.
Dr. Wei: So it sounds like a fairly simple concept that you’re describing...
Dr. Reeves: If you inject dextrose you are basically injecting fuel for the body cells. The cells of course transport the dextrose inside them so that within several hours the body has already used the glucose up in that area. Therefore there is nothing left behind that is unnatural. However, the cell, once it begins the repair process, continues that process. Those that are unaware of how prolotherapy works often think you are using a placebo when you inject dextrose because most are aware that dextrose is a simple sugar and then using sugar water by injection is like taking a sugar pill. The reason why dextrose by injection is not a placebo is because you’re not taking it in your mouth and your insulin doesn’t have the ability to drop the dextrose concentration. So it’s like you’re bypassing your stomach. You’re putting a high level of dextrose around the cell. In order to stimulate the cells to produce the growth proteins you only need to surround the cell with one half percent dextrose. If you listen to TV. about emergency rooms or hospitals you realize they use dextrose in 5% or more concentration. Therefore we can stimulate healing by injecting only of a fraction of that. Compared to injection in an IV, which distributes and dilutes dextrose rapidly, injection in a local area around a ligament or tendon or in a joint keeps the level of dextrose high for several hours. The DNA in local cells begin to produce new proteins for growth within about 20 to 30 minutes.
Dr. Wei:   What types of musculoskeletal conditions do you think that prolotherapy works best in? Since we’re talking, the people that are probably listening to this are being interested in soft tissue disorders as well as arthritis. I mean are those areas where prolotherapy would be indicated?
Dr. Reeves: The simplest way of describing soft tissue is a part of our body that is not hard when you knock on it. Bones are really hard when you knock on them. Cartilage, compared to bone, is soft tissue, and cartilage cells also begin to produce repair proteins, called growth factors, when exposed to dextrose. Growth factors, once produced, hook onto the outside of cells that you want to repair. When they hook on they send a signal to the cell’s DNA to begin a repair or growth process. . Bone cells do not respond to dextrose, and do not respond to the growth factors produced by soft tissue cells. Therefore, repair can be stimulated in ligaments and tendons and cartilage without causing a bone response. That is good because we don’t want more bone spurs. Pain in chronic sprain or strain in arthritis is contributed to very heavily by degeneration in either ligament, tendon, or cartilage, or it can be due to the little nerves being oversensitive in that area. A very exciting area of research is based on the understanding that nerves are soft tissue also. It appears as though nerves that have been abnormal for a long time in an area of chronic pain can be stimulated to repair and begin behaving normally by exposure to dextrose. So, while you are treating the damage in ligament, tendon or cartilage, at the same time you are treating the nerves that are over sensitive in the area so that they begin to act more normally and thus produce less pain.
Dr. Wei: So you’re getting a dual effect really in that you’re not only treating the actual problem with the tendon or ligament but you’re also getting an effect on the perception of pain. Would that be safe to say?
Dr. Reeves: That’s what’s been so particularly exciting because when a person hurts long enough in an area the nerves in that area become abnormally sensitive to pain. There is a term for that called "wind up " When nerves are over sensitive, it is like your football team is facing another team called pain. When you have nerves that are oversensitive it is like your football team has no linebackers. When the opposing team sends a pain that gets through your line of scrimmage you have no linebackers to keep the pain from getting to your brain. This explains how the person that has chronic pain can hurt in an area of pain even with stimulation that would not normally hurt like touch. Another way of describing this is like a baseball player with a glove on and the glove gets smaller and smaller and cannot catch as many balls as it used to. It has been thought that once patients become oversensitive that there are permanent changes in the brain and spinal cord that cannot be changed. However it appears that some of the change is actually in the nerves that we can reach and that by simulating the cell to become more healthy the oversensitivity can actually be reversed. You can understand why we are excited about the potential that prolotherapy offers for pain even of several decades.
Dr. Wei: Now you know, I guess this boils down to timing because you’re mentioning these situations where injury has occurred and that with prolotherapy you can somehow correct the problems with the pain perception because of the damage of the nerves. So I guess that sort of leads to the question which is when do you start to use prolotherapy and you know is there such a thing as being too late?
