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Top Six Reasons Why Platelet-Rich Plasma Injections Fail

The other day we received an email from a person who had Platelet-Rich Plasma (PRP) Injection that failed to produce any results. “Not impressed, did not work for me. Had it done for my back,” she said. Comments like these are charged with emotions as almost all of these patients have paid for PRP injections out of their own pockets. That’s why the same patient also added later “…but did empty my wallet.” For us, her comment was one of the kinder ones. Others, who were really mad at seeing their money wasted, called it a sham, quackery, and “ways for doctors to make money.” We understand this sentiment. And we can’t argue with the fact that these treatments may have been failures.

But the thing is very few people, including some expert physicians understand why these PRP injections fail.

What The Tremendous Popularity Of PRP Means

In the 1990s, there were about 150 new research articles on Platelet-Rich Plasma every year. At least in the Pubmed database. Back then, only a select group of physicians who really understood the treatment actually offered it to their patients. Now, just this year alone, there were more than 600 new articles. The trend line has gone from a gradual climb to a “U curve” or exploding popularity.

Platelet-Rich Plasma PRP Injections Search Results Pubmed Database

And so did the number of physicians offering this treatment.

Certainly, money wasn’t the objective for those physicians – for if it were, the best ways to do it would’ve been to prescribe a battery of tests, drugs and surgeries approved by insurance companies. Instead, the physicians started offering it once they knew well the inherent benefits of an interventional autologous medicine like Platelet-Rich Plasma.

The problem is, not all physicians were that passionate about it.

Some did it because patients asked for it. Some did it because everyone else was doing it. Still others just wanted to experiment with it casually.

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And so not all Platelet-Rich Plasma injections worked. That’s why, as the treatment exploded in popularity, we saw a small portion of those treatments end up being a waste of the patient’s money – and that gets talked about a lot because, as I mentioned above, the patient usually has huge emotional response to the outcome.

But on the other hand, majority of the patients are happy about their results.

“I had it done on my injury and MAN, IT REALLY WORKS!!!”

That’s another response we got on the SAME DAY that this women told us it didn’t work for her. Another physician also told us the very same day, “PRP works great. We have had fantastic results on patients in the office.”

So what’s making the difference?

Why do some PRP treatments work spectacularly while some others turn out to be a dud?

That’s what we’ll explain in the rest of this post here. There are six main reasons why it can fail. Plus a seventh no-so-common reason. Let’s look at them one by one.

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1. Improper Selection of Patients

As much as the Platelet-Rich Plasma injection enthusiasts would like beat the drum of its universality of application, there are certain instances where a PRP injection may be unnecessary. The classic case is demonstrated in the 2015 Double-Blind Randomized, Placebo-controlled Study that showed that PRP injections are NOT beneficial at all.

According to expert researchers we subscribe to, it is clear that this study had selected the WRONG PATIENTS!!!

Here’s what that means. This study, conducted by researchers at Cooper Medical School of Rowan University, New Jersey, was done in the emergency care department where patients who’d just had a ankle sprain were given a Platelet-Rich Plasma Injection.

First of all, ankle sprains are relatively acute medical condition, commonly occurring due to over-stretching and tearing of the muscle or tendon. And they’re usually healed on their own. The thing that emergency care physicians usually do for this condition is to put ice packs or local anesthetic to numb the pain so the patient can rest. For patients who’re very active, their body is able to heal itself from most of these types of ankle sprains very rapidly. For them, a PRP injection might not accelerate healing. On the other hand, because injections break up the tissue and poke holes, it can actually cause unnecessary complications.

That’s why successful studies on Platelet-Rich Plasma Injections are almost always done on chronic wounds and injuries that wouldn’t heal on its own. If you’re out to test PRP’s efficacy, the untreated-by-PRP “control group” should be non-healable so we can determine clearly the effects of PRP.

So definitely, Platelet-Rich Plasma injections are not ideal for emergency care.

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The same is true for patients on the other end of the spectrum. That is the category of patients who’d been on steroids and drugs for a long time and are in the very advanced stages of the disease. Although there might be hope, Platelet-Rich Plasma might not be enough to reverse course here.

The ideal candidate for Platelet-Rich Plasma injection is a patient who has a relatively new, chronic musculoskeletal condition and whose only other option is surgery or heavy steroid/drug use.

2. Use of certain drugs

One of the other reasons why Platelet-Rich Plasma may not be ideal for emergency care patients is that when patients come in with intense pain, it’s a common practice for the ER physician to administer powerful local anesthetics and/or steroids in high dose. The problem with both of them is that they are are known to be toxic to stem cells and growth factors as shown here here, here and here. So if you’re using these steroids, anesthetics or drugs, it is recommended to wait till the patient can get off of them before applying Platelet-Rich Plasma. Otherwise, the toxicity of the chemicals may limit Platelet-Rich Plasma’s ability to recruit stem cells to the area.

For example, the local anesthetic Marcaine is found to be extremely harmful to stem cells even in small quantities. So as a general practice, the patient has to avoid harmful steroids, anesthetics and drugs at the time or up to 48 hours prior to PRP injections.

3. Lack of Rehab

It’s been reported that PRP injection works well when combined with the physical therapy for sports injuries. However, some physicians mistakenly see PRP injections as an alternative to physical therapy. Hence the comparisons like these where PRP is pitted as a rival to physical therapy. The fact is Platelet-Rich Plasma can only supplement the effects of a proper rehabilitation program as illustrated in this study which demonstrated that PRP + physiotherapy is more effective than Dry Needling + Physiotherapy for patellar tendonisis.

There is one thing we need to add to that though. Most PRP injections are done in a way that breaks up scar tissue and triggers new healing response to which the platelets can respond. So the best post-Platelet-Rich Plasma treatment rehab program is one which treats the patients as if they just had an acute injury. Meaning, the physiotherapy regimen following a PRP injection has to aim at square one – stimulation of blood flow to the injured area to provoke the inflammatory response. This is a different approach than the usual where the PT tries to attenuate the inflammatory response.

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4. Under dosing

Under-dosing is a serious problem in this field. If you’re using PRP with below 3X platelet concentration, you’re under-dosing your patients. An example is the PT vs PRP study we highlighted earlier. Not only did they mistakenly conclude that Platelet-Rich Plasma could be an alternative to Physiotherapy, they were severely under dosing the patients by using PRP with 2.1-2.5X concentration of platelets.

