Feb 2, 2015
The world of Regenerative Orthopedics began in the United States with the publication of a scientific article reporting the results of platelet rich plasma in the treatment of knee arthritis. That took place about six years ago. No one really understood at the time of the publication why something so important in the clotting cascade of the human body would be beneficial in the treatment of an arthritic joint.
The next step in improving results of Platelet Rich Plasma injections for an arthritic joint was the understanding that whereas one injection would help, three injections over a three month period would improve outcomes. Scientists began further efforts at understanding why the platelet, so critical in the clotting cascade, would be beneficial in treating arthritis, and soon a better understanding of how platelets function came to be appreciated.
Platelets are the primary source of bioactive tissue growth factors. When concentrated they are potent. When activated, they release their growth factors and cytokines in clinically active quantities. Regenexx has developed a formula for superior concentrations and immediate activation. Whereas most Platelet Rich Plasma is created at bedside, we create ours in a laboratory with maximum concentration and prompt activation. Our research supports better stem cell growth following the Regenexx SCP procedure. Although the Regenexx Stem Cell Plasma formula is part of the Bone Marrow Aspirate Concentrate algorithm, we now are able to offer it when indicated as an independent intervention when Bone Marrow Concentrate is not possible. In addition, it is a wonderful “booster” when anticipated milestones with Bone Marrow Aspirate Concentrate are not met. Let me cite two patient examples.
Two years ago, an 83 year old man was selling his condo in Palm Springs because his arthritic knee would no longer tolerate a round of golf and his co-morbidity posed a very high risk for a joint replacement. He sought consultation and I recommended a Regenexx SCP intervention. Three weeks after the procedure, he took his condo off the market and returned to Palm Springs for the winter migration from Chicago. I spoke with him via phone in August and he had purchased his tickets for the return migration to the desert this winter.
36 weeks ago, I performed a Bone Marrow Aspirate Concentrate/Stem Cell intervention into the right hip of a 29 year old man with early onset degenerative arthritis. At six weeks, he was 25% symptomatically improved. At 12 weeks, he was 50% improved. At 18 weeks, he was still 50% improved so I administered a C-SCP booster. At 36 weeks he is 80% improved and thrilled. Cellular Orthopedics requires a continuum of monitoring and possibly more than one intervention.
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Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Sep 15, 2014
Well, there we were again over the Labor Day three day weekend, cycling up the elevations and over the roads of Southwest Wisconsin. In between, I was able to spend several hours wading in several of my favorite creeks that meander through the Driftless Area. As far as the fly fishing was concerned, it was with a hopper and dropper but I met with little success as I fished during the heat of the day. When it came to cycling though, that was very successful as on three consecutive days, my wife joined me after her cycling sabbatical of 15 years. Our group went out on long rides and two of the wives, mine included, joined us for part of the venture. Why this all becomes important is that two years ago, I was experiencing a major problem with my left knee. The symptoms, arthritis related, had caused me to stop running, decrease my cycling mileage, and alter my skiing agenda. One day, I decided it was time and I underwent a Cellular Orthopedic intervention in my left knee. It was either that or change my entire recreational agenda and limit myself to swimming.
I am happy to report that the musculoskeletal care via Cellular Orthopedics for this Mature Athlete worked and here I am, living a totally unrestricted life. My winter ski trips to the west are being planned so as not to interrupt my work schedule this winter. The absence of knee pain allows me to look forward to another long weekend in pursuit of the 20 inch Brown Trout before the end of the season in Wisconsin..Two years ago, I wasn’t sure if there would be any more skiing in my life or wading up the spring creeks because of the arthritic knee. Sure, I could always fish from a drift boat but it isn’t the same and the Wisconsin spring creeks are for wading, not drifting while seated in a boat.
OK, you get the message; the role of Bone Marrow Aspirate Concentrate derived Stem cells in Musculoskeletal Care of the Mature Athlete. Now if you will excuse me, I am off to the fitness center to stretch, run and row; all made possible by that Cellular Orthopedic Intervention, two years ago.
Tags: arthritis, athletes, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Knee, Mature Athlete, Osteoarthritis, Regenexx-SD, stem cells, treatment
Jul 14, 2014
Beware of a company that treats everything from MS, to ALS, to arthritis with stem cells.
It is the obligation of anybody using stem cell therapy to track and report his or her data. I run a large registry with a designated medical researcher using the same outcomes criteria I used as director of a joint replacement program at a major university. I also have access to a full time bio-statician to analyze data. In August, I will report that data on-line and begin publishing the Outcomes in peer reviewed publications. My mission statement is musculoskeletal care of the aging athlete.
