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Therapeutic Plasma Exchange 101 Lindsay Jost

Therapeutic Plasma Exchange 101: Get Answers to Your Questions

Are you ready to take charge of your health? Schedule your free 20-minute discovery call with our New Patient Coordinator to see how you can become a patient at MaxWell Clinic and start your healing journey today.

Therapeutic Plasma Exchange (RPE) is a truly revolutionary tool for physical healing and longevity. It can be transformative for people who have suffered with serious conditions like autoimmune disease and dementia because it helps to clean your blood and removes certain harmful substances circulating in your plasma. 


This innovative therapy has the potential to slow down the rate of brain and body degeneration. But most people have never even heard of Therapeutic Plasma Exchange. And those who have heard of it are often left with more questions than answers.

Lindsay Jost, APRN, FNP-C has seen firsthand how remarkable TPE is for illnesses that have been resistant to other treatments. 

Watch the video about Therapeutic Plasma Exchange and:

  • Understand exactly what TPE is and how it may support you or your loved one
  • Uncover common misconceptions about how TPE works
  • Discover what conditions TPE is most useful for
  • Learn the next steps to be considered for TPE

At MaxWell Clinic, we have seen no greater therapeutic tool for physiological transformation than Therapeutic Plasma Exchange. 

Looking for more information to read about plasma exchange? Take a look in depth article: Therapeutic Plasma Exchange: Hope for dementia, Alzheimer’s, memory loss, and autoimmune disease.

Why Choose MaxWell Clinic For Therapeutic Plasma Exchange?

MaxWell Clinic is the largest outpatient facility in the United States dedicated to providing Therapeutic Plasma Exchange. We also:

  • Have some of the highest levels of customization and safety protocols
  • Provide opportunities for systems medicine integration – offering comprehensive assessment and treatment to support your health

Our medical director, Dr. David Haase, is a Vanderbilt and Mayo-trained doctor and is double board-certified. In the last 20 years, Dr. Haase has taught more than 10,000 physicians his protocols that aid patients with Alzheimer’s, dementia, and other chronic illnesses. 

We’ve helped many patients in the Nashville area and beyond reach a higher quality of life. Check out a few of their testimonials here

How To Get Started with Therapeutic Plasma Exchange

Your life should be lived without the fear of losing your brain and body function. If you or your loved one has been diagnosed with a neurological or autoimmune condition, or if you’re worried about developing one of these conditions, there is hope! We believe your body is designed to heal. 

To learn more about Therapeutic Plasma Exchange, click here to schedule your free 20-minute information phone call. 


