The following article offers a compilation of frequently asked questions, as well as GARM Clinic’s answers, thus providing a glimpse into GARM Clinic’s defining philosophy. When reading answers to the questions and the associated discussions, it becomes obvious GARM Clinic’s extraordinary patient outcomes are a result of a complex program that offers greater benefits to patients than those expected from the sum of its individual parts, which include: comprehensive evaluations; customized treatment programs designed by a world renowned orthopedic surgeon; multiple tissue processing options; high numbers of stem cells; and an intense commitment to excellence by the entire GARM Clinic Team.
Q & A.
Why is selecting a customized treatment option offered by GARM Clinic an excellent choice?
The physician’s experience and skill in obtaining patient historical information and the expertise in clinical examination techniques combined with a thorough anatomical understanding, enhance the clinical diagnostic capability and accuracy. Then ultrasound correlation of the suspected pathologic anatomical structures identified by the thorough clinical evaluation, provides confirmation of the area or structures requiring treatment.
GARM Clinic physicians also have extensive experience in recognizing and interpreting subtle injury sites demonstrated by MRI and CT images, as well as considerable radiographic interpretation experience in identifying and at grading subtle arthritis effects.
These capabilities allow GARM Clinic physicians to appropriately direct treatments, by creating customized, targeted treatment plans that address multiple anatomical injuries, areas of inflammation, and areas of scar that can contribute to joint and musculoskeletal discomfort and dysfunction.
Based on these critical assessments, a comprehensive and unique treatment plan is developed for each patient that is individualized for the specific areas of interest, which have been identified by this comprehensive assessment program.
My Doctor completed a regenerative medicine course last month, what will GARM Clinic do that is different?
From a patient perspective, a so-called professional, who has attended a 3-5 day course likely will not have the experience or skills necessary to recognize or to treat complex MSK problems effectively or thoroughly. The physician’s depth of experience creates a unique benefit for the patient. From that depth of experience, one has an understanding of what will work and what will not work, as well as having real experience with all of the options available for articular cartilage, ligament, tendon, and muscle repair. This knowledge and experience help guide the regenerative medicine options for situations and conditions that have a strong probability for which autologous derived stem cell treatments will work.
Why are autologous stem cell treatments at the GARM Clinic heralded as “exceptional”?
Glenn C. Terry, M.D., founder and Chief Medical Director of GARM Clinic, is a highly skilled, internationally acclaimed, U.S. Board Certified Orthopedic Surgeon, who provides a hands-on, thorough record review, history, clinical exam, ultrasound, special study review (X-ray, MRI, CT Scan) evaluation for each patient. This experienced, thorough approach helps identify patients with a high probability for success with an autologous stem cell/biocellular treatment. After the evaluation, Dr. Terry creates a detailed, customized treatment plan for the patient. Throughout this process, Dr. Terry and the entire GARM Clinic Team’s commitment to excellence are apparent: years of knowledge and experience are focused on one patient at a time.
Why is a GARM Clinic Physician a good choice for me?
In every aspect of life, knowledge and experience are important; in medicine, these are critical. In the treatment of musculoskeletal problems, an orthopedic surgeon who has: 1) successfully completed an orthopedic residency; 2) completed an orthopedic sports medicine fellowship; 3) developed and participated in international associations to compare diagnostic and new treatment alternatives; 4) built an extensive practice in orthopedics treating all manner of acute and chronic orthopedic (musculoskeletal) conditions with success; 5) researched and written about anatomy, injury evaluation, and treatment results; 6) has decades of experience treating patients from all walks of life; equals a formula for remarkable patient results.
What is so special about GARM Clinic physicians, compared to my pain management regenerative medicine doctor?
Understanding the evolution of anatomical and pathologic roles in the progression of orthopedic disease states and treatments for those disease states is key. Dr. Terry’s experience in orthopedics and sports medicine, combined with a deep understanding of the anatomical and functional issues, provides patients with unsurpassed treatment options in regenerative medicine.
Other Common Inquiries received by GARM Clinic:
1) Do all patients receive the same treatment?
No. Because the regenerative medicine procedures at GARM Clinic are highly customized to each patient’s needs, GARM Clinic physicians take the time to listen to each patient, provide a comprehensive examination, and therefore, gain a deep understanding and extent of his/her problems prior to planning each procedure.
2) My hip is really stiff but does not hurt; however, my knee hurts. Are these two events related?
Quite likely. In chronic disease states and with some complex acute injuries, there are frequently associative conditions that must be addressed. These associated issues are sought and addressed responsibly and thoroughly by GARM Clinic physicians, in addition to addressing the primary problem initially reported.
3) Does GARM Clinic treat other sites in addition to the joint space?
