Category Archives: Platelet Rich Plasma Injections


Hair Loss Got You Down? Platelet-Rich Plasma May Regrow It … – Health Essentials from Cleveland Clinic (blog)

Are you looking for a hair loss solution? A therapy that promotes healing in injured joints may help restore your lost hair.

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About 50 million American men and 30 million womenhave male- or female-pattern baldness. It can begin early in life, but is much more common after the age of 50, when more than 50 percent of men will experience some kind of hair loss.

However, an emerging treatment platelet-rich plasma (PRP) therapy appears to help regrow lost hair. And, there are virtually no side effects from PRP, except for a mild feeling of pressure at the injection site, saysdermatologist Shilpi Khetarpal, MD.

Physicians began using PRP therapy about a decade ago to speed up the healing process in damaged joints after injury or surgery.

During the treatment, a technician draws your blood and spins it in a centrifuge to separate out the platelets and plasma. Doctors then inject the plasma, which helps repair blood vessels, promote cell growth and wound healing, and stimulate collagen production.

Doctors began using PRP in dermatology after researchers found that high concentrations of platelets in plasma cells help promote hair growth by prolonging the growing phase of the hair cycle.

Doctors inject plasma into the scalp where hair loss has occurred. They typically administer injections monthly for three months, then spread them out over about three or four months for up to two years. The injection schedule will depend on your genetics, pattern and amount of hair loss, age and hormones.

Because the treatment is cosmetic, insurance does not cover the procedure, Dr. Khetarpal says. The cost ranges between $500 and $1,000 per injection session.

Other treatments for hair loss currently on the market are often more problematic for many patients, Dr. Khetarpal says.

There are two FDA-approved medications for treating hair loss: finasteride and minoxidil.But you must take these drugs consistently over time and results are inconsistent, she says.

Each drug also sometimes has side effects:

Hair transplantation is another option, but it requires cuts in the scalp and recovery time is longer, she says.

Because it is a surgical procedure, doctors typically recommend hair transplantation only for those who have dramatic hair loss. A transplant is also more costly and leaves scars. Doctors can perform PRP therapy prior to transplantation, which can provide better results with more dense hair growth, Dr. Khetarpal says.

Recent research bears out the potential of PRP therapy.

In a 2014 study, researchers in India looked at men with male-pattern baldness who used both approved medications, but saw little change in their hair growth.

After four PRP treatments, they had about 30 percent more growth in thinning areas.

A 2017 study out of Italy also found male patients had increased hair and density in areas where doctors used PRP therapy.

Dr. Khetarpal says it takes about three months to see an improvement. After that time, most of her patients both male and female have regrown 30 to 40 percent of the hair theyve lost.

Part of the success of PRP comes from selecting the right patients for therapy, Dr. Khetarpal says. PRP is safe and effective for many people. However, you should not have PRP therapy if you fall into either of these groups:

PRP therapy works better if your hair loss is recent. It is more challenging to wake up hair follicles that have been dormant for a long time, Dr. Khetarpal says.

I tell people I can get your hair back to what it was five years ago, she says. If your hair loss is older, you may see some recovery, but its likely not worth your investment of time and money.

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Hair Loss Got You Down? Platelet-Rich Plasma May Regrow It ... - Health Essentials from Cleveland Clinic (blog)

Platelet-rich plasma injections for osteoarthritis of the …

The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Platelet-rich plasma injections for osteoarthritis of the knee, in May 2014.

Osteoarthritis of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint. Articular cartilage deteriorates because of trauma and wear and tear. This leads to exposure of the bone surface. Symptoms include pain, stiffness, swelling and difficulty walking.

Treatment depends on the severity of the osteoarthritis. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility. When symptoms are severe, surgery may be indicated: options include upper tibial osteotomy and unicompartmental or total knee replacement.

W90.3 Injection of therapeutic substance into joint

Y53.2 Approach to organ under ultrasonic control

Z84.6 Knee joint

X36.8 Other specified blood withdrawal

In addition a code from the ICD-10 category M17 Gonarthrosis [arthrosis of knee] would be recorded.

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Platelet-rich plasma injections for osteoarthritis of the ...