What prompted this tirade is the increasing marketing bombardment by Regenerative Medical providers offering false hope and information based on faulty science. Fat stem cells are not better than bone marrow stem cells for osteoarthritis In fact, for an osteoarthritis application, about 10 papers where fat and bone marrow cells were compared showed that the bone marrow cells were more suited to the application. The big issue with fat stem cells is that the closer the cell source is to the target tissue to be repaired or helped, the more likely it is that the cell will work. So bone marrow cells are involved in helping and maintaining joints and the fat cells from your stomach are not. I highly recommend the reading of a Blog written by Dr. Chris Centeno, the founder of Regenexx for a more complete explanation
http://www.regenexx.com/2014/07/checking-the-facts-about-fat-stem-cell-therapies-breaking-down-the-slick -marketing/
This is a common problem with clinics offering fat based stem cell therapies as there is scant evidence that this therapy is effective for arthritis at this point. Rather than conceding that fact, most clinics will -quote research that looks great on the surface but falls apart once you dig just a little deeper! So whom can you trust?
Prior to the dawn of contracted medicine, a patient had a doctor in whom they trusted and confided. When there was a need for a specialty referral, the family physician made the recommendation. Now that patient chooses health care based on a contract or even worse, an app. Perhaps in the evolving era of Cellular Orthopedics one might be guided by the message in Robert Browning’s classical poem Rabbi Ben Ezra…”Grow old along with me/The best is yet to be, The last of life, for which the first was made”. One of John Lennon’s final songs written “Grow Old with Me” appeared in the album Milk and Honey. For stem cell experience, updates and questions, make an appointment with this senior.
Tags: arthritis, athletes, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Orthopedic Surgeon, Osteoarthritis, Regenerative, Regenexx-SD, stem cells
Mar 20, 2014
Osteoarthritis is essentially joint failure because all structures of the joint undergo pathologic changes. Traditionally, OA was considered to be a disease of articular cartilage, with loss of cartilage considered to be the essential pathologic process for OA. In recent years, however, it has been realized that OA affects the entire joint structure, including the synovial lining, ligaments, supporting subchondral bone, along with the articular cartilage. Each structure in the joint plays a unique and important in the daily function of the joint. Articular cartilage, with its compressive stiffness and smooth surface; synovial fluid, which provides a smooth and frictionless surface for movement; the joint capsule and ligaments, which protect the joint from excessive excursions; the periarticular muscles, which minimize focal stresses across the joint by appropriate muscle contractions; the sensory fibers, which provide feedback for muscles and tendons; and the bone supporting the cartilage (subchondral bone), with its mechanical strength and shock-absorbing function all interact in an intricate manner to provide optimal function for the joint. Destruction of any of these structures or a disruption in the balance between them leads to the process of arthritis.
A discussion of each risk factor is beyond the scope of this Blog but they may be divided into systemic categories (advancing age, gender, genetics) and local categories (anatomy, trauma, body mass, repetitive use injury, bone density). In considering the clinical features, there is no correlation between the X-ray and the degree of pain. The most likely sources of pain in OA are synovial inflammation, joint effusion, and bone marrow edema. All is dependent on and mediated by a loss of balance in the cartilage cell (chondrocyte) mediated balance between growth factors, cytokines and enzymes that breakdown the cartilage. OA becomes an inflammatory process initiated and propagated by inflammatory mediators that lead to the demise of the articular cartilage first and damage to other structures over time.
How might stem cells change the natural history of Osteoarthritis progression? The stem cells are chondrogenic when introduced into the proper environment. Even if they do not give rise to chondrocytes that are responsible for manufacturing collagen type 2 and aggracan; The Bone Marrow Aspirate derived Stem Cells when concentrated and introduced into the arthitic joint produce the cytokines and growth factors to control the breakdown of extracellular matrix by Interleukin 1-B and tumor necrosis factor-a. Difficult to understand? Call, make an appointment, I will explain and then you decide about a stem cell intervention rather than a Total Joint Replacement.
