AmnioFix® -Regenerative Injection Therapy

What is AmnioFix?

AmnioFix® is a brand of placental graft matrix (PGM) used in regenerative medicine to help your body to regenerate soft tissue and heal damaged tissue. AmnioFix® contains natural factors, called “growth factors,” for homogolous use to modulate inflammation, reduce scar tissue formation, and enhance healing.

What are growth factors?

Growth factors are powerful agents that our bodies produce to signal cells to come to the target site, help the site to heal, and help your own cells regenerate the damaged tissue. AmnioFix® contains some of the most important growth factors for healing.

Which growth factors are in AmnioFix?

There have been 226 different growth factors, specialized cytokines, and enzyme inhibitors identified in AmnioFix®. Some of the most notable regulatory factors that help enhance healing are: Transforming Growth Factor Beta (TGF-B), Fibroblast Growth Factor (FGF), and Platelet Derived Growth Factor A & B (PDGF AA & BB).

Why AmnioFix?

The use of amniotic tissue has been documented in published literature since the early 1900’s. Amniotic membrane has been the subject of many scientific publications evaluating its use in modulation of inflammation, reduction of scar tissue formation, and enhancing healing. All of the amniotic membrane tissue for AmnioFix® is donated by healthy consenting mothers undergoing scheduled caesarean sections. The amniotic membrane is the cover that was surrounding the baby and is typically discarded after the baby is born. The recovery of the membrane does not affect the baby or the delivery process. Therefore, the donation process does not share the ethical concerns associated with embryonic tissue.

All tissue donors are tested similarly to testing done for donated blood. The amniotic membrane then undergoes a validated proprietary process to thoroughly cleanse and preserve the tissue, called the PURION process. The steps of the PURION process include: cleansing the tissue, drying the tissue and sterilization. AmnioFix® allografts are procured and processed in the United States according to the standards and/or regulations established by the American Association of Tissue Banks (AATB) and the United Stated Food and Drug Administration (FDA).

Is AmnioFix® Right for Me?

You may consider AmnioFix® an option if:

  • You have been diagnosed with an injury resulting in inflammation.
  • Conservative treatments such as rest, physical therapy, chiropractic, steroid injections, NSAID medications, and/or bracing have not provided lasting symptomatic relief.
  • You want a non-steroidal option or have reached your limit of steroids injections.

Before and After Treatment

Before treatment: You will be scheduled for an evaluation and likely some diagnostic imaging such as x-rays or MRI to determine if AmnioFix® is the right treatment for your condition.

After treatment: The treatment site might appear red and be tender to the touch. The procedure might cause some soreness that may last for up to 2-3 days. If the area is painful or swollen, or if you have any questions about the response you are having, please call our office and ask to speak to a provider. You will be scheduled for a follow-up with your doctor 8 weeks following your AmnioFix® treatment.

Rehab: Depending on your condition, your physician may prescribe some home rehabilitation or refer you to a physical therapist. To get the optimal results from your AmnioFix® treatment, it is important that you follow your doctor’s post-treatment care instructions.

The Use of Dehydrated Human Amnion-Chorion Membrane



Fearless cardiologist author, Dr Aseem Malhotra, busts myths and shares Pioppi health secrets

One of the most influential cardiologists in Britain and a world leading expert in the prevention, diagnosis and treatment of heart disease, Dr Aseem Malhotra is a brave advocate for public health initiatives. An award-winning NHS cardiologist, Dr Malhotra has successfully motivated leading academics, the media and politicians to make sugar reduction a health priority in the UK. His academic publications can be found in the BMJ and BJSM (see links below) and he is prominent in mainstream media. He recently published what is already a best-seller, “the Pioppi Diet: A 21 day lifestyle plan”.

For more BJSM (British Journal of Sports Medicine) podcasts click here: BJSM Podcasts

How to File a Health Insurance Claim Form as explained in “the balance”

By Mila Araujo

Updated May 01, 2017  Link to original article 

When to File a Health Insurance Claim Form

A health insurance claim is when you request reimbursement or direct payment for medical services obtained. The way to obtain benefits or payment is by submitting a health insurance claim via a form or request.

What Are the Options to File a Health Insurance Claim

There are two ways that you can file a health insurance claim.

