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
May 20, 2014
In the last week, I have become aware of four companies developing new regenerative medicine product for Musculoskeletal Care of the Aging Athlete. What I find extremely interesting is the fact that two years ago, when I entered the practice of using bone marrow aspirate concentrate in an attempt to postpone or possibly avoid a joint replacement in an arthritic knee or hip, the orthopedic community was very critical telling patients that regenerative medicine was still ten years away. Fast forward two years and four new initiatives into the emerging field of regenerative medicine have come to my attention; underwritten by orthopedic surgeons or companies that have produced prosthetic joints for over 30 years. All of the product in development has not yet been approved by the FDA and many developing products are still being tested in Europe. What we at the Regenerative Pain Center offer is within FDA guidelines and approved by all regulatory agencies of the government. At the same time, I am very much aware of what is taking place nationally and internationally; when a newer regenerative medicine product is made available and FDA approved, we at the Regenerative Pain Center will be aware and closely evaluate as to whether it should be incorporated into our service line.
Let me be candid, our success rate is not 100 per cent. There have been three or four hip patients that have not provided the outcome the patient sought or that I hoped to provide; namely, avoidance of a hip replacement. On the other hand, the vast majority of hip bone marrow aspirate concentrate procedures are still allowing the patient a very full return to activities with about 70% percent patient satisfaction at a minimum of one year. When it comes to those who sought help for an arthritic knee, we have done even better with an 85% patient satisfaction outcome at a minimum of one year. Several of those patients had reached a plateau at six months but realized a marked improvement in the pain score with a Platelet Rich Plasma refresher. When a patient elects to under go a bone marrow aspirate concentrate hip or knee intervention at the Regenerative Pain Center, that patient may be assured that what we are doing is based on FDA guidelines and our clinical outcomes research. In addition, each patient should recognize that Regenexx continually statistically reviews our outcomes data. Last week, we recognized that those who underwent Cellular Orthopedic interventions for an arthritic knee did best when the cell count of mononuclear cells exceeded 400 million. Be aware that we count the cells in every Regenerative Medicine procedure. Our approach is no longer “this is the way we do it.” Our approach is based on experience and outcomes research, the same that I used in a long joint replacement career.
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, medicine, Orthopedic Surgeon, Regenerative, Regenerative Pain Center, Regenexx, stem cells
Mar 8, 2012
Musculoskeletal Care of the Mature Patient
The potential benefit of regenerative medicine is avoidance of orthopedic surgery. That’s the goal and I am the orthopedic surgeon leading the charge. I have spent several years now investigating, meeting, traveling, learning and preparing for that reality with the start-up anticipated in mid-April. While there is anecdote about subjective improvement following autologous, mesenchymal, Bone Marrow Concentrate derived stem cells for management of arthritis, there are no peer reviewed published long-term clinical outcomes to the best of my knowledge. There have been testimonials by orthopedic surgeons that following the adjunctive use of stem cells in conjunction with arthroscopic micro fracture of an arthritis knee, when the patient subsequently underwent knee replacement, hyaline cartilage was observed growing rather than fibro cartilage. This is not good enough for me, as I want a procedure that will postpone the need for a joint replacement or possibly eliminate that need. Is it a matter of when to intervene with regenerative medicine? When there is major deformity of an arthritic joint, significant alteration in function and a “bone on bone” X-ray, it probably is too late. Will regenerative medical intervention delay the joint replacement by a three to five year control of pain by the anti-inflammatory nature of bone marrow concentrate or will the joint cartilage actually re-grow? These are unanswered questions and what I seek to learn as I embark on my clinical project
Recently, the orthopedic surgical spine community became aware of a fourfold risk of cancer in patients who underwent spinal fusion using Bone Morphogenic Protein to increase the likelihood of successful fusion. As a result, attention quickly was redirected to stem cells as an adjunct in spinal surgery to replace human BMP. As of this writing, I have found no evidence of carcinogenesis in conjunction with autologous, mesenchymal Bone Marrow Aspirate Concentrated stem cells used in the skeleton and certainly not when used in a joint. The same might not be said when embryonic stem cells have been injected into the blood of patients to treat probably what shouldn’t be addressed with stem cells in the first place. Desperate people are not infrequently victims of charlatans as has been repeatedly pointed out on 60 Minutes. Contrast the risks of stem cell misdeeds with the benefits of scientific application. Today, the AMA News headline covered the potential for stem cells to eliminate the need for long-term anti-rejection pharmaceuticals in organ transplant recipients.
How to avoid orthopedic surgery by an orthopedic surgeon? Not just a mission statement by an ethos. Call to see if you are a candidate.
Mitchell B. Sheinkop, M.D.
312-475-1893
1565 N. LaSalle Street, Chicago, Illinois 60610
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, medicine, Osteoarthritis, Pilot Study, Platelet Rich Plasma, PRP, Regenerative Pain Center, stem cells, Ultrasound Guided Injection