hello everybody
welcome to our regenerative plasma exchange get answers to your questions
webinar i am lindsay jost and i am one of the nurse practitioners and clinicians here
at the maxwell clinic i am also privileged to be one of the overseeing clinicians for our regenerative plasma
exchange program and what i am going to do this evening is go through all of your top questions
we’ve been um up in adam in the regenerative plasma exchange world for
um a couple years now and so over that period of time we’ve had the opportunity
to really harvest a lot of patient questions and inquiries and things that we get most frequently and so what we
thought we would do this evening is just kind of break that down and really have more of a casual conversation about
regenerative plasma exchange what it is what it means how it works our process here at our clinic how is it accessible
we’re hoping that this gets out far and wide so that any if there are any curiosities on regenerative plaza
exchange that after this webinar and our time together this evening those
boxes have been checked those questions have been answered or at least you have
resources to have to go to the next steps for where you go from here so that that way you can quench your curiosity
thirst on all things regenerative plasma exchange so i’m just kind of giving everybody a couple
minutes to hop on and log in and get comfy maybe you are at home after a long day of work or
maybe you’re still at work either one i just want to give everybody a couple minutes to to
log on and i’ll reorient here as well so we are almost at the two-minute mark
so i’m going to go ahead and dive in because this evening brace yourselves we have a lot of
content which is really exciting so again i’m lindsay jost i’m one of the nurse practitioners here at the maxwell
clinic i’m also one of the overseeing clinicians for our regenerative position exchange program and tonight this is
your regenerative plasma exchange faq get answers to your questions webinar so
let’s dive in
so what is regenerative plasma exchange that’s the question on everybody’s mind
so let’s talk about the basics well in order to talk about the basics we have to kind of know how it works
because you might be thinking to yourself i don’t even know what you’re talking about okay let’s strip it down so
here you have an illustration of a plasma exchange participant a patient if you will
what happens is we actually put two iv catheters one
in each arm into the patient their old blood the blood that has been circulating in their body gets taken out
of one of the arms and then it goes into a plasma exchange which is also known as
apheresis so you may hear those words interchangeable we’re talking about the same process and procedure so
regenerative plasma exchange or apheresis device
the device itself actually centrifuges it spins and it separates the plasma
component of the blood from the red blood cell component the plasma component gets wasted and
removed as you can see from the image here and then the blood cells are saved and
they’re actually transported down to another part of the machine
then we have albumin so we’ll go into the details of what albumin is a little later in this
talk but for now just to explain how it works we then put replacement albumin in
and mix them with your blood cells that we had just removed from the blood that was circulating in the system
and this new fresh replacement albumin mixed with your
cells gets infused back into the body so it’s a full circle process this is
just the general basics of how plasma exchange works
this is a face you might know and love or that is familiar to you this is our fearless leader dr david hasey and so
here is a photo in real life not illustrated of how this works so as you
can see on the left hand side here we have a photo where you can see both iv
lines in each arm one of these lines is going into the machine and extracting out the old blood
and the other line is infusing in the replacement albumin and red blood cell combination and it’s happening it’s kind
of like a symphony in a dance it happens pretty simultaneously
over here you can kind of see our plasma exchange or apharis’s device that he is
connected to and let’s get a little close and personal with the device itself just so
you’re familiar with all the parts and pieces so to the left is a more broad
overview we’ve got our general screen here that gives us all our parameters
and that we can kind of run the machine by we have all of these beautiful bags
uh these bottles that you can see flipped over which if we look to the image to the right you can get a little
bit more up close and personal but that’s the albumen that i referenced in the initial slide
back behind here we’ve got a little normal saline we’ve got a little anticoagulant that helps in the
separation process of the plasma and the red blood cells and this ladies and gentlemen this wonderful
yellow looking substance that is the old plasma in this bag here and this
actually gets dumped into this little red bag that you can see a little bit better on the picture on the left
but you can see a little in the picture on the right as well and that’s the waist plasma all these wonderful little tubes and
colors help work in sympatico together to make that process seamless
so that is a general overview of how the procedure itself works so how did this happen how do we think
to ourselves why would we ever do this and what is the benefit and and how did this come to be from a optimization
standpoint well it’s because of mice and peribiosis so there is a study that
happened a few a while back where they actually they sewed
two mice together an old mouse and a young mouse poor little things and they hobbled along together and what they
found was really really interesting the old mouse actually got a little
younger and the young mouse got a little older so what does this say to us this
is like wait a second so shifting out and removing the toxins and
oxidized molecules that build up in time as we age can actually create
neural stem cell proliferation increased blood flow they noticed enhanced olfaction which is an enhanced sense of
smell skeletal muscle rejuvenation this is unbelievable so this got us
thinking how could we do this in humans to increase longevity and quality of life
then there was the ambar study this is a cornerstone of
why we do what we do here at the maxwell clinic the ambar stands for alzheimer’s
management by albumin replacement the ambar trial was key
in creating the idea that this could be really beneficial for those who had cognitive decline
so the primary objective of the ambar trial which is something that you’ll hear a lot throughout this talk and then if you come and engage further with us
for regenerative plasma exchange the primary objective is really to see the efficacy of plasma exchange by measuring
variations in cognitive function and carrying out daily activities of living
so they took mild to moderate stage patients with alzheimer’s disease you can see here there are 496 participants
and by the time you get to mild to moderate stages of this you the cognitive the cognitive abilities
are pretty well advanced so they took these patients and they did
one plasma exchange a week for six weeks in a row of the full volume exchange they then
did many exchanges following that over a 14-month period of time they measure
their progress through neuroimaging many mental state exams and other standard
cognitive tools and what they found was remarkable
so the global function how somebody is able to function their daily life overall
what we expect to see is where this red arrow is going you know in neurodegeneration the thing about it is
is that it tends to only have one trajectory and that is down the only question and
predominant variable per individual is how fast that’s going to happen
so whenever we looked at this ambar trial and we saw that the results
actually showed a 61 percent less decline over a
14-month period of time that is the definition of hope it is unbelievable there have been
countless trials from the pharmaceutical companies trying to find a drug that
could influence alzheimer’s progression or cognitive decline in this way and it just hasn’t been found
so as you can see from this graph the beginning part here is that once a week
for six weeks and then they did those mini exams a little bit further out but the 61 less decline is just it is
getting to a point where if you know this information you can’t not consider this
a treatment or possible option for those who are suffering from mild to moderate alzheimer’s
