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Episode 21: Osteoarthritis (OA) with Dr. Musnick, MD

Updated: Jan 15




Podcast Drop Date: 9/26/23


In this episode, Dr. Musnick explains osteoarthritis (OA), a condition that involves cartilage loss, smaller joint spaces, bone spurs, and inflammation. Learn about the common areas in the body where OA appears and aspects that can lead to its development. In this conversation you'll understand the various factors affecting OA, such as injuries, metabolic issues, and how treatments like supplements and therapies can help. Discover how taking care of hormones, improving posture, and using specific treatments can make a big difference for your joints. Tune in to to learn more about the world of osteoarthritis, and gain helpful tips for keeping your muscles and joints healthy for a better life!




Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.


Welcome back, everybody. We're here in our brand new Eagle facility. We're so excited to be here. And I'm happy to state that for the first time ever, Dr. Musnick has complimented some of our art and our decorations because usually you're kind of a hard critic about some of the decor we put up. Sorry, you've been absent. We are so thrilled to announce that we're at our new location in the Hearty Eagle. We've we've. I know we took a little break from podcasting, but we were up to some pretty fun projects. And opening our new Center for Optimal Health was one of them. So we're thrilled to be here. So I'd like to introduce my guest this evening, Dr. David Musnick. He's a highly accomplished clinician and diagnostician diagnostician, specializing in orthopedic sports, medicine and functional medicine with board certifications in both sports medicine and internal medicine. He brings a very impressive 33 year background in sports, medicine and internal medicine, with 26 years in functional medicine experience. Dr. Musnick's extensive experience has led to the development of his unique assessment and treatment approaches showcased through countless cases.


Amber Warren, PA-C: Not only has his work been published in numerous books, but he's a sought after speaker on various conditions, notably osteoarthritis, which we'll be discussing tonight, and concussions. Originating from Boston and spending much of his career in Seattle, Dr. Musnick now calls Idaho his home, bringing his expertise and passion for athletics, outdoor activities and specialized treatments to our community. And we are so grateful. It's such an honor to get to work with you, and I'm so glad to have you back and thank you interviewing you on I know a topic that you are known for and we need to continue to bring more healing to this community through this diagnosis. So tonight, we're discussing osteoarthritis. Yes, I feel so passionate about this topic because I noticed in our patients my biggest concern, not only how it leads to a decreased quality of life, but my concern is our patients can't move like their bodies are designed to move when they have this ailment. So I'm really excited to dig in this evening. So let's start. So all of our listeners know mostly at a cellular level what is OA or osteoarthritis.


Dr. Musnick, MD: Okay, so I want to start at a structural level and then I'll go to the cellular level because I think it might be easier. Okay. So what we mostly think of as osteoarthritis, we're going to look at this in terms of say, we'll talk about the knee because that's a good example. Knee and hip. Although it can happen in any joint in the body and the spine. So what we see is a loss of cartilage and a loss of joint space on imaging studies. And then we can see also these bone spurs that are called bone spurs. It's really build up of calcium. And then what it is also, believe it or not, in most doctors do not know this. You probably do, but most doctors don't know. This is there's effects on bone and muscle and in progressive osteoarthritis of a joint. The the bone actually loses bone density and develops pathology in regards to decreased bone density cysts, bone spurs. So that's just one of the take home points that any doctor looking at this, any clinician looking at this, has to look at the bone and ask themselves the question, what do I have to do to support this bone? What is already going on with this? But what do I have to do to support the bone? There's a lot of inflammation going on in these joints and what's really interesting is in medical school or you were you might have been taught this.


