The Ultimate Performance Success Following a Cellular Orthopedic Procedure

Every year at this time, we each recall and celebrate several significant events of historic, cultural and spiritual importance. No matter what your roots or upbringing or present belief, these past eight days usually involve a gathering of friends and family to jointly read and remember that which happened long ago and still impacts us today. Whether done in a house of worship or in the home, somehow, we ask similar questions and teach our children and grandchildren that which befell us in ancient days. To underscore those similarities, some years ago, when my son had his Bar Mitzvah at the Western Wall, a Franciscan Monk who I had come to know invited us the next day to a Pre-Easter service at the Church of the Holy Sepulchre. Other than The Gregorian chants and the frankincense, the superstructure of the 90-minute service was quite familiar.

I use this yearly celebration to reflect and meditate; it also initiates the spring cleaning ritual in our house. Having grown up in Humboldt Park and later Albany Park to parents who left Europe in time, Passover meant it was time to clean and wash the kitchen cabinets, recycle, and dispose of certain foods. On Division Street, we lived near my orthodox grandparents; in Albany Park, they lived with us, so the everyday plates and silverware were taken to the basement and exchanged for special settings reserved for this time of year.

Certainly, times have changed and we have assimilated; but my wife still prepares the appropriate meals for the week and makes sure the house is immaculate. Then the family and company visits end and we are challenged by the need to address the residual back scuffs on our wood kitchen floor; lots of them and pronounced. Here is where the ultimate test of the cellular orthopedic intervention to my own hips and knees, now almost four months ago comes into play.

With the coverage varying between the Masters, Cubs, and Sox games in the background, we genuflexed, spread the Murphy Oil Soap and started rubbing away with microfiber wipes. This exercise lasted about two hours, admittedly with several breaks. Nevertheless, we accomplished our mission and I got up unassisted to head to the health club for my strength training respite.

This morning, Section one of the Chicago Tribune carried three full pages, in color, competing ads concerning Regenerative Medicine; none giving much information about science or outcomes but certainly employing one-time prominent athletes as spoke persons. Is it worth a free lunch to become a marketing dupe? As readers of my Blog know, I myself had Cellular Orthopedic intervention to my knees at the end of 2017 and to my hips at the start of 2018. This morning I scheduled two ski trips in 2019 to Vail; on Saturday morning, I am headed to Southwest Wisconsin for a long weekend to bike and fly fish; and I am on standby at any time to genuflex and spread that murphy oil soap.

So as advertised on Friday night Cable, you may receive a $250 gift certificate for attending a Stem Cell Seminar, or you may get examined and receive counsel from this orthopedic surgeon focusing on Cellular orthopedics. For the latter call 312 475 1893 to schedule an appointment, one on one. You may access my web site and watch the webinar at www.Ilcellulartherapy.com

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Update on the Cellular Orthopedic intervention to my knees

Update on the Cellular Orthopedic intervention to my knees

If you read my blog posting last week, you would have learned that I personally underwent a cellular orthopedic intervention to both of my knees on Wednesday, 12/27. The symptoms attributable to my own osteoarthritis had progressed to a degree that I was becoming limited in my recreational profile. While there indeed was a response to anti-inflammatory medications, every time I am reminded of the potential complications of NSAIDS, I become medication adverse. This led to the injection into both of my knees of an Autologous Protein Concentrate (APC) with the hope of treating my pain and slowing the progression of cartilage degradation and destruction of my knees.

The process used was a cell-concentration system which concentrated my own anti-inflammatory cytokines and anabolic growth factors. Pioneered in Europe, an ever-increasing number of professional athletes have been prolonging their careers by accessing this treatment. I have waited over five years for the Autologous Protein Concentrate methodology to become available in the United States; three weeks ago, I was granted access. To date, my pain secondary to knee osteoarthritis is not only reduced but gone; I can only hope it stays that way. My function is significantly improved as evidenced by an ability to have pursued my fly fishing passion chasing bone fish with my wife, daughter-in-law and son for three days in Ascension Bay, Mexico, over the New Year weekend.  For those unfamiliar, bone fishing requires a continued down and up to a platform on the front of a three-man boat with prolonged standing while balancing. At times, I climbed out of the boat and waded through the flats for 30 to 45-minute intervals until it was time to change locations. Since returning home on January 1, I have been able to return to my fitness profile without restriction previously afforded by my Osteoarthritis generated symptoms and limitations.