so we’re going to look at this a little bit more because it’s really interesting so
when what they broke down for their results and what we have seen is that as you can
tell in all patients there was an improvement versus those here in the red
line who did not move forward plasma exchange in moderate alzheimer’s
there is also a notable difference between the two but in mild alzheimer’s they actually they didn’t just slow
progression they got better they got better this is huge so the
earlier in the memory loss process that one begins plasma exchange treatments
the more benefit one will likely achieve from the data that we’ve seen so far
many people seek us out for longevity promotion even before memory loss begins so if you say to yourself you know i
really i’m doing okay from a cognition standpoint however i’m
aging and i’d like to optimize regenerative plasma exchange has a place
in that realm as well
the most benefit occurred during the time of weekly plasma exchanges so if you’ll notice just in the circled areas
here the biggest jump between decline which is the blue line and improvement
or clinical effect which is the pink line happened during that weekly burst
that first six weeks so the more frequent and higher volume plasma exchanges that is better from what we’re
seeing than less frequent and we use this information whenever we are customizing patient recommendations and
orders for plasma exchange here at maxwell clinic as well we really use the ambar trial as kind of
our our general guide for where we go because this data that we saw here was
just unbelievable so a little more information because to answer the question of what is plasma
exchange so regenerative plasma exchange specifically is an innovative therapy
that has the potential to slow down the rate of both brain and body degeneration whether your needs are autoimmune or
cognitive decline or you just want to boost your vibrate longevity rpe regenerative plasma exchange has the
potential to help you improve your daily function and address contributory causes it is
truly life-changing from the the results that we have seen so far
how does this work why is that the case well as we get older no matter who you are the more birthdays
you accumulate your blood becomes polluted with oxidized molecules and inflammation residue just as
a side effect of being alive we like to refer to these in
more simple terms as rusty and sticky molecules because the oxidization and inflammation can kind of make that
happen so that can adversely affect both your brain and body because your microvascular system is impaired
since it’s not as optimal as it could be since your blood is the river of nourishment for your cells the health of
your cells dramatically is influenced by the health of your blood through regenerative plasma exchange we
can remove certain harmful substances that are circulating in your plasma to nourish your cellular habitat and
support your regenerative factors so think of it this way plasma is the habitat of your cells much
like the rain forest is the habitat of a certain animal or
the woods is a habitat of a tree based on the health of that environment
if there’s forest fires versus if it’s a flourishing
jungle that’s going to change the impact of the health of the trees or beings
within that environment the same is true for your cells so when your blood is cleaned
and the total load of oxidized molecules is decreased meaning the plasma is
shifted it’s much easier to nourish your both your brain and your body
so we’ve got tpe versus rpe there’s a lot of letters what does this mean is there
a difference let’s talk about it so what is the difference between tpe
and rpe well therapeutic plasma exchange also known as tpe is the most common way
in which plasma exchange is delivered worldwide it is mainly used as a powerful
treatment option for severe autoimmune diseases it has been in practice for a very long time typically in a hospital
setting more acutely regenerative plasma exchange also known as rpe is a patent-pending modification
of tpe that was developed here at the maxwell clinic to optimize both the safety and the potential effectiveness
of plasma exchange for multi-tissue regeneration as we combat common age-associative
degenerative processes like frailty dementia alzheimer’s mild cognitive decline at maxwell clinic we do
everything possible to improve both the safety and efficacy of the procedure so rpe really systematizes these factors
for safety and the data that we’ve collected so far to help us ongoingly modify our process in an effort to
improve its effectiveness rpe can also be utilized by these proactive individuals who are looking to
potentially optimize their overall stem cell function by cleaning their cellular habitat it’s really exciting
do you only offer rpe at maxwell clinic we offer both so therapeutic plasma
exchange or tpe which is used for conditions such as autoimmune disease and the treatment of acute toxicities we
absolutely do rpe also known as regenerative plasma exchange which is maxwell clinic’s
patent-pending and trademark process for decreasing the potential side effects of tpe while individualizing replacement
fluids and augmentation components to potentially optimize for stem cell activation so what we do here is the
main the main nuts and bolts of tpe or therapeutic plasma exchange is performed
we augment that a little bit in our regenerative plasma exchange process to help individualize replacement fluids
and augment different components to have a better outcome or a more augmented outcome
is our intention so regenerative plasma exchange at maxwell clinic our experiences
how many plasma exchange procedures have you done so what i’m doing just to orient you
here at the very top and bold these are our most common questions so we’re just
going through those one at a time in in different categories so how many plasma exchange procedures have you done well
as of april 2022 we have completed hundreds of plasma exchange procedures at maxwell clinic for a variety of
reasons autoimmune disorders cognitive decline stem cell optimization and long covid just to name
a few has anyone with blank ever done plasma exchange at mexico clinic and insert in
the blank our new patient coordinator gets all kinds of questions about this so while we don’t keep a list for our
support team of every patient diagnosis plasma exchange has been used for at maxo clinic what we can share is that we
have used plasma exchange patients dealing with everything from autoimmune to cognitive decline and to those just
wanting to boost their vibrant longevity how would i know if it’s right for me or my loved one then well a consultation
visit with one of our plasma exchange clinicians this is why a consultation is so beneficial what we do is we discuss your
particular needs with our clinicians here to see if rpe is the right fit for you and your health goals at maxwell
clinic we take personalized care very very very seriously and our plasma exchange program is no exception which
is why every person as they come through and they have an rpe consultation gets a
tailored and personalized order set and protocol based upon their goals
have you treated anyone with lewy body dementia we do have experience with louis valley dementia the ambar trial as
we went through earlier was completed on dementia patients some of which may have had lewy body dementia lewy body
dementia is a clinical diagnosis as the only way this type of dementia is confirmed is that autopsy upon death
therefore we believe regenerative plasma exchange is good for any type of alzheimer’s or dementia this is also why
we take all types of memory loss seriously as we saw in the anbar trial the sooner plasma exchange is performed
even in mild cases the better the outcome and our goal here is for more good days
have you treated patients with lyme disease of plasma exchange this is a big one so plasma exchange is not an indication
for patients with lyme disease at the present time however there are some reports that plasma exchange has been
helpful in some individuals that carry a diagnosis of lyme or have a diagnosis of lyme that is recurrent and resistant to
other forms of treatment so plasma exchange may be beneficial for these individuals overall for other
reasons which would be determined through a consultation visit with our plasma exchange provider and i highly
encourage if anyone is listening to this for themselves or a loved one and they have persistent lyme disease
schedule a consultation with us because there are so many things that we can do and guide even in the regenerative
plasma exchange space that can be beneficial do you have statistical success or