Dr. Reeves: Well, what we have found is that regardless of the number of years that a patient has had chronic pain, a high percentage of patients still respond with pain and functional improvement. A rough estimate would be that 80% respond in a very good or excellent fashion with pain less than a year and 70% with pain of twenty to thirty years. Things become more complicated with pain for many years but it does appear that with this reversal of the nerve irritability and repair of the structures that the amount of years a person has hurt does not matter as much as we thought. Your question was "Is it ever too late?" The other end of that question is – "Is it ever too early? The general approach has been to let the body do its own natural healing process for several months before you use prolotherapy. That’s logical of course. However, in the future and even in the present we will be able to accelerate the process of healing and increase the likelihood of healing in more significant injuries. . This is particularly critical in athletes that are in a hurry to get back to sports. You may have heard in the last Super Bowel that several athletes had been recently treated with injection of platelet rich plasma, which is another form of prolotherapy to get them back to sport faster than usual. Therefore treatment that enhances healing that the body is already trying to do on its own is another use of prolotherapy.
Dr. Wei: Okay, so that’s interesting because I’m sure that many of our listeners have heard about platelet rich plasma but they haven’t realized that it actually is a form of prolotherapy. Can you maybe elaborate on that a little more?
Dr. Reeves: Prolotherapy is a method of injection treatment designed to stimulate healing. I previously mentioned that the needle can cause a little bleeding which can stimulate healing because that is the effect of blood exposure. Platelet rich plasma is more powerful than blood because you’re taking a patient’s blood to spin in a centrifuge. The high velocity spin in the centrifuge separates the blood into a yellowish-clear layer called plasma which has few cells in it, and a red cell layer that is very thick. In between is a layer in which platelets accumulate. They are less dense than red blood cells and more dense than plasma so they spin out right in between. Platelets contain growth factors that are already made and ready to being work immediately when they are activated. If you can collect that concentrated layer and inject it in an area of disrepair, the platelets active promptly after injection and you have a very powerful stimulant for healing. In the PRP are also some stem cells. The exact potency of platelet rich plasma has not been compared with dextrose but it is likely that is several times more potent than dextrose. However, it cannot be used in a large areas because one ounce of blood makes only about ½ teaspoonful of platelet rich plasma. Injection of PRP is most certainly injection designed to stimulate healing so it is another way prolotherapy can be performed.
Dr. Wei: Well, certainly platelet rich plasma is a lot more expensive than say using dextrose. No question about that.
Dr. Reeves: Currently platelet rich plasma costs about $200 for every teaspoonful. However, currently we are working on ways to make platelet rich plasma much less expensively so that it it is more easily affordable for the common man (or common woman). I can say with all confidence that PRP will indeed be available and affordable for everyone in the very near future. We are currently designing clinical trials using the inexpensive PRP.
Dr. Wei:   I’ve read your chapter in The Waldman Textbook.  I noticed that you had, in your pictures, a lot of diagrams illustrating the different points that you would inject. So it looks like you’re probably inserting a needle in many locations for certain disorders?
Dr. Reeves: The chapter summarizes treatment of most every area of the body. Although ligaments and tendons in various parts of the body respond to stimulation a little differently, when we inject proliferent, all connective tissue in the body will grow. Joints are more complex because they can have a number of pain sources. So when we’re talking about a knee for instance, we find that we’re treating pain sources both inside and outside the knee. An example of the importance of treating pain sources both inside and outside the joint is seen in patients that still have pain after a joint replacement because they still have pain sources outside the joint itself. For this reason whenever we talk about treating joint such as a knee or a shoulder for example, we’re talking about how to inject the joint itself and also the key ligaments and tendons around the joint. More recently we are also treating some of the superficial nerves around the joint. By doing so we address every source of pain for an even more complete pain relief.
Dr. Wei: That point that you just made is key. I think that a lot of people, well, a lot of doctors actually, feel that okay, if a person say has a rotator cuff problem in the shoulder, well if I just inject let’s say cortisone into the shoulder for the rotator cuff, then that should take care of things, forever and ever. And I personally don’t think that that’s the way to go. You have any thoughts about that?
