Frequently Asked Questions

The initial orthopedic consultation with Dr. Silva is $500 for an in-office visit or telemedicine visit, which includes a thorough review of your medical records, a physical exam, and a diagnostic ultrasound of peripheral joints, if applicable.

Please note: The consultation fee does not include any treatment procedures.

Yes! We offer telemedicine consultations for patients who can’t visit in person right away. You’ll receive the same level of attention and care planning as an in-office visit. We’ll coordinate everything for your trip, including exams and treatment. An all-in-one visit if needed.

Dr. Silva doesn’t require X-rays, MRIs, or CT scans for your first consultation. If imaging is needed, he’ll order it. But if you already have recent scans, bring both the report and a CD copy to your appointment. This helps him assess your condition more accurately without unnecessary delays or duplicate tests.

During your first visit, Dr. Silva will take time to understand your condition, review your records, and discuss personalized treatment options. You’ll receive a full outline of recommendations, pricing, and pre- and post-procedure instructions so you know exactly what to expect.

Regenerative medicine is a non-surgical way to treat pain by helping the body heal itself. We use treatments like PRP, prolotherapy, and stem cell therapy to repair tissue, restore movement, and reduce pain. Everything we do is based on real results and guided with advanced imaging.

Dr. Silva recommends a personalized plan before and after your procedure to improve results. This often includes rehab exercises, adjusting medications, and using braces if needed. Your full protocol will be discussed during your visit and designed to help you recover fully and avoid setbacks.

When tissue is injured, platelets release growth factors that signal the body to begin healing. PRP concentrates those platelets and delivers them directly into the damaged joint, tendon, or ligament. This can reduce inflammation, support tissue repair, improve joint stability, and encourage healthier regeneration over time. Because placement matters, IOW performs all PRP injections under ultrasound or fluoroscopic guidance rather than by feel.

PRP is most often used for musculoskeletal problems: chronic joint pain, tendon and ligament injuries, sprains and strains, joint instability, mild-to-moderate osteoarthritis, and inflammation-related pain. It's frequently chosen by patients who want to avoid steroid injections or delay surgery. The right fit depends on which tissue is involved and how advanced the condition is.

For the right patient, PRP can be a strong alternative to repeated cortisone shots or surgery — it targets the source of the problem rather than masking pain. A published cohort study of PRP for knee osteoarthritis found response rates of roughly 75% in patients with mild arthritis, 66% with moderate arthritis, and just over 50% with severe, bone-on-bone disease at one year — a pattern that matches what IOW sees clinically: PRP helps most with tendon and ligament injuries and early-to-moderate arthritis, and less with end-stage degeneration. Many patients weigh PRP's one-time cost against years of medication or a surgical recovery.

Source (verify/replace before publishing): Yurtbay et al., “Predictors of Effectiveness of Platelet-Rich Plasma Therapy for Knee Osteoarthritis: A Retrospective Cohort Study” — responder rates by Kellgren-Lawrence grade at 12 months.

PRP pricing depends on the condition treated and how many areas need care, so a precise figure comes after your consultation. Because PRP targets the underlying tissue, many patients find it cost-effective compared with ongoing pain medication, repeated steroid injections, or the total cost of surgery and its recovery. See the Insurance & Cost FAQ for a full pricing breakdown.

Both are regenerative injections, but they work differently — here's how they compare:

They aren't mutually exclusive — at IOW they're sometimes combined, depending on which tissue is involved and your goals.

PRP is a gradual process, not an instant fix. Many patients notice temporary soreness or swelling in the first days — a normal part of the healing response — with functional improvement over roughly 4 to 12 weeks as tissue remodels. Some conditions need a short series, and IOW builds a rehab plan around your specific timeline.

Mild soreness, swelling, or stiffness at the injection site is expected and usually eases within days to a couple of weeks — it reflects the inflammatory healing response PRP is designed to trigger. Some patients feel briefly run down afterward. Pain that is severe, worsening, or accompanied by fever, spreading redness, or warmth is not typical and should prompt a call to IOW so we can check for infection or another issue.

Because PRP relies on a healthy inflammatory response, patients are generally asked to stop NSAIDs (like ibuprofen) for about 7–10 days before and after treatment, since these blunt healing — always confirm with your physician first. Supportive nutrients such as vitamin D, magnesium, and collagen are commonly discussed as part of recovery, but timing and suitability are individual. IOW gives you a personalized pre- and post-procedure plan rather than one-size-fits-all rules.

PRP may fit patients who have joint, tendon, or ligament injuries, are in early stages of arthritis, haven't improved with physical therapy or medication, want a non-surgical biologic option, or are trying to avoid repeated steroid injections. IOW confirms candidacy with a physical exam and diagnostic ultrasound before any treatment is scheduled.