outcome information very very common question so at maxwell clinic we pride
ourselves on treating each individual with a customized program for health improvement as i mentioned earlier we
are all about personalized systems medicine and really emphasize the personalized part of that
regenerative plasma exchange may be one element of a treatment plan and repeated plasma exchanges may be necessary
depending upon the issue addressed as such all of our results vary from patient to patient meaning
we don’t have apples to apples comparison to create traditional statistic analysis very easily because
every single person has an individualized treatment plan we really track individual patient
outcomes while we model after the ambar trial we personalize recommendations for frequency duration etc based on patient
presentation from what we’ve learned to date through individual patient cases and we tailor these plasma exchange
order therapies to their unique needs and desires we really focus on
what do you want your health for and our plasma exchange program is no exception to that question
we factor that in deeply whenever we’re looking at what recommendations or frequency
or settings would be best for this particular patient at maxwell clinic what sets us apart
really is this personalized approach and so as i previously mentioned our regenerative plasma exchange program is
no exception to that there are a variety of ways that we track individual patient outcomes such
as through subjective symptom tracking standardized cognitive assessments like cns vital signs mini mental status exam
mochas microvascular function assessments like the glycotech which is just an amazing
test specialty blood test as well as biologic age measurement and telomere assessment to name it just to name a few
since we practice truly personal systems medicine this tailor type of care doesn’t easily allow for generalized
statistical nature as i mentioned however the majority of our patients find notable benefit from regenerative
plasma exchange and i can say that personally and overseeing being one of the clinicians to oversee this program
the patient testimonials are they’ll they could bring tears to your eyes it’s it’s very very moving
we also boast that we may be the highest success rate for peripheral venous
access of any center in the united states what does this mean this means that we rarely have to have our patients
have a central line or port placed in order to complete plasma exchange this decreases risks and rates of infection
tremendously this statistic alone sets us apart and puts us squarely in one of the best
standards of care for plasma exchange that exists it dramatically decreases the complications that we see that are
associated with central lines like infection and blood clots making this procedure overall on the whole
substantially safer do most patients who start this therapy
see benefits and want to continue yes yes yes yes yes yes most patients who start rpe see benefits
and continue the course of their personalized treatment recommendations time and time again
is there another clinic that offers outpatient plasma exchange anywhere maxwell clinic is the first and only
outpatient facility in that the united states dedicated to providing regenerative plasma exchange
at the present time so regenerative plasma exchange procedure itself your questions
explained who can benefit from regenerative plasma exchange well
as more data emerges and clinical trials are performed it is becoming very clear that neurodegeneration and diseases
associated with aging such as alzheimer’s parkinson’s and frailty have the potential for improvement with
regenerative plasma exchange as we showed from the data in the ambar trial this is not a conclusive list though as
rpe has the potential to improve daily function and optimize stem cell activity and longevity in many individuals not
just those with neurodegenerative disease processes when we clean the plasma and cellular habitat we nourish
the body and the brain that is amazing for anybody and
based upon your overall goals how many treatments will i need well
each patient has different needs most patients begin with a short series of procedures followed by less frequent
ongoing procedures this is highly dependent upon medical history current symptoms level of function and ability
to participate in the program our providers will give their ideal recommendations for frequency at your
plasma exchange consultation and then you and the program coordinator will work together to get that scheduled
afterwards how much plasma is removed during one
procedure approximately 60 to 70 percent of your blood plasma will be removed
during one procedure and then replaced by medical grade five percent albumin protein
we cannot remove a hundred percent of the patient’s blood because it’s continually circulating during the
procedure so what is this album in business we keep talking about for those of you who
are not familiar well albumin is something that your body naturally makes the liver is a master producer of this
protein and it is a protein that keeps intravascular fluids inside vessels and prevents their leakage it is synthesized
as well as produced in the liver so what we’re essentially doing as you can
see from this image down here is that plasma 55 percent
of the total blood volume you’ve got your formed elements at 45 that’s your
red cells your white cells your platelets those are the portion that from that original image
get removed from your old blood and go back into the machine to get mixed with the albumen to go back into your body
the plasma itself is 58 albumin on its own right this is something your body makes naturally you’ve got globulins in
there and fibrinogen so fibrinogen is something that we track it is also why
we need to make sure there’s usually about 24 hours in between procedures so that your body can re-equilibrate and it
does so very very quickly albumin itself is a the medical grade and i just
did a picture over here you saw those bottles in the photos earlier but what happens is it is sterilized it goes
through an fda approved process this is medical grade albumin which is just down to the protein element in this fluid and
that is what is being replaced back into your body so we’re taking albumin out and then we’re replacing it with albumin
a lot of people will ask well where does where does this albumen bottle come from
it does originate from donors however it is extrapolated
sterilized there’s a huge heat process and it gets stripped down to just the
protein component as you see in this bottle that is then administered back in a lot
of the concerns that would happen if we were doing oh donated plasma directly into your body
cross-contamination disease things of that nature are not of concern whenever
we’re using albumin there’s it’s a part of the reason why it’s so tricky and why we are not um doing
you know young plasma or direct donor to human
administration because there’s a lot of other factors and potential risk there
do you replace this with saline and albumin or just albumin so we get this question a lot if you guys remember from
the initial photo the saline is the bag right behind right behind the little bottle there on
the on the image the plasma is replaced with just the albumin mixed with your red blood cells the same amount that was
removed so it it’s replaced in a one-to-one ratio saline is used to prime the lines whenever the machine is hooked
up and an even exchange of albumen for the plasma that we removed is made while we
typically replace with just albumin we will at times add a saline bolus if
needed which is just a bolus means a little burst of additional fluids into your system for maintaining blood
pressure homeostasis throughout the procedure do you use donor plasma i know i
addressed this a second ago but our plasma is replaced with albumin we do not replace it with human plasma at this
time what kind of machine do you use for plasma exchange we use the fercenius
amicus which is the newest and most state-of-the-art aphorasis device in existence we love working with this
device they are fda approved machines that are capable of separating all types of web products
can a port be used to administer plasma exchange yes if necessary we can have a port placed
but maxwell clinic has one of the highest rates of peripheral access in the nation as i mentioned before we are
very successful at using peripheral veins for plasma exchange so for those of you who are not familiar with the
language that i’m using there peripheral veins mean when i look down at my arm