Dr. Musnick, MD: I don't know if you were we were taught rheumatoid arthritis is the inflammatory one and osteoarthritis isn't. And it's it's really wrong because osteoarthritis is very inflammatory. And the interesting thing about the cellular level or sort of what goes on in a cellular level, there are so many things called cytokines and these biochemicals that are very inflammatory. So if you look at what's going on at a cellular level in these joints, all these inflammatory, let's call them molecules for now because there's so many different ones. So you can you can you can group them as inflammatory molecules and there's a lot of them. And I'm not going to start naming them because they wouldn't make sense to people interleukin this, that and the other thing. Then there's these things called metalloproteinases mmps. And these things break down joints. There's proteases that break down the cartilage and the matrix. And so there's like quite a few of these molecules that one would have to think about How do I deal with this? How do I help my patient with these molecular processes going on? And that's totally different than the conventional model. If someone says you've got osteoarthritis, take ibuprofen and ibuprofen doesn't deal with most of these molecules and we'll get into that later.


Amber Warren, PA-C: Yeah. Okay. So. You're approaching this from a completely different lens, if you will, and you're really assessing the patient from head to toe as opposed to just looking at the knee. What are the what are the most common sites where we see osteoarthritis develop?


Dr. Musnick, MD: Good question. The neck and the neck is really interesting because that's not thought about that much. But the neck is a big site of osteoarthritis. And one of the telltale signs of that is people have restricted range of motion.


Amber Warren, PA-C: So maybe not even pain, just lack of motion.


Dr. Musnick, MD: Well. Usually some pain, but you can a person could just have lack of motion, lack of range of motion and rotation, not inflection. Flexion is usually maintained, but the telltale signs.


Amber Warren, PA-C: Show us what flexion is or.


Dr. Musnick, MD: Flexion is usually maintained, but extension is restricted. Side bending is restricted, rotations restricted, and not all of them the same. Right. So the neck a big deal, low back, lots of osteoarthritis in the low back we call it. It's actually called on MRI reports, facet arthropathy. What that means is decreased joint space. It means bone spurs and even what can happen there is the whole spine can start shifting forward or back and impinge nerve roots. So so the neck is a big problem with osteoarthritis because a person can get impingement of nerve roots and have weakness or pain in the distribution of a nerve root. Or the worst thing is the spinal cord. If it gets really bad, it can hit the spinal cord and cause what's called cervical stenosis, where a person has trouble walking. Now, the average clinician is not going to assume that because a person comes in with trouble walking or a wide based gait, that they have osteoarthritis in their neck. But that's one of the first things I think about and I have to rule it out. And then so those are the two spinal areas where it's the most. Then you start at the hands. Some people have nodules in the fingers. Those are called heberden's nodes. So hand osteoarthritis. But a big site that people don't realize is osteoarthritis is this first CMC joint of the thumb where people get pain. And and the funny thing is it's not funny initially. It's hypermobile and then it wears down and we'll talk about Hypermobility.


Dr. Musnick, MD: But then it wears down and they get osteoarthritis. Their elbow is not a common site for osteoarthritis. Shoulder can get osteoarthritis, the AC joint, which is part of the shoulder but not the actual shoulder joint, gets osteoarthritis and then the shoulder won't move as well. And then we're looking at the hip big site for osteoarthritis. Then people can lose range of motion in the hip, have trouble walking and pain when they walk hip. Osteoarthritis can actually lead to referred pain in the thigh or even in the knee. It can masquerade like that, but hip osteoarthritis can cause knee problems and hip osteoarthritis can cause low back problems. So one of the other rules of thumb is any clinician doctor or any looking at this has got to always look at the spinal joint that relates to the extremity joint and the joint above and the joint below. So when I look at a knee osteoarthritis, I'm going to look what's going on with the foot, what's going on with the ankle, what's going on with the hip. And so then we get down to the knee, which is a really huge place for osteoarthritis and then that makes it difficult to walk and difficult to do a person's activities, a difficult to exercise. And then people can get ankle osteoarthritis as well, which is not very well known. But I've definitely seen it. And one of the big deals that triggers it is trauma. So an injury to a joint can subsequently lead to osteoarthritis later on. Yeah.


Amber Warren, PA-C: What are some other origins? Because I feel like in my patient population, I'm seeing a lot younger individuals starting to develop arthritis or just joint pain and mobility.


