02/25/2019    Richard Silverstein, DPM

Axolotl Biologics (David Kahan, DPM)

I have been utilizing Axolotl products for a
year and a half now with great success.
"Intriguing time" indeed sir! I commonly refer
to this point and time in medicine as a
"regenerative boom" because we are at the
beginning stages of literally transforming the
way we treat our patients. The reach is
limitless from inflammatory conditions to wound
care.

Over this time period, I have injected over 75
patients with Axobiofluid A (A is for ambient
temperature). The volume of injection ranges
based on the type and location of the pathology.
It can be stored at room temperature so carrying
a supply in the office is feasible and makes
scheduling around the patient's schedule much
easier. Plantar fasciitis and Achilles
tendonitis are my main injection sites but
plantar capsulitis, sinus tarsitis, and ankle
injections are also common.

Patients need to be walked through the process
from day one, explaining that the amniotic fluid
is simply a liquid that would otherwise be
discarded. Procured under strict FDA guidelines
ensures proper processing and distribution. It
is an immune privileged product, so there is
minimal chance of rejection by the body. For a
plantar fascial injection, I inject 1 cc of
Axobiofluid A combined with 1 cc of sterile
saline solution. I do not do this in concert
with PRP or under ultrasound guidance.

In the current climate we are in, patients turn
to the Internet for everything- obviously both
good and bad. They know how long a surgical post
op period can be with limitations of standing,
driving and working. Patients do not want to be
out of work or have huge surgical deductibles to
be responsible for. They get it! Injections of
amniotic fluid allow the patient to continue to
work while receiving ongoing treatment. We
encourage our patients to stop NSAIDs prior to
use because they are immune suppressors and the
effect we are after with amnio is to stimulate
or "jump start" the immune system. The amniotic
fluid is loaded with growth factors and proteins
that helps jump start the healing process.

Results! That is what this is all about. So
how do we define success or failure? Prior to
injecting, we have the patient fill out an
analog pain scale and we monitor their progress
on a weekly basis. Within one week of the
injection it is not uncommon for them to drop on
the pain scale anywhere from 25%-40%. Along the
way, they continue to stretch and wear good
fitting shoes and we certainly get them into
orthotics or appropriate bracing. This isn't a
magic bullet as I tell my patients, we still
need to do all the normal conservative therapies
to prevent the biomechanical forces from causing
the condition to return.

Recently having a patient present in tears with
9/10 Achilles’ tendonitis pain and a large
posterior spur, she opted for amniotic injection
over surgery as conservative treatments had
already failed to produce results. Within 72
hours she went from a 10/10 down to a 2/10.
From there she progressed to a 0.5 and after
getting her into custom orthotics and raising
her heel, her pain has not returned despite
having a large posterior spur. She is thrilled
and now 3 months out from her injection, she has
not had the need to come back in. As a
physician, there really is no better feeling
than healing a patient, who otherwise would be
headed to the OR.

Disclosure: I sit on the medical advisory board
for Axolotl Biologix.

Richard Silverstein, DPM, Havre De Grace, MD

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