let’s say in my little elbow crease and i squeeze my arm and it pops up or you’ve ever given blood before
it means taking a needle and sticking it in without having a line that’s been implanted into your body already it is a
when you arrive you have no nothing in your body you sit in the chair you are then stuck with a needle that’s what
we’re considering to be peripheral access 98 of patients at maxwell clinic had their
regenerative plasma exchange conducted using peripheral access only we have a very high success rate of this and it’s
something we take great pride in do i have to live in nashville to have rpe at mwc
well while the majority of our patients are local we do have several out-of-town patients who fly in on a regular basis
to receive this treatment flying is not usually recommended on the same day as a procedure however it is possible if the
procedure is completed in the morning it is not contraindicated if you have to
have plasma exchange in the morning need to fly that evening that’s absolutely fine we more or less make that recommendation
from a logistical um also if it’s your very first plasma exchange
we wouldn’t recommend flying that evening just because you may feel a bit fatigued it’s a new procedure you’re not
really sure how your body adjusts so we want to make sure that that is well planned for on the foreground
what side effects could be expected and i’m happy to report that the side
effect list isn’t is not very long which is great and all of the potential side effects we have methods in place to
mitigate and make people feel more comfortable so it’s it’s possible to experience
numbness or tingling in the nose hands or feet and it’ll happen around your mouth as well and if this happens during
your procedure you’ll just let your plasma exchange technician know so while you’re here with us you always have a
staff member with you and they’ll ask you repeatedly we get kind of annoying about it like are you
okay are you warm are you cold are you feeling anything um and you’ll just tell them hey i’m starting to feel a little tingling what
that is is that’s hypocalcemia so that means your calcium just dropped a little too low too fast
uh your electrolytes shifting and mineral shifting during plasma exchange is completely normal
what we do when that happens is we just slow the rate down the procedure a little bit and that tends to go away
pretty quickly so it’s nothing of acute concern to be worried about the patient may also experience low
blood pressure and what we do is we will often as i mentioned give a little bit of extra fluids to make sure that
doesn’t happen um we’re checking your blood pressure about every 15 minutes during the procedure and so we’re
keeping a very close eye on that headache difficulty accessing veins our
biggest side effect is getting stuck multiple times if we’re not able to get good peripheral access so at maxwell
clinic another thing that sets us apart is once you schedule your plasma exchange procedure our
tpe support team and clinical staff will reach out to you we’ve got some supplements that we have you start ahead
of time that will help plump those veins they’ll give you instructions to do to
help really set you up for the best peripheral access experience possible
a histamine response to the replacement fluids that’s a little bit of an allergic reaction perfectly fine a
couple of the supplements that we give people ahead of time to prime their body is to try to decrease any sort of
histamine response that might happen we also have things here on hand if that
does begin to happen rashes or or just feeling like you know a little flush we can jump on that right
away we take many precautions to limit the potential side effects and we’ll continually assess during the procedure
to ensure safety of our patients those are really the major hitters as far as potential side effects that can happen
during the procedure how will i feel after a plasma exchange well
some patients report feeling an increase in energy improve clarity of vision subtle neurological function
improvements we had to put this story in here because it’s just fun we were amazed by this one particular patient
recently who was noticing that before his plasma exchange he was starting to
type the incorrect word so in his mind he would want to type the word and and he would type the word different
and it would once he had plasma exchange that corrected itself and lasted for two
to three months after his plasma exchange it was really interesting something really subtle this is a high functioning human
doesn’t have any major cognitive issues but just that little tweak that he noticed
improve erectile dysfunction improve sleep quality in depth improve mobility improved emotional regulation the day of
or after the procedure just to name a few however we do recommend resting or light exercise or keeping exercise really
light the day of the procedure to avoid any significant fatigue later our patients report feeling fatigued the
day of the procedure sometimes just after they get home as the body may be adjusting to the shift in electrolytes
so like we mentioned rest and eating a well-balanced meal after the procedure i wouldn’t wouldn’t plan to train for an
ironman that same evening part of our post care is to check in with every patient within 24 hours after
a procedure if your procedure and that’ll be by phone with one of our our clinical team members here
if your procedure was on a friday this check-in would be the following monday so for this reason we do not schedule
first-time plasma exchange procedures on fridays how can you tell if it’s working
well we track your progress by assessing how you feel and function as well as
as well as often recommend blood tests and procedures that help quantify how biologically old you are it is a really
fascinating test to be able to see okay my chronologic age may be 42 but
biologically and how i’m methylating things actually says i’m 48 i really
need to work on this and so what we can see over time after plasma exchange is actually an
improvement in how biologically old people are it’s really really fascinating so these additional tests
are best ordered and integrated into your plan of care and working alongside one of our maxwell care clinicians so
our plasma exchange program is really a single service line program and what that means is when you come in for a
consultation the purpose of our consultation is really to assess eligibility and suitability for the
procedure itself then whenever you come in we always have one of our overseeing clinicians on site
however and we’ll check in with you every you know couple couple procedures
we’re always available if anything uh occurs or there’s there’s an urgent need or something like that and we’re
available through portal messages but as far as taking care of your long-term
goals as a whole integrating optimal supplements what are other opportunities for foundational care for what you’re
looking to do maxwell care is the way to go we have an incredible team of
clinicians who are highly experienced in functional and personalized systems medicine who can integrate and really
coalesce not only plasma exchange and the things we’re tracking there but also
your entire timeline and history and everything you’ve been through to date you know additional testing and
opportunities for improvement it’s the two together is really the secret sauce for our patients who tend to accelerate
while doing this regenerative plasma exchange process so some reported benefits thus far
in addition to what i’ve already mentioned is improved exercise tolerance improved cognitive function as well as
improved microvascular perfusion if you proceed with regenerative plasma exchange we will collect various lab
values and data to research and track these observed symptomatic benefits
what lab work would indicate i’m improving well this is really exciting so we are
actually setting up a study with a major university brand new hot off the press news to study factors in the blood that
are diagnostic with alzheimer’s disease it will be a first of its kind study that is that’s something separate that
we’ve got going on our clinical research arm of our center which is really exciting but on a daily basis right now we
measure markers of brain autoimmunity and neurodegeneration we also regularly test cognitive exams such as a mocha cns
vital signs and the patient’s subjective experience when it’s somebody who has cognitive decline the family and those
closest to them and their experience of how the patient is doing is also important what you may notice if you
come to us for regenerative plasma exchange and your main complaint is cognitive function