Dr. Musnick, MD: Okay, here's one. A concussion is going to almost lead to osteoarthritis in the neck because it's very hard to hit your head without damaging the neck. So so that's one thing. Then there's all this new information on metabolic dysfunction, all kinds of issues with metabolism, glucose regulation, inflammatory metabolic conditions that are that are causing increased inflammation in joints. Yeah. And what's really interesting in that is whenever anybody has systemic inflammation, they can not only have achy joints from that, but it can accelerate osteoarthritis on particular joints. But body inflammation can lead to brain inflammation, it can lead to brain fog and such. So there's metabolic aspects to this. There's there's other things, believe it or not, steroid injections that are done in joints accelerate osteoarthritis because they damage cartilage cells. Right? So that's that's they lead.


Amber Warren, PA-C: To temporary relief in a lot of patients. But it's very temporary.


Dr. Musnick, MD: It's very temporary. And that's why people are told you can't have too many of these. Yeah, but in my practice, I really I will tell them the risks and benefits and say let's go with other options because I don't want to use a treatment to decrease inflammation that's going to lead to die off of cartilage cells. It's not a good idea.


Amber Warren, PA-C: Absolutely. And you're so spot on. We're so even as a community of providers here at FMI, we often are emailing, Hey, I need a really good orthopod of the knee. Someone's due for a knee replacement or a really good orthopod of of of the hip to get a hip replacement or some kind of fusion in. The neck. And it's like we've got these subspecialists in the Treasure Valley that only deal with the neck. Only deal with the knee. Only deal with the hip. So they might replace the knee or fuze part of the neck without realizing what that's going to do to the upper below structure. So the the approach of just that, that whole body and the musculoskeletal system as a whole that you you take is so valuable for our patients. Well, the.


Dr. Musnick, MD: Other thing is, did you know that a lot of people should not be having these surgeries if the other options were given to them? Yeah, I know. So, yes, there's definite indications for hip replacement. There's definite indications for a knee replacement fusions in the neck or fusions in the low back. Those are very prone to side effects because then the level above and the level below will break down and that leads to some fusions actually lead to osteoarthritis in the spine. Yeah. So I do think that people should be given the whole range of options. But did you also know that a person can react to the materials of the joint replacement? I've seen numerous people that got knee replacements that were swollen. Yeah. You know, they came in and I said, How long have you been swollen and warm for? Oh, months. And I figured out they were actually reacting to the materials in the joint replacement.


Amber Warren, PA-C: Well, it's it's a foreign body, right? Just like breast implants or a tattoo would be. You get that stuff in your in your body and it inevitably reacts to it. And I'm sure development of autoimmune disease is not far down the road in some in some instances.


Dr. Musnick, MD: But you want to hear something fun and interesting. Always. The best way that I've been able to deal with reaction to foreign materials is with frequency specific microcurrent treatment. Really, I have been able to treat people with hips, hip replacements and knee replacements that they were having problems with and at least get the swelling down and the inflammation down related to the materials.


Amber Warren, PA-C: Wow.


Dr. Musnick, MD: How interesting. You you can't then you got to work on the range of motion if there's range of motion issues.


Amber Warren, PA-C: Yeah, Yeah. So you start with a patient and you're really evaluating head to toe, you do a full body head to toe exam. You're not just looking at the knee. If they come in with I've seen them, you, you're often having your patients walk in the hallway and you're. Yeah, I'm looking.


Dr. Musnick, MD: I'm always looking. I'm always looking at how they walk. I'm always looking at the joint above and below this I'm looking at muscle strength. Yeah. Because now there's all this information that decreased muscle strength near these joints can contribute to it. And I'm looking at metabolism and you know, some of these places that are offering PRP, which we'll be talking about, and you just go in there and then you get that they are neglecting everything.


Amber Warren, PA-C: Here, that there's all these new PRP like drive through clinics that are popping up.


Dr. Musnick, MD: But and we do it here. But yeah, but it has to be looked at in regard to what is that appropriate and getting the patient ready for that. Yeah. If it's going to be appropriate, you have to get the patient ready for it because there's I would never do PRP on somebody without decreasing systemic inflammation, working on the metabolism and then giving them the right supplements that they need to support their cartilage and decrease all the inflammation. And we'll be talking about that.