Dr. Reeves: We don’t want to dismiss steroids completely. They have their place. There are certainly conditions that are inflammatory and very quickly respond to steroid injections. However, as a cause of chronic pain degeneration instead of inflammation has to be considered. Many years ago, looking through a microscope pathologists found a few inflammatory cells in most conditions, and this led to the impression that the pain source was inflammatory and every condition was labeled as an itis. The tendency to call every condition an it is has persisted somewhat until the present day although for the past 25 years, basic scientists have found that the primary change under the microscope is degeneration and not inflammation. Now the term osis is being used more and more instead of it is because osis is a term that means degeneration. So what we really need to do is to find and treat those areas where tendons and ligaments and cartilage have become degenerate or unhealthy.
Dr. Wei: So for people who are listening to this, a  take away message is that the word tendonitis which means inflammation of the tendon, is wrong. It’s actually a tendonosis meaning a degeneration of the tendon. Which is why a technique like prolotherapy will work and something like a steroid injection won’t necessarily be as effective. What about a condition like, okay, let’s say for instance a patient presents with neck pain and they’ve been told that this is a "myofascial problem." How would you approach that?
Dr. Reeves: Myo means from muscle and fascia is the connective tissue around muscle fibers.   Myofascial pain therefore means pain from muscles or their connective tissue. Many physicians thought the source of pain in chronic pain was from the muscles themselves. We all know that people in chronic pain tend to have tight muscles. The reason why those that do prolotherapy avoid the term myofascial pain is because we consider that the muscles are reacting to damage in their attachments and the real damage is not in the muscle. What we are suggesting is that, when the ropes in our body become weaker or insufficient the muscle part of our body protectively stays under tension to keep us from moving too quickly or too much. This tightness in the muscle is what we feel and it creates a stiffness as well. Therefore, stiffness is one of the indications of loose ligaments. So, if loose or weak ligaments and tendons cause tight muscles, if you want to loosen you muscles and let them relax you must tighten or strengthen the tendon or nearby ligaments. When the tendon or ligament is normal your don’t need to protect you anymore and they can begin behaving normally.
Dr. Wei:   Is there a specific solution that you typically use for prolotherapy?
Dr. Reeves: Typically about 12.5 to 15% dextrose is what’s used for most ligaments and tendons and traditionally many have used 25% dextrose inside joints thinking that the fluid in a joint will dilute the dextrose somewhat. There are other more inflammatory solutions available such as an alcohol called phenol or a product called sodium morrhuate which is an oil. However, as we spoke of before, we’re looking at ways to make platelet rich plasma cheaper so that we have an option to move from our dextrose to other solutions that are more natural, have less side effects and have more power.
Dr. Wei: So, a reasonable next step for a stronger type solution would be platelet rich plasma?
Dr. Reeves: Yes. And I might mention something about the use of ultrasound. You know what I’m about to say because you have been teaching others how to use ultrasound to locate and treat damaged areas in ligament and tendon. Now, with high resolution ultrasound, the same type that mothers and father use to see their babies, we can finally see damaged areas. We can see holes in ligaments and tendons and areas where the tissue is just not lined up normally. We don’t see the rope like appearance like we should. This opens up new ways to research because now we can observe with ultrasound before and after treatment and demonstrate visually how the tissue has healed. We are also looking at ways to monitor changes in cartilage such as in the knee.
Dr. Wei:  How often would you use a prolotherapy procedure? Lets say for instance, let's take a common example. A person comes in and they have a tendonosis of their elbow. How often would you do a prolotherapy procedure on that person?
Dr. Reeves: If you want to be the most cost effective and you have someone who’s not having to get back and throw the ball for their team and do a sport immediately, I feel the most cost effective way is probably about every two months. Consider what happens when you break a bone. The doctor puts a cast on for 1-2 months. Or if you sprain your ankle you are often told it will take about 2 months to largely heal. First you grow new tissue and then the new tissue takes time to mature. So, if the time is available and there’s no huge hurry, two months is okay. If you treat much more often, especially more than once a month I’d probably be using something stronger that would work quicker.
Dr. Wei: So if you have this person with the elbow problem you’re saying every two months. Is this going to be something that’s going to have to go on indefinitely or is this something that you know a patient would respond to with maybe two or three treatments?