BMC contains cells that help regulate inflammation and support the body’s natural repair process. Placed precisely into damaged tissue under image guidance, it may improve joint function and reduce pain over time. It’s typically considered for more advanced degeneration or complex injuries where deeper regenerative support is warranted.

Adipose-derived stem cells are harvested from your own fat tissue and processed into a concentrated cellular product that helps regulate inflammation and support the body’s natural repair process. Placed precisely into damaged tissue under image guidance, they may improve joint function and reduce pain over time. Adipose-derived therapy is typically considered for more advanced degeneration or complex injuries where deeper regenerative support is warranted.

No. Products made from amniotic, placental, or Wharton’s jelly tissue do not contain living stem cells, despite how they’re marketed. Evidence-based orthopedic care uses your own stem cells, derived from bone marrow or fat, combined with your own growth factors and precise, image-guided placement. IOW does not offer donor “stem cell” products that lack live cells.

Watch for these red flags:

• Claims that treatments “cure” a serious disease
• Donor “stem cell” products that contain no live cells
• Injections performed without imaging guidance
• Pricing that seems too good to be true
• Providers without fellowship training in interventional orthopedics

Legitimate care is grounded in diagnostics, realistic expectations, and published evidence. IOW’s physicians are fellowship-trained in interventional orthopedics, and every injection — PRP, BMC, or adipose-derived — is placed under ultrasound or fluoroscopic guidance, never by feel. We welcome questions about where your cells come from and how they’re delivered.

Patients with joint, cartilage, tendon, or ligament damage who want to avoid or delay surgery may be candidates. It’s commonly considered for knee arthritis, cartilage defects, tendon injuries, ligament damage, and some spine-related issues, but it isn’t appropriate for every condition. IOW confirms candidacy with a consultation, imaging, and a review of what’s already been tried.

When performed using your own cells and image guidance, published research reports encouraging outcomes, though risks and results vary. A 2024 prospective cohort study in Scientific Reports followed 37 knees with severe osteoarthritis for four years: 35 improved, a 95% success rate, and none underwent knee replacement during follow-up. Because this was a small study without a control group, it does not establish that treatment will work for every patient. IOW reviews the realistic evidence for your specific condition during consultation.

For some patients, yes. Stem cells are often considered for knee osteoarthritis, cartilage wear, and certain meniscus or ligament injuries when the goal is to preserve the joint and avoid or delay replacement or surgery. It works best for moderate degeneration rather than end-stage, bone-on-bone arthritis. Imaging and an exam determine whether your knee is a good fit and whether PRP, BMC, or adipose-derived cells is the better tool.

Stem cell therapy from fat or bone marrow usually costs more than PRP because collecting and processing the tissue is a more involved procedure. Exact pricing depends on your condition and treatment plan and is shared as a full breakdown after consultation. Many patients find the cost lower than expected for the level of diagnostics and image-guided care involved.

Prolotherapy creates a controlled healing signal at damaged ligaments or tendons. The injected solution triggers a localized inflammatory response that prompts the body to produce new collagen and strengthen the treated tissue. Over time this can improve joint stability, reduce pain, and address the underlying cause of chronic instability rather than masking symptoms.

Prolotherapy is commonly used when ligament laxity or soft-tissue weakness drives pain or dysfunction — including chronic neck or low back pain from ligament instability, shoulder instability or rotator cuff strain, knee or ankle instability after repeated sprains, tennis elbow and other tendon injuries, plantar fasciitis, and certain cases of osteoarthritis. The pattern of ligament involvement on exam and imaging determines whether it's the right fit.

Both are regenerative injections, but they target different problems — here's a side-by-side look:

They can be combined — the right option depends on which tissue is failing and your goals.

Because ligaments heal gradually, prolotherapy is usually delivered as a series — commonly 3–6 sessions spaced several weeks apart. The exact number depends on the severity of the injury, the joint involved, and how your body responds over time. Your plan is mapped out at consultation.

Performed by trained providers under image guidance, prolotherapy is considered safe, and serious complications are uncommon because it uses non-toxic solutions that target the body's own repair process. Published research backs this: a controlled study of dextrose prolotherapy for ACL laxity found significant, sustained improvements in pain, swelling, and range of motion through 3 years of follow-up. The most common side effect is temporary soreness or stiffness at the injection site, which usually settles within a few days.

Source (verify/replace before publishing): Reeves & Hassanein, “Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity” — 3-year follow-up outcomes.

Prolotherapy may suit patients with chronic joint or soft-tissue pain linked to ligament or tendon injury, those who experience instability rather than severe structural damage, and people who want to avoid surgery or repeated steroid injections after rest, physical therapy, or medication haven't helped. Imaging is often used to confirm candidacy and guide treatment.