we’ll most likely be doing the mocha tests and cns vital tests are really our neurocognitive assessments on a regular
basis so we can see how you’re doing over time in the case of autoimmune conditions we can monitor antibody levels in the blood
in addition to patient symptoms to determine improvement for optimization measurements we really
look at lab work to better understand mitochondrial function telomere lengths and biological age expression over a
trajectory of time there are many different ways we’re able to track how patients are doing maxwell
clinic is so unique and that we work with over 35 specialty lab companies across the globe to have the very best
diagnostic and tracking tools at our fingertips i don’t think we communicate this as well as we could in the fact
that there’s a lot of personalized clinics or functional medicine clinics that have access to
more expansive testing but they typically work with one or two labs working with 35 specialty lab companies
is absolutely miraculous and as a clinician it’s like being a kid in a candy store
because we go okay whatever condition that is plaguing you or whatever goals you have
we can find a tool to assess measure and get to the root cause in the next level and it’s really something special and
unique about being here at the maxwell clinic that i don’t think occurs in in most clinics across the
world so patient resource utilization is something we take very seriously and that means your money and funds because
we all as our wonderful founder likes to say we all have an unlimited number of
desires when it comes to our health and a limited number of resources whether it’s time money energy effort so what
our maxwell clinicians are excellent at doing is discerning and discernment with which tests and tools would best track
progress on each individual patient’s goals so part of what we do here is we say okay
what’s going to get us our biggest bang for the buck in your long-term trajectory where do we
need to go what do we need to measure and that’s why i’m working with maxwell care clinician is also really imperative
in this process do i need to fast for lab work for the rpe procedure or for
the rpe procedure well for our routine lab work and the normal procedure you do not need to be fasting you should eat a
balanced breakfast and stay well hydrated but you don’t want to over hydrate the morning of because when
you’re in the chair and you have the iv in both arms you’re not gonna be able to get up to go to the bathroom
so you want to just drink normally that morning and make sure you empty your bladder
before you sit in the chair but then the days leading up to it just make sure that you’re
adequately hydrated if any fasting blood work is needed the nurse will inform you of this and assist you in scheduling the
lab work so our plasma exchange program coordinators will get you all that information how long does the procedure
take it takes about two to four hours in total what are the contraindications so really
interesting and this is why we really harp on a plasma exchange consultation because there isn’t a lot of
contraindications to plasma exchange whenever we’re expanding it out in the regenerative space so typical
contraindications for therapeutic plasma exchange include challenges with venous access if we can’t access your veins
then we’re not going to be able to do the procedure and without placing a more central line
actively septic individuals so people who are really sick who have organ failure who are really infected
they just aren’t stable enough most the time to be able to proceed a known allergy to albumin or heparin
that would be a contraindication or any pre-existing hypocalcemia so if you know that your calcium is really really low
it doesn’t mean that we can’t figure something out and customize your plan but it would be something that we’d need
to have a long conversation about and look into a little bit further does plasma issue this this is a hot
question of the day does plasma exchange shift immunity after previously
receiving a vaccine there is a potential transient decrease
in the total antibody load of the patient after receiving plasma exchange but i want to emphasize the word
transient because this typically comes back up over time without acute impact on the effectiveness of the vaccines
if i do an rpe procedure once or twice a week aren’t you taking out some of the new plasma i just received you know what
people will say to us is wait a minute this is not an inexpensive endeavor and so you
mean to tell me that like the good oil change that just happened you’re just going to take all that back out well i want to explain this a little bit
further because that’s not exactly the case so it’s important to understand that while the clean albumin that’s
being put into the system is replacing oxidized and more polluted albumin protein
it’s believed that the most important part of the plasma exchange is really what’s removed not necessarily the
albumin being put back in let that sink in for a second so plasma exchange is a very complex fluid it’s
filled with lots of cellular messengers inflammatory substances fragments of dna proteins toxins really anything you can
measure in a blood test so it’s the removal of these accumulated compounds that is the most important accumulated
keyword while some of us like to use the oil change analogy as if we were taking out
is the you know the bad oil and putting back in the good oil it doesn’t really best explain the repollution that occurs
within the body within 24 hours of a one plastic change procedure so we like to use the lake and wetlands
analogy what does that mean exactly well we can clean the lake as if the lake was
your plasma and your blood however the wetlands that surround the lake like all of your body tissues
will re-pollute the lake after the lake is cleaned that’s what we’re talking about with accumulation so whenever you have so
we’ve let’s say we’ve got a river here in this photo and we’ve just put all this clean
albumin in it well all your body tissues have accumulated those toxins and
oxidized molecules over the years of your life and they just like the wetlands with will
seep all of that back into the freshly cleaned river or lake and so it’s
re-polluted so this is why more frequent plasma exchange can be administered at the
beginning to better gain maximal benefit because we’re having the opportunity to actually make headway on the total body
burden the total that is accumulated in your system versus just a one-time effort i think truly that’s why the
ambra trial was so successful in showing that great jump there in the beginning when there
was that burst done weekly because they were able to get into the accumulation
with that said some is better than none and benefit is still gained by spacing them out because a lot of times back to
the resource utilization conversation you know it’s not an expensive endeavor and so we have to make that decision so
i don’t want you to also think that you’re not garnering any benefit if you’re unable to or it’s not recommended
to stack them a little bit closer together in the beginning we have the opportunity to see the
needle move more significantly by cleaning the lake back to back so to speak but we’re working against
progressive degeneration so any type of clean out is beneficial to the system overall and how the engine runs
how do i know if plasma exchange is right for me like this all sounds fantastic but what about me this is determined at your consultation
so determining safety and recommendation for the plasma freezes procedure it depends on the patient’s health medical
history reasons for seeking it out we determine each individual’s eligibility based on their unique case which is why
we always begin with a consultation visit plasma exchange is a relatively safe procedure as we’ve outlined with a low
contraindication profile therefore we don’t have a list of strict contraindications at present and we take
each patient case by case factoring in all aspects of their health history as well as recent lab work if it’s
applicable i like to do plasma exchange but i know you guys have other procedures can you
tell me if that’ll be added in well at maxwell clinic we do utilize we have a ton of ancillary supportive
procedures it’s incredible such as iv nad neurofeedback iv ozone hyperbaric
oxygen chamber and other therapies just to name a few our recommendations are really truly
personalized to each patient case and the next best step would be for you to schedule consultation so we can outline
