Nov 3, 2014
From time to time, I consult with patients who just don’t meet the inclusion criteria regarding Bone Marrow Aspirate Concentrate intervention for arthritis. At the same time, some of those patients are so pharmacologically dependent owing to medical conditions demanding maintenance that I am unable to offer them autogenous hope from their own Platelet Rich Plasma or that which may be created from a patient’s own platelets. While in the minority, as an orthopedic surgeon offering Cellular Orthopedic interventions for arthritis in those unable to undergo a joint replacement wherein the internist deems the procedure unsafe or who seek to avoid or at least postpone a joint replacement; weight loss, physical therapy, cortisone injection and visco-supplementation are short term fixes and not necessarily without potential risks. The real damage to stem cells from cortisone injections became the subject matter of several recent scientific publications. First no harm is what I was first taught in my orthopedic training.
Over the past several months, I have sought treatment alternatives for patients as described above; not candidates for current interventions with standard autogenous procedures. Enter the new alternative, allograft. Derived from Amniotic Fluid, the intervention is FDA approved, safe, and in some cases, even covered by third party indemnification. There are many companies offering this treatment alternative and I am investigating the multiple options. Please be aware, amniotic fluid alternatives are not a substitute for Bone Marrow Aspirate Concentrate derived stem cells ; but there may be a place for this anti-inflammatory alternative when established Cellular Orthopedic options can’t be used in an arthritic because of medical co-morbidities such as heart disease, chemotherapy, kidney disease, liver disease, obesity, Diabetes, etc, etc, etc. Amniotic Fluid usage in Orthopedic is not new; there are publications dating back to 1938 in the orthopedic scientific literature. It wasn’t though until the last five years evidently that allograft investigation led to the development of currently available products.
If you fall into the category of patients who do not meet the inclusion criteria for Bone Marrow Aspirate Concentrate or in whom your Platelet Rich Plasma would not be a suitable alternative, you may be a candidate for Amniotic Fluid Concentrate intervention. Under certain circumstances, the allograft may be covered by your insurance. To learn more, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Osteoarthritis, Pain Management, Regenerative, stem cells, Synvisc, treatment
Oct 27, 2014
I refuse to ignore the 50-plus demographic; that patient population is enormous and growing. According to a Nielson study, by 2017 boomers will control 70 percent of the country’s disposable income. Aging athlete, you are relevant. Additionally, as you are learning, there is an ever increasing deductable in your indemnification. That fiscal obligation could be used as an investment in your athletic future. Let me cite several examples of what is possible through Cellular Orthopedics.
Last year at this time, a 57 year old man presented with an arthritic left hip and had already received several orthopedic surgical recommendations for a left total hip replacement. Having learned about my work from the internet, he decided to get educated about the new world of regenerative medicine made possible through Bone Marrow Aspirate Concentrate. As the father of two teen age boys, he was concerned about a major surgical procedure and the inherent risks. He underwent a Bone Marrow Aspirate Concentrate in late November. When seen in late January, he reported that he had planned to take his two sons skiing in Colorado over their Easter vacation. Last week, he came in for assessment, reported how thrilling it was to have skied with his family: and told me of his New Years reservations for a return skiing trip over the holiday break.
Another example is a soon to be 70 year old avid cyclist and skier who had to stop skiing three years ago because of two arthritic knees. Just as the above individual, he had been advised by several orthopedic surgeons to undergo joint replacements. I shared with him, the activity scale results of patients who undergo a bilateral total knee replacement and compared them with my data base of outcomes for patients with arthritic knees who undergo stem cell interventions. It is now two years later and he has already booked two weeks of helicopter skiing in 2015 and a week with his family skiing in Colorado in February.
A study in 2007 found that 70% of boomers would change home appliance brands and slightly more would switch clothing preferences. Medicine is constantly changing, especially the providers as are surgical techniques and non surgical options. Adult Mesenchymal Stem Cells and growth factors with cytokines contained in the Bone Marrow Aspirate Concentrate carry little risk and great potential to eliminate pain, increase function, help you maintain an active athletic profile; alter the natural history of the arthritic progression and perhaps even influence cartilage regeneration. There will always be an opportunity to undergo a joint replacement but wouldn’t it be better to maintain or return to a high quality of recreational performance with little or no risk and no incisions?