As in any and all treatments, a patient must be given informed consent and be warned both of the benefits and risks; so, I will let you in on an adverse event in my early outcome. Owing to the increased activity attributable to the diminution of my pain and increased functional capacity resulting from my initial response to the Autologous Protein Concentrate intervention, instead of climbing down from the fly fishing platform in the front of our boat when it was time to trade places with my wife, I jumped down. In so doing, I kicked the rod holding rack and fractured the fifth toe on my left foot, the pinky toe. Though a bit of a nuisance, it is not too great a price to pay for the relief and improved function of my knees.

To learn more, call my office and schedule an appointment; as I haven’t yet updated my web site with an explanation of the Autologous Protein Concentrate intra-articular injection for treatment of knee osteoarthritis (847) 390-7666.

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On Cartilage Regeneration

Since we practice in an emerging discipline of Regenerative Medicine, how is regeneration determined? Cartilage repair should be evaluated with use of a scoring system that considers the volume of the defect that becomes filled with repair tissue, the integration of repair tissue with adjacent cartilage, and the macroscopic appearance and biomechanical properties of the repair site. The macroscopic assessment is particularly important in evaluating cartilage repair because it provides information about the quality of the full repair site compared to the incidental histological assessment which only evaluates a biopsy of the repair site.

If the aforementioned answer to my introductory question may seem scientifically oriented, that is purposeful on my part; because only those able to explain Regenerative Medicine on a clinical, technical and scientific basis should be caring for your arthritic joint.  

While an arthroscopic evaluation provides the best opportunity for a determination of joint regeneration 18 months or greater following a Bone Marrow or Platelet Rich Plasma or other cellular orthopedic intervention for arthritis, an invasive surgical evaluation is not realistic. For a quantitative MRI to assist in the assessment requires availability of a specialized imaging center and there are just too many variables to allow for dependable quantitation; expense is prohibitive. The most dependable and reproduceable means of measuring the arthritic or injured joint response to a cellular orthopedic intervention is a history and physical examination, the latter completed with a tape measure and goniometer as well as an activity assessment. By comparing a baseline measurement prior to an intervention and at serial intervals following the procedure, one may determine if regeneration is indeed taking place and thus establish clinical practice guidelines and determine Evidence Based Quality and Value.

Now for the real question, does cartilage regeneration need to take place on a macroscopic level for cellular orthopedics to succeed? New therapies such as bone marrow derived stem cells, growth factors and cytokines; platelet-rich plasma (PRP); and IRAP (interleukin-1 receptor antagonist protein) first and foremost address the bio-immune basis of degenerative arthritis. By controlling the pain and eliminating inflammation; stopping the progression (at least slowing) of Osteoarthritis; reversing scarring, thus improving motion and function; and lastly, possibly regenerating cartilage for those in whom regeneration is possible. From the editors of the Encyclopedia Britannica: “Interleukin (IL), any of a group of naturally occurring proteins that mediate communication between cells. Interleukins regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation.”

Should our future blogs and discussions address not cartilage regeneration but rather reversing the proinflammatory cytokine production from the synovial lining of the inflamed knee? One such possible pharmacological treatment of OA is anticytokine therapy. Interleukin-1 (IL-1), as a main inflammatory and catabolic cytokine in the pathophysiology of OA, represents one of the possible treatment targets.  Koby Bryant was one of the first highly visible professional athletes who travelled to Germany over eight years ago for Interleukin-1 Receptor Antagonist Protein intervention for an arthritic knee. Many, have followed including golfer Fred Couples for his problematic back.