Studies have shown that a concentration of at least 1,000,000 platelets/µl is needed for optimal therapeutic benefits. That is 5X the concentration of platelets in normal whole blood. Here is one such study.

That is the very reason why we advocate not using Gel-based PRP Kit for PRP separation. The problem with gel-based kit is that most of the platelets will get trapped in the gel. Instead a kit like DrPRP kit gives you 5X-9X platelets because it uses a mechanical separation process while giving the same 1-step convenience of gel separators.

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5. Using PRP as just another injectate

There is a fundamental difference between Platelet-Rich Plasma based orthopedic intervention and typical modern surgical and drug-based treatment. And that is surgery and the drugs are designed to eliminate symptoms of diseases. For example, pain is one of many symptoms that occur when a certain part of the body is out of balance. By taking a drug, steroid, NSAID or even undergoing surgical correction, the physician hopes that the pain goes away. This approach has led to all the problems that we face in modern orthopedic medicine. Because when we treat symptoms, the underlying problems usually don’t go away.

But scores of physicians look at Platelet-Rich Plasma with that same attitude. They inject Platelet-Rich Plasma expecting the symptoms to go away.

That’s NOT what Platelet-Rich Plasma is for.

Platelet-Rich Plasma is a HEALING AGENT. It’s different. It’s not designed to eliminate symptoms like a drug. The only thing that PRP can do is use the body to heal itself.

So the first task, if you’re an orthopedic surgeon or someone treating a musculoskeletal issue, is to IDENTIFY precisely what’s producing the symptoms. This means looking at the connection between various muscles, tendons and ligaments. Understanding how they work in unison and finding out what’s causing stress in the system. All the muscles and ligaments and tendons are like different pieces of the puzzle – pulling weights in sync with their functions. So if there’s a anomaly in the whole picture, chances are one of the pieces of the puzzle is not able to carry out its job.

For an easy example, a tightness in the hamstring might be a result of a twisted ligament or bone in the back caused by a bad sitting posture. So in addition to injecting PRP to the hamstring, you might also need to inject to the ligament or bone on the back. And advise the patient to change posture.

This is the definition of Interventional Orthopedics.

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And it requires extensive experience on the anatomy – AND delivering precise injections into the weaker links in the musculoskeletal system to improve overall function of the body. This means using image guidance technologies like fluoroscopy (Ultrasound guidance isn’t enough) to accurately place Platelet-Rich Plasma on areas which require healing. These type of injections enable efficient tissue regeneration and healing, and is usually not taught in medical school, residency, or fellowship.

That’s why we encourage physicians who’re offering PRP injections to get certified by taking one of the courses at the non-profit Interventional Orthopedics foundation.

Getting certified in Advanced Injection practices will make your Platelet-Rich Plasma results more consistent. There is a must-have for all physicians offering PRP Injections. It will also educate you on all the different ways regenerative medicine is being used right now.

6. Thinking only about relieving pain

We touched on it a little on the section above, but this is a broad topic that deserves an explanation on its own. Platelet-Rich Plasma as a healing tool is not something that you should make use of when your patients are in pain. Instead, PRP is used for a wide variety of issues that doesn’t involve pain including wound healing, skin aging reversal, wrinkle correction, dry eye syndrome, nerve regeneration, bone union, hair regeneration and even women’s fertility restoration and strengthening the uterus.

The bottom line is… Platelet-Rich Plasma isn’t just a tool for containing pain due to sports injuries. That days are far behind us now. Today, every physician, from the family physicians to neurologists and cardiologists, to fertility specialists and optometrists, to dermatologists and hair restoration experts… everyone uses Platelet-Rich Plasma.

Plus, more and more applications are discovered every day.

Platelet-Rich Plasma, on its own without funding by Big Pharma or the government, has become an integral part of modern medicine.

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BONUS: The 7th Reason Why PRP Injections Fail

7. Super-concentration of Platelets

We know all analogies are imperfect but we like to use the expresso shot analogy when it comes to platelets. Platelets are like expresso shots for healing. But like expresso shots, your body can’t function using expresso shots alone. It needs food. That’s why studies like this one by Giusti has shown that super concentrating the Platelets may not only be useless, it can actually be harmful. What they did was completely isolate Platelets and platelets alone – and applied it in different concentrations on tendon cells to see if higher concentrations hurt or helped. That’s not Platelet-Rich Plasma. That’s just platelets.

And Platelets alone can’t do the job. In fact, it has nothing to support the survival of cells.

Instead, Platelet-Rich Plasma, is rich in Platelets while also including a small portion of RBC, WBC and the plasma serum which contains the nutrients the cells needed to survive.

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That’s why research shows that taking the concentration above 1,000,000 platelets/µl doesn’t necessarily increase therapeutic benefits and as the Giusti study pointed out, it can actually have a detrimental effect.

This may not be an issue for the average physician, but it is possible to make this mistake thinking that higher concentration is better. That’s why we believe choosing the right Platelet-Rich Plasma kit plays an important role.

Because the kit has to produce Platelet-Rich Plasma in the ideal concentration – not just Platelets – so it can work every single time you administer it on patients.

Patent Application By Allan K Mishra

Speaking of the composition of Platelet-Rich Plasma, the famed Stanford researcher and Platelet-Rich Plasma pioneer Allan K. Mishra has recently filed a patent application titled “PLATELET RICH PLASMA FORMULATIONS” which can be found here. In it, Mishra claims he’s identified specific concentration of platelets, red blood cells, and white blood cells for treating treating connective tissue and/or cardiac tissue damage. It’s worth a look if you’re curious.

Add Regenerative Medicine to Your Practice

If you need help in getting started with Platelet-Rich Plasma, don’t hesitate to give us a call at (844) 377-7787 for a quick consultation. We can support you not only in supplying all the necessary equipment, but also provide you with the information you need to be a confident pioneer in this field. We’re looking forward to having you as part of our family.

You can also email us via hello@drprpusa.com or visit our shop to order directly.

Thank you for reading our blog. We love you.:)

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Six Ways Platelet-Rich Plasma Saves Your Patient’s Money

In 2011, Stanford University researcher Jason L. Dragoo, reported that there are over 86,000 PRP Injections performed in the US each year. Market analysis by exerts put the growth rate of the Platelet-Rich Plasma market at almost 12% compounded rate which means that the number is probably 170,000 this year. Yes, well over 170,000 PRP injections are performed annually in the US. A recent scientific research by Russian researchers claim that patients save about US$876.84 on average when choosing Platelet-Rich Plasma over conventional treatments. This researchers included only data for PRP applied for wound healing. But we believe the savings for sports injuries and arthritis patients to be much higher. That’s a WHOPPING $149 million in COSTS SAVED BY PRP INJECTIONS in the US alone.