all those options and a lot of times when we’re doing these plasma exchange consultation visits we’re going to
recommend what would be ideal we’re going to say okay if i had a the full
menu and i thought what would be the absolute best thing for optimization here’s everything i would do but we can
also highlight in there different optional things you know that can be because cost is a consideration so we
really work with people and it’s a it’s a conversation so i’ve mentioned cost a couple times so
it’s time to talk cost how much does it cost drum roll
regenerative plasma exchange is not inexpensive as i mentioned with the specialized equipment costly materials
specialty staff and time commitment to make this innovative outpatient therapy more accessible to more people
we do provide it at less than half of what the charge would be in a hospital
less than half i have so much pride at the numbers that we’re able to offer and
how we we are able to reduce this cost than what would typically be billed in
an acute setting it’s incredible your plasma exchange consultation visit
with the clinician is 950 200 of that is able to be applied to your first plasma exchange procedure
should plasma exchange be recommended and you choose to move forward each plasma exchange procedure is 4 900
so just for relative to to keep this relative and why this makes me so excited is because when you
have this procedure done in the hospital or more acute setting or even in other outpatient facilities that offer this
that bill to your insurance it can be billed anywhere from nine to sixteen
thousand dollars typically within the you know ten to fourteen thousand dollar range so to be able to offer this for 4
900 although i know that to some that can seem like a lot is so incredibly
exciting it’s unbelievable the 4 900 for the rpe procedure will
include the labs that are drawn immediately following the plasma exchange that we use to track the effects of the procedure these labs as i
just mentioned are only used to monitor the effects of the procedure itself the labs that are drawn prior to plasma
exchange to see how you are coming into the procedure are not included and can cost up to an additional 300 however we
do everything we can to keep that as low as possible what happens if i start a plasma
exchange procedure but i can’t finish it well if the procedure is partially completed anything less than fifty
percent we’re only charging you a partial procedure fee and that is typically around
twenty four hundred dollars if the procedure is complete at fifty percent or greater the patient will be
charged the full amount if the procedure is unable to start due to iv access issues or anything else the patient will
be charged just the 600 setup and supply fee for the machine materials
consultation questions so i talked about this consultation visit and and so now we have to get into
the details so how long is the consultation visit our plasma exchange consultation visits are 30 minutes long
and are all conducted via telemedicine which is via zoom the purpose of the plasma exchange consultation visit is to
determine eligibility and suitability for plasma exchange our clinicians will not be conducting a full case
consultation making supplement or other treatment recommendations at this time we highly recommend our maximal care
program if you’re seeking a comprehensive approach to optimizing your max well
who is my consultation visit with well your consultation visit will be with one of our overseeing plasma exchange
clinicians this could be one of our physicians dr david haasey or dr mark lickey or myself a nurse practitioner
lindsey jost or a combination of the above depending on availability
will i get a i might there we go will i get a refund if i
have a consultation and you tell me plasma exchange is not right for me no scheduling consultation does not
guarantee that plasma exchange will be recommended or ordered the cost of the consultation is for the time with the
consulting physician it is a visit or clinician team to review the patient’s case as well as a time for the visit
itself it’s to determine if it’s safe to order or recommend it in some cases it’s not
recommended or felt to be safe to proceed with until further evaluation or testing can be accomplished but we will help make those recommendations as far
as to guide you in the next best direction to better determine a root cause of the patient’s symptoms we do recommend our
maxwell care program as i mentioned you know plasma exchange is not a benign intervention and when patients are
experiencing debilitating symptoms without a clear physiological cause or path for a potential cause it’s
important that further evaluations are completed prior to being able to determine if it’s safe to do
what is the consultation cancellation policy a 48-hour notice is required in order to receive a refund is the
consultation only via zoom or can i come in person currently the consultation visits are only available via zoom
how do i get started i’m so glad you asked your first step is to schedule a consultation
stop telling me about these consultation visits they’re falling i promise come join us our staff will also assist in
guiding you to complete your new patient intake forms prior to your visit because we have to have that information to be
able to review your medications your supplements your medical history what’s going on with you why are you here what do you want your health for and all
those important questions how do i schedule this amazing consultation visit well
you can call our clinic at the number provided below uh the
615-370-0091 for those who are not looking at a screen to schedule a call with our new patient coordinator or you
can schedule a call directly online through our website where you might ask would that be
on our website up here at and you can click on the regenerative plasma exchange page
and if you scroll down you will see this little image here where you can click to either schedule a call or send us a
message directly so let’s talk about a couple online resources that you guys have at your
inner web fingertips at any time this is our regenerative plasma exchange
landing page so if you go to and you look at other therapies
yes therapies and services up there at the top you can click on regenerative plasma exchange and this is the screen
that you will be directed to as you’ll notice there’s a little button here to download our free regenerative
plasma exchange brochure i highly encourage you to do that it will expunge and go further into some of the details
that you may still be wondering about after this talk additionally if you scroll down on the
same page you will see three videos posted by our fearless leader dr david housey on regenerative plasma exchange
we have one for autoimmune one for cognitive decline and one for vibrant longevity our three most common buckets
and so you can get more information there and he’ll dive into all the details
there’s also if you continue to scroll down a link for the ted talk that he did
uh previously on hope for dementia and then he we have a bulletproof radio feature podcast to listen to as well
there is also a blog post so if you see hope for alzheimer’s
up there at the top i’m sorry hope for dementia dash alzheimer’s we have a blog post and you
can see both dr haasey and i with one of our plasma exchange patients get a couple more images of what that looks
like and get more information on that blog lastly i want to make sure i included a
little plug for the ambar trial and where you can find it in case you are a
data loving individual want to dive into that a little bit further so you can look at pubmed or you can google search
and this is what you’ll be looking for ambar an encouraging alzheimer’s child that raises questions uh griffels was
the company that sponsored that and so feel free to look that up and dive into those details it’s
just it’s just incredible so now i’m going to close with any
questions i see a couple pop up in the q a so i’m gonna stop sharing my screen here
and let’s dive in hi mom thank you
um yes i that absolutely made made me smile um
okay and another question is would you recommend a consultation for a 92 year
old who has dementia following coveted 16 months ago absolutely absolutely there is a lot that we can do
for the elderly patient population and you know what we can do is we can look
at how far along and how far progressed the dementia is
that’ll make a difference in our recommendations but it’s absolutely worth um having a consultation so we can dive
in further you know the long-haul covid symptoms are really interesting and how they affect the microvascular system and