Sometimes. For moderate knee arthritis or cartilage wear, regenerative options like PRP or stem cells may reduce pain and improve function enough to delay or avoid replacement, especially when combined with rehab. They're less effective for end-stage, bone-on-bone arthritis, where replacement may still be the best answer. A diagnostic exam and imaging give you an honest read on which category your knee falls into.

It depends on severity — here's how IOW typically maps treatment to the stage of arthritis:

IOW recommends one, the other, or a combination based on imaging, exam findings, and your activity goals.

Some meniscus tears — particularly degenerative ones — can improve with regenerative treatment and rehab rather than arthroscopic surgery. PRP or stem cells may support healing and calm inflammation around the tear, and image guidance lets us target it precisely. Not every tear is a candidate; the pattern, location, and your symptoms guide the recommendation, which is why diagnosis comes first.

Knee pain often stems from ligament sprains (such as ACL or MCL), meniscus tears, tendon damage, arthritis, or post-surgical complications. The knee also links closely to the hips, ankles, and low back, so dysfunction elsewhere can show up as knee pain. IOW uses movement analysis, exam, and diagnostic ultrasound to pinpoint the true source rather than treating symptoms alone.

Most patients ease back into low-impact activity within days, but return to higher-demand Eastside favorites — skiing the passes, cycling the Lake Washington loop, or pickleball — is staged, often over several weeks, because regenerative treatment works as tissue gradually remodels. Pushing too hard too soon can undercut the healing you're paying for. IOW gives you a specific return-to-activity timeline tied to your treatment and goals.

IOW combines movement analysis, a physical exam, diagnostic ultrasound, and image-guided diagnostic injections to identify precisely which structure is generating pain. That precision means treatment targets the actual problem — not a guess — for faster, more effective recovery.

Back pain can originate from discs, facet joints, nerves, the SI joint, or supporting muscles like the glutes and multifidus — and pain often refers from one area to another. IOW uses diagnostic ultrasound, functional assessment, and image-guided diagnostic injections to pinpoint the true source before treating, so care is specific rather than trial-and-error.

Many disc-related and sciatica cases improve without surgery. Depending on the source, IOW may use image-guided injections, regenerative treatments to support irritated tissue, and a structured rehab plan to reduce nerve irritation and rebuild stability. Severe cases with progressive weakness or structural instability may still need a surgeon, and IOW will coordinate that — but most patients never reach that point with a regenerative-first approach.

SI joint pain often involves both ligament laxity and tendon irritation — here's how IOW chooses between the two:

The choice follows a diagnostic exam and often image-guided blocks to confirm the SI joint is the true pain generator.

Yes. Many IOW patients arrive with post-surgical pain, hardware-related discomfort, or scar tissue. Targeted, image-guided regenerative treatments can address these residual issues and support better function even after prior procedures. Care is tailored to what the previous surgery did and didn't resolve.

Many patients resume light activity and driving within a day or two, but it depends on the injection, the area treated, and whether sedation was used — some procedures require arranging a driver for the same day. IOW gives you specific pre- and post-procedure instructions, including when it's safe to get back to your Eastside commute, desk work, or heavier activity.

If your back pain lasts longer than a few weeks, radiates into your legs, or disrupts daily life, it's time for expert evaluation. Early intervention often prevents a manageable problem from becoming a chronic one — and can reduce the likelihood of needing surgery later.

Hormone imbalances often show up as ongoing fatigue, weight gain, poor sleep, low libido, mood changes, brain fog, or reduced physical performance and recovery. Because these symptoms overlap with many other conditions, symptoms alone do not confirm an imbalance. The most reliable way to know is lab testing combined with a clinical evaluation.

Diagnosis begins with a physician review of your symptoms, medical history, current medications, and goals, followed by clinically appropriate lab testing. For men being evaluated for testosterone therapy, that usually means compatible symptoms plus low testosterone labs. For women, decisions depend on lab values but also symptoms, age, timing, and personal and family history. Some patients need additional testing or follow-up before a plan is finalized. We always check other components of health like vitamins, nutrients, inflammation and other biomarkers to ensure you have what you need to get healthy.

Options are individualized and may include bioidentical hormone replacement (BHRT) or, for selected adults, FDA-approved hormone therapy for a confirmed deficiency or menopause-related symptoms. Common delivery methods include:

Delivery method and dosing are chosen based on safety, effectiveness, lifestyle, and monitoring needs. Not every patient needs hormone therapy. We do only work with bioidentical hormones and do not tend to prescribe other synthetic types of hormones.

