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DISCLAIMER: Like all medical procedures, all the procedures that we perform have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else. 

Tuesday, December 26, 2017
By Edward Dieguez Jr. MD PA
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Have you noticed how medical care has changed lately and how it continues to change right under our noses?  


First of all, do you want more interference in the relationship between you and your doctor? Ask yourself that question!


1. The first ones to interfere were insurance companies, that have done nothing but drive the cost of healthcare through the roof, and we all are paying the consequences.


2. Second came the government, regulating every aspect of medicine you can think of.


3. The latest players wanting to interfere in the relationship between doctors and patients are the hospitals. They want more and more control over the doctors and the one who will suffer is you—the patient.  


The story of your friendly corner drug store pharmacist.

 A cautionary tale can be found by looking at friendly pharmacists of the past at their corner drugstore. Now, 90% of pharmacists work for one of the big chains, like CVS, Walgreens, Wal-Mart, etc. When you call one of these chains, you either get an answering machine, or, if you get lucky after pushing all the buttons on your phone, an employee will answer and put you on hold for 5 to 10 minutes before you can actually talk to the pharmacist that you are looking for. Why is that? Because the pharmacist does not care anymore; they are not running their own business. They have given in to impersonal corporate America, where they simply punch a clock in the morning and another one in the afternoon. The personal relationship with the customer has been destroyed. This is a good example as to why if you dislike how big pharmacy chains operate and do business, you should support the few remaining local independent pharmacists!


What is happening to your friendly independent doctor.

We are now seeing the same thing happening to the medical profession. Your friendly doctor that you have relied upon for years is being forced to join corporate America. You are already experiencing it, and most of you do not like it. You get admitted to the hospital and your doctor does not see you. You get somebody, sometimes a doctor and sometimes a nurse practitioner or physician assistant that works for the hospital and is controlled by the hospital. This person works under a whole different set of incentives. They really do not care about how you perceive them and don’t care about keeping you as a longtime patient. They don’t know you personally, either. You have simply become a number in their daily routine—somebody that they have to deal with before it’s time for them to clock out and the next shift to begin. When we see more and more physicians becoming employees of a hospital or when physicians enter into some kind of contract by which they are controlled by the hospital, medical care, and, in the end, the medical profession as we know it is on its way to the funeral home! Sadly, some physicians will sell their souls to the hospitals for money and will become active participants helping the hospital to achieve their goals of controlling all other physicians. These physicians that sell themselves are what I call hospital boys! Physicians will lose their independence just like the pharmacists have, if they allow the trend to continue.

The writing is on the wall when you hear statements such as wanting to evolve into a "health system with a focus on provider integration”. That is a loaded statement. While it appears innocent, that is essentially shorthand for wanting to control doctors, and wanting to have them, as the saying goes, “by the short hairs”. Nothing less. The hospitals’ main goal of integration is not better care for you. Their main focus is to work with big insurance companies, make a buck off the physicians, and increase the profits of the hospital that is paying that CEO a multi-million dollar salary and great retirement benefits. Check around. See the hospital and insurance companies CEOs’ salaries. In order for them to have those great salaries and benefits, somebody has to suffer and that somebody is the patient. How do you lose? By losing your personal physician, by paying higher insurance premiums, by paying higher deductibles and copays, and by getting less care. Yes, less care! When your doctor wants to order needed MRI or CT scans to make an accurate diagnosis, there will be delays at your expense, sometimes suffering in pain. In the process, you suffer as a patient but they, the hospital and insurance company CEOs simply don’t care. They have to protect their bottom line!


What is in store for you if we let it continue?

If both you and I let this trend continue, be ready to wait in long lines at medical clinics, like you do for example at Wal-Mart when the store is packed and there are only five out of thirty checkout registers open. The hospital and insurance company CEOs won’t care; the only thing important to them is their bottom line. And remember, by that time, the doctor is on the clock for x number of hours till he clocks out. He is not going to care if you need to return the next day, and he will not be available for you when he’s off the clock. You are not his patient anymore. You are the patient of “Corporate America Medical Care”. He is out of there, on time!


Possible solutions to the problem we find ourselves in! 