Yes. Another exception in GARM Clinic’s approach to treating patients is that GARM Clinic physicians embrace that each patient’s unique history and exam, confirmed by ultrasound, pose different treatment requirements. Most joint treatments for orthopedic purposes have multiple sources of difficulty. All joint components: intra-articular, articular cartilage, synovial folds, fat pad, tendons, ligaments, muscle, as well as other involved soft tissues. These sites are specifically identified by a combination of examination, then ultrasound or special test confirmation. Each patient, thus, has an individualized treatment plan developed. It is important to note that most of GARM Clinic’s treatments for musculoskeletal problems require more than just intra-articular injections, which is one attribute that sets GARM Clinic apart from other regenerative medicine facilities. GARM Clinic’s diligent approach yields improved patient outcomes.
4) Why is GARM Clinic special?
GARM Clinic Physicians embrace the fact that each patient is special; each patient’s history and examination are unique to him/her. A unique treatment plan is required and created that is specific for each individual.
5) How does GARM Clinic’s treatment for arthritis differ from treatments available at other facilities?
It is important to note that most of GARM Clinic’s treatments for musculoskeletal problems require more than just an intra articular injection. Other injured, inflamed, or scarred anatomical structures most frequently require treatment as well. This conscientious approach is an additional factor that sets GARM Clinic apart from other regenerative medicine facilities, and helps yield a higher probability for a positive patient outcome.
6) Why does GARM Clinic prefer fat instead of bone marrow or blood?
GARM Clinic has three options for autologous sources of stem cells: blood, bone marrow, and adipose tissue. Blood has the lowest number of stem cells per milliliter. Bone marrow has more stem cells per millimeter (ml) than blood, but less than adipose tissue.
GARM Clinic prefers adipose tissue for five reasons: 1) adipose tissue provides approximately 500x more stem cells per ml of tissue harvested than one ml of harvested bone marrow, 2) the harvesting process (as well as post procedure) provides greater comfort for the patient versus the harvesting of bone marrow, 3) adipose tissue delivers generous numbers of stem cells 4) culturing stem cells to increase numbers is not required, thus allowing for a same day procedure, and 5) Cell isolation techniques allow for a safe, same day IV infusion of the isolated stem cells.
7) Does the number of stem cells provided during a treatment process matter?
Yes. Substantial stem cell counts are important in achieving optimal outcomes for patients. At the end of each procedure, GARM Clinic physicians evaluate a retained sample of prepared cells used in the treatment process. This sample is analyzed using a flow cytometer to determine the estimated number of cells that were administered in targeted injections and/or provided systemically (IV, if applicable). GARM Clinic’s proprietary lab techniques are designed to maximize the cell counts for every patient. Again, when it comes to treatment outcomes, stem cells numbers matter.
8) Why not just PRP without stem cells?
Although PRP (platelet rich plasma) provides growth factors and cytokines that are beneficial, using PRP alone for regenerative medicine purposes is like attempting to build a brick wall with only mortar. Conversely, when adipose derived stem cells are combined with PRP in a biocellular mixture, exceptional healing/regenerative capability results. Thus, bricks and mortar will build a stronger wall.
9) Why is GARM Clinic located in Roatán?
Dr. Terry moved to Roatán because the regenerative medicine treatment options offered by GARM Clinic are not yet legal in the United States. Dr. Terry will not position himself, his practice, or his patients in possible “gray” legal areas. For more information, see the FDA’s most recent guidance discussing regenerative medicine (specifically autologous based stem cell (from any source) treatments’ requirements for minimal manipulation and homologous use) issued in December 2017. When reviewing this guidance, please note that the FDA placed all healthcare practitioners in the U.S. on notice with the intention of enforcing its ruling over the next 36 months.
Note the following excerpt from the FDA’s most recent guidance:
“In addition, we are informing manufacturers, healthcare providers, and other interested persons that over the next 36 months, we intend to exercise enforcement discretion under limited conditions with respect to the investigational new drug (IND) application and premarket approval (biologics license application (BLA)) requirements, for certain HCT/Ps.” To read the guidance in its entirety, please go to https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/CellularandGeneTherapy/UCM585403.pdf or request a PDF from GARM Clinic.
10) Are the treatments at GARM Clinic expensive?
Relatively speaking, yes, the customized autologous stem cell treatments are expensive. The value is priceless: a U.S. Board Certified Orthopedic Surgeon whose contributions to medicine are highly regarded in the international community focused entirely on one patient and his/her specific needs for one to two days brings exceptional value to the patient. GARM Clinic offers customized, cutting edge treatment options; it does not offer less expensive, “one size fits all” options. Commitment to excellence through leadership, teamwork, and intense focus yield the best and most positive patient outcomes, in GARM Clinic’s experience.
11) Is this treatment safe?
Yes. There is very little to no chance for a host/graft reaction or a teratogenic reaction, since the stem cells and the PRP are autologous, and already differentiated. Since general anesthesia is not required and only small amounts of local anesthesia are utilized, anesthesia risks are also significantly reduced. Finally, in GARM Clinic’s fourth year of targeted adipose derived stem cell and biocellular treatments, no complications from any of the patient’s own autologous injections have been observed.
GARM Clinic. Defined.
Commitment to Excellence = Extraordinary Patient Outcomes