Amber Warren, PA-C: Well, and from my understanding, one of the best ways to treat a in a patient that is overweight or obese is weight loss, because you take that extra pressure off of the joint. And so we're only going to be successful with these patients if we're getting them to work with our nutrition team and health coaching team and to to lose the weight and metabolically get them healthier, like you said, to decrease some of those inflammatory molecules that we're seeing. So you mentioned something earlier talking about how we're seeing facet arthropathy in the spine, which I see a lot on MRIs. But it's so interesting because I think most of us think we're going to find a way on x rays. So how are we how are you evaluating for. Okay.


Dr. Musnick, MD: Okay. So if you talk about the neck or the low back, regular x rays are pretty good because what you're going to see in the neck is decreased disc space height. So you start seeing disc decreased disc space size first at C5 6C6, seven. This place that's really bad is if someone does an open mouth. If they can't rotate, you have to do an open mouth x ray because that's the only way you can see the relationship between that upper level of the cervical spine. If they have osteoarthritis there, that can be a cause of headaches or decreased neck rotation. So so first of all, the clinician needs to know what views to order to to to to see that. And in the neck. It's an open mouth view. It's a side, it's a neutral view. And it's a it's a side view in the low back. It's just a two view. So what I would say is for many things, regular x rays are okay if if the clinician knows how to read them because you're going to see things like decreased joint space height anterolisthesis where part of the spine slips forward. Retrolisthesis It slips away. So but say for knees x ray is pretty reasonable. But if we're worried about the meniscus or we're worried about surface cartilage, you have to get an MRI.


Dr. Musnick, MD: Yeah. With a hip, an x ray usually is enough because it. We'll show a really decreased joint space. It can show Spurs and it can show changes in the bone. So the clinician needs to know the imaging studies with the hand. It's an x ray. Okay. Yeah. So every joint in the body has an appropriate imaging sequence to to evaluate it. And we don't need MRIs all the time. But it just depends what we're looking for, because that brings up an interesting point. I'm not just interested in does that person just have osteoarthritis? Well, what are the other structures in that joint? So, for instance, there's these these structures called the labral cartilage that's in the hip and the shoulder. We may need to evaluate that. There's tendons that you may have to evaluate. The best way to evaluate those are with ultrasound. And so it depends what structures we want to evaluate, like what I want to do when I do a consultation. I want to be extremely comprehensive. I want to identify every tissue they're having an issue with and then be able to address it. And so sometimes you need additional imaging studies, but I always give them the options and and see what the patient wants to do. And then I make my recommendations regarding the imaging studies. Okay.


Amber Warren, PA-C: You talk a lot about Hypermobility joint laxity as a contributing factor to. Okay. Can you break that down for us?


Dr. Musnick, MD: Yeah, that's really interesting. So most people think of Hypermobility and the only think of Urlus Danlos syndrome, because that's a that's a big term these days. Diagnostic term. Well, not everybody has Urlus Danlos syndrome or EDS, so. But there's a lot of people that have a loose joint, one loose joint, more than one loose joint. All you need to do is sprain a joint and have it not injure fully. And you can.


Amber Warren, PA-C: Have a joint not have it heal fully. You heal.


Dr. Musnick, MD: Yeah. Heal fully. Fully. Yeah. So you can end up with a loose joint or hypermobile joint.


Amber Warren, PA-C: How would how would a patient know that they have a hypermobile joint without coming to see you?


Dr. Musnick, MD: Well, they might. They might hear a noise. They could hear a noise. They could feel. Sometimes they feel something like it. It pops. Or they just. They feel it move. Like that's a subluxation.


Amber Warren, PA-C: Um, what are the most common?