And we’re just scratching the surface here.

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Skyrocketed During The Past 5 Years

Stephen Clark, PT, DPT, MBA, OCS, president and founder of Athletic Physical Therapy in Los Angeles, notes that “the number of physicians performing PRP procedures has skyrocketed during the past 5 years.” This correlates to the aggressive demand we’re seeing for this safe and autologous treatment. The patients can’t find enough physicians performing the procedure. We receive inquiries from patients wanting to do the treatments and some are even willing to go out of state if there’s none in their area.

Watch this response from this patient about her PRP injections.

And patients like Ken below come back for more after their initial injection.

The science, however, is just catching up with this trend. Recent FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled study and Meta-analysis of Level 1 Randomized Controlled Trials continue validating Platelet-Rich Plasma’s role as a better therapeutic tool than conventional treatments.

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Six Ways Patients Save Money When You Offer Them PRP

The big stumbling block for PRP is insurance acceptance. Right now, the insurance companies gleefully ignore the 0232T code – the CPT code for Platelet-Rich Plasma injections, with or without image guidance including its harvesting and preparation. But as they’ll soon realize, not accepting PRP injections is actually costing them a lot of money down the road. That’s why many physicians we talk to believe that it’s only a matter of time before the insurance start accepting it.

But even if it remains that patients have pay out of the pocket for these injections, it still is a very cost-efficient way for them to deal chronic injuries and degeneration.

Here are six ways we know.

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1. Symptom management vs true healing

Typical drug-based approach to healthcare is more symptom management than true healing. This is because the drugs typically do nothing to promote the reversal of the root cause. Instead, they’re good at masking the symptoms. The implications of this are vast when it comes to cost. Since the root cause is not addressed, the patient becomes dependent on the drugs as the disease progresses and symptoms recur. Each time they’re given a stronger dose or a different drug until it no longer works.

Now, compare that to Platelet-Rich Plasma’s approach to actually correct the root cause by promoting healing of the broken or degenerated tissues. Often patients are healed by just one or two injections. And they’re happy for years.

In the long run, the patient who’d had Platelet-Rich Plasma Injections are less likely to develop complications leading to surgery.

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2. Eliminate surgeries

This is huge. Analysts estimate that there are over 600 thousand knee-replacement surgeries performed every year. When people think of the cost of these surgeries, even minimally invasive ones, they only look at the hospital bill that may be covered by the insurance provider. But there are numerous other costs like loss productivity due to patient’s downtime, psychological costs, and even miscellaneous costs during the patient’s stay in the hospital.

Moreover, stuff like arthroscopic surgery, the most common orthopedic surgical procedure, has a history of leading to further deterioration and arthritis.

So the patient’s actual costs are high.

All of these are eliminated when you suggest your patients choose Platelet-Rich Plasma at an earlier stage.

3. Complications, scars or downtime

According to this paper, post-surgical complications can exceed $10,000 for each patient. That is just for surgeries. What about complications due to side effects of drugs? Research indicate that it’s about $1300 per adverse drug reactions.

In fact, medical complications and side effects are some of the biggest cost burdens associated with modern western medicine.

Then there are scars associated with surgeries. Not to talk about downtime.

Platelet-Rich Plasma on the other hand would have none of that troubles. This risk of injection is extremely low since it’s all autologous. And the procedure is done on an outpatient basis after which the patient can return to normal activities the following morning.

All of these translates to increased savings every time you recommend Platelet-Rich Plasma for your patients.

4. Multi-potential therapeutic effects

One of the problems with FDA-approved drugs is that they can only be prescribed for the stated purpose of use. A drug for arthritis patients can only be prescribed for arthritis patients even if it might help a patient with tendonitis. Thus if the patient has more than one orthopedic conditions, chances are each one will need different drugs specifically approved for that condition. Take arthritis and osteoporosis – they are treated completely different when using FDA-approved injections.

On the other hand, Platelet-Rich Plasma is multi-potential. It can be injected on…

  • Knees to heal meniscus, ACL, MCL and arthritis
  • Shoulder to heal rotator cuff tears and tendonitis
  • Hip to heal labrum and bursitis
  • Low Back to heal spinal degeneration and sciatica
  • Foot to heal Plantar Fasciitis, Achilles heel and ligament sprains
  • Elbows to heal lateral epicondylitis and medial epicondylitis
  • Bone to aid the union of fractured bones

You get the point. The possibilities are endless.

This means that the patient do not have to get an assortment of drugs if they need relief for multiple symptoms and thus there is no cost of acquiring new drugs (or potentially leaving drugs unused) each time they have a symptom.

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5. No research and marketing costs are added

This is one of the main advantage of Platelet-Rich Plasma injections. Unlike FDA-regulated drugs, for which the companies spend millions of dollars for research, several times more on marketing and mass production, there’s little capital costs involved with Platelet-Rich Plasma.

To produce it, all you will need to invest in is a good PRP Kit and a centrifuge and the patients can come and get the PRP injections unlimited number of times.

All the research on Platelet-Rich Plasma is done by independent researchers around the world and there’s one no single entity who’s licensing it. So customers aren’t paying for bloated research funding and marketing costs.

This means you can afford to charge your patients less.

6. Outpatient treatment, benefits small and independent clinics

The process of getting admitted to a hospital is mentally taxing. And most of the surgical procedures, however minimal require hospitalization. And that means you need big equipments and all sort of things. So only big hospitals can do those. There is an endless list of charges that the hospital needs to include as a standard and depending on the co-pay agreement with their insurance, the patients may end up paying anywhere from 10% to 50% of these extra unnecessary charges.

With Platelet-Rich Plasma, though, it is an outpatient treatment done in small, independent clinics as a 45-minute procedure. And these clinics are very cost-efficient in their operations because they do not need to employ a lot of staff.

The takeaway? Patients pay significantly less compared to surgeries. And the small, independent clinics have a big advantage over large hospitals.

