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Ask Dr. Mike: Prolotherapy, Measuring Heart Disease Risk with a Calcium Score Test & More

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans. Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

I'm considering having prolotherapy on my knee and I'm wondering if it works. Can you shed some light on this?

Prolotherapy, also known as proliferation therapy or regenerative injection therapy, is a nonsurgical therapy that helps heal an injury by stimulating your own body's healing mechanisms.

A sugar solution is injected to the area where you're experiencing pain. This causes blood flow, immune cells, and water to move towards the injected site (in this case, your knee) to start the healing process and decrease pain.

Dr. Mike strongly believes in this therapy and suggests to giving it a try.

Is the calcium score test to measure heart disease valid?

Yes, it is. This test is used to help determine your real risk for heart disease. If you're someone who has low risk -- which means you don't have a family history and your blood work came back fine -- you may not need this test. If you're high risk, meaning you have several factors that are contributing to poor heart health, or you might have already had a heart attack, this test isn't for you, as other treatments should be discussed.

However, if you're someone who's considered medium risk (a few factors that could be contributing to heart hearth), a calcium score test can be extremely beneficial.

The test will put you in a range from 0-400; the higher the score, the greater the risk for heart disease. If you get the calcium score test done and you score above 100, that's considered abnormal. But, if you score between 100-400, there is an increased likelihood of a heart attack within the next couple of years.

If you're in the medium risk range and your calcium score test came back high, you might want to consider talking to your doctor about chelation therapy.

Is bike riding bad for men?

No. There is a very small risk for prostate cancer or sexual dysfunction. Some bike saddles and riding position can put pressure on nerves, so finding a comfortable position, avoiding long rides, and standing up on your bike can help relieve that pressure.

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it. or call in, toll-free, to the LIVE radio show (1.877.711.5211) so he can provide you with support and helpful advice.

RadioMD Presents:Healthy Talk | Original Air Date: February 25, 2015
Host: Michael Smith, MD

It’s time to ask Dr. Mike on Healthy Talk. Call or email to ask your questions now. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. or call: 877-711-5211. The lines are open.

If you’d like to ask a question live on air right now, call 877-711-5211. I could also use more of your emailed questions, This email address is being protected from spambots. You need JavaScript enabled to view it. . AskDrMikeSmith (all one word)

So, this question is about prolotherapy. “I’m considering having prolotherapy on my knee, but I’m not sure if I fully understand how it works and if it works. Can you shed some light on this?”

Yes. This is an interesting therapy and it does work. It does. The official conventional name, I guess, the medical name is “proliferation therapy”. Let me try that again, “proliferation therapy” or “regenerative injection therapy”. What happens here, we’re basically just taking advantage of the fact that the body is awesome. That’s how I could sum up prolotherapy. The body is awesome at repairing itself. It just sometimes needs a stimulus to kind of get it going and that’s what prolotherapy is. It’s a solution, usually like a sugar solution. The technical word for this is a “hyperosmolar solution”, meaning that when you inject it, it has a lot of particles in it, compounds in it, so that it forces blood flow towards it. Water moves towards it and it brings all of the immune cells and repair cells into that, in this case, the knee joint. So, you’re injecting this solution that, in and of itself, the solution’s safe. It’s just usually like dextrose or sugar, but it just draws in the blood flow, it draws in the immune cells and the repair cells.

At first what happens is, the cells that first get into the joint kind of break everything down and then the cells that follow are a lot of the repair cells—cells that make collagen and start to rebuild the connective tissue and it does work. It’s just taking advantage of the body’s normal repair process and that’s what prolotherapy is. There is a ton of anecdotal evidence and that’s simply evidence where people will tell us they love it. Maybe not in a clinical trial, they just simply had it done and they swear by it and there’s tons of that. Many people will tell you prolotherapy really helped them and in even some cases, some case reports, avoiding surgery and even knee replacement or hip replacement, stuff like that. So, there’s a lot of that type of evidence. Now, as far as clinical evidence it’s a little bit less impressive, but it is there. There is evidence for knees, for instance, that prolotherapy can decrease pain, increase range of motion down the line. It does take time and then, of course, if you have any sort of immune issue, it may not be the best idea because we’re taking advantage of the normal immune response. So, if you’re on drugs to bring down the immune system like steroids or if you just simply have some sort of immunosuppression, it may not be the best thing for you, but assuming this person that asked this question, you have a normal immune response, prolotherapy should be great for you. I think you should give it a try.

