To learn more about how we can offer comfort and well-being, follow our blogs. 


DISCLAIMER: Like all medical procedures, all the procedures that we perform have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else. 

Monday, March 12, 2018
By Edward Dieguez Jr. MD PA
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1. What is it? 

Is an inflammation of the fluid-filled sac, or bursa, that lies between the ischial tuberosity and the tendon that attaches the hamstring muscle to the bone.


2. What is the cause?

Injury or overuse can irritate the bursa causing the bursa to become inflamed, swollen, and painful. It is also caused by inflammation or injury to a nearby tendon, the hamstring that insert on the ischial tuberosity. This injury can be from direct trauma to the area, or from injury to the hamstring muscle or tendon through activities such as running or bicycling. Ischial bursitis can also result from sitting for long periods on a hard surface,


3. Symptoms

This may include pain when sitting and pain at the center of the butt that can radiate going down the back of the leg that mimic sciatica. This can be felt during walking or even when flexing the hip at rest.


4. Treatment

      a) Concervative Treatment.-  These are the  simplest and most commonly use. They include of rest, ice, compression and elevation is done for managing the ischial tuberosity pain. These techniques are not always effective, and are   not helpful in restoring the tissue injury. They only in alleviating the pain for short term, but it is not quite effective in chronic cases of ischial tuberosity pain. Additionally if the patient takes prolonged rest or ice application, there is decrease in the blood supply which delays in the healing process.   

     b) Physical therapy: This also help in controlling and reducing the ischial tuberosity pain. However it does not provide a permanent solution, as it does not repair the damage in the muscular tissues and ligaments.

    c) Analgesic Medicines: A variety of analgesic are also used for treating the ischial tuberosity pain. They will only relieve the pain and will not heal the damaged tissues. Analgesic should only be used for short term duration, as using them long term produces significant side effects and may affect the kidney function. Steroid such as hydrocortisone are also used sometimes and will relieve the pain but weaken the tissue even more.


The therapy modalities that fallow are very advance therapy modalities and there are not many physician familiar with them. These treatment methods require very skilled and experienced physicians and health care staffs to conduct them.


     d) Prolotherapy: This is a favorable and very advanced treatment method for pain in the ischial tuberosity. A hypertonic dextrose solution is injected in the areas of the damaged tissues to produces inflammation, which stimulate the local stem cells to repair the damaged area. This treatment helps in depositing new collagen and repairing the injured ligaments. It promotes strengthening of the soft tissues, which leads to gradual improvement of hamstring tearing. This process helps in resolving the ischial tuberosity pain.


     e) Stem Cell Therapy: This treatment is an innovative method for treating ischial tuberosity pain. Stem cells obtained from the bone marrow of the patient are injected into the area. This leads to self-restoration of the affected tissues alleviating the associated ischial tuberosity pain. Stem cell procedure is a a natural treatment process.


     f) Platelet Rich Plasma Technique: This therapy is used in conjuction or as a booster, after stem cell therapy. There is large amount of cytokinin present in the Platelet Rich Plasma, which reinforces and helps in coordinating the physical involvement required for healing of the bones and soft tissues.








Friday, March 02, 2018
By Edward Dieguez Jr. MD PA
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Check this out! We couldn’t have grown without you!


We are sponsoring the Health and Wellness Expo to be held on Saturday, April 28, 2018 from 10:00AM to 4:00 PM (EDT) at the World Golf Village Renaissance St. Augustine Resort 500 South Legacy Trail St. Augustine, FL 32092.


There are over fifty companies attending already. Dr. Dieguez will be in attendance to answer questions about all our modalities of treatment offered at our office.

Thursday, March 01, 2018
By Edward Dieguez Jr. MD PA
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Most of the patients view surgery as like getting a part fixed in their car. A part wears out, so you replace it or “fix it” with a new one.

I prefer to look at it like Doctor Centeno describes it: “Surgery is damage to accomplish a goal,” and that goal is not always accomplished. Let’s take this surgical damage concept to the knee. Here attached are some pictures of the damage caused during a knee replacement procedure. Piece of cake!! Muscles split or cut, tendons cut, nerves pulled, bones cut, ligaments and tendons stretched. Minor stuff! 


1.Pain after knee replacement surgery.

Persistent post surgical pain is a prevalent but under acknowledged condition after total knee replacement. Three to four years after knee replacement surgery 44% of patient still experience significant pain. In fact 15% report severe-extreme persistent pain.