As a last resort I had two injections of PRP

Platelet-Rich Plasma is here to stay. The skyrocketing demand is proof. And there is no reason why you shouldn’t be offering it. Thousands of cases prove that it works. We’ve shown you how it saves your patients money.

If you’re an orthopedic surgeon, rheumatologist, and/or run a pain management clinic, you’re doing a tremendous disservice to your patients if you’re not suggesting Platelet-Rich Plasma to your patients. Because Platelet-Rich Plasma has the highest adoption rate in this field – and for a reason. It has become indispensable.

The second group of people who uses PRP is aesthetic professionals followed by ophthalmic surgeons.

We’ll let some of the stories from Physicians themselves convince you about offering Platelet-Rich Plasma.

Here’s one physician who saw the value in Platelet-Rich Plasma ONLY when he himself was forced to seek the treatment.

“I am a physician who suffered with high hamstring tendinopathy which prevented me from playing competitive soccer and sprinting. I tried all conventional treatments for two years without any improvement. These included physiotherapy from a nationally recognized sports physio. I also used NSAIDs, fish oil/omega 3, glucosamine and chondroitin. I was looking at retiring from competitive sport. As a last resort I had two injections of PRP by a specialist sports physician. After three months I can now run without pain. This was a last ditch treatment that worked for me. (Although it was a trial of n=1).”

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Another dentist reports that he’s been using it for more than 8 years for grafting procedures.

PRP is very effective in bone grafting procedures with a huge amount of research supporting it’s effect in speeding healing. It’s use in tendonitis seems to be questionable. I am an oral & maxillofacial surgeon and have used it for greater than eight years with great success in my grafting procedures in the jaws.

The point is, we could go on and on and on about the reasons why a lot of physicians are excited about this treatment. It is simple and practical enough to quickly adopt it into your practice. And the risks are absolutely minimal.

Consider Getting Trained For Advanced Precision PRP Injections

That being said, you might want to undergo training for advanced prp injections at the Interventional Orthopedics foundation. Because, the ability to accurately localize the Platelet-Rich Plasma is one of the biggest needle movers when it comes to extracting the maximum therapeutic benefits. According to the foundation, only 1% of the physicians are able to do these precise injections without training. And so, chances are you may not have had the training. The Interventional Orthopedics Foundation also offer home study videos if you’re not able to attend in-person.

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And if you need help setting up your Platelet-Rich Plasma workbench, we’re here to help. Give us a call at (844) 377-7787 or drop us an email via hello@drprpusa.com. We handle everything from PRP kits to centrifuges to workspace for PRP and marketing brochures.

How to choose the best PRP Kit (Platelet-Rich Plasma) 1
How to choose the best Platelet-Rich Plasma (PRP) Kit

For an incredibly straightforward process, the science of Platelet-Rich Plasma extraction has been surrounded by scores of debating researchers for over a decade about the composition and the method. Today, we’re going to clear up all of that by helping you choose the best Platelet-Rich Plasma (PRP) kit.

How to choose the best PRP Kit

First of all let’s talk about not using a kit. Yes, you can draw blood into a test tube, centrifuge it, take the top portion and call it PRP. That’s called “bloody PRP” and it is the least effective containing maybe 1-1.5x platelets if you’re lucky – and a whole lot of Red and White Blood Cells. This is what you should not ever think of doing because it’s not the real Platelet-Rich Plasma. In some cases, this way “bloody prp” has been known to have caused post-injection flare ups.

Using a Platelet-Rich Plasma kit on the other hand, you can get a platelet concentration anywhere between 5X and 7X the average.

How to choose the best Platelet-Rich Plasma Kit

This 5X-7X concentrated serum is what is known as Platelet-Rich Plasma or Autologous Conditioned Plasma. These professional kits allow you choose to allow or disallow red and white blood cells in your final product depending on applications. For example, researchers now suggest Leukocyte-poor Platelet-Rich Plasma for osteoarthritis and Leukocyte-rich Platelet-Rich Plasma for tendinopathy applications.

However, there are some commercial kits that may not deliver exactly what you want in your PRP.

To understand that fully, here’s a diagram of the components in blood.

How to choose the best Platelet-Rich Plasma Kit

And here’s how it will segregate itself after centrifugation.

How to choose the best Platelet-Rich Plasma Kit

Based on the technique of segregation, the kits are classified into two types.

1. Gel separators

Gel separators are those that basically nothing but a special test tube with some gel inside. It works because the gel has the density that’s in between blood and platelets. So when you fill it with whole blood and spin, the platelet portion of the blood will go to one side of the gel and the blood portion on the other side. But the biggest drawback of these gel-based PRP kits is that most of the platelets will end up getting caught in the separator gel itself. Hence the 1-1.5X concentration you get when you sequester the platelet part. One positive aspect is that the gel also separates white blood cells. So the PRP obtained is has almost zero RBC and WBC.

2. Buffy coat based

The kits that produce a visible buffy coat layer after centrifugation are the best at giving concentrations of platelets anywhere from 5X to 7X. What’s a buffy coat? Buffy coat is a thin layer, neutral or buff in color, formed between the blood and the platelet serum and are essentially plasma with suspended platelets. Now, having a buffy coat by itself will not be of much use. Instead you must be able to carefully separate the buffy coat from the RBC without contamination. When separated the right way, the buffy coat will be mostly plasma and white blood cells (leukocytes) with 5X-7X platelets concentration with less than 10% RBC.

How to choose the best Platelet-Rich Plasma Kit

3. Buffy coat based, double-spin

Yes, there is a third type of Platelet-Rich Plasma kits and those are buffy-coat based and that can do double-spin without introducing further Red Blood Cells into the mix. This is the best Platelet-Rich Plasma kit you can hope to have. Because essentially what it can help you do is sequester the Plasma + Platelets mix and do a further short run spin in the centrifuge to further isolate the Platelets. This time the platelets will be accumulated at the bottom of the Plasma serum. Once this is done, all you have to do is take the bottommost portion of the serum which will be 5X to 7X concentration of Plasma. This is what is called Platelet-Rich Plasma or Autologous Conditioned Plasma.

Getting this kind of end-product is key here as researchers have identified that for clinical benefits, the Platelet-Rich Plasma needs to be 1 million platelets per μL or more. This is 5x to 7x the normal platelet count of 200,000 platelets per μL.