POINT OF VIEW: Battle opioid crisis by treating pain without narcotics – Palm Beach Post

The misuse of opioids, including prescription pain relievers, has led to an explosion of narcotic addiction and narcotic-related deaths. It is now considered an epidemic. Physicians are thought to be a major contributor to this increase in addiction, as they readily prescribe narcotics for pain relief following injury and surgery, leading to an increase of people who are becoming addicted to these substances. Once physicians stop prescribing these medications, these addicted individuals seek other sources. Of course, the purity and safety of drugs purchased outside the medical-pharmaceutical establishment are additional factors causing injury and death.

There is another way to treat acute injury. The solution is to find alternatives to surgery. Rapid treatment of injuries reduces the inflammation and pain, and avoids the use of narcotics.

Injury initiates an inflammatory response that protects against infection and initiates the healing response. Persistent inflammation, however, causes further tissue damage. Delayed treatment and persistent inflammation cause even further harm to the already injured part of the body.

A recent study of 111 patients compared standard physical therapy and conservative treatments to early injection therapy for acute injury. Thirty percent of the patients had neck injuries, 10 percent had mid-spine injuries and 60 percent had low back injuries. Patients treated more timely had significantly improved outcomes, and most of those treated immediately after injury demonstrated complete recovery. None of the patients medically treated immediately after injury required narcotic medication. This and other recent studies suggest that rapid medical treatment of injuries substantially reduces both the degree of impairment and the amount of narcotic use following accidents and trauma.

Physicians can help stop the opioid crisis by limiting the prescription of pain relievers and looking to other effective treatment options, including laser treatment, platelet rich plasma therapy, steroid injections and other alternatives. As physicians, we need to educate our patients on the importance of rapid treatments, getting to the source of the pain quickly and finding solutions and therapies that address those specific issues directly.

LAWRENCE GORFINE, WEST PALM BEACH

Editors note: Dr. Lawrence Gorfine is president of the Palm Beach Spine & Diagnostic Institute.

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POINT OF VIEW: Battle opioid crisis by treating pain without narcotics - Palm Beach Post

Bears continue to mix and match on O-line with Kyle Long limited … – Chicago Sun-Times

With Prospect High School as their setting, the Bears continued to prepare themselves for a future without guard Kyle Long.

Long returned to practice Thursday but didnt participate after undergoing treatment on his surgically repaired right ankle a day earlier.

Coach John Fox said Long met with the doctor who originally performed his surgery in December in Charlotte, North Carolina.

It was pretty convenient, Fox said. We actually planned it about a week ago. Its just timed that way. I thought it went well. And we held him back today. The treatment they did usually requires 24 hours off, but he feels a lot better. Were excited to get him going again.

Bears guard Kyle Long. (AP)

Fox didnt specify which treatment Long underwent, but platelet-rich plasma (PRP) injections, which promote healing, can require a downtime of 24 hours.

With Long out, Hroniss Grasu practiced at center with the first-team offense, and Cody Whitehair was at left guard.

Its a look the Bears experimented with in Bourbonnais, but it also could be their starting look Saturday in the preseason game against the Cardinals.

There is flexibility that we need in the line, Fox said. Well see how it goes and how we start. We still havent met in really how were going to approach the game as a staff yet.

Another possibility is keeping Whitehair at center and playing Grasu at left guard.

[Grasu is] going to have to know both, Fox said. Hes going to have reps at both.

QB order

The Bears will maintain the same order at quarterback against the Cardinals: starter Mike Glennon, backup Mark Sanchez, then No. 3 Mitch Trubisky.

In and out

Linebackers Danny Trevathan (knee) and Nick Kwiatkoski (concussion) and defensive lineman Akiem Hicks (sore Achilles tendon) participated in practice in various capacities.

Cornerback Prince Amukamara (hamstring), defensive lineman Mitch Unrein (concussion) and nickel back Bryce Callahan (ankle) did not participate.

Follow me on Twitter @adamjahns.

Email: ajahns@suntimes.com

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Bears continue to mix and match on O-line with Kyle Long limited ... - Chicago Sun-Times

Study: Implicit hype? Representations of platelet rich plasma in the news media 5 things to know – Becker’s Orthopedic & Spine

After seeing athletes like Tiger Woods, Tom Brady and Kobe Bryant use platelet rich plasma to treat their injuries, consumers have been more motivated to treat their injuries with the same treatment.

However, a recent study by Tim Caulfield, Canada Research Chair, published in PLOS, showed this form of treatment may be exaggerated by the media.

