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06/23/2023 Allen Jacobs, DPM
Therapeutic Injections of Dextrose (Elliot Udell, DPM)
I know little about prolotherapy, nor do I have any expertise in holistic medicine. With that preamble, I find the demands on Dr. Kornfeld to produce literature defending his use of prolotherapy both interesting and somewhat disingenuous. For many years Dr. Ribotsky, as an example, advocated the use of fillers for the treatment of various foot lesions. Where was the literature to support that? Anyone familiar with the 2023 International Working Group on the diabetic foot guidelines will note that the majority of wound care products advocated by “thought leaders in the diabetic foot” within our profession, have little, if any studies to support their use. Yet my colleagues continue utilizing these modalities. I am sure that Dr. Kornfeld would not utilize therapies that he did not feel were in the best interest of his patient and did not provide satisfactory outcomes. He would be a fool to do so. Look at the recent study-based calamity that occurred with the recent Covid pandemic. How reliable were those studies in retrospect? Not everything we do, and I would venture to say the majority of what we do, is not based on RCTs. Evidence-based medicine includes the experience of the practitioner, and the observations of that practitioner in treating patients. With reference to selection of therapies, medical or surgical, my old professor, Dr. Ganley used to ask “how many bad results can you afford to have limping about your town?”
I have no doubt that Dr. Kornfeld has seen satisfactory results with his treatments. The fact that there are no studies to support the use of a particular therapy, equates to the fact that the absence of these studies also tell us that there is no evidence that these therapies do not work. As for the placebo effect, how many arthroscopic surgeries are effective because of the placebo effect, how many medication‘s we prescribe help as the result of a placebo effect? How many topical antifungals for onychomycosis does Dr. Udell prescribe that have no good studies to support their use? Let us not be so quick to condemn anyone or make unreasonable demands on another practitioner that we do not make upon ourselves in daily practice.
Allen Jacobs, DPM, St. Louis, MO
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06/21/2023 Glen N Robison, DPM
Therapeutic Injections of Dextrose (Elliot Udell, DPM)
Elliot Udell, I have followed your comments on this platform for many years, and for this one I cannot stay silent on prolotherapy. The doctor who started the discussion was asking advice for treating Interdigital neuromas and the proper dosage of the % medium used. Here is my experience with prolotherapy
I have been using prolotherapy for over 10 years, stabilizing ankles, repairing torn plantar fascia, tendon and plantar plate tears, and even neuromas. When given in the right dosage, the right way to inject and absolutely no anti-Inflammatories such as Advil or ibuprofen or aspirin and say in the ankle when it is set properly it is very effective. I was trained by Kent Pomeroy MD here in Phoenix AZ who was world renowned before his passing.
I have treated well over several hundred patients using prolotherapy (50% dextrose with 1% lidocaine as my medium of choice) I have treated professional athletes, college athletes to high school age students, my success stories with my patient are no longer a debate but a proven safe therapeutic treatment for someone who is not a surgical candidate or someone who does not what surgery as a first option. And I do not charge what you are suggesting, not even a fraction of that.
I am sure you would call my best-selling book “ Healthy Dad, Sick Dad” where I tell patients to eat blueberries, green beans, and fresh ginger to help lower blood sugar a “quakery" but tell that to the many of my patients who have tried the diabetic diet in the book that has lowered their blood sugar successfully.
I don’t know why you have so much hatred towards natural remedies, but I am tired of your lamb blasting those few of us out there that want a healthy discussion on other treatment options other than surgery, and by the way, I am surgically trained.
Glen N Robison, DPM, Mesa, AZ
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