Tags: Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Orthopedic Care, Orthopedics, Osteoarthritis, Regenerative, stem cells
Feb 25, 2014
We survived another Polar Vortex in Chicago at the end of January and beginning of February with an additional 18 inches of snow. It got so bad two weeks ago, my wife and I took three children, and four grandchildren skiing in Vail for a week. While we were away, it warmed up and rained here; now it is very cold again. Saturday, we returned; this morning, I looked at my heating bill and I had to take a walk. Next came the drive to the office; and while listening to the radio, I was reminded of the Avon Walk for Breast Cancer even though the high predicted for today is 15 degrees. The Walk takes place each Spring around the country; this year in Chicago, the Walk to raise research dollars is scheduled for May 31 to June 1. I realize that many of my Blog entries over the year are focused on competitive athletics and high intensity personal recreation. The walk for breast cancer research dollars though is not only a personal commitment but it is societal statement as well at its best. Start planning ahead if you want to take part and be involved.
Just as training for a marathon or triathlon, if you want to participate and finish, you have to prepare. A two-day walk is not a Sunday stroll in the park. You would do best to seek out a training group as a motivator. While the weather outside may be less than inviting, the earlier you start training, the better. Now is a great time to find a comfortable walking shoe. It is true that whither you wonder, there is nothing you can do about the weather; but, there is always the indoor mall on a cold, snowy or rainy day.
“Dr. Sheinkop, I would love to partake but my arthritis limits my activities”, a frequent excuse I experience with a new patient in my practice. As I have written many times, the symptoms of arthritis may be eliminated or diminished by weight reduction, strengthening, anti-inflammatory medications and appropriate bracing. Included among the anti-inflammatory pharmaceuticals are the visco-supplementation “gels”. Assume if you will that you have followed my above prescription, tried the generic recommendations and, still have distance-limiting symptoms. There are several proprietary possibilities that fall under the category I call Cellular Orthopedics. The various possibilities for intervention start with Platelet Rich Plasma with a continuum to Bone Marrow Aspirate Concentrate derived Stem Cells. (To be continued.)
Many patients have told me to take a walk when I tell them Medicare or insurance does not cover cellular orthopedics. Now I am telling you to go take a hike with the assistance of stem cells
Feb 18, 2014
Musculoskeletal Care of the Mature Athlete
A 67-year-old man came to my office to learn more about Bone Marrow derived Stem Cells for his arthritic knees. While he had been discouraged by his sports medicine physician from seeking the Regenerative Cellular alternative, he was not ready to undergo a bilateral total knee replacement after having investigated the potential complications associated with the surgery. I started with a review of his medication profile and determined that BMAC/Stem Cells might not produce the quantity and quality potential I would want to see to justify the procedure. My concern had to do with the adverse effects of certain medicinals on stem cell numbers. I offered an alternative, Concentrated Stem cell Plasma.
The development of Regenerative Cellular interventions for the management of arthritis started several years ago with Platelet Rich Plasma. Platelets not only play a role in initiating the clotting cascade, they contain an abundance of anti-inflammatories and healing agents termed growth factors. At the outset, clinicians performed a venous puncture and filled a test tube with blood. The latter was now spun in a centrifuge and the plasma with platelets suspended was injected in the arthritic knee. Within a year, it became apparent that two or three staged PRP interventions would result in better outcomes. About a year ago, the group of physicians at Regenexx began concentrating the Platelet Rich Plasma 10X and the results of treatment have been very encouraging in that patients did better and for longer than with standard PRP. More recently, we have developed a better way to activate with a faster and longer acting release of growth factors.
Bone Marrow Aspirate Concentrated/Stem Cells remain the best possible alternative in our Cellular Orthopedic Regimen at this time. Concentrated Stem Cell Plasma (PRP 10X) is a reasonable alternative although with a shorter outcome potential and probably to a lesser extent. No bridges are burned. I have suggested the 10X PRP option to patients heavily dependent on pharmaceuticals for co-morbidities or when I anticipate a possible compromise in the quantity or quality of stem cells because of age or other factors. Primum Non Nocere, First No Harm. There is nothing lost and a lot gained by a staged approach to the Regenerative Medical management of arthritis.
Addendum: I now have several patients who were managed as above when their pharmaceutical profile excluded them from a stem cell procedure; that went on to loose weight and get fit, and minimize their medication dependency. By so doing they became reasonable candidates for stem cells; and, now are enjoying the longer term and more comprehensive benefits of Bone Marrow Concentrate Stem Cell intervention.
Tags: C-SCP, Concentrated Stem Cell Plasma, Growth Factors, joint replacement, Orthopedic Care, Orthopedics, Platelet Rich Plasma, PRP, Ultrasound Guided Injection