Now, you may ask yourself, how can this trend be stopped? It’s not easy, but there are a few things you as patients and we as physicians can do. It all starts with supporting each other. On the physician side, we have to understand the financial constraints of patients and adjust our rates to a point that are affordable to the patients and work with them with good intentions to help them meet their healthcare needs. Some patients out there are paying over $400.00 a month on a good insurance policy and even then still have a $3000.00 yearly deductible. Still others have a really cheap policy and think they have great coverage, only to discover reality when the time comes to go to the doctor and nothing is covered or have to jump hoops to get anything done. Remember you get what you pay for and the more intermediaries there are, the less you get. That is why a direct physician-patient relationship without control from any third party is so important and is the best. On the other hand, patients have to realize that nothing is free in this world we live in and physicians have expenses to meet running an office and all that entails. You have to be realistic. If you treat your health like a priority, like you do having the latest technology such as an iPhone and a big screen TV, with all the additional expenses both entail monthly, you should be able to pay a reasonable doctor’s office fee and most outpatient procedures.

Here is one way many people are managing the insurance/healthcare crisis: by buying insurance only for catastrophic coverage and then paying for the other outpatient doctors’ office care out of pocket, like you do at the vet with your dog or at the dentist. Remember what really gets expensive quickly is if you fall in the hospital after an accident or major illness and catastrophic coverage would take care of most of that.

Many doctors’ offices, realizing the problem patients are facing getting trapped between the big insurance companies and the hospital conglomerates, have come up with real solutions for these patients while still at the same time providing top of the line personalized care like the old days. Issues many patients may be facing include no insurance, high deductibles, a desire for better care than what the insurance company provides, high co-pays, delaying tactics by their insurance companies, access to specialist care made difficult by their insurance company or primary care doctor running an HMO, having an insurance that not many offices accept etc., etc., etc. Many of us independent physicians understand these issues and have come up with very affordable cash flat rates to help those patients. Similar to what dentists and veterinarians do when their clients have no insurance.

So trying to work under the above scenario, if you need our services and have no insurance or a bad insurance or insurances we don’t accept, please call our office in St. Augustine, Florida at 904-827-1455. We have developed affordable flat cash rates to work with you!

Wednesday, November 15, 2017
By Edward Dieguez Jr. MD PA
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1)   Mechanics of ACL tears. The ACL is usually torn as a result of a quick deceleration, hyperextension or rotational injury that usually does not involve contact with another individual. This injury often occurs following a sudden change of direction. A person typically reports feeling a popping sensation in the knee. When hit from the side , injuries to the ACL are often associated with medical meniscus and medial collateral ligament (MCL) tears, collectively known as the “unhappy triad”.


2)   Symptoms of ACL tears. Pain in the knee, instability of the knee, swelling, stiffness, bruising and pain on standing.


3)   Types of injuries to the ACL.  An anterior cruciate ligament injury often is called a sprain. A sprain occurs when the threads or fibers of the ligament  stretch or are torn. An ACL injury is classified as a grade I, II, or III sprain.


  • Grade I Sprain.  Ligament is stretched but there is no tear of the fibers. Patient is  in pain, there is some tenderness and swelling but the knee does not feel unstable or gives out during activity.


  • Grade II Sprain. Here the fibers of the ligament are partially torn. Patient is in pain, there is some tenderness and moderate swelling. The joint may feel unstable or give out during activity.


  • Grade III Sprain. Here the fibers of the ligaments are completely torn in two parts. There is tenderness (but not a lot of pain, especially when compared to the seriousness of the injury). There may be a little swelling or a lot of swelling. The ligament cannot control the knee movements. The knee feels unstable or gives out at certain times. We can sub-classify these tears in two types:


                a)    Complete retracted tears.-  In these tears the ligament has snapped back like a rubber band. While complete retracted tears are likely to require surgery, we need to be sure your tear is retracted before we decide how to treat it. 


                b) Complete non-retracted tear.- In these there is still something holding the ends of the ligament together because it has not snapped back.

 4) ACL injury treatments options. It is important first to rest the knee and waiting for the   swelling to subside. Pain medications and crutches and an ACL knee brace may be indicated.  Wearing an ACL brace can help prevent more injury to the Anterior Cruciate Ligament and help support your knee after an ACL tear or injury.

Additionally treatment includes exercises, surgery or stem cell therapy procedures. This modality can be utilized in certain types of ACL injuries. Not all ACL injuries require surgery.


  • Exercises.  You should start slowly and gradually increase the

intensity of the exercises. Do not push yourself to the point that you feel pain. Talk to your doctor about how to best progress. It may include exercises such as bridging, glute seats, hamstring curls, heal raises, heal slides, quad sets, Shallow standing knee bends, straight leg raise to the front, straight leg raise to the outside.


