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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. 

Thursday, October 12, 2017
By Edward Dieguez Jr. MD PA
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A) What is different about Proliferative therapy Injections?

The differences between the newer interventional proliferative medicine techniques and the old simple cortisone injections are several.  These differences are significant, with cortisone having many long lasting deleterious consequences in the long run, especially if you get repeated injections over time. I will enumerate these differences starting with the effects of Prolotherapy. 

          * Proliferative therapy is an injection procedure that aims to heal and strengthen tissues that have been damaged by injury or daily wear and tear and is causing pain.


          * Proliferative therapy procedures works in conjunction with the normal healing mechanism of the body to heal damaged tissues that cause pain.


          * Proliferative therapy,  stimulates and/or fires up as the case may be, the normal healing process. 


          * Proliferative therapy will lead to tissue healing and secondarily to pain control. 


          * With Proliferative therapy, healing is the goal. 


On the other hand what do cortisone injections do for you? I promise, you won't like it:


          * Cortisone takes care of the pain by inhibiting the healing mechanism and acting against the normal body reaction that would lead to healing of the damaged tissues that re causing the pain!


          * Cortisone will stop the pain but it also stops the normal body inflamatory reaction that is in charge of healing tissues anytime there is damage to tissues in our body. The price you pay is high because the damaged tissues never heal correctly.


          * What happens then? Well as you probably have experienced it yourself, a few weeks after a cortisone injection the pain comes back and you need another injection!  


          * As the years go by receiving cortisone injections, without tissues been able to heal properly, the condition you came to see the doctor about will worsen instead of getting better. There is no healing taking place when cortisone is used. Degeneration of your joints, your spine etc., will get worse instead of better! 



B) What is then the value of Proliferative therapy? 


          * The value of Proloferative therapy and regenerative medicine is evident if you consider the healing! 


          * Proliferative therapy is not a band-aid solution that in the long run makes things much worse for you by inhibiting the normal healing process in your body and that at the end leaves you holding the bag with damaged joints, and weakened ligament and tendons that eventually will lead to surgery.


          * In Proliferative therapy, natural substances are used such as sugar water or saline that have no deleterious effects on your body like cortisone.


          * Proliferative therapy is a recognized orthopedic procedure that stimulates the body's healing process to strengthen and repair injured and painful joints and connective tissues.


          * In our office patients that undergo Proliferative therapy experience usually good results. After they complete sucessfully the treatment protocol, they simply vanish from our office for years and go back to their everyday activity without pain. This is totally the opposite of what you see with cortisone injections that keep coming back and coming back every three to four month or sooner!  


C) You may ask yourself why then is cortisone still being injected instead of Proliferative therapy?


The reasons are mainly three:


          * First of all not many doctors even know or have a clue about Proliferative therapy. It is not something they teach in medical school.


          * According to there are only twelve Physicians in the entire state of Florida that are trained in this field. Dr. Dieguez is the only one in Saint Augustine and one of two in north Florida with the other one being in Destin, Florida. 


          * It is a procedure not paid by insurance companies as it often happens with many other procedures. So, unfortunately many times cortisone is the only alternative for some patients! But if you can afford to spend a few dollars out of pocket on your health, you would be a fool not to if you consider Proliferative therapy with its all around benefits. 

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 hamstrings 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 are good 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 helps 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, since 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 to conduct them.


     d) Proliferative therapy: 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) Autologus Cell Therapy: This treatment is an innovative method for treating ischial tuberosity pain. 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. Orthobiological injection procedure is a a natural treatment process.


     f) Injection of plasma rich in platelets: This therapy is used in conjuction or as a booster, after autologous Cell therapy. There is large amount of cytokinin present in the Plasma rich in platelets, which reinforces and helps in coordinating the healing of the bones and soft tissues.








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?  These changes are bad for patient care. 


First of all, do you want more interference in the relationship between you and your doctor? Ask yourself that question! The three players so far interfering in your relationship between you and your doctor are as follows:


1. The first ones to interfere were insurance companies, and they have done nothing but drive the cost of healthcare through the roof.  We all are now 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 their patients are the hospitals. They want more and more control over the doctors and the one who will suffer is you—the patient. The sooner they make your doctor get you out of the hospital ready or not, the more money they make.  