Here are five things to know:

1. In the United States, 87.1 percent of news articles about platelet rich plasma were sports related stories.

2. Of the articles published about platelet rich plasma, 64.8 percent included a brief description of the procedure while 32.5 percent included a detailed description.

3. Approximately 67 percent of articles portrayed platelet rich plasma injections as a routine procedure and 22 percent portrayed the injections as new or cutting edge.

4. In total, 11.7 percent of the articles published described the injections as being experimental.

5. In the end, 23.8 percent of platelet rich plasma injections articles described the treatment as effective.

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Study: Implicit hype? Representations of platelet rich plasma in the news media 5 things to know - Becker's Orthopedic & Spine

Sports hype of platelet-rich plasma ‘powerful marketing tool’ but distorts the science – CBC.ca

When injured elite athletes talk aboutusing platelet-rich plasma (PRP), the coverage fuels hype that makes it harder for average consumers to see the limitations of the potential treatment, a new study suggests.

Athletes including American golfer Tiger Woods, NFL quarterback Tom Brady and now-retired NBA playerKobe Bryant have reportedly used the decades-old approach.

When PRP is used in sports medicine circles, theperson's blood is collected and spun to concentrate the platelet component of the fluid, which is then injected back into an injured area, such as a torn tendon.

Tim Caulfield, who holds the Canada Research Chair in health law and policy at the University of Alberta, and his co-authors reviewed newspaper coverage of PRP use between 2009 and 2015in Australia, Canada, Ireland, New Zealand, United Kingdomand the United States. It waspart of their ongoing researchinto what he calls "bunk" or "science hype" exaggeration of the benefits of science and understatement of any risks or other concerns, including instem cell treatments.

"When PRP is covered in the sports pages, it's talked about in a way that if you were just a casual observer of the science, you would assume that this works and that, we think, is a very powerful marketing tool," said Caulfield.

"If you see a story about a pitcher, a football player or track and field star getting PRP and you have an injury and you know of a clinic near you that's offering PRP, I think it does make it seem like it's more legitimate and perhaps that the science is further along than it really is."

In last week's issue of the journal PLOS One, Caulfield and his co-authors reported that a large majority of PRP articles from Australia (97.1 per cent), theU.S. (87.1 per cent)and Canada (79.4 per cent) were sports-related stories.

The exception was in New Zealand, where less than 10 per centwere sports-related. The researchers found that81.8 per centof the articles analyzed were cosmetic stories.

Reality TV star KimKardashianfirst promoted PRPas an anti-aging treatment through thevampire facials she underwenton her show in 2013 to avoid wrinkles.

Caulfieldsaid he sympathizes with sports reporters but he wants the public to recognize how elite athletes are willing to try just about anything, even unproven, because they're desperate to return to play.That doesn't necessarily mean the treatment works.

"To date, the science [for PRP] is far from definitive," he said.

The researchers said their findings raise questions about why there havebeen so few well-conducted, large clinical trials into PRP to truly judge how much it helps or harms.

Dr. Ryan Degen, an orthopedic sports medicine surgeon at Western University in London, Ont., is seeking funding to conduct a clinical trial on PRP.

"The trial that we're going to try to get off the ground is to look at knee arthritis to see if [PRP is]warranted to treat the arthritis or if we should just be sticking with the conventional injections that we've been using," Degen said.

Degen advises athletes to tread cautiously.

Degen tells his patients there are a few possible indicationsto use PRP in sports medicine, but other times, it's not worthwhile, particularly given that the expense can range from $250 to several thousand dollars.

Many people look up to elite and professional athletes.But the study's findings suggest part of the cautionary message around PRP use is lost when athletes are the source of the message, said Dr. Mark Leung, director of the primary care sport and exercise medicine program at theUniversity of Toronto.

For "elite athletes, one of the names of the game is you start to try and compete and win at whatever cost and that may include your health, and so I don't thinkmany individuals [in] the general population may understandthat aspect."

The reality is, PRP injections don't replace an accurate diagnosis and reliable treatments such as exercise, weight management and rehabilitation, Leung said.

"There was some evidence for its use in tennis elbow or in partial tendon tears," said Leung. "I think that evidence is starting to become less clear [on] when to use it and what regimen, because even the way it's been studied has been a bit murky."