Bioidentical hormones are chemically identical to the hormones your body makes. When guided by proper testing, physician oversight, and regular follow-up, hormone therapy is considered safe for appropriately selected patients. Safety depends on the individual, since potential side effects, contraindications, fertility effects, and monitoring needs vary by therapy, which is why ongoing lab monitoring is part of the plan. Hormone therapy is not appropriate for everyone.

You may be a candidate if you have compatible symptoms and lab findings that point to a hormone imbalance. Hormone therapy is not right for everyone, and symptoms alone do not confirm a deficiency. Candidacy depends on your symptoms, medical history, current medications, risk factors, and lab results. In some cases, referral to primary care, endocrinologist or another specialist may be the better next step. A consultation is required to determine what fits you. We do not perform primary care services here.

Risks and side effects depend on the specific therapy, dose, and delivery method, and some therapies have effects on fertility that are discussed in advance. This is why IOW reviews benefits, risks, alternatives, and monitoring needs with you up front, and why lab follow-up continues during treatment. Results are not guaranteed, and the plan is adjusted based on how you respond.

Men and women have distinct hormone needs, so evaluation and treatment differ. Men are typically evaluated for testosterone therapy using symptoms plus testosterone labs. For women, menopause and perimenopause decisions weigh symptoms, age, timing, and personal and family history against individual risk factors. In both cases, treatment is recommended only for a defined clinical indication, with individualized dosing which is adjusted over time to your needs.

Some patients notice improvements in energy, sleep, or focus within about two to six weeks, while other benefits develop more gradually over several months. Results vary based on your baseline hormone levels, overall health, and how consistent you are with follow-up care. The goal is steady, monitored progress, not an overnight change.

Some hormone optimization therapies are covered but other types of therapies are elective and are not covered by insurance. IOW offers transparent pricing and financing options, and exact costs depend on your evaluation, the therapy selected, and monitoring needs. A consultation gives you a clear plan and pricing before you decide.

The stellate ganglion is a cluster of nerves in the neck that helps drive the sympathetic, or fight-or-flight, response. By placing local anesthetic near this bundle, SGB can temporarily quiet overactive sympathetic signaling. For some patients this calms hyperarousal and supports autonomic regulation, which may make other treatments such as therapy or medication more effective. Response and duration vary from person to person.

SGB may be considered for symptoms linked to an overactive sympathetic nervous system, including PTSD-related hyperarousal, anxiety symptoms, dysautonomia and POTS, and persistent Long COVID symptoms. It is used as an adjunct alongside standard care, not as a stand-alone cure. A consultation determines whether your symptoms and history make SGB a reasonable option.

No. SGB does not erase trauma, cure PTSD, or permanently reset the nervous system. It is intended to temporarily reduce sympathetic overactivity, which may ease symptoms and create room for evidence based mental health care to work. It does not replace therapy, medication, or standard medical treatment. Benefits, how long they last, and whether more treatment is needed vary by patient.

When performed by trained physicians with image guidance, SGB is generally well tolerated. Temporary and expected effects can include eyelid drooping, a hoarse voice, mild swallowing changes, warmth in the arm, or nasal congestion on the treated side, which usually resolve as the anesthetic wears off. Uncommon but serious complications are possible, which is why a consultation reviews bleeding risk, infection risk, anatomy, and other contraindications first.

SGB is a minimally invasive, in-office injection. IOW uses ultrasound to guide placement near the cervical sympathetic chain. The injection itself takes only a few minutes, with additional time for preparation and a short monitoring period afterward. Most patients go home the same day and receive specific aftercare instructions.

Some patients notice a change within hours to days, while others feel less or nothing at all, since responses vary. When relief occurs, it can last from weeks to months or longer. Some patients choose a single-block trial first to see how they respond before committing to an individualized treatment plan, and some need repeat injections for longer-term benefit.

There is no fixed number. Care often starts with a single-block trial to gauge your response, and the plan is adjusted from there. Some patients do well with one or two injections, while others benefit from a short series. Your physician builds the plan around your symptoms, your response, and your goals. It is recommended that you try both sides to start and then continue on the side that is most effective, which is usually the right side.

SGB may fit selected patients with sympathetically driven symptoms who are already engaged in standard care and want an adjunctive option. It is not appropriate for everyone. Active infection, certain bleeding risks, some anatomical factors, and other contraindications can rule it out. A consultation is required to review your symptoms, medications, and medical history before SGB is considered.

SGB is meant to work alongside, not replace, evidence-based mental health care and standard medical treatment. It is generally an elective procedure and often not covered by insurance, so coverage and cost are reviewed during your consultation. IOW offers transparent pricing, and a physician will confirm whether SGB is a reasonable next step for your symptoms and goals.