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. Unfortunately, they have mostly disappeared!  Now, 90% of pharmacists work for one of the big chains, like CVS, Walgreens, Wall-Mart, Publix etc. When you as a doctor 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 sometimes as long as 30 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. They also don't care if the doctor  waits on the phone for thirty minutes before he can call in your refill. This lack of caring on the pharmacist part will have an effect on how long you have to wait for your prescription. The doctor may be busy with patients and may have to hang up and call the pharmacy later or transmitted electronically and when you get to the pharmacy your prescription may not be ready. Or worse yet, the doctor may require you to come to his office to pick up the new prescription because he can afford to waste that much time on the phone or the computer.  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. They are getting bought out by hospitals with the help of the government and insurance companies. For example some insurance companies in Saint Augustine Florida are not letting independent doctors be participating providers of certain plans created specifically for certain Hospitals Acountable Care Organization (ACO) participating physicians. This ACO is like a little club in which the Hospital has 51% of the votes in any decision taken by the group. What does this do? The hospital has complete control of these physicians that belong to the ACO. What is this insurance program called? Florida Health Plans. Physicians that do not belong to the ACO or drop out of it are not allowed by the insurance company to be participating provider. And they are pushing this insurance hard. Just ask around to the people that work at these hospitals. Look at the Bill Boards put out there by "so called independent insurance agents ". I myself have not been allowed by the insurance company to be a provider of this plan because I want to remain independent serving my patients. Another physician I know was dropped from the insurance plan because he dropped out of the ACO. 

Now ask yourself how does this affect you the patient? To start with it affects you in two ways. First if your friendly physician is not in that group (ACO) and you have an insurance that is only good for ACO doctors you have to change doctor unless you pay out of pocket because the insurance will not pay your friendly doctor. Second, those doctors that participate will have their hands tied and will only be able to do or order the test approve by the insurance company or the hospital otherwise they don't pay. Result is that your relationship with your long time physician is also lost.

 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 you don't even know 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 and your family as a longtime patient. They don’t know you personally, either. You have simply become a number in their daily routinesomebody 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! You will be left with a few independent practitioners like myself and some others that really love what they do for their patients and do not want the interference.  

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 or see in the press or social media  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, give you less care and increase the profits of the hospital that is paying that CEO a multi-million dollar salary and great retirement benefits for the big chiefs. They all retire with what I call a golden parachute. "Wealth Extraction" is call by some.  

Check around. Google it and see the hospital and insurance companies CEOs’ salaries. Where this happens, 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 a link to 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 a day 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, when his time is up!


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 an 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 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 it entails and also taxes to pay.

You have to be realistic. If you treat your health like a priority, just  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 get admitted to 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 904-824-0955. We have developed affordable flat cash rates to work with you and your situation.

Sunday, October 01, 2017
By Edward Dieguez Jr. MD PA
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Traditional vs Alternative Medicine

Just recently, the European Academy Science Advisory Council (EASAC) issued a press release criticizing homeopathy, but in the process it also took a shot at all alternative medicine by claiming that there could be only one type of medicine -traditional medicine. This attack comes with very poor timing since traditional medicine is losing ground. So much so, that it was announced just this week by the University of California, Irvine, that it is planning a $200 million alternative medicine center. 

Some patients don’t like some settings within traditional medicine. They either know, or soon figure out that the system can chew them up and spit them out when  they are most in need. In the last few years, many traditional medicine practitioners, myself included, have gained respect for many forms of alternative medicine and many like me have mastered different aspects of alternative medicine.


Have you asked yourself why people love alternative medicine?

When a patient goes to a practitioner that is open to alternative medicine, the patient soon learns that they can talk to these physicians about acupuncture, Orthobiologic Medicine (including Prolotherapy, Plasma Rich in Platelets, Cell Therapy, and also craniosacral treatments), chiropractic care, homeopathy, naturopathy, and so on.

 Unfortunately, some physicians just can’t buy into alternative therapies. They are eager to criticize and don’t miss an opportunity to shed a bad light onto those of us that do practice some form of alternative medicine. They call us funnies and even quacks. But on the other hand, they continue offering their patients procedures and surgeries that have been proven not to work. Some of these are high dollar procedures that are done by the thousands.

 Whether those practitioners that ignore and put down alternative medicine like it or not, an old survey by the National Institute of Health (NIH) found the 4 in 10 patients choose alternative medicine. If the study was conducted today, most likely the number of patients that choose alternative medicine over traditional medicine would be significantly higher. Some have quoted as many as 6 of every 10 patients choose a form of alternative medicine. Most importantly, 84% of patients using alternative medicine have high confidence in its safety and efficacy.  I personally feel that a combination of the traditional and alternative medicine would be the best.


With the widespread availability of traditional medicine, why is this happening?

As stated by Dr. Christopher Centeno, a pioneer in regenerative medicine, “it is easy to see that alternative medicine is entirely the opposite of all the things patients hate about traditional medicine. It’s open-minded where traditional medicine is close-minded. It offers hope, while its counterpart frequently offers pessimism. Its practitioners will spend time with patients and be friendly and welcoming, while the other side’s physicians are rushed, overextended, and brusque.”