1. The first way, and the most convenient, is when your medical services provider can submit the claim directly to the insurance company through the network directly electronically.

2. The other way is by filling in the health insurance claim form and sending in the paperwork yourself. If your health service provider is not in the network for your health insurance company and can not file the claim on your behalf, then you will have to file a health insurance claim form to request payment for the medical services obtained.

What Kinds of Information Do You Need to File a Health Insurance Claim Form

If you have to file your own health insurance claim here are the steps you will need to take along with some helpful tips on submitting your insurance claim form

4 Steps to Filing Your Health Insurance Claim Form

1. Obtain Itemized Receipts: You will need to ask your doctor for an itemized bill. An itemized bill lists every service that your doctor provided and gives the cost of each of the services. Make sure any medications or drugs provided during any treatment are clearly listed with itemized costs.

Your health insurance company will need you to attach the original itemized bills to the claim form.

List of Things on a Health Insurance Claim Form:

The claim form should be fairly self explanatory to fill out. It will ask things like:

  • your insurance policy number
  • group plan number or member number
  • who received the services (for example if it was the primary insured or a dependent like a child, spouse or domestic partner)
  • if there is co-insurance or dual coverage
    what was the visit for (accident, workers compensation), etc.
Online Health Insurance Claims When You Need to Request a Reimbursement

You used to have to submit health insurance claims through the mail, but with advances in technology health insurance companies and medical benefit plans now offer a few different options, depending on the health insurance company.

When you go to the doctor or other medical provider and are told that you have to submit your own insurance claim form it means that the doctor or facility does not ask the health insurance company to pay for your bill and you must do it yourself.

2. Get Your Claim Form: You will need to contact your insurance company to obtain a health insurance claim form or download a copy from their website.Your claim form will also give you additional instructions pertaining to what other information they may need from your doctor or health care facility.

Submit Your Health Insurance Claim Form Online

Before you start filling in paperwork and heading to the post office, always check your health insurance company’s website.

Many insurance companies now offer the possibility to log onto your health and medical benefits plan online.

You can ask your employer if your health plan offers this option, or if your healthcare plan is not through your employer, contact your health plan insurer directly to find out if they have access to their services online. Usually, if you go to your insurance company website, there will be a place where you can log on. If you do not have the information call them and have them help you set it up.

You may also be able to fill information online and submit at least part of the claim via your health insurance company website. If they do not offer full online submission, you may be able to start the claim and just mail in the supplementary documents with the associated reference number.

Advantages of Making Your Health Insurance Claim Electronically Through a Website

The benefit to submitting claims online is that the payment for your claim may be significantly faster, in some cases 24 hours.

Getting your payment processed as fast as possible is worth going through the trouble of setting up an account to manage your services online. There is also a good chance that when you fill in your form online, you will also immediately see what portion of the claim is covered, what your co-insurance clause is and what deductible, if any, applies. Setting up an account to access your health insurance benefits and claims online will help you be better prepared to understand the related health insurance out-of-pocket expenses, or what kind of refund or payment your benefits plan will pay.

When You Have to Submit Your Health Insurance Claim By Mail

In some cases a health insurance provider may not offer online submission, or may limit online forms to specific services. In those cases you may have to print a health insurance claim form and fill in the details, then submit it via the mail.

3. Make Copies: Once you have your claim form filled out and your itemized bills from your doctor, don’t forget to make copies of everything. This will eliminate any errors that may be made in the claim process and make it easier for you to re-file your health insurance claim if it gets lost.

4. Review then Send: To make sure everything is completely accurate, call your health insurance company and tell them you are about to send in your health insurance claim form. Review with them all the paperwork you have and ask them if there is anything else you need. Also, ask your insurance company how long should you expect to wait for your claim to be paid and mark that date on your calendar. Once you have everything in order, send out the claim form to your insurance company. The address to send the claim form should be on the claim form itself. Keep an eye out on your calendar for the claim date that you marked and contact your insurance company if you don’t receive your claim within the time frame given to you.

Resource Links:

Mediator Release Test (MRT) in combination with the LEAP Protocol

“Let food be thy medicine and medicine be thy food.”― Hippocrates

This quote is often cited to emphasize food’s importance. A food’s quality is usually thought to be what agencies such as the USDA and the FDA have to say. There have certainly been great strides in food quality with improved storage techniques and cleanliness. But is it good for me?  The accepted food pyramid may not be the best way to know. The increasing ++incidence of illnesses like diabetes and obesity brings our current understanding of food into question.

