Mar 2, 2015
It starts with an evaluation, a Bone Marrow Aspirate Concentrate intervention, a custom brace, and sports specific physical rehabilitation protocol that changes with the seasons, a nutritional consultation, a dietary supplement prescription, and a Concentrated Platelet Rich Plasma/Lysate Booster when appropriate. That’s my recommendation for hiking, biking, climbing, skiing, staying fit and fly-fishing. These far reaching futuristic statements are based on my clinical research, anecdotal observations on patients who join me in the aforementioned activities and my own lifestyle. Should your impairment return once you are a Sheinkop alumnus, or should you see an increase in arthritic related symptoms, do it again in a year or five.
You are what you eat is in part a truism. So too, you can be what you want to be. Sure we age and sure we all have to live with age related adjustments; the answer is not to quit. Take my prescription for maintaining or returning to the active life. To learn more, call for an appointment. As an example, we have changed our visco-supplementation formula because of a new development to one injection rather than three. We have improved our Platelet Rich Plasma formula to be much more effective than last year and we are constantly updating our Bone Marrow Concentrate formula.
So what’s in the Cellular Orthopedic news? “Novel Technology to increase Concentrations of Stem and Progenitor Cells in Marrow Aspiration.” Headline this weekend and I looked into it further. After all, I have a responsibility to my patients to stay in the forefront of new developments. As I delved further, I found that this “advanced” technology was tested on three patients before being brought to market. My analysis of this “breakthrough”, come back when you are for real. Then came the Alpha 2 Macroglobulin filter positioned to compete with Platelet Rich Plasma methodologies. The cart was put before the horse on this one, as we don’t even know if Alpha 2 Macroglobulin will work on a human. Then there is the Hip-Spine connection; but I will save that for next time.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, Synvisc, treatment
Feb 26, 2015
As we statistically analyze our Outcomes data, in preparation for presentation at 2015 Regenerative Medicine Meetings, it becomes increasingly apparent that Cellular Orthopedics is not a “one and done” event. Neither for that matter is a total joint replacement. While skiing in Vail last week, I was in the company of two Sheinkop patient alumni, one a patient under 40 who had undergone Bone Marrow Concentrate hip intervention for advanced osteoarthritis several years ago and one, a 70 year old who had undergone stem cell intervention for his arthritic knees back in 2012. Yes, I take care of friends and they still are speaking to me. Not only do they communicate but, bike and fish with me as well. In both cases as I followed their initial responses, I convinced them of the value of a second procedure and in both cases, it really worked. The younger Sheinkop alumnus is a boarder, the older, a skier. Nevertheless in both cases, they are still extremely active in spite of advanced arthritis in major joints. Might only one stem cell intervention be necessary if I could treat you earlier in the arthritic process? That’s to be determined by ongoing clinical surveillance. The important issue is that both individuals are examples of the potential of Bone Marrow Aspirate Concentrate. There are many more and in the coming days I will Blog about statistically significant Outcomes as I prepare my speeches and manuscripts. Incidentally, while skiing in Vail last week, I happened to change the channel from a sporting even to the movie, Casablanca. Truly, one of the greatest movies of all time; of the great quotes was Rick Blaine’s “here’s looking at you kid” (Humphrey Bogart). What really caught my attention in addition to Ilsa Lund (Ingrid Bergman) was her quote “Play it once, Sam. For old times’ sake”.
How do the stem cells work? It may not just be the stem cells that make a difference in an arthritic joint. We now know that Bone Marrow contains in addition to stem cells, two other major areas of benefit, Growth Factors and Cytokines. While the Adult Mesenchymal Stem Cell may help regenerate cartilage damaged by injury and arthritis, it is the Growth factors and Cytokines that also play an equally important role in the anti-inflammatory effect and reversal of the arthritic process. What happens when we concentrate and prepare the Bone Marrow and execute the Cellular Orthopedic intervention following the Regenexx algorithm of care is reversal or at least a slowing of the arthritic process, a diminution of pain, an improved functional capacity and a delay, maybe avoidance, of a total joint replacement. While there still may be a need for an occasional Tylenol after a BMAC/Stem Cell intervention, you have a good chance of joining me as an alumnus on the slopes, on the bike, wading up a trout stream, or in a fitness pursuit. As well, we may have to do it again in a year or two; but I have yet to record a complication. “Play it once, Sam. For old times’ sake” or in the stem cell world, play it again Dr. Sheinkop to keep me going.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
Jan 29, 2015
From a Patient in Canada
On January 20, 2015
“Thank you, Doctor,
How are you today? Hope well.
My Mom is very grateful for your kind help, mentions your name frequently and wants to schedule the 3rd Rx-SD visit to your office in 2-3 months.
Please provide us with the special 50% discounted price for the procedure similar to the last time in July and the time convenient for you if possible.
Thank you for your help.
My Mom is currently almost free of pain, walks around the house with a walker. The 2nd Rx-SD procedure on July 9,11, 2014 went really well and with the anesthesia was painless. My Mom trusts you, wants to see you every 8-12 months and to start walking without a walker this summer.”
This was the Holiday greeting last month
“Thank you, Doctor,
We wish you a merry Xmas and all the best in 2015.
Thanks to your kindness and knowledge, we found you when we were in real pain and needed you the most and you saved us. My Mom is very gratefull to You, calls you God and mentions your name daily, she’s feeling better only because of your help. My Mom and I both wishing you good health and all the happiness, many years ahead and a Happy New Year 2015.
Thank you for your help
Kind Regards,”
On Oct 7, 2014, at 8:32 AM
“Thank you, Doctor,
3 months passed after the 2nd SD procedure (9 July).
