Jun 20, 2016
This past Thursday, I was reading the Steve Chapman article in the Chicago Tribune and in the article, he quoted French Sociologist Gustav Le Bon who is best known for his 1895 work The Crowd: A Study of the Popular Mind. While Chapman was trying to explain the Trump phenomenon, I saw an explanation as to why patients with arthritis make decisions as to how to proceed with care. At the recent Orthopedic and Biological Institute meeting in Las Vegas, speaker after speaker including napropaths, chiropractors, and non-board certified physicians presented a show and tell as to how they approach arthritis in this day of expanded access to orthobiologics. The explanations given approached the realm of fantasy; missing from the several day event were science, outcomes and results.
In the past several months, I have watched the entry of large orthopedic companies, with whom I have had a 40-year plus joint reconstruction relationships, into the growing specialty of Orthobiologics. These companies not only bring research support into our specialty of cellular (interventional) orthopedics, they carefully scrutinize those with whom they partner so the net result is evidence based patient care, research and education; not unfounded claims by “Camp Followers”. Witness the ad in a suburban newspaper placed by chiropractors offering stem cell containing amniotic fluid for the treatment of arthritis. I have written about this scientifically unfounded claim in this Blog before and I will emphasize it again, there are no living stem cells in amniotic fluid after processing, irradiating and fast thawing.
Assume if you would that you have an arthritic joint wherein your symptoms and limitations are no longer responsive to cortisone injections, anti-inflammatory medications, physical therapy, hyaluronic acid injections and the like. Your choices historically have been to either wait until end stage arthritis and then have a joint replacement or have a joint replacement early on and risk the potential adverse life changing consequences versus the potential benefits. Today there is an alternative option that will help postpone a joint replacement or possible help avoid one; it falls within the emerging discipline of Regenerative Medicine. Warning though, don’t be a victim of illusion; seek out a consultation and opinion from a board certified specialist who integrates cellular orthopedic patient care with research and education.
Call (312) 475-1893 to schedule your Orthobiologic consultation.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, joint replacement, Knee Pain Relief, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Regenerative, stem cells, technology, treatment
Jun 13, 2016
Just as I hope to improve patient activity with delivery of Bone Marrow Concentrate (BMC), Stem Cells and Concentrated Growth Factor for grades 2 and 3 osteoarthritis, might the success of a surgical procedure at the time of the initial trauma be significantly improved by the adjunct of BMC, Stem Cells and GFC thereby heading off a suboptimal response to an initial trauma surgery? Clearly, being driven as medical practice is in the US; that is to assess pain and then determine the anatomical treatments to relieve that pain has to change. It would make more sense for the surgeon to examine the “flaws” in anatomy, and judiciously treat with BMC before the flaw leads to frank pain and other issues. There is a need for the preemptive integration of Cellular Orthopedics in both the early arthritis and traumatic environments.
Bone bruises and bone edema are grossly under treated in the current orthopedic paradigm. If we would offer patients a Bone Marrow Concentrate intervention at the time of injury or in conjunction with surgery, it is possible, actually likely, that progression to higher arthritic scores will be greatly delayed.
To put things in a proper perspective, most patients expect an improvement of physical activity after total knee replacement. In a Feature Article How Much Improvement in Patient Activity Can Be Expected After TKA?, from a major university center in Germany, only 22% of TKR recipients met health-enhancing physical activity (HEPA) guidelines and only 31% achieved an active lifestyle. In contrast, our data indicates that greater than 70% of our patients who have undergone a bone marrow concentrate/stem cell intervention for osteoarthritis are active in recreational athletics and fitness pursuits including skiing, cycling, golfing, dancing, hunting, fly fishing, basketball, etc.
You the patient have to determine how to proceed and become an advocate for your own arthritic care be it interventional or preemptive. Clearly, the orthopedic surgical and sports medicine communities are behind in integrating orthobiologics into treatment protocols. To stay ahead and learn more be it arthritis or a recent injury requiring surgical repair, consider a cellular orthopedic consultation 312-475-1893 to schedule an appointment.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
May 19, 2016
From the AMA Morning Rounds May 16, 2016
Today’s Medical News Prepared Exclusively for You
Leading News
“Exercise linked to reduced risk of several cancers”
ABC World News Tonight (5/16, story 11, 0:25, Muir) reported, “The
National Cancer Institute confirms that moderate exercise, all the way
up to intense exercise, lowers the risk of” cancer “in many forms.”
The Los Angeles Times (5/16, Healy) reports that the research,
published in JAMA Internal Medicine, suggests, “exercise is a powerful
cancer-preventive.” Investigators found that “physical activity worked
to drive down rates of a broad array of cancers even among smokers,
former smokers, and the overweight and obese.”
US News & World Report (5/16, Esposito) reports that
investigators “analyzed data from participants in 12 US and European
study groups who self-reported their physical activity between 1987
and 2004.” The researchers “looked at the incidence of 26 kinds of
cancer occurring in the study follow-up period, which lasted 11 years
on average.” The data indicated that “overall, a higher level of activity
was tied to a 7 percent lower risk of developing any type of cancer.”
TIME (5/16, Park) reports that “the reduced risk was especially
striking for 13 types of cancers.” Individuals “who were more active
had on average a 20% lower risk of cancers of the esophagus, lung,
kidney, stomach, endometrium and others compared with people who
were less active.” Meanwhile, “the reduction was slightly lower for
colon, bladder, and breast cancers.”