  • Surgery. Most surgery for anterior cruciate ligament (ACL) injuries

involves replacing the ACL with tissue called a graft. Usually an autograft (tendon tissue taken from another part of the body) is used. With this type of graft you get better results than with allograft. Most people who have ACL surgery have favorable results, (notice the word favorable) with reduced pain, and also good but not normal knee function and stability. Some will still have knee pain and instability. An intensive rehab program to strengthen the knee then begins. The rehab program often lasts up to a year. There can be quite a few problems with the surgically replaced ACLs. First with an autograft the muscle the graft is taken from never fully recovers its strength. Second, the operated knee never regains its normal position sense to guide normal landing. Finally, few patients ever return to their prior level of sports and 2/3 of young ACL surgery patients will have arthritis by the time they are 30 years old.


  • Stem Cell Therapy Procedure. One of the big problems with the  surgery in general is that the graft tendon is inserted at a much steeper angle than the original ACL. As a result, we often recommend to our patients that they consider newer precise biologic injection options, like stem cells, before considering a surgical ACL replacement. This may be a better option that should be explored, especially if you have only a partial or complete nonretracted ACL tear.
Thursday, November 09, 2017
By Edward Dieguez Jr. MD PA
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Rotator cuff tendons tear are among one of the most frequently seen tendon tears. One common modality of treatment is surgical repair but the failure rate is extremely high. Achieving sustained healing fails in about 20 to 90% of patients! 



The two causes of tears are injury or degeneration. Because most rotator cuff tears are largely caused by the normal wear and tear and degenerationthat goes along with aging, people over 40 are at greater risk.

People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.

Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.



 Surgical repair is a common modality used to treat these types of injuries but the failure rate of achieving sustained healing ranges between 20 to 90%. Re-tears are very, very, common.

 The reason for the high failure rate and re-tears has to do with compromised healing at the junction of the tendon to the bone, at the so called enthesis. This is mainly due to poor vascularity, fatty infiltration etc. that occurs after the tear. The more re-tears the worse it gets.  Additionally early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from one study, suggest for instance to keep the arm externally rotated during elevation in cases of supraspinatus or supraspinatus plus infraspinatus tear, since this could help prevent re-tear. Remember the more tears the less likely that the rotator cuff tendons will completely heal and it eventually leads to shoulder instability and possible shoulder replacement surgery!



When rotator cuff tear occurs the shoulder turns into a hostile non-healing environment and when surgery is performed this hostile non-healing environment gets worse. This hostile environment precludes healing.

A hostile environment are the words used by some surgeons to describe the shoulder capsule following a rotator cuff tear and “repair surgery”. In a new study doctors expressed concern about the post rotator cuff surgery healing environment.

Here is what doctors writing in the Orthopaedic Journal of Sports Medicine had to say:

  • “Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing.
  • Tears often progress without intervention, and current surgical treatments are inadequate.
  • Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears.


The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function even after surgery. Other articles describe that the goal of our treatment should be to turn a hostile non-healing joint environment into a healing environment through the use of regenerative comprehensive Prolotherapy that includes healing factors from blood platelets and stem cells.



Arthroscopic debridement, partial repair with margin convergence, biceps tenotomy or tenodesis, and more recently suprascapular nerve release have all been described as potential treatments which are effective at alleviating pain, but have little effect on strength and funtion.


Comprehensive Prolotherapy treatment for torn rotator cuff without surgery produces great results. By stimulating stem cell growth, it increases the amount of fibrocartilage formation. This is the tissue that helps make up ligaments, tendons, and cartilage and stabilize the joint improving the hostile environment and promoting healing of the tear.


In new research in the medical journal Orthopaedics & traumatology, surgery & research, doctors tested the effectiveness of Prolotherapy in difficult chronic refractory rotator cuff tears. They were hoping to find that dextrose prolotherapy would reduce pain and improve shoulder function and patient satisfaction.

  • 120 patients with chronic rotator cuff lesions and symptoms that persisted for longer than 6 months were divided into two groups: one treated with exercise and the other treated with prolotherapy injections.
  • In the Prolotherapy group ultrasound-guided prolotherapy injections were applied
  • In the exercise group, patients received a physiotherapy protocol three sessions weekly for 12 weeks.