plasma exchange just as i described you know unable to kind of clean out those long-term oxidized molecules and toxins
and being able to clear a pathway from an inflammatory standpoint you know the
the data that they’re seeing so far for long covet is is really tremendous and and regardless of age so yes yes yes yes
to a 92 year old um with long haul coven which toxins does the plasma exchange
remove for example um well
it’s kind of a catch-all and i don’t mean to be vague on that um but
you know we’ve seen shifts in um our the metals you know the
mercury your leads your cadmiums your things like that because whenever you decrease that over time a lot of those
toxins are held in the tissue space so when you clean the plasma it does cause
it to kind of go back in but just being able to clear that is is really useful
there’s from a cardiovascular health perspective we know that plasma exchange will
transiently decrease triglycerides cholesterol and things
like that it does tend to re-normalize and bump back up but just having the opportunity
for that to to kind of have more free flow makes a big difference from a vascular standpoint um
michelle i’ve got your name so i’m gonna get back to you if you can put in your email here i’ll
get back to you with a little bit more specifics on the toxins as a follow-up question
let’s see tpe didn’t last very long when it first started and it wasn’t considered effective for the cost because of that
what has changed i don’t know if i understand that question um
so therapeutic plasma exchange has been a lot around for a really long time in the acute hospital settings um and been
shown to be effective you know that the kind of age-old the age-old sort of acronym is if you can’t figure
it out a free sit out so when patients become really septic and acute you know a lot of times
they’ll go to plasma exchange because it it was seen to be effective so i apologize if i don’t understand that
question but i’m not quite sure how to to answer that
okay there we go i worked in the icu we did tp for scleroderma and it just didn’t last long that’s so interesting
yes so in the thank you for giving me a little more clarity so in the uh
autoimmune space different than cognitive decline uh autoimmune
when we use therapeutic plasma exchange we decrease antibodies for a period of time we increase quality of life we
increase stem cell activation we actually have a number of scleroderma patients
one of which was unable to work and function and had some hand
symptoms that is now able to go back to work just because of the symptoms being able
to decrease so it it does come back you know with autoimmunity it doesn’t cure
the autoimmune process but what it can do is it can down regulate the total number of
antibodies to increase the stem cell activation to be able to allow the body you know one of our principles here is
that we believe the body was designed to heal and i see that every single day and so
with a couple of scleroderma patients that i’m thinking of you know that are now able to function in their lives
because they’ve been able to decrease their total antibody load they’re the healing mechanisms are able to
actually kick in so it is a long-term procedure when it comes to autoimmune for maintaining and
keeping up with quality of life unfortunately it’s it’s not something that you is kind of a one and done or a
burst and then done it typically is a maintenance something that they have to do more often so that’s probably why um
and i don’t know if you were able to track patients long term from the icu standpoint
all right is there any part of the procedure covered by insurance no so
we typically are um we are an outpatient uh are out of insurance out of the network i should say cash pay practice
here the therapeutic plasma exchange and regenerative plasma exchange is we do
not submit to insurance directly what we have found for patients who have autoimmune conditions because cognitive
decline and optimization are not a traditional indications through insurance reimbursement for therapeutic
plasma exchange so even if you self-submit your bill they will not reimburse for that but if you have an
autoimmune disorder we have had patients who will pay for the procedure
they will take the receipt and invoice they can get from our office which you can get those upon requests at any time
and then they’ll self-submit to their insurance and get reimbursed directly i don’t believe they get reimbursed for
the full amount but they do get reimbursed from a portion from what the feedback that we’re getting
will plasma exchange help with circulation about how many sessions to see a change
um yes plasma exchange does help with circulation it is um amazing for
peripheral neuropathy we’ve had a couple patients who after doing more regular plasma exchange um had a tremendous
shift in their ability to feel their feet which can be a little disorienting if you’re not used to being able to feel
your feet um however in a good way so it does it does help with uh circulation
and we so i mentioned a little bit earlier we have a test called the glycocheck which measures microcirculation so in patients where
circulation is something that we’re monitoring we will get a baseline measurement of your microcirculation and
then we’ll track that over time with plasma exchange so your symptoms are key but then also we can track that through
that testing as well how long will a patient with cognitive so last question how long will a patient
with cognitive decline have to continue doing regenerative plasma exchange at
5000 a session we can afford it for months or years what’s the longest time you had an improvement last great
question so what we tell patients with cognitive decline uh mild to moderate or new onset
alzheimer’s and what we’ve factored in and done a lot of cost analysis on is that a year of plasma exchange
doing it if we mirror it exactly to the amber trial so the amber trial is once a week for six
weeks once a month thereafter so if we do that for a year the total cost for that out
of pocket is less than a year of memory care or assisted living services it is
not inexpensive however so unfortunately when it comes to a diagnosis of dementia
alzheimer’s or severe cognitive decline we’re only going in this direction and so in order to
use co use therapeutic plasma exchange or generative plasma exchange to help to improve that it is an ongoing therapy so
what a lot of patients and their families will do is they will do it initially because our goal is more
good days our goal is not to cure alzheimer’s with plasma exchange yet
obviously that is that is what we would love to be able to do but right now we aren’t seeing that we can cure it but
what we can do is improve quality of life for longer for a disease process that we know only tends to go in one
direction so that you can have more time at home with your loved ones able to function at
a higher level than they would be had they not done this therapy so it’s it’s a it’s a conversation and it’s a lot to
consider but whenever you’re you’re dancing in that space of just knowing that they’re only going to be going
downhill to have more good days with them is it it’s just invaluable it’s it’s
incredible and so would love to discuss that with more in more detail you know looking at a very
specific patient their trajectory their history their labs you know to see what kind of benefit we could gain
thank you everybody for your additional questions i hope to have given at least a little bit more context understanding
around regenerative plasma exchange and what it can do and that most of your questions are answered if you have any
other ones do not hesitate to reach out to us and we look forward to hearing from you
soon have a great night

This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, website or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This blog does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. We cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this blog or website.

If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment immediately. Never disregard professional medical advice or delay in seeking it because of something that you have read on this blog, website or in any linked materials. If you are experiencing a medical emergency, please call 911 or call for emergency medical help on the nearest telephone immediately.

Lindsay Jost, APRN, FNP-C

Lindsay Jost, APRN, FNP-C is a board certified Family Nurse Practitioner whose enthusiasm for comprehensive care, unique intuitive insights and clinical experience creates an instant feeling of connection.