Historically, I have directed my Blog to fitness, improved activities of
daily living, and recreational endeavors. The Leading News report
quoted above introduces an additional goal. Considering the significant
progress in research and management of different cancer types, after
mesothelioma explained, I am not going to suggest
that you will prevent cancer by undergoing a cellular orthopedic
intervention to an arthritic hip or knee; but, I am introducing the
concept that by my improving your activity level and functional
potential with a cellular orthopedic intervention for the symptoms of an
arthritic hip or knee, I will improve your exercise capacity and your
exercise tolerance with the inferred inherent health care benefits be it
cancer prevention, heart health, etc.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, cancer and exercise, cancer statistics, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Dr. Sheinkop, Hip, Hip pain, Hip Replacement, improve joint pain, joint pain, joint replacement, Knee Pain Relief, Mitchell B. Sheinkop MD, national cancer institute, Orthopedic Care, Osteoarthritis, Regenerative, Subchondroplasty
May 12, 2016
You may have seen this subject matter before but research and everyday experience reminds me that one has to hear the informed consent three times for the best retention.
Clinical translation of regenerative medicine technologies requires a source of stem and progenitor cells and growth factors. The most success in Cellular Orthopedics to date has come from Bone Marrow Aspirate Concentrate wherein concentrations of mesenchymal and hematopoietic stem cells and soluble growth factors are recovered, concentrated and the joint intervention shortly follows. The procedures we use offer an FDA-compliant means of concentrating autologous stem and progenitor cells, platelets and growth factors to be used in the treatment of osteoarthritis of a joint. In a single event, we may introduce a means of pain relief, increase joint motion, improve activity and quality of life, reverse osteoarthritic changes on a bio-immune basis and possibly affect joint regeneration.
The standard of Regenerative Medicine remains Bone Marrow Aspirate Concentrate; the most studied approach in clinical practice. I am aware of the option of Fat Graft Harvesting, Micro-fracture of the Fat Graft and injection of the emulsified adipose tissue into a joint; but to the best of my knowledge at this time, the clinical outcomes results are no longer than 90 days, so stay tuned or just keep reading my Blog to update.
Platelet Rich Plasma preparation process certainly has improved over the past several years and now allows for protein and growth factor concentrating but with the notable absence of the Progenitor Cells ( Mesenchymal Stem Cells, Hematopoietic Stem Cells, etc.)
Amniotic Fluid Concentrate has recently gained traction in the clinical practice setting as a replacement for Hyaluronic Acid derivatives or synthetic alternatives but the clinical results are only now being studied. I have said it before and I will emphasize, there are no living Stem cells in Amniotic Fluid Concentrate after sterilization and processing. That is not to say, AFC is not a superior option with a longer lasting pain relieving anti-inflammatory benefit to Hyaluronic acid based offerings.
There is no test now that you have studied my Blog but hopefully you are more familiar with Regenerative Therapies. As part of my Clinical Practice, we have developed the Center for Clinical Investigation. To learn what might best suit your needs, call 847 390 7666 and schedule a consultation.
Tags: Amniotic, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, FDA, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
Apr 4, 2016
Patients should participate in strengthening, low-impact aerobic exercises, and neuromuscular education; and engage in physical activity.
Rationale:
This recommendation is rated strong because of seven high-strength studies of which five showed beneficial outcomes. The exercise interventions were predominantly conducted under supervision, most often by a physical therapist.
I recommend weight loss for patients with symptomatic osteoarthritis of the knee and a BMI = 25.
Rationale:
Physical Function shows important improvement in outcomes for this patient population. Function also shows statistical improvement that is clinically significant. Diet and exercise combined achieves the best results.
I do not recommend using acupuncture in patients with symptomatic osteoarthritis of the knee
Rationale:
In Studies that comparing acupuncture to groups receiving non-intervention sham, usual care, or education, the majority, show no clinically significant improvement. While there is a lack of efficacy, there is no potential harm.
I am unable to recommend for or against the use of physical agents (including electrotherapeutic modalities) in patients with symptomatic osteoarthritis of the knee.
Rationale:
Due to the overall scientifically inconsistent findings for various physical agents and electrotherapeutic modalities, I am unable to make a recommendation for or against their use in patients with symptomatic osteoarthritis of the knee. To better understand the role of pulses in the management of arthritis, I am waiting for FDA approval to launch a clinical trial using a pulsed brace after a bone marrow concentrate/stem cell procedure.
I am unable to recommend for or against manual therapy in patients with symptomatic osteoarthritis of the knee.
Rationale:
Due to the lack of studies examining most manual therapy techniques, I am unable to opine. No studies evaluating joint mobilization, joint manipulation, chiropractic therapy, patellar mobilization, or myofascial release were found of scientific merit.
I cannot recommend using glucosamine and chondroitin for patients based on science; yet I personally use them
Rationale:
At this time, both glucosamine and chondroitin sulfate have been extensively studied. There is essentially no evidence that minimum clinically important outcomes have been achieved compared to placebo. There is no evidence of potential harm. The same may be said of the neutraceuticals methylsulfonylmethane, omega-3, gelatin, vitamin D, dimethylsulfoxide, antioxidants, and coenzyme Q10. 01
I will not use needle lavage for patients with symptomatic osteoarthritis of the knee.
Rationale:
The published evidence shows little or no benefit from needle lavage in the treatment of osteoarthritis of the knee.
I am able to recommend growth factors and stem cells derived from Bone Marrow Aspirate in conjunction with platelet rich plasma for patients with symptomatic osteoarthritis of the knee.
Rationale:
I have an ever-increasing Data-Base of Outcome measurements to support my recommendations with Levels of Evidence at 1B and 3 with a Grade D governmental guideline Grading (the highest). You may learn more at the National Guideline Clearinghouse (http://www.guidelines.gov) or make an appointment at 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