Dr. Musnick, MD: People feel like their shoulders moving too much forward. Okay. Um. In the sacral iliac joint. That's one of my favorite joints in the body that most people don't know about. That's the lowest part of the low back. If the sacroiliac joint is loose, a person can buckle. When they walk, they can just, like, almost fall. But it can hurt every time they step. And so each hypermobile joint can have they're sort of like the most interesting thing is the most common signs of hypermobile joints that people will know about is tight muscles, muscles in spasm trigger points because say around the shoulder, if a person had a loose shoulder anteriorly, which is forward, then the superior trapezius will get tight. Other muscles will get tight and they go to a massage therapist complaining of tight muscles. And then if you get a few massages and those don't go away. The problem is an underlying joint issue, not just a muscle issue.


Amber Warren, PA-C: Right. Makes so much sense. Yeah. Yeah. Okay. How much do you think that our just current. I mean, I'm just thinking society, the society we live in, right? I'm thinking for these basilar thumb joints, all the texting and us on our electronic light. I'm thinking people that are leaning down, looking at their phones all day, poor posture throughout the day. Those of us that have jobs where we sit a lot. How much do you think just just just our posture in our day to day is really leading to the development of these hyper lax joints and therefore tense muscles in osteoarthritis?


Dr. Musnick, MD: That's a really good question.


Amber Warren, PA-C: Do you see that? I'm curious if you see that a lot.


Dr. Musnick, MD: So I think posture leads to can lead to neck osteoarthritis. I think even bad pillows can lead to neck osteo. Anything that allows ligaments to stretch beyond the way they're supposed to stretch it doesn't support it. Right. When you're talking about people texting on the phone and repetitively using their thumbs on computers, and that's an interesting thing because I don't think that necessarily leads to joint laxity, but I think that leads to tendonitis. Um, I don't know that it would lead to joint laxity, but definitely there's a lot of tendonitis going on around the thumb tendons and there's a lot of thumb tendons. So I think posture plays a role. I think sedentary lifestyles not moving enough actually contributes to knee osteoarthritis because joints do better when they move in general, because did you know that the biophysical stimulus for cartilage regeneration is compression, decompression and gliding of cartilage? So the only way you can get that is with certain types of movements. So whenever I see a patient with osteoarthritis, I'm going to prescribe a certain set of exercises to get those biomechanical forces working to work on their treatment. Good.


Amber Warren, PA-C: So let's move to treatment. That's a good Segway. I first want to start with supplements. What supplements are you having success with in these patients? With Yeah. So wear and tear.


Dr. Musnick, MD: The way I look at that is what are my goals? So one of my goals, I want to decrease all the inflammatory molecules. And like I said in this podcast, I'm not going to list them, but they're like NF Kappa B TNF Alpha. I mean, there's so many of them and a lot of them, they start with IL, which is Interleukins. At any rate, I want to decrease as many of those. And the other thing I want to really decrease or suppress is the metalloproteinases and the proteases that are going to break down the joint. So what's very interesting is we can accomplish a lot of this, get a lot of these molecules lower with a highly absorbable curcumin. To get about half of them lower and a really good strong omega three with the EPA component. So what a lot of people don't realize is most omega threes are EPA and DHA. The DA is good for the nervous system and the brain. The EPA is good for the joints, but we need pretty good doses of that to do this job. And so I'm talking at least 2 to 3g of EPA omega three itself, which is, you know, it needs a strong product. Then the other thing is we want to support cartilage cells directly by encouraging increased sulfur content.


Dr. Musnick, MD: Okay. And so that's where glucosamine sulfate comes in. But what's rather interesting is there are so many glucosamine sulfate products on the market, most of them don't work. The reason is the research showed it had to be stabilized so the glucosamine sulfate had to be stabilized, it had to be in the sulfate form. And so what do you see? Most glucosamine products are glucosamine. Hydrochloride they're not. The sulfur form makes sense and most of them are not stabilized. Okay. So so that's one thing. And the dosing has to be right. So what's really interesting is it has to be a high dose one time a day for one joint. Let's say we're just supporting one knee. So 1500 milligrams of stabilized glucosamine sulfate once a day for just one knee. But if you get another hip in there or you get a spine in there, 750mg, two of those twice a day to support the sulfur component here. Yeah. And then there's dietary things to support sulfur, but glucosamine sulfate has other properties, so I always use it. The other thing is that our listeners might be interested in is shellfish based. Glucosamine has a lot of mercury and lead and metals. So I don't I do not use those products.