In an attempt to solve this riddle, there has been an increase in special tests for food allergies and specialty diets. Are these just fads, or are they based on science? Is there a test of diet that is right for you? This has become a hot topic. There are many “experts”, and it can be difficult to make sense of it all.

I want to share with you my practice’s experience with food sensitivity testing and diet modifications, which uses a practical approach and sets realistic goals. This has been very positive. The process begins with dietary counseling and interventions to decrease inflammation. This usually has secondary benefits such as weight loss and improved blood sugar control. I then proceed to test for food sensitivity with Mediator Release Test (MRT) followed by dietary counseling and coaching with the LEAP (Lifestyle, Eating, And Performance) protocol. Success is measured by the increase in function, decreased pain, and improvement in chronic conditions such as high blood pressure and diabetes.

Below is a video by Susan Linke, a registered and licensed dietitian, Certified LEAP Therapist (CLT), and Certified Gluten Practitioner (CGP). She explains this concept. To learn more, contact my office at (865) 577-1914 for more information.

To your health – Dr. Lakatosh


Is it harder to sleep as we age? Unfortunately yes.

As we age many of us find that it is harder to go to sleep and wake up rested. Below is a link to “Insomnia: What You Need to Know as You Age”, an article from Johns Hopkins Medicine.  I invite you to read this and take time to evaluate the quality of your sleep.

Insomnia: What You Need to Know as You Age

I also added a link for WebMD,”10 Things to Hate About Sleep Loss”, which you may be surprised to learn.

10 Things to Hate About Sleep Loss

Improving your sleep will have numerous benefits and may help you live longer and healthier.

Genicular Nerve Radiofrequency Ablation for Select Patients with Persistent Pain

An option for difficult-to-treat chronic knee pain

By Michael Schaefer, MD, and Robert Bolash, MD

Chronic knee pain is often a challenging condition to treat. Pharmacologic interventions commonly fail to provide adequate relief and can be limited by adverse effects. Corticosteroid injections provide only temporary relief, while hyaluronate injections are expensive and controversial. Newer “regenerative” injection treatments such as stem cells and platelet-rich plasma are still considered experimental and are often not covered by insurance. Surgical interventions for joint preservation are limited, and total joint replacement is often not an option for young or obese patients. Even after arthroplasty, unremitting knee pain continues to afflict some patients.

Radiofrequency ablation for genicular nerves (GNRFA) is a relatively new and lesser-known treatment option that is proving effective for certain patients. A randomized controlled trial demonstrated significant improvement with GNRFA throughout the 12-week follow-up period. At Cleveland Clinic, we consider patients for GNRFA who have failed or are excluded from other treatment modalities. The process begins with a diagnostic genicular nerve block.

Diagnostic Process

Genicular nerve blocks can be performed under fluoroscopic or ultrasound guidance. Nerves are targeted adjacent to the periosteum on the medial aspect of the tibia, and at both the medial and lateral aspects of the femur at the junctions of the shaft and the epicondyle.

Under fluoroscopic guidance, we approach the target by introducing a spinal needle from either an anteroposterior or lateral entry point with the final position residing adjacent to the bone. After negative aspiration, some physicians elect to administer contrast to exclude vascular uptake, avoiding a false negative result. To conclude the procedure, 2 mL of local anesthetic is deposited on each of the superolateral, superomedial and inferomedial genicular nerves.

While GNRFA performed under fluoroscopic-guided requires a procedure room, the ultrasound-guided procedure can be performed conveniently in the outpatient clinic setting without radiation exposure. In addition, two recent studies suggest ultrasound guidance improves accuracy of the diagnostic block by localizing arteries and soft tissues adjacent to the nerves. Again, all three genicular nerves are routinely injected – the superomedial, superolateral and inferomedial branches. Other branches have been reported to innervate the knee, but they are not suspected to carry as much nociceptive output from the joint, so injecting them may be less effective. In patients who report pain only on the medial side of the knee, the physician may choose to inject only the medial-sided nerves.