For non-elite athletes, Leung suggesteda more moderate approach to diet, workouts and recovery from injuries.

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Sports hype of platelet-rich plasma 'powerful marketing tool' but distorts the science - CBC.ca

When should you see a podiatric surgeon? – WTOP

This content is sponsored by MedStar Washington Hospital Center

Its Augustthe height of summerand many of us are taking advantage of the longer days to cram in more outdoor activities. For many, it just seems easier, and definitely more enjoyable, to go for an early morning run when its already light outside versus the dark days of winter.

But that increased activity also increases the risk of foot and ankle injuries, particularly among weekend warriors.

Sprains, which can vary widely in severity, are among the most common foot and ankle injuries. For minor problems, time-honored home remedies like icing, elevating, resting the foot and over-the-counter (OTC) anti-inflammatories are often all thats needed. But if you dont notice much relief after a few days of self-care, you should seek a professional opinion from a podiatrist, a doctor who specializes in foot and ankle care.

It may be that you need an ankle brace to support and protect the ligaments that were stretched or torn during the injury. More severe sprains may require a device called a CAM bootbasically a walking cast that relieves the ankle from bearing weight while it heals.

The good news is that most sprained ankles will getter better in a month or two.

Sometimes, however, what first seems like a badly sprained ankle may actually be a broken metatarsalone of the long bones in the middle of the foot. Because the symptoms of a break, especially a Jones Fracture, and a sprain can be so similar, some fractures dont get the early medical attention they may need, including surgery.

Individuals with chronic lateral ankle instability may also benefit from surgery to repair the damaged ligaments and return to a more active lifestyle. The condition is the result of cumulative injuries to the ligaments from frequent sprains, mostly due to overuse. That leaves the ankle more susceptible to chronic swelling, pain, tenderness and weakness, leading to even more sprains in the future.

Another quite common injury is plantar fasciitis, which occurs when you strain the ligament that connects the heel bone to the metatarsals. In 95 to 99 percent of people, it goes away with simple, conservative treatment like stretching, OTC inserts and physical therapy. If such steps dont provide relief, however, Im a big proponent of a promising new treatment called PRP.

PRP, or platelet-rich plasma injections, can often decrease or completely eliminate the pain of plantar fasciitis and other conditions, contributing to a speedier recovery. In the 30-minute procedure, some blood is withdrawn from the patient and then placed in a centrifuge to separate out the platelets, the component that helps with clotting, healing and tissue growth. Then the platelet-rich plasmanow containing three to five times more growth factors than normal is injected into the affected area.

Most patients can get back on their feet within a few days and can resume regular activity within a month.

Feet are the foundation of your fitness. If theyre in pain or stressed, you cant do much of anything. But properly supported, your feet can conquer miles in comfort.

Thats where the right shoes come in to play. And its tricky. Some lucky people are born with a perfectly normal foot; however most of us need some sort of assistance to help achieve the right mechanical balance. For instance, a bunion, flat foot or a really high arch can put extra strain on different tendons and ligaments, leading to arthritis, pain and degeneration.

But finding that sweet spot is a matter of trial and error. Sneakers that I regularly recommend to my patients dont work at all for my wide, highly-arched feet. You need to take time to find that brand and style that is going to be the best fit for your foots particular structure.

Orthotics can also help. I typically recommend that patients first try out an OTC support with a rigid sole, something like a piece of plastic, to see if that helps. In some cases, that may be all the arch support they need, while others may benefit more from a custom-made orthotic. Just be sure to avoid inserts that you can bend in half, which provide cushioning versus support.

The bottom line: Enjoy your summer activities, but dont beat up your feet in the process. And always see a doctor in the event of any significant swelling, bruising or pain.

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When should you see a podiatric surgeon? - WTOP

First-in-man intraglandular implantation of stromal vascular fraction … – Dove Medical Press

Back to Browse Journals International Medical Case Reports Journal Volume 10

Case report

Case reports

Video abstract presented by Kristin Comella.