Amber Warren, PA-C: That's my concern too, with having patients eat higher omega three fatty acid diet is I just no longer trust the fish. Yeah I know. They're just dirty.


Dr. Musnick, MD: I know. So I don't use I don't necessarily use the fish for that, but I want to use, say, omega three products that are at least tested for metals.


Amber Warren, PA-C: Absolutely.


Dr. Musnick, MD: Yeah. And ideally, possibly from, you know, the southern waters of, of Chile or some Argentina, someplace like that where it's a lot less polluted.


Amber Warren, PA-C: One of my favorite labs that I've been running, I mean, for a while on my clients, but I kind of go through phases where I start to run this lab more often and omega check or an omega quant where we can actually measure total, total omega three in the body. And I think that's really powerful for some of these patients that have a lot of inflammation as a way to to lower their inflammatory load. I'm just curious, this inflammatory talk, I'm curious if you're seeing in the post Covid era, because we know that like the spike protein and what that does for inflammation and with all the cytokines and stuff, Are you seeing more in this post Covid era or patients that I mean, I guess it's hard to evaluate because everybody's dealt.


Dr. Musnick, MD: With a lot of joint pain, people with achy joints, joint pain, and I'm seeing a lot of osteoarthritis now. How much of it I can attribute to, you know, post Covid, that's very tricky. But I do think that there's some immuno dysfunction, immunological dysfunction related to Covid. There's evidence that the spike protein can attach to different tissues in the body. And I think there may be some evidence that it can attach to joint structures. I'd have to look more specifically into that, but I am seeing a lot of it, yeah.


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Amber Warren, PA-C: How about peptide therapies for not only joint pain but full blown osteoarthritis?


Dr. Musnick, MD: So that probably the most prominent one would be BPC 157. Right. But body protecting, not orally injection wise. Yeah.


Amber Warren, PA-C: We use it orally for gut health and it works great for leaky gut.


Dr. Musnick, MD: Yeah. There's one called TB 500, which may also play a role. The other thing that's actually interesting is optimal using hormone health in a person with osteoarthritis, especially testosterone in a male, because let's say you have a low testosterone status in a male free or total or both. And then, I mean, they're going to have decreased muscle strength, which contributes to osteoarthritis. And and so but I think there is some evidence that that may definitely play a role. So I do think hormones should be evaluated and optimized in our patients.


Amber Warren, PA-C: Absolutely. I am blown away. How many postmenopausal women when we replace them with estradiol bioidentical, of course. Yeah. Joint pain just overall function their ability to because it's such a potent anti-inflammatory and antioxidant right estrogen and estradiol. So yeah I'm so glad you touched on that because I do think that's really significant. Okay. So we've got supplements. We are using peptides for osteoarthritis, we're using hormone replacement therapy. Now, I know this is probably your most favorite topic to talk about, this next approach to treating osteoarthritis. I know you've done some very specialty training and digging into the research on some other modalities we're using to treat osteoarthritis. Okay.


Dr. Musnick, MD: So I'm going to go through some of these. Okay. And so this is important that any patient needs to see somebody that covers all these areas because otherwise you're getting very incomplete treatment approaches. Right? So the first one is frequency specific microcurrent, and that can really decrease inflammation, It can decrease swelling, it can provide a lot of relief. But the the fascinating thing about it, some people with osteoarthritis actually have edema in the bone. So they so the MRI shows fluid in the bone. It should not be there. Right. And the frequency specific microcurrent and the FSM can can eliminate that pain.


Amber Warren, PA-C: Can you remind our listeners what the mechanism we've talked about FSM.