2. Need for knee replacement surgery.

Knee replacement surgery is many times unnecessary. In a new study released in the Arthritis and Rheumatology Journal the finding are alarming since it found that only 44% of the total knee replacements done in the US where judged as appropriate. In 27.1% of the knee replacement done in the US the evidence was inconclusive. And what is worse, in 34.3% the surgery was judged as totally inappropriate.



3.- Recovery from knee replacement surgery.

Recovery can take over six months and at times it can take up to a year. 
So as to not discourage patients from having knee replacement surgery, patients are told that they will be well and running around in no time. They use terms like “a few weeks”. “Few”! That is a big word. Ask your surgeon to define the word “few”. According to Dr. Brian Hatten MD who wrote “Road to Recovery” What to expect after knee replacement surgery it is not that simple. It for sure does not sound like a piece of cake to me. Just read the guide. Here is the link to it. 


4.- Cost of knee replacement surgery.

It can get way up there. Add them up yourself. Six to twelve weeks before you can return to work. If you have a deductible in your insurance policy it can go anywhere from a couple hundred dollars to three or five thousands dollars. Add to that any copays for doctors visits before the surgery, plus medications cost, plus physical therapy deductibles that your insurance policy may have, and any transportation cost you may have for a while since you won’t be driving for four to six weeks. All of these can add up to a good pile of money. In addition if your insurance policy covers only 80% of the surgery and hospital stay, you would be in for a big surprise since the average cost of knee replacement surgery is forty nine thousands five hundred dollars. So your 20% would be $ 9900. Not a piece of cake by any means. Check the following link for more details about cost.


5.- Complications and risks of knee surgery.

The older you are and the worse your health is the greater the risk. Complications include:  
a) A prosthesis component can become loose or dislocate if it does not seal to the bone well or is misaligned. b) Legs may be slightly different lengths after surgery. In some cases a shoe insert can remedy this problem. c) The new knee may be stiff. Most people who have undergone knee replacement surgery can bend their knees at least 115 degrees. However, some people develop scar tissue that hinders flexibility. This limited flexibility is more common in people who had limited flexibility before surgery. d)An allergic reaction to the bone cement can occur. In these cases the bone cement and prosthesis must be removed. e) Damage can occur to the knee’s patella (knee cap) and/or the soft tissue (muscles, ligaments and tendons) that support the joint between the patella and the femur. f) In rare cases there is damage to surrounding arteries, veins and/or nerves. g) Deep venous thrombosis (DVT) is widely recognized as a major risk in patient that undergo total hip or total knee replacement surgery. Even when proper prevention measures are taken, it is estimated that 3% of patients will develop DVT and 1.5 % will develop pulmonary embolus, the most common cause of death following joint replacement. 
h) 200% to 300% increased risk of bleeding stomach ulcer i) you are 30 time more likely to have a heart attacks in the first two weeks. And here are the references:



What other alternatives is there What other alternatives is there then that offers any significant chances of you avoiding surgery?

There are a variety of regenerative medicine techniques that are available today and that are becoming very popular alternatives to surgery! Many patients avoid surgery all together or at least postpone surgery for several years with simple Regenerative Medicine Procedures such as Prolotherapy, PRP and Stem Cell Therapy. These are done at the doctors office in a little over an hour under local anesthesia and at a much lower cost to you. You walk in and out! Find out more about these techniques before you plunge into a major surgical procedure specially when the damage done at times is irreversible. Talk first to friends who have had a knee replacement and see what they tell you. And remember, surgery should always be your last choice. You can always have it done later if all else fails!! 


         GIVE US A CALL!  YOU WILL BE GLAD YOU DID.  (904) 827-1455



Tuesday, December 26, 2017
By Edward Dieguez Jr. MD PA
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Have you noticed how medical care has changed lately and how it continues to change right under our noses?  


First of all, do you want more interference in the relationship between you and your doctor? Ask yourself that question!


1. The first ones to interfere were insurance companies, that have done nothing but drive the cost of healthcare through the roof, and we all are paying the consequences.


2. Second came the government, regulating every aspect of medicine you can think of.


3. The latest players wanting to interfere in the relationship between doctors and patients are the hospitals. They want more and more control over the doctors and the one who will suffer is you—the patient.  


The story of your friendly corner drug store pharmacist.