Dr. Reeves: In most ligament and tendon conditions,once you reach the point where you’ve got a structure that’s tight enough the symptoms stop and they patients don’t need to come back unless they’ve been injured again. Patients often show improvement after two treatments unless a source of pain has been missed. We like to get ligaments and tendons strong enough to where a person stops hurting and then strong enough to where they can handle the minor injuries of everyday living. Since healing continues beyond two months, if patients become pain and symptom free, the strength of the structure continues to increase further. In contrast, there are situations that are more severe like bone on bone arthritis where there’s really no cartilage left. With our current dextrose solutions you should find that patients feel markedly better but you probably will be seeing them every three to six months chronically. That is one reason why, especially for arthritis, we are working with solutions with more power in hopes of growing enough cartilage and repairing the joint surface enough to make treatments less frequent.
Dr. Wei: Okay. So sensation of pain is your target?
Dr. Reeves: Yes. Sensation of pain because in reality patients will go ahead and heal even more once their pain fully stops. The tissue as it matures further will often become more resistant to injury. They can be seen as needed after their pain is gone and function has normalized.
Dr. Wei: So, you mention this example of the bone on bone arthritis and since I’m a rheumatologist, right away my ears perked up. Are you putting the dextrose directly into the joint or are you also injecting areas near, in the joint capsule. For instance the adductor tubercle or areas like that as well?
Dr. Reeves: When there’s pain around the joint on attachments around the joint we will typically inject the attachments around the joint too. But for research purposes, we need to study simple and reproducible methods of treatment. We often do that by injecting inside the joint only and not treating every source of pain. In contrast, in everyday practice we inject both. When we do a study we often will screen patients by injecting their knee on the inside only with an anesthetic solution. If we eliminate most all their pain completely then we have a little bit more reason to think that they’ll be simple enough that we can treat just the joint. The use of ultrasound really helps because when we use it we can actually see the fluid go in the joint which makes treatment more accurate and effective. In fact, we’re about to begin a study in which we’re going to use a scope and look at the inside of the knee and take pictures of it and then inject proliferant solution, (First dextrose and then later other stronger solutions such as platelet rich plasma) After a set of injections a scope will again be placed to take pictures to see what has happened to the cartilage surface. We’ve never before been able to have the opportunity to take actual pictures of the inside of human joints.
Dr. Wei: That sounds terrific. I mean that’s sort of the holy grail is to be able to take photographs of a joint pre and then post treatment. So, you know, we’ve talked about the technique of prolotherapy. We’ve talked about the different types of situations where it can be used. We’ve talked about the timing. What about the complications?
Dr. Reeves: Complications are those that you expect from use of a needle. For example,  I have had one lung puncture in the last 15 years and have injected an estimated 45,000 rib attachments over that period. Now we use ultrasound guidance for all rib injections to treat the very important attachments between ribs and backbone. Another type of complication is one many people have experienced, as it is common with an epidural.  When you are injecting the low back you can get what’s called a spinal headache. That occurs when a small puncture is made through the sac that contains the spinal fluid, and a small leak occurs. That leak fixes itself but it creates a headache when you sit up. Again, we use ultrasound guidance for injections and this complication is now quite unusual. Infections can also happen anytime you use a needle. And usually those are in the neighborhood of one in 10,000 to 30,000 injections.  However, that rate appears to increase if steroid is included in the injection along with dextrose.  I have recently published a study indicating that and recommended not to mix steroid with proliferant solutions.  Although risks with prolotherapy are quite small over, the patient needs to have a reasonable indication to take that small risk.  For example,  we recommend using prolotherapy if the patient has pain or another troubling issue that is significantly affecting their quality of life or sport performance.  Other examples of functionally significant issues would include inability to turn the neck fully for checking traffic when changing lanes when driving or a change in walking pattern  that may lead to a fall or impaired work performce due to concentration limits related to pain . Pain itself is clearly a risk in everyday living. So we have to balance that risk against the small risk of complications.
Dr. Wei: That’s something that every doctor and every patient has to be aware of. Informed consent is a balancing of risk and benefits. You know, the time is really flying by. Are there any other words of wisdom that you might have for those people out there who are listening who are curious about prolotherapy? Anything else you can tell them?