My Mom feels a better improvement now vs right after the 1st procedure.
We have no words to express how grateful we are.
She still uses a walker but occasionally tries a bit on her own with a cane. The pain is almost gone, just occasionally when its rainy or she stands for too long. She didn’t find a great improvement after the PRP refill (2 May), followed by the 1st SD procedure (4 Dec).
What do you think, Doctor, should she just do the 3rd SD procedure in 6-11 months or is it better to do the PRP refill now prior to this. I was surprised to learn the latest Rx SD 2013-14 data show the result doesn’t depend on age (74), OA severity (3), BMI (35).
With BMI=35 what’s the average total hrs per day should she stand/walk?
Thank you for your help.
Kind Regards, “
On Aug 9, 2014, at 12:16 PM
“Thank you, Doctor,
The 2nd SD procedure on 9 July went well and with the knees anesthesia was very painless. After 1 month my Mom feels good, no pain, just a little bit of pain when its humid and raining, still can’t walk without a walker.
My Mom is really grateful for your help and hopes to start walking one day.
Thank you for your help.
Kind Regards,”
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
Jan 12, 2015
That quote comes from University of Chicago Economist and Nobel Laureate, Gary Becker, who died in 2014. Central to his work was the concept that economics can help explain behavior. As seems to be happening more and more, this Blog will expand on the evidence concerning Bone Marrow Aspirate Concentrate/Stem cell outcomes for intervention in the arthritic joint. The Data and my experience clearly document success at all stages of arthritis in a major joint for some period of time. What I am unable to conclude is in whom we are actually regenerating cartilage or in whom we are seeing pain relief and improved functional capacity owing to concentrated Growth Factors and Cytokines. Whereas my initial interventions two and a half years ago were limited to a “younger” arthritic demographic, the successes resulted in my expanding the inclusion criteria last year without age exclusion as I observed Outcomes success in those approaching 80 years of age. What I don’t know yet is in whom the improvements are related to the stem cells in the Bone Marrow Aspirate Concentrate or whether to the Growth Factors influencing your own stem cells or the Cytokines acting as anti-inflammatories, accompanying the stem cells in the Bone Marrow Aspirate Concentrate. What the evidence does indicate is that the older the patient or the more advanced the arthritis at the time of BMAC intervention, the better the outcome with a second or even third procedure. What I don’t know yet is a predictor of the survivorship of an outcome. I do know that the best chances of long-term benefits are in those with less than Grade 4 arthritis. For those who experience something less than hoped either in the initial result or extent of benefit, let’s explore the economics.
Just as our health care indemnification is undergoing change, so is my understanding of the scope of services that may be beneficial in this evolving discipline of Cellular Orthopedics. The good news is that unlike the insurance world where less health care coverage seems to be associated with greater cost for indemnification to the patient, I have identified a means of decreasing the economic burden to a patient for a repeat Bone Marrow Aspirate Concentrate/Stem cell intervention or related Regenerative Medicine injection, if a single procedure doesn’t provide the degree of relief or survivorship of outcome desired. It may well be that Cellular Orthopedics involves a range of approaches and not a single intervention. My office will work with you to provide you a scope of Evidence Based Care with an economic approach that allows the patient to avoid or at least delay a joint replacement.
Tags: arthritis, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, Hip, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
Jan 5, 2015
This time of year always brings with retrospection, reviews and prophecy, no matter what area of interest. As my area of professional concern is arthritis and assisting a patient avoid or at least delay a joint replacement, I thought it would be helpful to look at what Outcomes we recorded in our Data Base. Unlike the majority of Regenerative “experts” marketing themselves on the internet, I don’t cite the results of others or make unsupported claims, I document what I learn from having treated patients with Bone Marrow Aspirate Concentrate over two and a half years. Imagine if you would the complexity of having integrated patient care with clinical research using all the parameters I applied to development of new generations of total hip and total knee prosthetics during my almost 40 year joint replacement career. That’s why there are few if any involved in musculoskeletal care via Regenerative Medicine who are able to provide a patient the comprehensive experience I offer.
As of this morning, we have registered over 525 patients in our comprehensive Data Base with measurement pre and post Bone Marrow Aspirate Concentrate/Stem Cell intervention in 125 hips and almost 400 knees. Of the hips, three have gone on to a joint replacement; of the knees, two have gone on to a total knee replacement to the best of my knowledge. What I have defined from my experience is who will benefit from a BMAC intervention and who should undergo a joint replacement. Note the absence of reference to adipose derived stem cells. The explanation is simple; the FDA views such as a drug and hence does not approve the use of fat in the management of arthritis. I am also beginning to get a better understanding about how long the benefits of the intervention will maintain and how to best manage and extend those benefits. In the joint replacement world, the benchmark parameter is survivorship, how long until the prosthesis fails? In the stem cell world, I am interested in observing and prolonging the pain relief and functional improvement after the Bone Marrow Aspirate Concentrate Stem Cell procedure.
Evidence Based Medicine and Best Practices require maintenance of an outcomes data base; not an injection without ongoing follow-up. As I perused the internet this morning, other than Regenexx, I find a paucity of clinical data and a predominance of unsupported claims. In my lifetime of joint replacement surgery, there were many others performing large numbers of procedures around the country. We would meet periodically and present our own scientific outcomes and the evidence and learn from each other, all leading to the best possible clinical practices of total joint replacements. When it comes to the seductive claims from Stem Cell clinics found all over the Web, my challenge this year: Show Me Your Evidence
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, FDA, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