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx-SD, stem cells, treatment
Oct 20, 2014
We have been inundated with the fear of Ebola infections; the media has treated this as if each posting is to be a sensational headline in the National Inquirer. If the truth be told, your chance of acquiring an Ebola infection here in the US is about as likely as my winning the mega jackpot in the lottery. Fear Strikes Out was a marvelous film from the 50’s about a ball player overcoming mental disease; caution, you are being given mental disease by the sensationalism regarding Ebola and will succumb if not careful. What you should really be frightened about are hospital acquired infections. It has been estimated that in excess of one million MRSA infections take place in the US each year with in excess of 100,000 deaths. That doesn’t include the community acquired MRSA infections estimated last year at an additional 14%. The cost of Methicillin Resistant Staph Aureus infection last year exceeded 45 Billion Dollars Now what about C-Diff infections superimposed on those receiving antibiotics for hospital acquired infections, over 14,000 deaths last year according to governmental sources?
Regenexx published a study earlier this year in which not one single deep infection could be attributed to the minimally invasive methodology associated with a stem cell or similar cellular orthopedic procedure. In my practice, not only have I not recorded a deep infection, there hasn’t even been a superficial one reported. That’s not to say it may not happen in the future as I deal with Diabetics from time to time and patients with other immunosuppressive disorders; but I haven’t seen an infection yet in what is now approaching 400 procedures. I perform Bone Marrow Concentrate/ Stem Cell and related Cellular Orthopedic-Regenerative interventions in a surgi-center with all fluid manipulations in a sterile environment and under a sterile hood with a fully gowned RN. A joint replacement carries with a known infection rate. That incidence no longer is accurately recorded as the patient is promptly discharged from the hospital and the subsequent readmission for infection is not reported as associated with the recent joint replacement surgery
I have posted my results of Bone Marrow Aspirate Concentrate /Stem Cell interventions in this Blog on many occasions and compared the 18 month results to those of a knee replacement noting a lot more activity and recreational pursuits in the Cellular Orthopedic recipient group being realized. When a patient has advanced arthritis, a joint replacement is the treatment of choice. For those who want to continue or return to the highest possible age related profile, why not consider a stem cell procedure?
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, FDA, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative Pain Center, Regenexx, stem cells, treatment
Oct 13, 2014
Assume if you will that your physician receives your MRI report with the description of a torn meniscus. You had recently been to the medical office with a chief complaint of pain in your knee, an X-Ray was completed, and then you were sent for an MRI. Not everyone with an MRI describing a meniscal tear should have arthroscopic surgery nor should everyone with a “positive” MRI for a meniscal tear receive stem cells. The adage in medicine: “never say always or never”.
Many scientific studies in the last ten years have shown the absence of value and probable harm of arthroscopic surgery in the face of arthritic meniscal tears. On the other hand, the sports medicine community ha s been very successful in the athletic world when the meniscal injury was acute and the result of trauma indicating a “bucket handle” tear. What about the patient population who seeks medical attention for a painful knee and the mechanical symptoms of giving way, pivot shifts, locking or “clunking” no matter at what age? I fit into that description as ten years ago on the left and nine years ago on the right. I had sustained a trauma on one occasion while playing tennis and on a second, when while running on a treadmill, a third party tripped the chord and the treadmill suddenly stopped. A few days later, I was running with my dog in the park and down I went, but, I hadn’t stepped in a hole or tripped over anything. Then the pivot shifts started and the “clunking”. The MRI was consistent with meniscal cleavage tears. Arthroscopy and partial meniscectomy promptly resolved the problem on both occasions and I returned to my unlimited athletic and recreational pursuits.
My point, never say always or never. Each patient is unique even if that patient falls into a certain age category. In general, when the younger patient sustains a traumatic meniscal tear that is not accompanied by ligamentous or articular damage, arthroscopy is the way to go. (There is emerging evidence that any knee injury at any age wherein intra-articular damage results should be considered for early BMAC intervention to prevent arthritis but I will cover that in a future blog.). At the other end of the spectrum, if the MRI of a patient overage 60 indicates a meniscal tear but with accompanying arthritic changes, our data clearly shows a Bone Marrow Aspirate Concentrate intervention is the treatment of choice. Then there are the “tweeners”. When there are arthritic changes with mechanical symptoms, there is a role for arthroscopy in conjunction with a BMAC-Stem Cell procedure. If you are confused, you are not alone. Arthroscopy is the most common orthopedic procedure in the United States costing Medicare and the insurance industry, hundreds of millions, perhaps billions a year; but with little scientific evidence to support the economic burdens imposed. A chance to cut is not necessarily a chance to cure. Rarely is there an emergent or even urgent need for arthroscopy in the knee. If you have been told that your MRI indicates a “torn meniscus”, it may be amenable to Bone Marrow Aspirate Concentrate and stem cells alone or in conjunction with arthroscopy. I am always available for a second opinion or to answer your questions. 312 475 1893
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Interventional Orthopedics, Knee, Knee Pain Relief, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, stem cells, treatment
Oct 9, 2014
While it is understood that a Bone Marrow Aspirate Concentrate Stem Cell intervention introduces a cartilage regeneration potential via Mesenchymal Stem Cells, continued research is expanding our knowledge as to what else is in the concentrate in addition to stem cells. For instance, many have heard the story of basketball legend Kobie Bryant’s trip to Germany several years ago and the success of the procedure called IRAP wherein Interleukin 1 Receptor Antagonist Protein was concentrated after a blood draw over a four day period and injected into his arthritic knee with great success allowing him to return to professional basketball. There followed many professional athletes and famous persons. Most recently, I read of Willie Nelson’s converting a failed rotator cuff repair into a functioning painless shoulder with IRAP. There have been marked improvements though in the non surgical approach to arthritis and soft tissue injury since the introduction of IRAP, we know it as Bone Marrow Aspirate Concentrate and Stem cells.