If this Blog has introduced new considerations and questions, then let me clarify. Call 312 475 1893 to schedule an appointment. You may watch my webinar at www.Ilcellulartherapy.com

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“Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-based Products: Minimal Manipulation and Homologous Use”

On November 16, 2017, The FDA posted definitive guidelines concerning what meets minimal manipulation rules and regulations and what is accepted under the practice of medicine guidelines in the specialty of Regenerative Medicine. The FDA further restated the requirement that regenerative medicine be governed by homologous use. As I interpret the guidelines there are winners and losers:

Winners
Physicians who use compliant regenerative therapies:

  • Amniotic fluid without stem cells
  • Blood-derived preparations (e.g., PRP, PPP)
  • Bone marrow aspirate

Losers
Physicians who use non-compliant regenerative therapies:

  • Adipose tissue-derived materials obtained by enzymatic digestion
  • Amniotic fluid with cells Cord blood derived materials (non-autologous treatments)
  • Stem Cell Clinics that advertise about using amniotic fluid as a source of stem cells and regenerative therapy along with those clinics that treat everything from alopecia to ALS to arthritis

You might ask how is that different from the current situation? First of all, the FDA Commissioner has stated in press releases that the FDA is going to go after bad actors. The Cures Act provided for increased funding to the FDA, which we suspect the Commissioner will use in part to go after the bad actors. Also, the FDA wrote in their Guidance on Minimal Manipulation and Homologous Use that “healthcare providers” need to pay attention. We have never seen them explicitly refer to the doctors and clinics providing regenerative medicine. Finally, the FDA indicated that there would be a transition period (3 years) during which manufacturers would need to enter the RMAT program to get their non-compliant products properly approved; or else. And the reason that there could be teeth in the “or else” is that the FDA will get lots of fees from all of the non-compliant products entering the RMAT program.
Last of all, what the FDA did not address as part of consumer protection; but what I incorporate in my daily practice is evidence based intervention.

Now that you are better informed and have an idea as to the laws governing our regenerative medicine marketplace, stay away from the Charlatans and Camp Followers. Then take the next step and ask your physician for the Outcomes Evidence on which a regenerative intervention for your arthritic joint is based before undergoing a procedure. To better understand that evidence call for (312) 475 1893 to set up a consultation

You may watch my webinar by accessing my web site www.ilcellulartherapy.com.

* Minimal Manipulation and Homologous Use

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My Algorithm If Stem Cell Intervention Doesn’t Last or Doesn’t Work

I am being forthright; based on my review of data, while 80% or more of my patients continue to enjoy
satisfactory outcomes at four years or more following a stem cell intervention, there are those whose
symptoms and functional limitations recur. Please be aware that when I undertake the care and
treatment of a patient with a symptomatic and function limiting joint, it is with the notion of
regeneration and long-term benefit. It doesn’t always happen; there are may possible explanations.
Most important though is the need to identify possible causes of potential failure at the beginning, and
that is why we have recommendations before and after a procedure as to how to manage alcohol, diet,
supplements and a rehabilitation protocol. We also review your past medical history to identify any
possible indication that your stem cells have been adversely affected by co-morbidity or prior
treatments.

Assume if you will that you adhered to the initial pre-and post-intervention protocol but now returned
to my office months or years later with recurring symptoms. First and foremost is an updated medical
history and physical examination. That is followed by repeat images including X-rays and an MRI.
Mechanical progression of joint injury may result from aggravation of the preexisting damage by
subsequent trauma. Then there is the reality of identifying new processes within or adjacent to the joint.
This morning, I returned the phone call of a southwest Wisconsin dairy farmer; not the same patient I
wrote about last week. He has been a patient for over four years with a full restoration of work related
activities and recreational pursuits following several regenerative interventional options. After three
hours of basketball, three weeks ago, his knee pain returned. I called him back while he was milking his
cows and it was the first time I have been “mooed” at over a cell phone. I requested that the patient
update his X-rays, MRIs and then allow me to reevaluate him. A repeat stem cell intervention with a
more advanced technology, a subchondroplasty in addition to the stem cell intervention of his joint?
The recommendations will be based on an updated evaluation. In my practice of cellular orthopedics, it
isn’t one and done. Additionally, some of the more advanced techniques are being covered in part by
health care insurance

If you want to learn more, call for an appointment (312)475 1893
You may access my web site at www.Ilcellulartherapy.com and watch my webinar

After I completed writing this Blog, I opened the Bone and Joint Newsletter.
Lead article: Study Suggests Knee Replacement Be Reserved for Those More Severely Affected by Osteoarthritis. A recent analysis found that the current practice of TKR as performed in the USA had minimal effects on quality of life and quality adjusted life years

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