Medical Tourism  Kiev, Institute of Family Medicine

Yaroslav Miroshnikov, Director of the Institute of Family Medicine

Director of the Institute of Family Medicine Yaroslav Miroshnikov:
“Regenerative medicine? Cell-tissue transplantation? We implement these ideas in our medical practice”

Doctor Miroshnikov is andrologist- sexual pathologist according to his first specialization. On the very initial stage of his medical practice he received evidence of what he had never doubted: his specialization does not “belong” only to him. Sexual pathology is actually butting and integrative specialty in medicine. So, there is no definite answer in eternal argument: who is to take care of men`s health – urologist or psycho therapeutist. The truth is that sexual function is synthetic one, so it demands not just urological or psychological background from a doctor, but therapeutic, endocrinological, neurologic and a lot of other skills and knowledge.

On the other hand, there exists objective reality: our health, including sexual, depends partially on our lifestyle and on influence of the environment. These factors made people “hostages” of their own crazy lifestyle; evolution of “Homo Sapiens” is far behind scientific, technological and economic progress. Number of various diseases, which have become more frequent lately, is natural reaction of human body for this lag.

But our organism, like everything alive in this world, has another very important property – ability to regenerate. That is the main task of a doctor – to stimulate physiological process of regeneration, create optimal conditions for its realization. But what is the best way to do it?

These must have been thoughts of Doctor Miroshnikov, candidate of medical science, when four years ago he decided to сreate his author`s project - Institute of Family Medicine in Kiev. Today Yaroslav Miroshnikov is the Director of this successful Institute and our interlocutor.

Yaroslav Miroshnikov: “We work in clear legal framework, absolutely legally”

Yaroslav Miroshnikov: “We work in absolutely clear legal framework”

-Yaroslav Olegovich, why Institute of Family Medicine?

-Because no matter how medical technologies improve, medicine is, first of all, personal doctor`s experience plus empirics. No specialist would argue with that. It is not accidental that, according to world statistic, 80 % of health problems are solved with assistance of a family doctor. Such a doctor is aware of health condition of grandparents of the patient, his child diseases, when he got married, conditions and reality of his life. In a word, a family doctor is better informed and that gives him an opportunity to make the best choice in treating a patient under his charge.

And only when it comes to providing with highly specialized medical help, necessity of which must also be suspected and diagnosed by a family doctor, a patient is sent to a hospital for, let`s say, heart operation or neurosurgical brain or intracavitary operation.

-Looks like such direction in our medicine is developing rapidly…

The direction is correct, well-intended, but life will show how it will work in practice. Ukraine has always been famous for its “bright minds”, but, unfortunately, there have been problems with realization of their ideas. I can judge by experience of my own clinic: there is huge distance between intention and realization. We have to think everything over very carefully.

-What have you created? What is the special appeal of your author`s project?

-First of all, it is about organization of the business. We declared our main principles: competitiveness and closed cycle.

-What does it mean?

-Competitiveness – is, on the one hand, prevention of narrowness of interests of a specialized doctor, and prevention of their mismatch with interests of our patients.

80% of health problems are within the competence of a family doctor

-Think yourself: Does a doctor of certain specialization want to have stable work and appropriate salary? The answer is definitely “yes”. But a patient, in his turn, strives to know objective diagnose and get qualified help. They both want, as the hero of the famous movie would say. But modern medicine is formed in the way that many human diseases require involvement of specialists of different specializations. Here is classic example: pain, pelvic pain, in particular. In western specialized literature it is called “Syndrome of chronic pelvic pain”. This disease is often treated by urologist after diagnosing prostatitis. However, there is great aphorism of a French urologist: “Diagnosis “Prostatitis” is a dustbin of medical ignorance”. In fact, chronic pelvic pain may be in competence of neuropathologist, surgeon, proctologist, physician or vertebrologist, who deals with vertebral column, with the same level of probability.

So, the idea of competitiveness principle is ability to gather right here, at my table, doctors of different specializations, who will have equal opportunities to treat the patient with the abovementioned pelvic pain, for example. It is very important that doctors are gathered at the moment when results of necessary tests of a patient are available and they have to diagnose and determine strategy of treatment. Every doctor, “aspiring” to treat each particular patient must prove to me that the disease is of his profile. And as the Director of the Clinic I do not care, roughly speaking, which of doctors will get profit from that. All I am interested in is that a patient stays at the Clinic and he or she is satisfied with results of treatment.

-By the way, my first private medical cabinet was called “Council of physicians”. This idea proves its value here, in the Institute of Family Medicine too.

-Probably such approach also has its drawbacks?

Maybe, but it minimizes risk of medical error on the most important level of healing – diagnosing and treatment strategy determining level.

Doctors of all necessary in our sphere specializations plus nurses and laboratory assistants are at your service.