 A great number of patients have complained to me that when they visit other traditional medicine practitioners, they have to wait for long periods of time to be seen even when they were given an appointment time. It is common for many to wait an hour or even more. Many never even see the doctor and just see a nurse practitioner or physician assistant. There is nothing wrong with these professionals but the doctor needs to see he patient and provide their higher degree expertise and knowledge to the case at hand. Also many times the patients feel rushed. At our office, we feel that the patient’s time is as valuable as ours and we strive to see everyone at the time scheduled. Additionally, I see all the patients personally and try to answer all their questions and go over treatment alternatives.


Why this migration from traditional medicine to alternative medicine?

Let’s analyze the hypocrisy of traditional medicine to try to explain the migration.


1.- Steroid injections.-  Despite the evidence that repeated steroid injections result in diminished pain relief, the toxic effect on stem cells, and that it kills cartilage, steroid injection remains the most common knee procedure worldwide.


2.- Lumbar fusion surgery.-  Research has shown that fusion surgery is no more effective than plain lumbar laminectomy or physical therapy and, that patients still have the same pain more than a decade after surgery. Despite these facts, the fusion industry is still strong.


3.- Knee meniscus surgery.- It has been shown to be ineffective at relieving pain, is no more effective than physical therapy and creates the perfect setting for arthritis to develop. In spite of these facts, knee arthroscopy is the most common knee surgery performed in the US.


4.- Narcotics such as opioids not only do not relieve pain in some people but can actually amplify it. Additionally, its indiscriminate overuse has created a national crisis that we are all too familiar with.


Here is an interesting quote taken from Dr. Chistopher Centeno: “The university-pharma industrial complex is a conflicted mess. Medical school professors are on the pharma dole left and right. Drug companies put their names on boardrooms and have infiltrated medical school classrooms. Medical schools teach physicians to avoid original thinking and follow clinical flow charts drafted by the same professors taking money from pharma.  Finally the Universities themselves have become big businesses and now hold more cash than the US government.”


What is the ideal relationship between traditional medicine and alternative medicine?


The use of alternative medicine has become so popular among patients simply because the patients have become aware that for certain ailments it works better and there is much less risk involved. In other cases, traditional medicine works better. That is why in our office we try to strike the right balance between the two and that is the way it should be with every practitioner. Combining the two modalities works best, and that is what I try to do with my patients. Being open minded is very important!




Sunday, July 15, 2018
By Edward Dieguez Jr. MD PA
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Where are the sacroiliac joints? 

 They are located in the lowermost part of your back. There is one on the right and one on the left side. These joints as the name implies are formed by the sacrum in the middle as a wedge in between the right and left iliac bone. On top of the sacrum sits the lumbar spine.  Strong ligaments in front and in the back hold the bones together. The actual articular surface of each joint is very irregular. 


What is SI joint dysfunction? 

It is improper movement of the joints that connect the sacrum to the iliac bones. 


What can cause it?

*Pregnancy or recent childbirth 

*Lower lumbar fusion

*Leg length disparity


*Contact sports

*Regular heavy lifting, or labor-intensive jobs

*Pelvic or low back muscles unconditioned combined with prolong sitting 

*Direct result of injury or trauma, such as the jolt from a fall


What are the symptoms?  

Lower back pain usually unilateral dull and aching. Pain usually spread to the hips, buttocks and groin. Sciatic-like pain from sacroiliac joint dysfunction rarely extends below the knee and may include numbness and tingling. Reduced range-of-motion in the lower back, hips, pelvis, and groin, which may cause difficulty with movements such as walking up stairs or bending at the waist.


How to diagnose SI joint dysfunction?

There is no single test to diagnose it. Among the test used we have the sacral thrust test, the distraction test and the Faber test.  However an injection of the SI joint in question is the gold standard for diagnosing that the SI joint is the source of the pain. 


What are the treatment options? 

After a good diagnosis is made, basically the treatment  will depends on the severity and on how long you have been suffering from it. Conservative therapy is always better than surgery and much less risky. Initially and if not too severe or prolonged, prescription NSAID along with prescription muscle relaxants ice or heat and physical therapy including manual manipulation may be best.  A pelvic brace or support may be useful for a hypermobile joint. 


If all of the above fails, the most successful treatment by far with minimal risk is Proliferative therapy injections using hypertonic dextrose or Plasma rich in platelets. On each Proliferative therapy session, the ligaments that hold the joints together are injected precisely where they attach to the bone. This points are called Enthesis. Injection these point with the proliferant solution, stimulates the local local tissues to grow and strengthen the ligaments. These in turn strengthens the joint.  The goal here is to strengthen the ligaments that hold the joint together. Usually  four or five sessions  separated three to four weeks apart wil do the trick.