Views: 12

Kristin Comella,1 Walter Bell2

1US Stem Cell, Inc, Sunrise, FL, USA; 2South African Stem Cell Institute, Parys, South Africa

Background: Stromal vascular fraction (SVF) is a mixture of cells which can be isolated from a mini-lipoaspirate of fat tissue. Platelet-rich plasma (PRP) is a mixture of growth factors and other nutrients which can be obtained from peripheral blood. Adipose-derived stem/stromal cells (ADSCs) can be isolated from fat tissue and expanded in culture. The SVF includes a variety of different cells such as ADSCs, pericytes, endothelial/progenitor cells, and a mix of different growth factors. The adipocytes (fat cells) can be removed via centrifugation. Here, we describe the rationale and, to our knowledge, the first clinical implementation of SVF and PRP followed by repeat dosing of culture-expanded ADSCs into a patient with severe xerostomia postirradiation. Methods: Approximately 120 mLs of adipose tissue was removed via mini-lipoaspirate procedure under local anesthetic. The SVF was prepared from half of the fat and resuspended in PRP. The mixture was delivered via ultrasound directly into the submandibular and parotid glands on both the right and left sides. The remaining 60 mLs of fat was processed to culture-expand ADSCs. The patient received seven follow-up injections of the ADSCs plus PRP at 5, 8, 16, 18, 23, 28, and 31 months postliposuction. The subject was monitored over a period of 31 months for safety (adverse events), glandular size via ultrasound and saliva production. Results: Throughout the 31-month monitoring period, no safety events such as infection or severe adverse events were reported. The patient demonstrated an increase in gland size as measured by ultrasound which corresponded to increased saliva production. Conclusion: Overall, the patient reported improved quality of life and willingness to continue treatments. The strong safety profile and preliminary efficacy results warrant larger studies to determine if this is a feasible treatment plan for patients postradiation.

Keywords: adipose tissue, ADSCs, cell therapy, MSCs, PRP, stem cells, SVF, xerostomia

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Sabathia on DL because of knee; Montgomery back – Daily Astorian

Yankees left-hander CC Sabathia was put on the 10-day disabled list because of right knee inflammation and left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre

The Associated Press

FILE - In this Aug. 1, 2017, file photo, New York Yankees starting pitcher CC Sabathia winds up during the first inning of the team's baseball game against the Detroit Tigers, at Yankee Stadium in New York. Sabatthia was put on the 10-day disabled list because of right knee inflammation and left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre. (AP Photo/Kathy Willens. File)

NEW YORK (AP) Forced to leave a start this week because of knee pain, CC Sabathia initially thought his career might be over. Now, the 37-year-old left-hander hopes to miss just one turn for the New York Yankees.

Sabathia was put on the 10-day disabled list Friday because of right knee inflammation, and rookie left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre to make Sabathia's start in Sunday night's series finale against Boston. Sabathia's DL trip was retroactive to Wednesday, a day after he allowed four runs in three innings at Toronto.

"When it first happened initially, I was freaking out," Sabathia said. "I was in a lot of pain and I felt like I was letting the team down."

Sabathia calmed down after he spoke with his wife, Amber, and an MRI showed no additional damage. He had cortisone and platelet rich plasma injections on Wednesday and felt well enough to play catch Thursday.

Sabathia hopes to throw a bullpen session Sunday, then get ready to return.

"I think it's going to be a question mark until he throws the bullpen," Yankees manager Joe Girardi said.

Sabathia originally was to have maintenance injections at regular intervals.

"We didn't because I felt great, so we didn't want to like kind of mess with it," he said.

Sabathia is 9-5 with a 4.05 ERA in 19 starts, including 14 scoreless innings in two wins against Boston. He pitches with a brace because of the knee, which was repaired with surgery in July 2014 and last October. He had not had pain injections since the last operation.

A knee replacement may be necessary when his playing days are over. He wants to be able to play golf and bowl.

Montgomery, 7-6 with a 4.05 ERA in 21 starts, was optioned to Scranton on Sunday, the consequence of the late-July acquisitions of Sonny Gray and Jaime Garcia. Montgomery never left town and threw a bullpen session Thursday at the Class A Staten Island Yankees.

Second baseman Starlin Castro, sidelined since July 21 by a strained right hamstring, and first baseman Greg Bird, who hasn't played since May 1 because of a right ankle injury that needed surgery last month, are likely to start minor league injury rehabilitation assignments next week.

"I'm just excited to play," Bird said.

New York also activated infielder Tyler Austin from the 10-day disabled list and optioned him to Triple-A. Austin had been sidelined since late June by a strained right hamstring and hit .217 (5 for 23) during a seven-game rehab assignment with the RailRiders.