How to choose the best Platelet-Rich Plasma Kit

The DrPRP Kit – Probably The Best PRP Kit

There are various kits for Platelet-Rich Plasma separation. But our kit, the DrPRP kit, is special in that it uses the dynamics of the tube design to give you full control over the end-product. You can get 10cc of usable product that you can manipulate to your specific needs. You can sequester the platelet serum and double spin it for 5X-7X above baseline platelet concentration. You can get a completely amber product or red product depending on whether you want a little red blood cells in your end product or not.

Leukocyte-Poor Platelet-Rich Plasma

When you’ve gotten the Platelet-Rich Plasma, deciding on if you need Leukocyte-poor Platelet-Rich Plasma is the next step. Although there is no consensus on the presence of leukocytes, some researchers maintain that the leukocytes are inflammatory and may inhibit the power of cytokines and growth factors to create new cells. The researchers on the other side of the argument claim that without inhibitory effect of the leukocytes there will be excessive scar tissue at the healing site. Leukocytes-Rich Platelet-Rich Plasma is known to contain more growth factors like TGF (which improves collagen synthesis), PDGF (increases cell metabolism) and VEGF (assists the formation of new blood vessels).

Other studies show that Leukocyte-rich PRP is most effective in the treatment of tendinopathy while Leukocyte-poor PRP is most effective in the treatment of osteoarthritis. It’s better that you try them out both and come to your own conclusion.

In case you need to use Leukocyte-poor Platelet-Rich Plasma, you may need a Leukocyte-Reduction (LR) filter. Conventional LR filters use electrostatic attraction in micro-sized filter membrane to retain Leukocytes while allowing the rest of the components to pass through. Drawbacks of this filter include clogging of the filter membrane half-way through the filtering process. A better LR filter is based on Controlled Incremental Filtration (CIF) method. With the CIF-LR filter, you will be able to remove 99.99% of leukocytes from the Platelet-Rich Plasma.

How to choose the best Platelet-Rich Plasma Kit

The Lack Of Clinical Evidence Myth

Let’s address ignore the elephant in the room, shall we? There are some doctors who believe that Platelet-Rich Plasma is just a fad. They say, “Show me the double-blinded peer-reviewed evidence.” It’s not that the other stuff they use for their patients are all double-blind proven and peer-approved. They just want to see it for this one. It doesn’t matter that the scientists who discovered growth factors in plasma got Nobel Prize in the 1950s. It doesn’t matter that they started using Platelet-Rich Plasma to heal gums in 1970s. It doesn’t matter than there are more than 6,000 studies on it till now. Use this search query in the NIH database and you’ll spot more than 1000 of them.

The hard evidence is of course money. Why are hundreds of thousands of customers taking out hundreds of dollars out of their wallets to pay for Platelet-Rich Plasma? Why are the independent researchers worldwide spending the very little research dollars they have (compared to the big pharma research moola) on studying this treatment?

A doctor who’s reviewed over 700 PRP treatments said the treatment has over 70% satisfaction rates with over 50% patients coming back for more.

How to choose the best Platelet-Rich Plasma Kit

An Incredible Healing Story

So far, Platelet-Rich Plasma is spreading mainly through word of mouth. Many patients take it up as the treatment of last-resort and later go on to shout it over the mountains. Here is one such story.

Three years ago, Bernie (not real name) came to see an Orthopedic Surgeon for a troubled shoulder affected by OA. After trying out the usual remedies, the OS suggested a shoulder replacement surgery. He wasn’t willing to do it. But the pain became unbearable. So the OS got him to do an arthroscopy instead. Bernie came out of the “clean out” like a new person. Unfortunately, the feeling didn’t last long.

In fact, things started getting worse. He couldn’t even hang up a shirt or pick up a pile of magazines on the floor. His arm would lock down every night. And took as much as 3 painkillers every night before sleep. As days passed, things only got worse. Then someone told him to give Platelet-Rich Plasma a shot. At this point, he was considering the OS’s original recommendation for the replacement surgery. But thought he’d try Platelet-Rich Plasma before that.

Bernie was also working with a Physiotherapist at that time. Both the PT and OS said it’s doubtful that Platelet-Rich Plasma would be beneficial – not only because the OA had advanced but also because his shoulder has 3 tears and most of bones were already worn out (his humerus was basically flat.)

Anyway, they decided to give Bernie two Platelet-Rich Plasma injections. After the injections, Bernie was told to continue the painkillers as the PRP would take some time to take effect. But what Bernie experienced was something totally unexpected.

He started improving almost immediately. And stopped taking the painkillers after two nights.

In the next two months, his shoulder became problematic only on 2-3 occasions – all while performing all the activities that he couldn’t previously perform, including activities that he wouldn’t dare think of before the injections. For example, he could ride the lawn mower for more than 45 minutes.

Needless to say, both the OS and the PT was impressed.

After seven months, Bernie has reported that he’s sleeping most nights without painkillers. After about a year, Bernie came back to say he has even less pain now. He haven’t been to the PT or the OS in several months.

Now take a guess. No points for the right answer though. Do you think Bernie will recommend PRP to others?

Check out our PRP Kit here.

How to choose the best Platelet-Rich Plasma Kit

Rheumatologits' Guide To Platelet-Rich Plasma2a
The Rheumatologist’s Guide To Platelet-Rich Plasma

Shelly (not the real name) had been suffering from Achilles Tendonitis for a while now. She has rheumatoid arthritis and celiac disease. Plus she had a minor surgery on one of her toes and it had gone a tad bit bad. She was determined to find a solution and started with all the usual treatments. When it became obvious that the solution she’s looking for is not so straightforward, she began flirting with alternate treatments. Someone suggested Platelet-Rich Plasma. And so began a love-affair.

I got my first PRP for my Achilles Tendonitis and the doctor told me to get a shot each for 8 straight weeks,” Shelly said. A bit doubtful, she stopped after the second treatment. By the third week, the Tendonitis showed more progress than all of the previous months trying so many conventional treatments. She says, ” just three simple shots and my foot was probably 75% better.”

This is what Rheumatologists can expect when they introduce Platelet-Rich Plasma to their patients.

Rheumatology Had Found A Winner

Rheumatology is one of the fields of medicine that has immensely benefited from the advances of Platelet-Rich Plasma. Because it turns out that Platelet-Rich Plasma Injection is one of the most simplest treatments for musculoskeletal diseases – those that affect the joints, muscles, and bones, swelling, and deformity.

However, they have not been pushing the limits of this novel treatment, as well as the dermatologists.