-Our second principle becomes operative here: closed cycle of treatment. It is not just intended to provide with ergonomics, optimal economic effectiveness of treatment process, but is also meant to fight extremely narrow medical specialization.

Here is a typical example from real life. A man comes to the Clinic and goes straight to urologist – “I have prostatitis”. But, in fact, along with that he has some other small proctologic problems. According to our Institute`s statistic, that`s what happens in 74 cases of visits to urologist out of 100. But not many patients know that modern treatment of prostatitis is often incompatible and even contra-indicated if they have “parallel”, even insignificant proctologic problems. What does our clinic do in this case? We make obligatory preliminary analysis. If we find, let`s say, piles or polyp, we dispose of them first, rehabilitate a patient and only after that get down straight to his prostatitis.

In other words, within one institution under integrated control a patient`s problems are solved by different in their medical profile specialists; optimal succession of medical treatment is developed.

-All these are so-called organizational “special appeals”. What are medical priorities in your author`s project, what are their peculiarities?

-We strive to work and what is important- according to international standards, many of which are adapted for special goals of the Institute of Family Medicine. In particular, we have very strong base in diagnostics of infertility, both male and female. In case of male sexual disfunction topical diagnostics is successfully used. It enables to estimate in complex condition of sexual health and health condition in general. All these facts explain medical merits: system, algorithmization.

Along with main medical directions, use of regenerative medicine in our clinic is rather interesting, serious and productive.

-What is regenerative medicine?

-Regeneration, in other words – renewal –is physiological process, which is peculiar to all alive organisms, including each of us too. But like I any other physiological process, certain preconditions should be created for realization of regeneration. We analyze them carefully in any particular case of medical practice, but not just use regenerative medications. In other words, we carry out serious work at preparation period of regenerative medicine. We are obliged to create in all the necessary conditions and background for this in patient`s organism.

Regenerative medicine is use of medications, derived from cells and tissues of organism in different degrees of differentiation.

-We have formulated four main ones at our Institute. The first one is compensation of the main disease. Here is classic example for you: many patients (out of foreigners as well) come to us for help with insular diabetes. We try to explain to them that direct use of regenerative drugs without compensation of insular diabetes – that is normalizing level of sugar and hemoglobin in blood – has no sense. That`s why specialists of our clinic normalize diabetes first, then ensure regeneration of the whole organism. The second principle is desintoxication: with help of diets, intravenous infusions and such harsh methods as plasmapheresis. All these methods are successfully used and specialists can estimate the essence of the above mentioned. The next level is disinfection. I can explain this term for an ordinary reader by the elementary example of infertility. If there is sexually transmitted or any other infection in a patient`s organism, then we should first neutralize it, dispose of inflammatory process, and only after that – normalize regeneration of male spermatogenesis and female ovogenesis. And, finally, the fourth principle – desensibilization, which we also offer to our patients.   In other words, it means normalizing of allergic status of organism. After that there comes turn of regenerative medicine.

-Let`s answer our readers` question: what is regenerative medicine in its practical use?

-It is use of medications, derived on basis of cells and tissues of organism in different degrees of differentiation.

-Are we talking about so-called stem-cells, which have caused so much rumour lately?

-Yes, about stem-cells as well. But we should first answer another question: why did false roumors about them appear? Because the cart was put before the horse. To be more exact, the “cart”, this rather productive direction in medicine, was laid on reckless commercial basis. They became to use these cells whether it is necessary or not everywhere at crazy prices, besides on unprepared people as long as they had enough money. But patients should be prepared. Even operation of appendicitis removal demands preparation of a patient. Aorta-coronary bypass surgery also demands preparation of a patient… And a patient definitely should be prepared very carefully for this interesting method of treatment with use of stem-cells. And before that this patient should be selected very carefully.

-And still: why do these stem-sells cause such preconceived attitude?

There are several myths on this account. First of all, it is about understanding (or to be more exact, misunderstanding) of nature of stem-cells. Since genuine poly patent “universal” stem-cell is not used either by us or any other legal medical establishment of the world. Sells of certain degree of differentiation are used, which are, figuratively speaking, adjusted for certain purpose: liver, nervous tissue… Cells used at our Institute have the status of imuno-biological medications. They are allowed for use by pharmauceutists, The Ministry of Health Care of Ukraine. So we make quite legal records in a medical card that a patient got certain imuno-biological medication. In his turn, the patient gives his written agreement. So I emphasize again that we work absolutely legally.

Here is another cause for idle talk: stem-cells and diabetes. For some reason many people believe that stem-cells heal this decease. In fact, such opinion is false from the very beginning. Cells by themselves do not heal diabetes. They prevent and heal complications of this disease, but diabetes must be compensated. Disability and death from diabetes happen not from diabetes, but from its complications: gangrene, impotence, blindness, lesion of kidneys. Stem-cells are intended to prevent all these things; they renew sell reserve, lost because of increased level of sugar.