___

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Sabathia on DL because of knee; Montgomery back - Daily Astorian

Felix Hernandez, Hisashi Iwakuma remain hopeful of return to the Mariners’ rotation – Seattle Times

Both pitchers hope to help the Mariners in the final month of the season if not sooner.

Regardless of their performances prior to theirrespective injuries that landed them on the disabled list, the possible return of either Felix Hernandez or Hisashi Iwakuma or both to the Mariners rotation would be welcome addition. Its a unitthat has been hampered by injuries, lack of production and turnover. They would also be helpful in Seattles push for a spot in the postseason.

To be clear, neitherpitcher is returning in the coming days. And its not unfair to have a less than optimistic prognosis that neither would pitch again this season.

But they bothbelieve they will return.

Hernandez went on the disabledlist onSaturday for the second time this season with bursitis in his shoulder. He was placed on the disabled list on April 26 following a start in Detroit. He wouldnt return until June 22.

The last time it was in the back of my shoulder, he said. This time its in the front. They say its the same bursitis. Im not a doctor. I just tell them what I feel.

And he feels likethis discomfort isntnearly as bad as the first time.

They said three to four weeks, but I dont think so, he said. I can probably come back earlier. I just have to be careful not to rush it because of what could happen.They said its more inflamed than last time, but I feel better than last time. I dont understand it.

Hernandez recalled the days leading up to this DL appearance.

I felt fine before the last start in Texas, he said. The day I pitched in Texas I felt good. The next day I felt a little something in my shoulder. But I was fine before that. I was actually feeling really good.

That something in the shoulder didnt feel any better when he tried to play catch.

The next day in Texas, I was like, what is going on with my shoulder?' he said. I told them I cant throw a bullpen.

After examinations and tests from Dr. Edward Khalfayan, he received a platelet rich plasma (PRP) injection into the shoulder to speed up the healing process.

Im just hoping everything is good, he said. Im doing my treatment and waiting a few more days to see if I can play catch.

Hernandez is known to be a bit dour when hes on the disabled list and is not a fan of discussing his health. But he was in a good mood on Thursday with the team back in town. That wasnt the case when the injury first occurred.

I was so pissed, he said. Im still pissed. Im trying to calm myselfdown and, you know, smile to hide what I feel inside. Im just focused on getting healthy and help this team get to the promised land.

There was a belief that Iwakuma wouldnt return this season after experiencing multiple setbacks in his return from the shoulder inflammation that landed him on the DL on May 10. And he still may not. But hes going to keep working to do so. While the Mariners were on the road, Iwakuma threw three shorter bullpen sessions a major step back to being ready.

The plan is for him to throw an extended bullpen on Friday. If hecomes out of that healthy, Iwakuma would throw a simulated game next week. If that went well, he would head out on a rehab stint of at least two to three starts. If those went well, he might return to the rotation. Obviously, thats a lot of ifs that must go right to see him return.

It is tough to be be honest, he said through interpreter Antony Suzuki. It is whatit is. Its been a long process.But you have to go through your steps and go in the right directionand hopefully I will come back soon. The team is playing very well and you do have a strong feeling of wanting to help right now.

After receiving some injections and getting shutdown from his throwing program for a week in July, Iwakuma hasnt had any issues.

Better arm speed, better arm action, getting my mechanics and my deliveryto where I want to where its stress free on the shoulder, he said. As long as my mechanics are good, as long as Im not flying open, I dont feel anything. But when I do start flying open, I do feel tightness. Thats what Im working on right now.

Also

Mitch Haniger (facial laceration) participated in the pregame workout on Thursday, including taking batting practice on the field. He could go on a rehab assignment by next week. It could be a prolonged stint for Haniger, who was struggling before getting in the face by a95 mph fastball from Mets pitcher Jacob deGromm. With the Sept. 1 roster expansion looming, the Mariners could wait to activateHaniger from the DL, which would allow them to avoid another roster move to make room for him.

Veteran catcher Tuffy Gosewisch was outrighted to Class AAA Tacoma on Thursday. Gosewisch was designated for assignment on August 6 to make room on the 40-man roster for reliever Ryan Garton, who was acquired in a trade from the Rays.

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Felix Hernandez, Hisashi Iwakuma remain hopeful of return to the Mariners' rotation - Seattle Times