Dr. Reeves: Well, since everybody has chronic pain it may be helpful for me just to take a minute to briefly mention some common and very treatable conditions. For example, jaw problems or TMJ disorders. This is a very common condition. The patient will complain of grinding their teeth , having some difficulty with their jaw locking or opening their mouth fully, and may have some headache in the temple area. The jaw may click or pop. That’s one of the easiest things to treat with a tiny needle in the jaw and they can feel better quickly. The ligaments of the jaw respond typically with just a few treatments. Another example is patients that complain of migraine or tension headaches. Tension headaches originate from the attachments at the base of the skull and, specifically tendon and ligament attachments there. In addition most don’t realize that the triggers for migraines are usually tendons and ligaments. There’s some that just have pure migraines but most people, if you try to heal those ligaments that hook on to the head, will find that their migraines become much less frequent and less severe. Once ligaments and tendons normalize the tendons stop pulling on the base of the head, stiffness decreases, headache improves, and the neck become more flexible. Going down the back, we talk about the shoulder such as rotator cuff issues. Rotator cuff tears can heal. You just want to be sure that the rotator cuff is not torn completely apart. Patients with elbow pain often have what’s called tennis elbow or golfer’s elbow which responds nicely to treatment. Loose wrists, painful fingers, painful thumbs are also conditions we see commonly and treat with success. With respect to the lower body, we talked about knee arthritis. Low back pain is also one of the most common things we treat, as are ankle sprains. As ligaments get weaker they protect the joints less and less. For example, consider a patient who, while walking, has their ankle suddenly turn in without warning and they nearly fall. Ligaments that are loose do not give the proper sensation to tell you if they are being stretched and because of this you can roll the ankle before realizing it. If you inject those ligaments around the ankle with dextrose or other proliferants, the ligaments tighten and then you have proper signals to your body when you’re starting to stretch and this will help decrease repeated injuries. So those are just a few brief examples of some of the pain conditions we’ll see.
Dr. Wei: This whole field now is exploding so rapidly and it’s exciting because both you and I are part of this baby boomer generation and we many of us have aches and pains that we don’t want to suffer from. So this is really exciting stuff. The times’ really flown by and what a fantastic interview and I want to thank you so much Dean. I think those listening out there got a real treat today. For people who want to contact you would you like to give out some information on how they can find you?
Dr. Reeves: I am the organizer for a web site summarizing prolotherapy and its research. It is called ResearchInProlotherapy. It has general articles for medical or non medical people but also summarizes research for those interested in digging in deeper. The web site can also be reached by typing in I remind my patients that Superman was always played by a Reeve or Reeves but that I am just a Clark Kent. The web site also refers you to some other web sites that may be helpful and it does have my e-mail. Our goal is to provide an informative and up to date web site that is enjoyable to read. 
Dr. Wei: And for those people who would be interested in maybe helping with perhaps contributions or whatever, assistance they can provide. Is there anything you’d like to tell our listeners about that?
Dr. Reeves: Research in prolotherapy has been largely entirely self funded for two reasons. One is that there is no profit in dextrose and drug companies have no incentive to fund research. The second is that we want our research to be free of any bias that proprietary support would bring. I tell people that if it wasn’t for the scholarships my children got I wouldn’t have done much research. We have several very exciting projects in several countries in design stage now for arthritis, are completing a study on a very common athletic condition in adolescents in Argentina, and are considering projects on acute conditions for the first time such as acute ankle sprain. To give an example of the expenses that are being self funded, I just bought an ultrasound machine for Argentina to allow my co author to accurately inject the knee and also follow effects on cartilage appearance. Even though we got a tremendous price break, that little machine was more than $22,000. We would love to have more help financially. So if someone gets fixed and is in a position to support research, my coinvestigators and myself would greatly appreciate it.
Dr. Wei: I just wanted to tell people who are listening on the CD that Dr. Dean Reeves, in addition to his research and other organization involvement,  has been an instructor in some of our courses where we’re teaching ultrasound to other physicians and  has always been generous with his time, his knowledge, and his expertise.   So, I just want to thank you again Dean.
Dr Reeves:  You are certainly welcome. 

K. Dean Reeves, M.D. is a physician and medical researcher in the area of pain caused by arthritis, chronic sprains and chronic strains. His private practice is located in the greater Kansas City area of Roeland Park, Kansas.  He collaborates in research with other locations across the country and internationally, and is licensed in the states of Kansas and Missouri.

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Dr. K. Dean Reeves

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