Another myth: cells are charlatanism and they actually do not work. What can I say in this case? Though, I have almost answered this question above: stem-cells are in no way cheating.   Personally I have been using this method for almost six years, being the Main Research Assistant of Coordination Center of Organs, Tissues and Cells Transplantation of Ukrainian Ministry of Health. So, I can judge about it from my own experience and with full responsibility.

Though, with the same responsibility I can say that stem-cells are not panacea for all diseases. Every problem should be solved individually.

Our lifestyle has great influence on our health

-Absolutely. In our professional language it is called development of differentiated indications. It is one of the most important directions of researches and gives rather effective results. As a proof of that, for example, we keep photos of alive and healthy infants – children of hopeless in their reproductive capabilities parents. One of fathers of such a child offered his sperm to a clinic for its insemination in-vitro, but they refused, since they were not sure of positive result. In our case, children were born in natural way. But there are no miracles here: specialists of our clinic worked with such couples from 12 to 18 months. There are appropriate methods. The same in case with such spread disease as liver cirrhosis. We manage to prolong life of such patients for several years.

-Does it mean that after being healed in such a way at the Institute of Family Medicine your former patient can be a “normal” person again and lead his usual way of life?

This is the deepest delusion: that although regenerative medicine is not panacea, but its use enables patients behave the way it would be contra-indicated in case of ordinary treatment. No way! Roughly speaking, if we saved a patient from harsh diabetes or prior-cirrhosis condition, it does not mean that from now on he can drink vodka in huge amounts because he was treated with some regenerative medication. No way again! If our former patient starts doing it again, he will soon return to his previous unhealthy condition and probably we will no longer be able to help him. No one has cancelled importance of lifestyle, which has great influence on our health. Let me remind you that, according to data of the World Health Care Organization, 50% of our health is determined by our lifestyle, 20% depends on genetics, 20% - on ecology and only 10% depends on a doctor and vegetative drugs.

 -Let`s specify once more: who and with what diseases can come to your Institute for help?

-People, suffering from diabetes, those, who have had ischemic stroke. We also deal with male and female infertility, pathologic menopause, dermatological diseases (first of all psoriasis), liver diseases, hepatitis (in particular, alcohol), initial liver cirrhosis, diseases of joints of not rheumatic etiology, sexual disfunction.

We have experience of work with so-called “Arabian diabetes”. By the way, epidemic of diabetes in Arabian countries is big problem due to local genetic and racial peculiarities as well as inadequate nutrition of people. 70% of population are affected by this terrible illness. There is also some experience in working with citizens of the USA. Regenerative therapy is not allowed in the USA because of religious and law preferences. But it is successfully used in Ukraine, allowed in the CIS countries, Eastern Europe, in China.

The main office of the Institute of Family Medicine is situated here

At general organizational level we keep abreast, about what much has been said above. Speaking about scientific component, we can only dream of budget, assigned by western corporations for researches at their medical establishments. Nevertheless, we also find means for scientific development in our budget. We regularly attend international congresses, learn about progressive technologies from our foreign colleagues, try to develop our own technologies. And we succeed in that. Five patents have been protected lately. There are, for example, patents in treatment of infertility. There is a very interesting patent for physiological operation on renewal of erective function. Why do I call it physiological? Because most operations of this kind are connected with prosthetics – putting an implant into penis. This may cause a man and his sexual partner certain psychological discomfort. On basis of our researches and consultations with physicists and chemists we have developed our own method and created physical model of erection – method, enabling men to restore their own erection. The most pleasant thing is that the method is especially effective in treatment of young patients with initial vascular impotence and its efficiency reaches 80%.

Of course, we publish articles about our innovations in different editions; attend various international and local conferences. I personally, as the main sexual pathologist- andrologist of the city, organize scientific-practical forums of specialists. In other words, we do not stew in our own juice and do not run 100-meter sprint for record in our own garden.

-Does your clinic own appropriate technological equipment for scientific research and medical practice?

-No doubt! We have our own laboratory, great physiotherapeutic base, the most up-to-date imported equipment. In a word, we have everything that might be necessary for effective highly-qualified work.

-What about personnel?

We work with highly-qualified doctors of all necessary for us specializations plus nurses, laboratory assistants. About 20 people in general. It is here, right in the main office of the Institute on Nemanskaya Street, 6. There is also a small stationary surgical department in “Medical Town”. If we need to hospitalize our patient for complicated operation, we know where to address, since we have established durable business cooperation with our colleagues throughout the city.

Please contact tour operator “Prime Excursion Bureau” for getting detailed information about terms of treatment at the Institute of Family medicine and contact phone numbers for operative connection with personnel or Director of the Institute Mr. Y.Miroshnikov.

For objective estimation and prediction of results of treatment, please show results of your examination (case records).

This material will be studied by personnel of the Institute of Family Medicine and you will be provided with qualified help.