               (Both groups were instructed to carry out a home exercise program.)


  • Both the exercise group and the Prolotherapy group achieved significant improvements.

- Prolotherapy group had significantly better pain relief scores at weeks 3, 6, and 12, and last follow-up.

-Prolotherapy group had significantly better shoulder abduction and flexion at week 12 and last follow-up, and in internal rotation at last follow-up.

In the prolotherapy group, 53 patients (92.9%) reported excellent or good outcomes;(No significant difference was found in external rotation at any follow-up period).

-  in the control group, 25 patients (56.8%) reported excellent or good outcomes.

As shown by the research rotator cuff tears can be treated with stem cells, platelet rich plasma, and Prolotherapy with great succes.

Thursday, October 12, 2017
By Edward Dieguez Jr. MD PA
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A) What is different about Prolotherapy Injections?

The differences between the newer interventional regenerative medicine techniques and the old simple cortisone injections are several.  These differences are significant, with cortisone having many long lasting deleterious consequences in the long run, especially if you get repeated injections over time. I will enumerate these differences starting with the effects of Prolotherapy. 

          * Prolotherapy as a regenerative procedure aims to heal, regenerate and strengthen tissues that have been damaged by injury or daily wear and tear and is causing pain.


          * Prolotherapy as with all regenerative procedures works in conjunction with the normal healing mechanism of the body to heal damaged tissues that cause pain.


          * Prolotherapy like all regenerative procedures stimulates and/or fires up as the case may be, the normal healing process. 


          * Prolotherapy will lead to tissue healing and secondarily to pain control. 


          * With Prolotherapy as with all regenerative procedures, healing is the goal. 


On the other hand what do cortisone injections do for you? Promise, you won't like it:


          * Cortisone takes care of the pain by inhibiting the healing mechanism and acting against the normal body reaction that would lead to healing of the damaged tissues that re causing the pain!


          * Cortisone will stop the pain but it also stops the normal body inflamatory reaction that is in charge of healing tissues anytime there is damage to tissues in our body. The price you pay is high because the damaged tissues never heal correctly.


          * Waht happens then? Well as you probably have experienced it yourself, a few weeks after a cortisone injection the pain comes back and you need another injection!  


          * As the years go by receiving cortisone injections, without tissues been able to heal properly, the condition you came to see the doctor about will worsen instead of getting better. There is no healing taking place when cortisone is used. Degeneration of your joints, your spine etc., will get worse instead of better! 



B) What is then the value of Prolotherapy? 


          * The value of Prolotherapy and regenerative medicine is evident if you consider the healing! 


          * Prolotherapy is not a band-aid solution that in the long run makes things much worse for you by inhibiting the normal healing process in your body and that at the end leaves you holding the bag with damaged joints, and weakened ligament and tendons that eventually will lead to surgery.


          * In Prolotherapy, natural substances are used such as sugar water or saline that have no deleterious effects on your body like cortisone.


          * Prolotherapy is a recognized orthopedic procedure that stimulates the body's healing process to strengthen and repair injured and painful joints and connective tissues.


          * In our office patients that undergo Prolotherapy experience amazing results. After they complete sucessfully the treatment protocol, they simply vanish from our office for years and go back to their everyday activity without pain. This is totally the opposite of what you see with cortisone injections that keep coming back and coming back every three to four month or sooner!  


3) You may ask yourself why then is cortisone still being injected instead of Prolotherapy?


The reasons are mainly three:


          * First of all not many doctors even know or have a clue about Prolotherapy. It is not something they teach in medical school.


          * According to there are only twelve Physicians in the entire state of Florida that are trained in this field. Dr. Dieguez is the only one in Saint Augustine and one of two in north Florida with the other one being in Destin, Florida. 


          * It is a procedure not paid by insurance companies as it often happens with many other procedures. So unfortunately many times cortisone is the only alternative for some patients! But if you can afford to spend a few dollars out of pocket on your health, you would be a fool not to if you consider Prolotherapy with its all around benefits. 

Sunday, October 01, 2017
By Edward Dieguez Jr. MD PA
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Just recently, the European Academy Science Advisory Council (EASAC) issued a press release criticizing homeopathy, but in the process it also took a shot at all alternative medicine by claiming that there could be only one type of medicine -traditional medicine. This attack comes with very poor timing since traditional medicine is losing ground. So much so, that it was announced just this week by the University of California, Irvine, that it is planning a $200 million alternative medicine center. 