Okay. Number two: “Is the calcium score test to measure heart disease valid?” Yes, it is. That was an easy one, right? So, this is a test that is used to help determine what someone’s real risk is for heart disease. So, you know, if you’re somebody who has low risk, your doctor has looked at bloodwork, family history, your own personal history and there’s just nothing there and, overall, you’re at low risk, you probably don’t need a calcium score done. And, if you’re somebody on the flipside of that, right? You know, high risk for heart disease. Let’s say you already had a heart attack or you have a lot of those 17 heart disease risk factors like cholesterol issues, blood pressure, inflammation, you don’t need a calcium score test because you’re already high risk and you should be treated for those things, right? So, low risk and high risk for heart disease, you don’t need a calcium score. It’s really for that middle, medium risk person that the doctor’s just not quite sure. Maybe you have a family history, but you don’t have anything personal. Maybe you have just 3 or 4 of those 17 heart disease risk factors and you have a few cousins that all had heart attacks in their 50’s, but no first degree relatives or something like that. So, you’re kind of in this “iffy” group. We’re not really sure where you fall. That’s where a calcium score test could be beneficial. They basically just look at how much calcium is in your system. You get a score that ranges from 0 to 400 and the higher the score, the greater the risk for heart disease. As a matter of fact, a score greater than 100 is considered abnormal, but if you score between 100 and 400 on a calcium score test and you are at that medium risk, there is an increased likelihood of a heart attack within 3 to 5 years. So, it does give some information. So, if you’re a medium risk and you score less than 100, see your doctor, “Ah!” He takes a breath and so maybe we don’t have to be so aggressive. But, if you’re medium risk and you score above 100, “Ah! Let’s be a little more aggressive in treating some of the heart disease risk factors.” One of the common questions that I get that conventional medicine doesn’t really have an answer for in many cases, is what do you do? Okay. So, I’m a medium risk person and my calcium score is 200, let’s say, or 300, whatever. It’s above 100. What do I do? I mean, is there a way to bring that down? Well, the only way that I’ve seen work and, again, it’s more anecdotal, although there was a publication last year that showed some promise, and that’s for chelation therapy. IV chelation with a compound called “EDTA” can remove calcium. There’s even an oral supplement of EDTA that might be helpful, but the research was done with an IV EDTA. So, oral chelation, IV chelation, might be something to try. There’s another oral chelating agent called “modified citrus pectin”, which is a protein found in fruit and stuff. If you break it up into smaller pieces, it’s called “modified” and when you ingest that, it’s been shown to act as kind of a chelater as well. So, oral EDTA, IV EDTA or modified citrus pectin all could be helpful if you’re medium risk and your calcium score is greater than 100. Okay. So, that takes care of that one.

Alright. Next question. “Is bike riding bad for men?” So, I’m assuming this is in the context of prostate issues. That’s my assumption. “Is bike riding bad for men?” Well, okay, the theory is sitting on the seat puts pressure on the prostate which can increase lymphatic tissue and inflammation, cause prostatitis, that kind of stuff. So, May Lynn Paul is a contributor to Healthy Talk segments. I had her look into this a little bit, assuming that that’s what this person is talking about. The results suggest that “no or very small increased risk in prostate cancer or sexual dysfunction”. I’m assuming that that’s what this person is talking about here and that’s what May Lynn found. Some bike saddles and riding positions do put pressure on the nerves and arteries that supply the prostate, the penis and the testicles. So, finding a comfortable saddle that doesn’t cause numbness and avoiding very long rides and standing up periodically all can help. So, there you go. So, there’s really no clinical evidence that bike riding is going to cause prostate issues. So, I’m assuming that’s what you were looking for.

This is Healthy Talk on RadioMD. I’m Dr. Mike.

Stay well.