Rheumatologits' Guide To Platelet-Rich Plasma

Are you a rheumatologist?

If you are, I’m pretty sure you have tried Platelet-Rich Plasma for your patients.

And if you did, you may have saved a few of your patients from going under the knife. But not every Rheumatologist have bought into the idea of Platelet-Rich Plasma. This is unfortunate since just in the osteoarthritis segment alone there are over 27 million U.S. adults who’d be much happier if their rheumatologist had suggested Platelet-Rich Plasma Injections.

Like Kenneth (not the real name), who was part of an experimental group at a local university and got PRP Injection for his torn hip ligament. Prior to this, he was told that he’d need surgery. But three (!) years later, the pain has never really returned and he’s had no surgery.

Another patient, Desiree (not real name), said she and her husband are firm believers of the treatment. It shoved her plantar fasciitis into oblivion and gave her husband’s shoulder joints and knees a big boost.

Cases like these are not rare.

Not All Treatments Of Platelet-Rich Plasma Are Successful

We’d be the first to admit that we’ve seen quite a number of cases where Platelet-Rich Plasma failed to show improvements. Sometimes, we’ve seen cases where the same patient can have mixed results. Like Lynda (not real name) whose PRP treatment for her severely sprained right ankle worked like a charm whereas the one for her similarly compromised left big toe turned out to be a dud.

Rheumatologits' Guide To Platelet-Rich Plasma

But we can improve the chances of success dramatically by adhering to a standard for the following.

1. Concentration

By definition, PRP must contain a higher concentration of platelets than baseline. This can vary as the baseline, which is the platelet concentration in the patient’s blood, varies. But the use of a good PRP kit like this can result in a concentration that’s 5X-8X times the baseline concentration. This kit can also be used to get a downgraded sample with 2.5X – 3X times the baseline concentration, which may sometimes be required based on the treatment performed. Therefore, getting a PRP kit that only produces lower grade PRP is not advised.

2. White Blood Cells (Leucocytes)

PRP containing white blood cells have a different biologic effects than the ones without. The most popular form of PRP is L-PRP which contains Leucocytes. The DrPRP Kit which provides higher concentration of platelets delivers an end product that’s classified into three fractions: the Red Blood Cells (RBC) without platelets, the Platelet Serum in which the platelets are suspended and the Buffy Coat which contains both the platelets and white blood cells (WBCs). This makes it possible to adjust the end product to include some White Blood Cells. Because, the macrophages (circulating monocytes) present in WBC can remove debris and ingest harmful foreign particles, bacteria, and dead or dying cells to speed up the healing process.

3. The Use Of ACD

The standard protocol for Platelet-Rich Plasma requires the addition of an Anti-Coagulant (ACD) to prevent the blood clotting. The addition of ACD makes the blood more acidic than normal. This can have a negative effect on the half-life of growth factors. So in certain cases, we recommend buffering the PRP back to a physiologic range prior to injection.

Rheumatologits' Guide To Platelet-Rich Plasma

The Growth Factors In Platelet-Rich Plasma

The Platelet-Rich Plasma owes it’s healing prowess to the growth factors found in platelets. They are made accessible to the tissues and ligaments when the platelets are activated. The exact roles of these growth factors remain a bit vague at this time but from what researchers have been telling us it is evident that they support a wide range of processes in all three of the healing stages – inflammation, proliferation and remodeling.

Here’s a nice little infographic that lists out the functions of the primary growth factors in Platelet-Rich Plasma.

GROWTH FACTORS IN Platelet-rich Plasma

Clinical Evidence

1. Platelet Rich Plasma and Subacromial Tendonitis

In recent years, Platelet-Rich Plasma has proven to be effective for Subacromal tendonitis. In a study conducted by Dr. Turlough O’Donnell, MD, and Aamir H. Shaikh, MSc, MRCSEd, MCh, of UPMC Beacon Hospital in Dublin, Ireland, 102 patients were treated with PRP injections administered directly into the suprasimatos tendon (shoulder) and 102 patients were treated with treated with 20 mL solution of 0.05 percent bupivacaine and 80 mgs of methylprednisolone.

“At 12-month follow-up, patients who received a series of PRP injections were 16 times less likely to have undergone surgical intervention than patients who received corticosteroid injections,” the authors reported.

Another study by Michael Carpone DO et al, which concluded that “a single ultrasound-guided, intralesional injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory Rotator Cuff Tendonitis.”

2. Platelet Rich Plasma and Epicondylitis

Epicondylitis is often a chronic case of tendinopathy and a healing response is usually hard to obtain. Platelet-Rich Plasma’s role in this started in 2006, when in a Pilot study by Allan Mishra, 19 patients with refractory epicondylitis who were prescribed surgery, was given a single Platelet-Rich Plasma injection. After 8 weeks, patients reported 60% improvement which rose to 93% and after just two years.

In another controlled clinical study, the effect of PRP was compared with corticosteroids, in a randomized, double-blind manner with 100 patients who had chronic epicondylitis. After one year, the authors concluded that PRP significantly exceeded the clinical benefit obtained by corticosteroids.

3. Platelet Rich Plasma and Plantar Fasciitis

Plantar fasciitis is one of the bigger fields in rheumatology – and the standard procedure for rheumatologists has been to mask the symptoms using corticosteroid injections. However, in this study, platelet-rich plasma injection was found to better than corticosteroid injections at the three-month follow up.

4. Platelet Rich Plasma and Knee Osteoarthritis

There are multiple studies in the past 3 years, both controlled and open, which highlight the efficacy of Platelet-Rich Plasma for Knee Osteoarthritis. In the largest of these studies, researchers in Taiwan, conducted 8 single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials with 1543 participants to validate that Platelet-Rich Plasma does improves outcomes for patients with knee joint cartilage degenerative pathology. And does that better than Hyaluronic Acid.

However, recent research suggests that a combination of HA+PRP may be even more effective.

Platelet-Rich Plasma Knowledge Mandatory For Rheumatologists?

There is no doubt that Platelet-Rich Plasma is here to stay. And it can be the biggest item in the rheumatologist’s therapeutic rolodex. The safety, efficacy and simplicity is something that no other treatments can rival. However, as I mentioned before rheumatologists have not been taking advantage of it as much as others. Perhaps they are waiting for more conclusive evidence or insurance acceptance of the procedure, but considering that this procedure carries virtually no risk, it’s the somewhat of duty of every rheumatologist to give it a try. And come to new discoveries of their own.