Dr. Musnick, MD: So the mechanism of frequency. So, so what it is, is it's a modality, it gets applied to a person through these electrode strips that get put in our clinic and they get wrapped in a moist towel. So they conduct from the positive to the negative leads through the joint or joints or the spine. They have been shown to decrease all inflammatory molecules. I mean, they've been definitely shown to decrease TNF Alpha, but there's other interleukins that they decrease. So they are it's very anti inflammatory. They increase ATP, which is the energy molecule by about five times and they improve cell signaling. And they do a lot more than that. But those are some of the basic things that are known about what it does. It doesn't hurt and it can be very helpful in the treatment of osteoarthritis. And then another thing is pulsed electromagnetic fields, which a lot of people think are these huge machines with these coils. But there are other pieces of equipment that are smaller that actually help regenerate joints. So what I do in my treatment programs is I will integrate these things into the program. Like some centers are just jumping to platelet rich plasma and we'll be talking about that. But it's not appropriate unless you sort of have a whole program of the supplements and the modalities. What I just talked about is modalities. It's like equipment that you would use microcurrent pulsed magnetic field. There's even a role for laser for for some joints. It can there can be, especially in pain relief. Do you use red light therapy?


Amber Warren, PA-C: Have you seen benefits with that?


Dr. Musnick, MD: Yes. Good. Well, I have a laser that has both laser and red light therapy at the same time. So I use both at the same time. And then I don't know if you want me to go into this now, but there's the biologics, which orthobiologics are different than biologics. The rheumatologists use biologics, which are these immune modulating drugs, but orthobiologics are things like platelet rich plasma and bone marrow aspirate. And these are very exciting because. Platelet rich plasma is very anti inflammatory and has growth factors in it. Bone marrow aspirate has mesenchymal stem cells in it. And so they're both anti-inflammatory and.


Amber Warren, PA-C: Those are coming from cells. So you're drawing blood from the.


Dr. Musnick, MD: Patient, from the patient only. And and then I think we're having a whole podcast on this so people can look forward to that. So I don't want to go into too many details about it, but it is the patient's own biological materials, either from their bone marrow or from their blood. And platelet rich plasma is where we concentrate the platelets at least six times up to 16 times. And then there's there's quite a good effect. And that especially can be used in knee joints, hip joints, other, it can be put in other joints of the body shoulder, it can be put in other joints of the body. It's especially also used for tendons.


Amber Warren, PA-C: What do you ever say to a patient you just need a total hip or total knee or joint when they're just And what is it when they're full blown bone on bone and there's no cartridge left or there's no mobility, where do you reach that point with your patients where you send them off to a surgeon?


Dr. Musnick, MD: I've seen some patients that had very advanced arthritis where there is no joint space left in the hip or the knee. And I feel it's the, you know, it's the best thing to do. But you often I feel like some of these patients have to be metabolically tuned up before the surgery. Absolutely. And what's really interesting, did you know that there's things we can do even with homeopathy where we can get someone through a surgery post-op much quicker with much less pain and.


Amber Warren, PA-C: Peptides, not just homeopathy, but.


Dr. Musnick, MD: Peptides, peptides to Vpcs.


Amber Warren, PA-C: A perfect one, right? So recovery.


Dr. Musnick, MD: If they do need surgery, we can support them through that. But I mean, it's just like anything, it's like if a surgery is appropriate because they have no joint space left and lack such little mobility. But there's been people that said, look, you know, I know I need a total joint, but I can't do it for nine months or 12 months. And that's when it's appropriate to institute these other treatments. That's a good.


Amber Warren, PA-C: Point. Yeah. People are trying to meet their deductibles or they've got trips planned or they've got.


Dr. Musnick, MD: Other things that are really important. They say, I'm going to do it, but I can't do it for nine months, 12 months. What else can we do? So there's all these other things that we can do.


Amber Warren, PA-C: What is the average age? You start to see this inflammatory osteoarthritis develop.


Dr. Musnick, MD: Well, first of all. Most arthritis is inflammatory, but the most inflammatory arthritis is in the fingers. I don't usually see that before age 50. And the way you can identify that, the way a person could identify whether you have it, they actually have nodules on their fingers. They're coming in saying, you know, these joints look deformed right now. If a joint is bent, that might be rheumatoid arthritis. But if it's just sort of like the end joining the finger or the middle joint here and it's there's nodules that's probably inflammatory osteoarthritis of the hand.