When to Proceed to Therapeutic Ablation

If the diagnostic injection produces at least 50 percent pain relief on a numeric rating score reduction, the patient is deemed a candidate for GNRFA. Exclusions include systemic or local infection and electrical devices implanted in the region of the radiofrequency ablation. Additional vigilance is required in the presence of anatomic deformities or implantable cardiac rhythm devices when considering GNRFA because of the potential for a defibrillator to interpret radiofrequency as a shockable dysrhythmia. GNRFA can successfully be performed with arthroplasty or with other orthopaedic hardware in place.

The GNRFA procedure is typically performed with local anesthetic, although moderate IV sedation may be offered. Either ultrasound or fluoroscopic guidance may be used. Following local anesthetic infiltration, a radiofrequency cannula is guided in proximity to the locations of each nerve. Sensory stimulation can be used to confirm accurate placement. Motor stimulation is also performed to ensure the absence of adjacent motor fibers.

After positive confirmation of sensory placement and negative motor testing, 2 mL of 2 percent lidocaine is administered adjacent to the nerve to mitigate pain associated with radiofrequency lesioning. Radiofrequency ablation is performed at a temperature of 70 C for 90 seconds.

Postprocedurally, patients remain ambulatory and often return to work on the subsequent day. A few days of localized soreness is expected following the procedure with typical final results realized within one week.

Pain Relief Can Be Long-lasting

While Choi showed that relief continued for 12 weeks, in our practice, we have seen many patients sustain even lengthier analgesia, at times approaching a year. The GNRFA may be repeated if symptoms return.

GNRFA is a suitable management option for a subset of patients with inadequate response to more conservative modalities and even for those with postsurgical refractory knee pain.

Dr. Schaefer is Director of Musculoskeletal Rehabilitation at Cleveland Clinic.

Dr. Bolash is an anesthesiologist and interventional pain management specialist in the departments of Pain Management and Evidence Based Pain Research.

Jun. 2, 2016 / Orthopaedics / Research

This article appeared in ConsultQD of the Cleveland Clinic

Genicular Nerve Radiofrequency Ablation for Select Patients with Persistent Pain


Water: How much should you drink every day? This is what the Mayo Clinic has to say.

Water is essential to good health, yet needs vary by individual. These guidelines can help ensure you drink enough fluids.

By Mayo Clinic Staff

How much water should you drink each day? It’s a simple question with no easy answer.

Studies have produced varying recommendations over the years. But your individual water needs depend on many factors, including your health, how active you are and where you live.

No single formula fits everyone. But knowing more about your body’s need for fluids will help you estimate how much water to drink each day.

Health benefits of water

Water is your body’s principal chemical component and makes up about 60 percent of your body weight. Your body depends on water to survive.

Every cell, tissue and organ in your body needs water to work properly. For example, water:

·        Gets rid of wastes through urination, perspiration and bowel movements

·        Keeps your temperature normal

·        Lubricates and cushions joints

·        Protects sensitive tissues

Lack of water can lead to dehydration — a condition that occurs when you don’t have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.

How much water do you need?

Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water.

So how much fluid does the average, healthy adult living in a temperate climate need? The National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is:

·        About 15.5 cups (3.7 liters) of fluids for men

·        About 11.5 cups (2.7 liters) of fluids a day for women

These recommendations cover fluids from water, other beverages and food. About 20 percent of daily fluid intake usually comes from food and the rest from drinks.

What about the advice to drink 8 glasses a day?

You’ve probably heard the advice, “Drink eight 8-ounce glasses of water a day.” That’s easy to remember, and it’s a reasonable goal.

Most healthy people can stay hydrated by drinking water and other fluids whenever they feel thirsty. For some people, fewer than eight glasses a day might be enough. But other people might need more.

Factors that influence water needs

You might need to modify your total fluid intake based on several factors:

·        Exercise. If you do any activity that makes you sweat, you need to drink extra water to cover the fluid loss. It’s important to drink water before, during and after a workout. If exercise is intense and lasts more than an hour, a sports drink can replace minerals in your blood (electrolytes) lost through sweat.

·        Environment. Hot or humid weather can make you sweat and requires additional fluid intake. Dehydration also can occur at high altitudes.