OA progression is due, at least in part, to the up-regulation of inflammatory mediators and proteases after injury. Since elevated levels of catabolic enzymes in synovial fluid (SF) are associated with chondrocyte death and cartilage matrix degeneration within 1 week of injury, early intervention strategies should focus on modulating these cartilage-degrading enzymes within this time frame. Evidence suggests that the molecules and growth factors in the Bone Marrow Concentrate target these enzymes arresting adverse events and preserving joint health. That’s why in addition to pain relief and improved function, our informed consent speaks toward actually reversing the arthritic process.
Alpha’2Macroglobulin is a negative regulator of cartilage catabolic enzymes but that it is not present in vivo at sufficient levels to counteract the increased concentrations of catabolic factors that appear after injury. Therefore, the intraarticular injection of alpha’2M via bone marrow concentrate in addition to the stem cells along with all the other growth factors contained in bone marrow , when concentrated, is the only means of actually treating arthritis other than a joint replacement. All other medicinal and pharmacologic approaches are directed to the symptoms but not the disease.
Alpha2Macroglobulin is a powerful inhibitor of many cartilage catabolic factors and it can attenuate posttraumatic OsteoArthritic cartilage degeneration in the animal model… Alpha2-macroglobulin is a major protease inhibitor; the largest fraction is produced by the liver while the synovium produces smaller amounts.
In summary, up-regulation of cartilage catabolic cytokines and enzymes is thought to be a key mechanism of cartilage damage. Thus, inhibition of these molecules will likely slow or prevent the progression of disease while the stem cells regenerate the joint. If you want to learn more, call 847 390 7666.
Tags: arthritis, athletes, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Orthopedics, Osteoarthritis, Regenerative, Regenexx, stem cells
Sep 29, 2014
In seeking to continually improve results of Bone Marrow Concentrate Stem Cell interventions, we review our data base to try and better understand how to improve the success of a stem cell procedure both from the standpoint of pain control and the length of success. When it comes to the knee, I have looked at age and that isn’t as significant in anticipating a successful outcome as I had previously anticipated. Next it was the weight issue and Body Max Index but that hasn’t proved to have as significant an adverse influence on outcomes as I once had predicted although it does have a relation to the difficulty of the harvest. . There is no question that certain prescription medications have a very negative effect on stem cell performance; so much so that dependency on certain pharmaceuticals has caused me to seek an alternative approach to Bone Marrow Aspirate Concentrate. The pre-treatment range of knee motion is as reliable predictor of the outcome as is knee stability. If a patient has an unstable knee or less than 110 degrees of motion, the chances of stem cell success are problematic.
What influenced me to write this Blog is the correlation I am seeing between knee deformity and the degree of success and the length of success If a patient has a mechanical bowing of five to seven degrees or more or a knock knee over seven degrees, the results of stem cell intervention are less predictable and carry with a shorter length of success than might otherwise be the outcome. Knowing that your knee which still allows you to be active is worth saving in spite of the X-ray, will provide a higher certainty of maintaining an active functional capacity than a knee replacement affords; the stem cell route before considering a joint replacement is one worth serious consideration. In order to improve candidacy and long term success, I am now recommending correction of mechanical deformity via a procedure termed an osteotomy in conjunction with the stem cell intervention. The concept of correcting a mechanical knee axis for arthritis has over 50 years of history. With the advent of knee replacement, osteotomy alone fell out of favor; but with the short term success of stem cell intervention in avoiding or postponing the joint replacement while maintaining or returning an individual to a very active profile, mechanical axis correction makes a lot of sense. My initial goal when I undertook this Cellular Orthopedic initiative was to assist in postponing a joint replacement; now I seek to influence avoidance of a joint replacement
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, stem cells, treatment