Amber Warren, PA-C: Do you see some of these orthobiologics or PRP injections work for some of these autoimmune conditions?


Dr. Musnick, MD: Oh, for autoimmune.


Amber Warren, PA-C: Yeah. I'm just wondering about, like, like, like if a shoulder is really degenerative from rheumatoid arthritis and it's more autoimmune in nature. Have you tried? I'm just curious because I don't know the answer to that. If that's something that would work.


Dr. Musnick, MD: That's a good question. Well. The first thing one has to do is decrease inflammation as much as possible.


Amber Warren, PA-C: We know how to do that.


Dr. Musnick, MD: So I think it depends how much joint loss there is. So one thing that goes on in certain autoimmune conditions, which is rather interesting, is the supportive ligament joint capsule can be lax and hypermobile. So that PRP or something called Prolotherapy, which is like PRP only it uses dextrose or dextrose plus peptides if we're. So that brings up an interesting question. Do you just support the joint or do you support the joint and the joint capsule and the ligaments and the tendons? You've got to do all of it, right? But if there's loss of cartilage from rheumatoid arthritis or lupus or some of these things, yeah, PRP can definitely have a role. It hasn't. If you if you talk to all doctors in the country doing PRP and did a poll, probably not that many of them are seeing these patients because they're mostly going to the rheumatologist. But the rheumatologist should probably be referring to the doctors that do orthobiologics for these other things.


Amber Warren, PA-C: Yeah, they need to be. I'm not sure they are. We should do a separate episode on just your approach to these autoimmune patients too, because I know you have a lot of immunology background and kind of a subspecialty, so we like to end. Thank you so much. This has been such a fascinating discussion. You know this we like to end each of our each of our interviews with. If there's one piece of advice you could give our community and our patients with regards to this topic on treating avoiding osteoarthritis, what would that be? What's that one trick up your head?


Dr. Musnick, MD: Well, I mean, catch it early.


Dr. Musnick, MD: And get it evaluated by a clinician that can evaluate, you know, not only that joint the spine, the joint above the joint below, know the imaging techniques, know all the options for treatment, not just one option. Be able to present you with all the options for treatment. Because if you catch it early and you start supporting it, you're not going to have as much problem because, you know, if there's a lot of cartilage loss, it's very difficult to get that back. Yeah. So you want to prevent cartilage loss, you want to catch it early. If you suspect it, go get it evaluated. Yeah.


Amber Warren, PA-C: So if you're starting to experience maybe more pain after that workout or pain with your usual hikes, with your friends that didn't used to cause pain or mobility issues. Evaluation.


Dr. Musnick, MD: Right. And I would say most primary care doctors do not do a complete evaluation of this. They're too busy and they're not trained to do a complete evaluation of it.


Amber Warren, PA-C: I think most of them, like you said, yeah, prescribe pain medications, NSAIDs and refer to PT. And I know there's some value in physical therapy, especially if there's muscle imbalances or weaknesses that need to be addressed. I know you refer to a lot of physical therapists in the Valley, so.


Dr. Musnick, MD: Yeah, I'd say bare bones minimum. If you have a suspicion of osteoarthritis, at least see a sports medicine doctor or a physical doctor, med doctor or an osteopath or a chiropractor if it's the spine. Yeah. But just know that a lot of those docs don't have all the options either.


Amber Warren, PA-C: So come see Doctor Musnick. So, yeah, please, please come see this brilliant, brilliant physician. If you or any of your loved ones are dealing with some of the the ailments that we've discussed, thank you so much for your time. We so value your your expertise. Expertise in your knowledge.


Dr. Musnick, MD: You're welcome.


Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations Podcast. For more information on topics covered today, programs offered at FMI Center for Optimal Health and the highest quality of supplements and more go to fundmedfoundations.com.



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