·        Overall health. Your body loses fluids when you have a fever, vomiting or diarrhea. Drink more water or follow a doctor’s recommendation to drink oral re-hydration solutions. Other conditions that might require increased fluid intake include bladder infections and urinary tract stones.

·        Pregnancy or breast-feeding. Women who are pregnant or breast-feeding need additional fluids to stay hydrated. The Office on Women’s Health recommends that pregnant women drink about 10 cups (2.4 liters) of fluids daily and women who breast-feed consume about 13 cups (3.1 liters) of fluids a day.

Beyond the tap: Other sources of water

You don’t need to rely only on what you drink to meet your fluid needs. What you eat also provides a significant portion. For example, many fruits and vegetables, such as watermelon and spinach, are almost 100 percent water by weight.

In addition, beverages such as milk, juice and herbal teas are composed mostly of water. Even caffeinated drinks — such as coffee and soda — can contribute to your daily water intake. But water is your best bet because it’s calorie-free, inexpensive and readily available.

Sports drinks should be used only when you’re exercising intensely for more than an hour. These drinks help replace electrolytes lost through perspiration and sugar needed for energy during longer bouts of exercise.

Energy drinks are different from sports drinks. Energy drinks generally aren’t formulated to replace electrolytes. Energy drinks also usually contain large amounts of caffeine or other stimulants, sugar, and other additives.

Staying safely hydrated

Your fluid intake is probably adequate if:

·        You rarely feel thirsty

·        Your urine is colorless or light yellow

A doctor or registered dietitian can help you determine the amount of water that’s right for you every day.

To prevent dehydration and make sure your body has the fluids it needs, make water your beverage of choice. It’s also a good idea to:

·        Drink a glass of water or other calorie-free or low-calorie beverage with each meal and between each meal.

·        Drink water before, during and after exercise.

·        Drink water if you’re feeling hungry. Thirst is often confused with hunger.

Although uncommon, it’s possible to drink too much water. When your kidneys can’t excrete the excess water, the sodium content of your blood is diluted (hyponatremia) — which can be life-threatening.

Athletes — especially if they participate in long or intense workouts or endurance events — are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who eat an average American diet.

Letter to Our Patients

D O N A L D L A K A T O S H, M D
Orthopedic and Sports Rehabilitation

407 North Forest Park Blvd, Knoxville, Tennessee 37919 Tel: 865 577.1914 Fax: 865 577.1714

August 30, 2017

Dear Patients,

To begin, I want to thank you for the trust you have given me over the years as your physician. Taking care of you has been an honor for my staff and me.

I also want to let you know of some changes in my practice. As of September 6, 2017, my office will be relocating to 407 North Forest Park Blvd, in the Bearden area of Knoxville. My telephone number (865) 577-1914 and fax number (865) 577-1714 will remain the same. My Seymour and Fort Sanders West offices will be closing as of September 1, 2017.

Additionally, beginning January 1, 2018 my medical practice will no longer be participating in any insurance plans. What does this mean to you? I am still available to provide care, but it will be on a cash rather than insurance fee schedule. I will not be filing or participating with any insurance including Medicare.

A cash only model will enable me to provide care with greater efficiency and equal or lesser expense. I will be posting a fee schedule for services on my website, Many of my services are currently not covered by insurance such as Regenerative Injection therapy, i.e., prolotherapy, PRP etc. This was a factor in making this transition in that I plan to focus more on Regenerative Medicine. Impairment ratings for the Department of Labor EEOICPA program will not be affected by this change.

This type of medical practice may not be for everyone. Because of this, I am providing a list of physicians who accept insurance from which you can choose. I will continue to be the custodian of your medical records. At your request, I can send your medical records to fellow physicians assisting in your care.

If you have questions or concerns please contact my office at 865 577-1914.


Donald A. Lakatosh, M.D., FAAPMR
CAQ Sports Medicine

New Office Location

I will be relocating my practice to the Bearden area of Knoxville effective September 6, 2017.

The Seymour office and the Fort Sanders office will be closing at the end of August.

The new office address is:

407 North Forest Park Boulevard

Knoxville, TN 37919

Tel 865 577.1914   Fax 865 577.1714

There will be several exciting changes to announce in the near future, so keep posted.

If you have questions, concerns or recommendation please do not hesitate to contact our office.

Donald Lakatosh, M.D.