You can try this at a relatively inexpensive way – with this kit and a standard lab centrifuge like this.

The medical community need more rheumatologists’ acceptance of Platelet-Rich Plasma to formalize the frequency, volume and etiquette for this life-saving procedure. After all, there are 27 million Americans at stake here.

Plus, the Platelet-Rich Plasma industry is undergoing rapid changes. New innovations are added every month. Getting in the game in these early stages will make you one of the pioneers in the field.

Here’s a recent interview with Dr. Lance Johansen who says we might see Platelet-Rich Plasma being combined with genetics like Bone morphogenetic proteins (BMPs) and DNAs to help grow new cartilage.

Amniotic Fluid Platelet-Rich Plasma-01
Is Amniotic Fluid A Ready-Made Alternative To Platelet-Rich Plasma?

There is no doubt that PRP is the king of orthobiologics. Nothing else can match it’s minimal side effects, it’s ease of preparation, cost efficiency and quick treatment times. However, there is one other orthobiologic substance that is showing some promise as a ready-made alternative, Amniotic Fluid.

The Amniotic Fluid had been capturing the imagination of orthobiologic scientists as early as 1938 – it’s an excellent source of highly proliferative, low immunogenic regenerative material. They also contain other nutrients, collagen, hyaluronic acids and growth factors in abundance making them ideal for promoting regeneration.

It even has stem cells with B7H4 that promotes wound repair and shows promise for growing robust, functional blood vessels as demonstrated by scientists at Rice University and Texas Children’s Hospital.

But the Amniotic Fluid that we’re talking about today does not contain any live stem cells because of the cryoprocedure used for storing it. But this actually our advantage since the FDA does not allow for stem cells to be present in any amniotic based product at this time.

How Amniotic Fluid Allografts Are Produced

Our doctors love this – it’s like readily injectable PRP. So your patients gain almost all the benefits of Platelet-Rich Plasma without having to go through the process of extracting it yourself.

This Amniotic Fluid that is used as Allograft product is harvested from pre-screened mothers who had consented to donating their Amniotic Fluid at the time of c-section delivery. The fluid is then tested again in a laboratory before preparing them in a neat, ready-to-use format that can be instantly utilised for a wide variety of healing needs.

The one thing that makes Amniotic Fluid an excellent allograft is its low immunogenicity – it does not express the Class II antigens – making it unlikely to cause an immune response in other humans. Plus, these tissues are known to be anti-inflammatory, anti-microbial and anti-adhesive just like Platelet-Rich Plasma.

And did I mention they are multipotent cells? The best candidate for use as regenerative medicine.

While Amniotic Fluid does not have the advantage of being fully autologous like Platelet-Rich Plasma, the huge amount of collagen, elastin and fibronectin in Amniotic Fluid Allograft make it an excellent orthobiologic substance for skin regeneration. It also contains the usual growth factors PDGF, VEGF, EGF, FDF and TGF-B.

Amniotic Fluid Platelet-Rich Plasma-02

Allogen™ Amniotic Fluid Allograft

AlloGen is a new Amniotic Fluid product by New Life Regenerative Medicine that can be used intraoperatively or through injection therapies to improve chronic pain, sports injuries, arthritis, difficult to treat wounds and even the signs of aging.

Our doctors use it with Platelet-Rich Plasma to enhance the effect of the therapeutic injection. You can also combine it with hyaluronic acid, or bone marrow aspirates.

The product comes in two forms Allogen for use in hospital procedures and Allogen LI as an injectable for in-office procedures.

Allogen LI can also be used for cosmetic enhancement in conjunction with other facelift procedures.

The specifications of Allogen
Name: Allogen™
Category: Human Cell Tissue Product (FDA 361)
Constituents: Growth Factors
Cytokines
Collagen
Fibrinogen
Hyaluronic Acid
Messenger RNA
Protein
Source: Amniotic Fluid of pre-screened, consenting mothers during planned cesarean section
Shelf Life: 2 years when kept frozen at -65°C degrees to -85°C
Patient criteria: Same criteria as Platelet-Rich Plasma – most patients are eligible.
Packaging: Aseptically processed, packaged and cryopreserved (not sterile) stored on dry ice.

Amniotic Fluid Platelet-Rich Plasma-03

We’re Excited About The Potential Of This

We believe this is an excellent alternative to Platelet-Rich Plasma for those who don’t want to invest in the equipment and kits used for PRP Injections. And for those who’re new to regenerative medicine, this provides a stepping stone towards Platelet-Rich Plasma and possibly stem cells.

We are confident that once you get hooked to the potential of regenerative medicine, you’ll never do another procedure for sports injuries, tendon/ligament repair, chronic wounds and arthritis without it.

And possibly that will save a few of your patients from having to go under the knife.

Contact Us To Get Started With Allogen

Use the contact form below for a friendly no-obligation consultation to see if Allogen can really help in your field of speciality practice. We have so much research information, practice tips and specialty-specific advice to share with you.

You can also call us at (844) 377-7787.

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Dentox Platelet-Rich Plasma Botox Training
New Live Botox, Dermal Filler And Platelet-Rich Plasma Training

If you’ve been looking to up-level your facelift strategies with Botox, Platelet-Rich Plasma Training And Dermal Fillers, we have excellent news for you.

The wonderful Dr. Katz has agreed to partner with DrPRP for a series of one-day LIVE intensive workshops (on Saturdays, the next available one is in September) on his latest Dentox X-Lift procedure. It will feature the following:

  1. Botox Training
  2. Dermal Fillers Training
  3. Platelet-Rich Plasma Training
  4. The Dentox Lift Technique Training

Learn more about the training below or click the link below to register.

About Dr Howard Katz

Dr Howard Katz is one of the top experts and visionary in the field of face lifts and dental reconstruction. His name was included on Allergan’s Botulinum toxin (Xeomin, Dysport, Botox) patent applications for dental therapies as well as gel filler (Dermal fillers) formulations and Oraverse anesthetic reversal. You can read more about Dr Howard here.

About the Platelet-Rich Plasma Training

DrPRPUSA is honored to be able to team up with Dr. Howard Katz and the team at Dentox to organize this leading edge training on Platelet-Rich Plasma and facelifts. As Dr Katz is an actual scientist-dentist-clinician named on the intellectual property for Botox and gel fillers, you can expect the best hands-on training like the kind you’ve never experienced before.