 A cautionary tale can be found by looking at friendly pharmacists of the past at their corner drugstore. Now, 90% of pharmacists work for one of the big chains, like CVS, Walgreens, Wal-Mart, etc. When you call one of these chains, you either get an answering machine, or, if you get lucky after pushing all the buttons on your phone, an employee will answer and put you on hold for 5 to 10 minutes before you can actually talk to the pharmacist that you are looking for. Why is that? Because the pharmacist does not care anymore; they are not running their own business. They have given in to impersonal corporate America, where they simply punch a clock in the morning and another one in the afternoon. The personal relationship with the customer has been destroyed. This is a good example as to why if you dislike how big pharmacy chains operate and do business, you should support the few remaining local independent pharmacists!


What is happening to your friendly independent doctor.

We are now seeing the same thing happening to the medical profession. Your friendly doctor that you have relied upon for years is being forced to join corporate America. You are already experiencing it, and most of you do not like it. You get admitted to the hospital and your doctor does not see you. You get somebody, sometimes a doctor and sometimes a nurse practitioner or physician assistant that works for the hospital and is controlled by the hospital. This person works under a whole different set of incentives. They really do not care about how you perceive them and don’t care about keeping you as a longtime patient. They don’t know you personally, either. You have simply become a number in their daily routine—somebody that they have to deal with before it’s time for them to clock out and the next shift to begin. When we see more and more physicians becoming employees of a hospital or when physicians enter into some kind of contract by which they are controlled by the hospital, medical care, and, in the end, the medical profession as we know it is on its way to the funeral home! Sadly, some physicians will sell their souls to the hospitals for money and will become active participants helping the hospital to achieve their goals of controlling all other physicians. These physicians that sell themselves are what I call hospital boys! Physicians will lose their independence just like the pharmacists have, if they allow the trend to continue.

The writing is on the wall when you hear statements such as wanting to evolve into a "health system with a focus on provider integration”. That is a loaded statement. While it appears innocent, that is essentially shorthand for wanting to control doctors, and wanting to have them, as the saying goes, “by the short hairs”. Nothing less. The hospitals’ main goal of integration is not better care for you. Their main focus is to work with big insurance companies, make a buck off the physicians, and increase the profits of the hospital that is paying that CEO a multi-million dollar salary and great retirement benefits. Check around. See the hospital and insurance companies CEOs’ salaries. In order for them to have those great salaries and benefits, somebody has to suffer and that somebody is the patient. How do you lose? By losing your personal physician, by paying higher insurance premiums, by paying higher deductibles and copays, and by getting less care. Yes, less care! When your doctor wants to order needed MRI or CT scans to make an accurate diagnosis, there will be delays at your expense, sometimes suffering in pain. In the process, you suffer as a patient but they, the hospital and insurance company CEOs simply don’t care. They have to protect their bottom line! 

Here is an interesting article to look up:


What is in store for you if we let it continue?

If both you and I let this trend continue, be ready to wait in long lines at medical clinics, like you do for example at Wal-Mart when the store is packed and there are only five out of thirty checkout registers open. The hospital and insurance company CEOs won’t care; the only thing important to them is their bottom line. And remember, by that time, the doctor is on the clock for x number of hours till he clocks out. He is not going to care if you need to return the next day, and he will not be available for you when he’s off the clock. You are not his patient anymore. You are the patient of “Corporate America Medical Care”. He is out of there, on time!


Possible solutions to the problem we find ourselves in! 

Now, you may ask yourself, how can this trend be stopped? It’s not easy, but there are a few things you as patients and we as physicians can do. It all starts with supporting each other. On the physician side, we have to understand the financial constraints of patients and adjust our rates to a point that are affordable to the patients and work with them with good intentions to help them meet their healthcare needs. Some patients out there are paying over $400.00 a month on a good insurance policy and even then still have a $3000.00 yearly deductible. Still others have a really cheap policy and think they have great coverage, only to discover reality when the time comes to go to the doctor and nothing is covered or have to jump hoops to get anything done. Remember you get what you pay for and the more intermediaries there are, the less you get. That is why a direct physician-patient relationship without control from any third party is so important and is the best. On the other hand, patients have to realize that nothing is free in this world we live in and physicians have expenses to meet running an office and all that entails. You have to be realistic. If you treat your health like a priority, like you do having the latest technology such as an iPhone and a big screen TV, with all the additional expenses both entail monthly, you should be able to pay a reasonable doctor’s office fee and most outpatient procedures.

Here is one way many people are managing the insurance/healthcare crisis: by buying insurance only for catastrophic coverage and then paying for the other outpatient doctors’ office care out of pocket, like you do at the vet with your dog or at the dentist. Remember what really gets expensive quickly is if you fall in the hospital after an accident or major illness and catastrophic coverage would take care of most of that.