Some patients don’t like some settings within traditional medicine. They either know, or soon figure out that the system can chew them up and spit them out when  they are most in need. In the last few years, many traditional medicine practitioners, myself included, have gained respect for many forms of alternative medicine and many like me have mastered different aspects of alternative medicine.


Have you asked yourself why people love alternative medicine?

When a patient goes to a practitioner that is open to alternative medicine, the patient soon learns that they can talk to these physicians about acupuncture, Regenerative Medicine (including Prolotherapy, PRP, Stem Cell Therapy, and also craniosacral treatments), chiropractic care, homeopathy, naturopathy, and so on.

 Unfortunately, some physicians just can’t buy into alternative therapies. They are eager to criticize and don’t miss an opportunity to shed a bad light onto those of us that do practice some form of alternative medicine. They call us funnies and even quacks. But on the other hand, they continue offering their patients procedures and surgeries that have been proven not to work. Some of these are high dollar procedures that are done by the thousands.

 Whether those practitioners that ignore and put down alternative medicine like it or not, an old survey by the National Institute of Health (NIH) found the 4 in 10 patients choose alternative medicine. If the study was conducted today, most likely the number of patients that choose alternative medicine over traditional medicine would be significantly higher. Some have quoted as many as 6 of every 10 patients choose a form of alternative medicine. Most importantly, 84% of patients using alternative medicine have high confidence in its safety and efficacy.  I personally feel that a combination of the traditional and alternative medicine would be the best.


With the widespread availability of traditional medicine, why is this happening?

As stated by Dr. Christopher Centeno, a pioneer in regenerative medicine, “it is easy to see that alternative medicine is entirely the opposite of all the things patients hate about traditional medicine. It’s open-minded where traditional medicine is close-minded. It offers hope, while its counterpart frequently offers pessimism. Its practitioners will spend time with patients and be friendly and welcoming, while the other side’s physicians are rushed, overextended, and brusque.”

 A great number of patients have complained to me that when they visit other traditional medicine practitioners, they have to wait for long periods of time to be seen even when they were given an appointment time. It is common for many to wait an hour or even more. Many never even see the doctor and just see a nurse practitioner or physician assistant. There is nothing wrong with these professionals but the doctor needs to see he patient and provide their higher degree expertise and knowledge to the case at hand. Also many times the patients feel rushed. At our office, we feel that the patient’s time is as valuable as ours and we strive to see everyone at the time scheduled. Additionally, I see all the patients personally and try to answer all their questions and go over treatment alternatives.


Why this migration from traditional medicine to alternative medicine?

Let’s analyze the hypocrisy of traditional medicine to try to explain the migration.


1.- Steroid injections.-  Despite the evidence that repeated steroid injections result in diminished pain relief, the toxic effect on stem cells, and that it kills cartilage, steroid injection remains the most common knee procedure worldwide.


2.- Lumbar fusion surgery.-  Research has shown that fusion surgery is no more effective than plain lumbar laminectomy or physical therapy and, that patients still have the same pain more than a decade after surgery. Despite these facts, the fusion industry is still strong.


3.- Knee meniscus surgery.- It has been shown to be ineffective at relieving pain, is no more effective than physical therapy and creates the perfect setting for arthritis to develop. In spite of these facts, knee arthroscopy is the most common knee surgery performed in the US.


4.- Narcotics such as opioids not only do not relieve pain in some people but can actually amplify it. Additionally, its indiscriminate overuse has created a national crisis that we are all too familiar with.


Here is an interesting quote taken from Dr. Chistopher Centeno: “The university-pharma industrial complex is a conflicted mess. Medical school professors are on the pharma dole left and right. Drug companies put their names on boardrooms and have infiltrated medical school classrooms. Medical schools teach physicians to avoid original thinking and follow clinical flow charts drafted by the same professors taking money from pharma.  Finally the Universities themselves have become big businesses and now hold more cash than the US government.”



What is the ideal relationship between traditional medicine and alternative medicine?


The use of alternative medicine has become so popular among patients simply because the patients have become aware that for certain ailments it works better and there is much less risk involved. In other cases, traditional medicine works better. That is why in our office we try to strike the right balance between the two and that is the way it should be with every practitioner. Combining the two modalities works best, and that is what I try to do with my patients. Being open minded is very important!