DrPRP USA Platelet-Rich Plasma Training

The is one-day intensive program offers everything you need to expand your skill set and boost your bottom line if you’re a doctor, dentist, nurse and other qualified medical professionals in the facelift industry.

It will be featuring DrPRP USA Platelet-Rich Plasma kits and DrPRP Dermal filler makers.

Here’s the registration page and full details >>

Here’s Dr. Howard Katz himself explaining the key highlight of the event:

The training includes:

Hands-On Botox Training

Practice Botox on live patients and become completely confident in properly injecting Botox and related products.

  • Learn the latest FDA-approved procedures for Botox, Dysport and Xeomin from an instructor with more than 30 years experience
  • Get the skills to bring both cosmetic and therapeutic Botox injectables to your practice
  • Gain an understanding of documentation and legal requirements
  • Pick up tips on marketing and promoting your skills for the biggest possible income boost
  • Explore how to get more from your existing clients and bring in new clients too
In-Depth Dermal Filler Training

Learn how dermal fillers can satisfy patients and help prevent and reverse the signs of aging.

  • Explore how you can create natural-looking smoothing and reduce wrinkles with carefully placed injections of dermal fillers
  • Pick up the skills necessary for using Restylane, Juvederm Ultra, Juvederm Ultra Plus and other dermal fillers
  • Understand how choosing the right products leads to be best results
  • Find out how to correct your mistakes and the mistakes of others
  • Gain all the info you need to document, market and expand your practice with dermal fillers

Platelet-Rich Plasma Training Cosmetic

Cutting-Edge Platelet Rich Plasma (PRP) Training

Get ahead of your competition by bringing innovative PRP treatment to your practice for quicker healing and less expensive cosmetic procedures.

  • Learn how a patient’s own blood can be condensed into a powerful tool for cosmetic and therapeutic purposes
  • Ways to enhance bone grafting and tissue grafting, keeping treatments/profits in-house, and greater patient satisfaction from more painless, faster healing results
  • Gain the knowledge you need to use PRP therapy in place of dermal fillers for the same results at lower cost to you
  • Examine the ways to market your new skills while complying with the law
The Exclusive Dentox LIFT

Innovated by Dr. Katz, the Dentox LIFT allows you to perform a non-surgical facelift, with stunning results in under 30 minutes. No general anesthetic is required, there is no scarring, and results last for 1-2 years. Attract new patients, and offer your current patients this treatment to enhance their cheekbones, define a youthful jawline, and smooth their under-eye areas.

PLUS More extras including:

⇒ Proven Marketing Techniques
⇒ Free Staff Member Attendance
⇒ Patient Forms
⇒ 10 Hours Continued Education Credits
⇒ Courses include free access to the live, online Botox and Dermal Fillers refresher programs (4 additional credit hours each).. up to 18 total CE credits!

DrPRP USA Platelet-Rich Plasma Training

I believe this is a unique opportunity not only to learn from one of the nation’s pioneers in the facelift industry, also to meet other cool amazing people who’re rocking it in this space so you can learn from them and drastically improve your practice or clinic bottom line.

Registration is open now – it’s all online takes about 5 minutes of your time – and seats are filling fast 🙂

You can learn more about it all here >>

 

Here’s Why Dr OZ’s HealthCorps Gala 2017 Is A Must-Attend

It’s here. 🙂 DrOz’s HealthCorps Gala, one of the slickest networking event that medical professionals all over the nation can attend on a relatively low budget (and feel good about it) is happening this April.

Yes, we’re talking about the HealthCorps Gala 2017 event happening in New York. It brings together over 600 wellness “wellness influencers, celebrities, medical practitioners, institutional and individual philanthropists” to raise funds for HealthCorps.org.

DrPRPUSA-DrOZ-HealthCorps-Gala-Support

For those of you who don’t know, HealthCorps is a pioneering non-profit organization by Dr Oz to empower the teens to improve their physical and mental health that will lead to a more productive and happier lifestyle. His vision is bold – by empowering the teens to make positive choices in health, wellness and attitude, he’s providing our nation with healthy dose of clear-thinking that can rescue us from all potential problems in the next few years.

The aim is to install in high school students a healthy lifestyle, good self-esteem and an attitude of resilience.

The way HealthCorps does that is by providing high school students access to a full-time Coordinator to mentor them and organize a variety of during and after school activities.

That in itself is a worthy cause to support.

Obviously, we’re huge supporters of HealthCorps.

DrPRPUSA-DrOZ-Patti-Dixon-HealthCorps-Gala

Here’s our own Patti Dixon with Dr. Oz.

But even if you don’t believe in that cause…

It’s Hard To Dismiss The Biggest Networking Opportunity For Healthcare Practitioners

Yes, that’s right.

HealthCorps’ 11th annual fundraiser sticks to it’s reputation for the biggest (and stylish) event that gathers over 600 of the kind of people that we, medical professionals, like to be surrounded with.

Past guests include personalities such as movie star Hugh Jackman, media personality Phil Donahue, billionaire oilman Harold Hamm, celebrity chef Rocco DiSpirito, music legend Quincy Jones, music producer Russell Simmons, fashion legend Donna Karan and rapper LL Cool J.

That’s what we’re talking about. And according to participants, it’s one of the must-attend events for medical practitioners.

Those who have purchased the tickets can expect an epic glamorous night at the largest waterfront venue in Manhattan, Pier Sixty. For those who haven’t bought the tickets, here’s ticketing page for more information.

Visit DrPRPUSA At KIMES 2017

We’re glad to announce that DrPRP USA will be represented at the 33rd Korea International Medical And Hospital Equipment Show 2017 (KIMES 2017). Our guy Brandon Lee will be at B hall – L121. If you’re going, please drop by. 🙂

Drprpusa Platelet-Rich Plasma kimes 2017

Drprpusa Platelet-Rich Plasma kimes 2017

Drprpusa Platelet-Rich Plasma kimes 2017

 

A little bit about KIMES 2017

KIMES 2017 will happen on March 16-19 in Seoul and features more than 1,000 medical product suppliers from all over the world. You will see the latest cutting-edge consultation, diagnostic and medical device products.

This is Korea’s equivalent of our FIME (Federation of International Medical Equipment Suppliers) and if you want to stay on top of the latest trends in medical industry, this is the place you want to be.

drprp prp kit samples

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