Many doctors’ offices, realizing the problem patients are facing getting trapped between the big insurance companies and the hospital conglomerates, have come up with real solutions for these patients while still at the same time providing top of the line personalized care like the old days. Issues many patients may be facing include no insurance, high deductibles, a desire for better care than what the insurance company provides, high co-pays, delaying tactics by their insurance companies, access to specialist care made difficult by their insurance company or primary care doctor running an HMO, having an insurance that not many offices accept etc., etc., etc. Many of us independent physicians understand these issues and have come up with very affordable cash flat rates to help those patients. Similar to what dentists and veterinarians do when their clients have no insurance.

So trying to work under the above scenario, this is what I have come up with. If you as a patient need our services and have no insurance or a bad insurance or insurances we don’t accept, please call our office in St. Augustine, Florida at 904-827-1455. We have developed affordable flat cash rates to work with you and your situation.

Wednesday, November 15, 2017
By Edward Dieguez Jr. MD PA
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1)   Mechanics of ACL tears. The ACL is usually torn as a result of a quick deceleration, hyperextension or rotational injury that usually does not involve contact with another individual. This injury often occurs following a sudden change of direction. A person typically reports feeling a popping sensation in the knee. When hit from the side , injuries to the ACL are often associated with medical meniscus and medial collateral ligament (MCL) tears, collectively known as the “unhappy triad”.


2)   Symptoms of ACL tears. Pain in the knee, instability of the knee, swelling, stiffness, bruising and pain on standing.


3)   Types of injuries to the ACL.  An anterior cruciate ligament injury often is called a sprain. A sprain occurs when the threads or fibers of the ligament  stretch or are torn. An ACL injury is classified as a grade I, II, or III sprain.


  • Grade I Sprain.  Ligament is stretched but there is no tear of the fibers. Patient is  in pain, there is some tenderness and swelling but the knee does not feel unstable or gives out during activity.


  • Grade II Sprain. Here the fibers of the ligament are partially torn. Patient is in pain, there is some tenderness and moderate swelling. The joint may feel unstable or give out during activity.


  • Grade III Sprain. Here the fibers of the ligaments are completely torn in two parts. There is tenderness (but not a lot of pain, especially when compared to the seriousness of the injury). There may be a little swelling or a lot of swelling. The ligament cannot control the knee movements. The knee feels unstable or gives out at certain times. We can sub-classify these tears in two types:


                a)    Complete retracted tears.-  In these tears the ligament has snapped back like a rubber band. While complete retracted tears are likely to require surgery, we need to be sure your tear is retracted before we decide how to treat it. 


                b) Complete non-retracted tear.- In these there is still something holding the ends of the ligament together because it has not snapped back.

 4) ACL injury treatments options. It is important first to rest the knee and waiting for the   swelling to subside. Pain medications and crutches and an ACL knee brace may be indicated.  Wearing an ACL brace can help prevent more injury to the Anterior Cruciate Ligament and help support your knee after an ACL tear or injury.

Additionally treatment includes exercises, surgery or stem cell therapy procedures. This modality can be utilized in certain types of ACL injuries. Not all ACL injuries require surgery.


  • Exercises.  You should start slowly and gradually increase the

intensity of the exercises. Do not push yourself to the point that you feel pain. Talk to your doctor about how to best progress. It may include exercises such as bridging, glute seats, hamstring curls, heal raises, heal slides, quad sets, Shallow standing knee bends, straight leg raise to the front, straight leg raise to the outside.


  • Surgery. Most surgery for anterior cruciate ligament (ACL) injuries

involves replacing the ACL with tissue called a graft. Usually an autograft (tendon tissue taken from another part of the body) is used. With this type of graft you get better results than with allograft. Most people who have ACL surgery have favorable results, (notice the word favorable) with reduced pain, and also good but not normal knee function and stability. Some will still have knee pain and instability. An intensive rehab program to strengthen the knee then begins. The rehab program often lasts up to a year. There can be quite a few problems with the surgically replaced ACLs. First with an autograft the muscle the graft is taken from never fully recovers its strength. Second, the operated knee never regains its normal position sense to guide normal landing. Finally, few patients ever return to their prior level of sports and 2/3 of young ACL surgery patients will have arthritis by the time they are 30 years old.


  • Stem Cell Therapy Procedure. One of the big problems with the  surgery in general is that the graft tendon is inserted at a much steeper angle than the original ACL. As a result, we often recommend to our patients that they consider newer precise biologic injection options, like stem cells, before considering a surgical ACL replacement. This may be a better option that should be explored, especially if you have only a partial or complete nonretracted ACL tear.