Oct 30, 2012
I read the TUESDAY, OCTOBER 23, 2012, the ATLANTIC article by Timothy Caulfield and he is on target. “Media Cheerleading is misleadingly legitimizing the booming ‘stem cell tourism’ industry” and I agree. Professional athletes aren’t the only ones leaving our country for stem cell therapy; many chronically ill patients are doing the same thing. The ultimate question is when does the evidence justify the procedure? Do we have to wait for a mound of scientific evidence or may an experienced, credentialed physician and one patient make an informed decision together? What really amazes me is that the Bone Marrow Aspirate Concentrate procedure as advocated via Regenexx and others for orthopedic conditions in the US offers a more comprehensive approach via Regenerative Orthopedics than that for which the athletes are traveling outside of the country and yet they still seek out that stem cell tourism
Let me review some of my preliminary data we have recorded in our Concentrated Stem Cell Plasma (C-SCP) and Bone Marrow Aspirate Concentrate (BMAC) outcomes surveillance.
Number of Cases: Hip——–12
Number of Cases: Knee—— 62
Number of Cases: Shoulder—2
The procedure as performed in Europe that has received the most media exposure is termed IRAP or Interleukin-1 Receptor Antagonist Protein. The IRAP theory is that Interleukin 1 (IL-1) causes inflammation and that Interleukin 1 Receptor Antagonist Protein (IRAP) will bind with the cell and thus block the IL-1 from causing pain. In the normal state, IL-1 and IL-1Ra are in a state of balance. In Osteoarthritis, IL-1 is no longer kept in check by natural levels of IL-1Ra. While it may serve as an anti-inflammatory, Il-1Ra has no possible influence on cartilage repair. Not only does BMAC contain IL-1Ra, eight additional Growth Factors have been described that signal mesenchymal stem cells to migrate and divide. There are now 947 published articles confirming cartilage repair with Bone Marrow Mesenchymal Stem Cells.
If I have provided too much information and you are confused, I apologize. Try rereading my Blog as it may take three readings before you decipher the information. It is important though that you as a potential patient understand old fashioned “Made in the USA” Adult Autologous Mesenchymal Bone Marrow Derived Stem Cells offer the best chance of postponing or avoiding a total joint replacement.
Corrections in my Blog posted Tuesday, October 23, 2012
Spelling of Kobe Bryant. Misuse of ad when add was appropriate. Failure to use a closing parenthesis after the word retirement. My self imposed deadline and related hurry led to grammatical error for which I take full responsibility just as I do for the content of this Blog
Corrections in my Blog posted Tuesday, October 23rd
Spelling of Kobe Bryant. Misuse of ad when add was appropriate. Failure to use a closing parenthesis after the word retirement. My self imposed deadline and related hurry led to grammatical error for which I take full responsibility just as I do for the content of this Blog
Jun 28, 2011
Musculoskeletal Care of the Mature Patient
A patient falls on an outstretched arm and experiences a painful shoulder. The individual seeks assessment from an orthopedic surgeon because of pain in, and limited motion of the shoulder. The X-ray is compatible with minimal arthritic changes in the acromio-clavicular joint and a very normal gleno-humeral joint. There is pain with shoulder elevation so the orthopedic surgeon cannot determine if the limitation is due to a rotator cuff tear or pain. In addition, you have had some recent discomfort in your same upper arm, intermittent for several months. A Magnetic Resonance Image is requested and is interpreted as “a partial tear” of the rotator cuff. How should you be managed?
In an initiative to optimize skeletomuscular care, The American Academy of Orthopedic Surgeons has established work groups to perform systematic reviews of scientific publications on a particular subject and establish clinical guidelines as to the best methods of care. It is part of the evolution in clinical care from opinion alone as to how a patient is treated to scientific evidence based practice. Musculoskeletal care is many different things and practiced in varying settings and geography. In an effort to standardize and optimize quality and efficiency, the guidelines are being created.
In looking at the subject of rotator cuff problems, it was determined that there is inconclusive scientific evidence to support the majority of clinical approaches to treatment in the presence of a partial tear. Based on the clinical practice guideline that was approved by the American Academy of Orthopedic Surgeons for patients with partial rotator cuff tears such as the one described earlier, the following would be the evidence based medical approach:
1) non-steroidal anti-inflammatory prescription
2) physical therapy prescription
3) reassessment in 10 to 14 days and if no significant improvement, an intra-articular cortisone injection with continuation of physical therapy
4) repeat assessment at 6 weeks
If the patient is pain free, treatment is complete other than continued strengthening. If the patient still has impairment either from pain or weakness, there is no scientific evidence to support a continuing algorithm of care and the direction from the orthopedic surgeon will be based on experience and opinion including the following with no specific time milestones:
1) a second intra-articular cortisone injection and ongoing physical therapy
2) arthroscopic surgical repair
3) a single dose visco-supplementation injection
4) a Platelet Rich Plasma injection
5) stem cell management
Everything I have described after the six weeks of care based on scientific evidence is anecdotal opinion and individual orthopedic experience. On the other hand, the story of the Yankees’ Bartolo Colon shoulder is very seductive to every patient with shoulder impairment (NYDailyNews.com)
Jun 28, 2011
Musculoskeletal Care of the Mature Patient
A patient falls on an outstretched arm and experiences a painful shoulder. The individual seeks assessment from an orthopedic surgeon because of pain in, and limited motion of the shoulder. The X-ray is compatible with minimal arthritic changes in the acromio-clavicular joint and a very normal gleno-humeral joint. There is pain with shoulder elevation so the orthopedic surgeon cannot determine if the limitation is due to a rotator cuff tear or pain. In addition, you have had some recent discomfort in your same upper arm, intermittent for several months. A Magnetic Resonance Image is requested and is interpreted as “a partial tear” of the rotator cuff. How should you be managed?
In an initiative to optimize skeletomuscular care, The American Academy of Orthopedic Surgeons has established work groups to perform systematic reviews of scientific publications on a particular subject and establish clinical guidelines as to the best methods of care. It is part of the evolution in clinical care from opinion alone as to how a patient is treated to scientific evidence based practice. Musculoskeletal care is many different things and practiced in varying settings and geography. In an effort to standardize and optimize quality and efficiency, the guidelines are being created.
In looking at the subject of rotator cuff problems, it was determined that there is inconclusive scientific evidence to support the majority of clinical approaches to treatment in the presence of a partial tear. Based on the clinical practice guideline that was approved by the American Academy of Orthopedic Surgeons for patients with partial rotator cuff tears such as the one described earlier, the following would be the evidence based medical approach:
1) non-steroidal anti-inflammatory prescription
2) physical therapy prescription
3) reassessment in 10 to 14 days and if no significant improvement, an intra-articular cortisone injection with continuation of physical therapy
4) repeat assessment at 6 weeks
If the patient is pain free, treatment is complete other than continued strengthening. If the patient still has impairment either from pain or weakness, there is no scientific evidence to support a continuing algorithm of care and the direction from the orthopedic surgeon will be based on experience and opinion including the following with no specific time milestones:
1) a second intra-articular cortisone injection and ongoing physical therapy
2) arthroscopic surgical repair
3) a single dose visco-supplementation injection
4) a Platelet Rich Plasma injection
5) stem cell management
Everything I have described after the six weeks of care based on scientific evidence is anecdotal opinion and individual orthopedic experience. On the other hand, the story of the Yankees’ Bartolo Colon shoulder is very seductive to every patient with shoulder impairment (NYDailyNews.com)
