Mar 24, 2015
At least it is spring on Astronomical chart although six inches of snow yesterday in Chicago causes one to take pause. Nevertheless, I am off to Southwest Wisconsin this weekend to initiate my fly fishing journeys for 2015. One doesn’t necessarily equate fishing with physical demand. Yet last Friday, at an 18 month follow-up of a Bone Marrow Aspirate Concentrate/Stem cell intervention in a 74 year old patient with arthritic knees, who incidentally had been told he needed knee replacements, I received a very serious thank you because my patient was planning several fishing trips to Canada this year with children and grandchildren; something he had not been able to do for several years as he couldn’t get in and out of a boat. Now he is able to do so and plans to enjoy every moment. I plan to wade up the spring creeks and vault up and down the cliffs and boulders as a result of my own regenerative care last year. Two weeks ago, my wife and I returned from a fabulous week of skiing in Vail and the only runs I avoided were the cliffs.
I learned much over the winter about several golfers who had undergone stem cell care for both knee and hip. The post intervention rehabilitation regimen had resulted in their ability to travel to the South East and Southwest to play golf on multiple occasions when such had not been possible in the past several years for them. Of particular interest to me was the report from one patient who I had met two years ago when he was scheduled to undergo a hip replacement. First he spent some time changing his swing and in particular the positioning of his leg so it would turn out. That seems to have taken the pressure off the area of missing cartilage and impingement. Next, he underwent a stem cell procedure and he is no longer considering a joint replacement. Not being a golfer, I checked it out on the internet and indeed, a change in golf mechanics may eliminate the painful swing. When followed by the stem cell procedure, there is something akin to bacon and eggs or love and marriage.
In looking back over the winter that hopefully was, a 45 year old man who had had to stop running because of “bone on bone” in his knee and who had received a recommendation elsewhere for a knee replacement, indeed turned out not to have “bone on bone” when I reviewed his images although he did have a problematic knee. 90 days after undergoing an SD Regenexx procedure, he ran the Madison 50 furlong-Race. Well, now it’s time to put air in my tires and start planning ahead. I did receive a call last Saturday by my cycling partner concerning a Sunday morning ride; but with a temperature forecast of 29 degrees, I respectfully declined the offer. For those with joint injury or arthritis, everything and anything is possible in fitness, recreation, sports and a pain free walk in this new world of Cellular Orthopedics.
Tags: arthritis, athletes, Benefits and Risk, 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
Mar 16, 2015
When a patient schedules a Bone Marrow Aspirate Concentrate/Stem cell procedure in our office, part of the recommendations leading up to and following your SD procedure is elimination of Statins for a period before and after the procedure. While Statins are clearly effective in reducing the risk of major atherosclerotic cardiovascular events, and the cardiovascular benefits outweigh the risks of treatment, there is a skeletomuscular price to be paid with the use of Statins. With accumulation of more data and longer term monitoring on the outcomes of Statin prescription, we have learned that adverse events include, most commonly, muscle pain, aching and weakness usually without elevation of muscle enzymes, specifically the CreatineKinase. All Statins can cause myopathy defined here as unexplained muscle pain or weakness. While in rare settings, the myopathy may be accompanied by CPK levels more than 10 times the upper limit of normal, and progression to a serious irreversible form of myopathy, rhabdomyolysis, in most situations, it is muscle pain and weakness without changes in muscle related enzymes. In spite of all of these observations, as of this time there is no scientific explanation in most settings as to why a patient may manifest Statin intolerance.
As far as why Statins are associated with weakness, pain and muscle aches, there is no pharmacologic evidence other than the disappearance of symptoms when the dose is lowered , the proprietary prescription is changed or the pharmacologic is discontinued altogether. The high success rate of the disappearance of symptoms following a period of abstinence and then reintroduction is consistent with nonpharmocological mechanisms for intolerance.
Do Statins adversely affect the muscle cell mitochondria? In a group of obese patients for whom an exercise regimen was incorporated into their weight loss, fitness routine, those on Statins had a more difficult time with a higher expression of diabetes as contrasted with those who had not been prescribed the Statins. I am not an internist; I admit I use Statins as I have a cardiovascular disease family history. They are prescribed by my internist and I don’t challenge his expertise; my recent ultrasound/echocardiogram stress test results confirm his wisdom. Nevertheless, I now have a reasonable explanation for my own transient muscle discomfort and you have a reasonable explanation as to why we recommend the elimination of Statins prior to and following a Regenexx SD Stem Cell procedure for an arthritic joint.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenexx, stem cells, treatment
Mar 9, 2015
We are always learning from Data and in this Blog, I will let you learn with me. Please note that the results reproduced below are very preliminary and not to confused with the indications or results of our Bone Marrow Aspirate Concentrate/Stem cell interventions and outcomes. Because of the American Academy of Orthopedic withdrawal of support for visco-supplementaion (Hyaluronic Acid)in the arthritic knee, the orthopedic world is seeking something to fill that void, hence the interest in Amniotic Fluid Concentrate. Cortisone injections expanded with local anesthetics has been the mainstay but recent data indicates that local anesthetics kill cartilage and several cortisone injections are equally toxic to cartilage in animal models.
Interim Analysis of Prospective, Multi-Center Outcome Observational Cohort Registry of Amniotic Fluid Treatment for Osteoarthritis of the Knee Douglas Beall, MD,* Sri Nalamachu MD, **
Introduction Osteoarthritis (OA) of the knee is one of the leading causes of functional limitations and poor quality of life. Nonsurgical treatment of OA of knee includes oral medications and injection. Corticosteroid or hyaluronic acid (HA) injections to alleviate pain and/or improve function are common techniques but recently HA effectiveness has been questioned for the treatment of OA of knee in the Medicare population as well as for its overall efficacy. Alternatives are sought to provide pain relief and improve functional outcomes. Allograft amniotic tissues have a long history of clinical use. The use of amniotic fluid in the treatment of knee OA was initially reported by Shimberg who demonstrated that injections of the fluid improved knee function and pain relief without any significant adverse events in 68 patients. Amniotic fluid is a homologue to synovial fluid which acts as a cushion to protect and lubricate the contents in a closed environment. This study measures the safety and efficacy of processed allograft amniotic fluid in treating osteoarthritic knees using common, validated instruments.
Summary of methods This is a protocol-driven, single arm post-market Registry reviewed and approved by the Western Institutional Review Board (Olympia, WA). Patients with Kellgren Lawrence Grade 1-3 OA via radiologic examination were eligible for enrollment. Excluded patients were < 35 years, had BMI > 45 or had received Hyaluronic Acid injections in the previous six months, or steroid or PRP injection in the last three months. There were no threshold pain inclusion or exclusion criteria. Eligible patients were injected with 4cc of minimally processed amniotic fluid (AmnioClear LCT; Liventa Bioscience, West Conshohocken, PA) into the affected knee. Primary efficacy endpoints are VAS scores and WOMAC overall and Pain, Stiffness and Difficulty (function) subscore scales, measured during office visits at baseline and at 30, 90 and 180 days. Enrollees also filled out weekly Pain Diaries to report WOMAC Pain subscore (5 questions) at weeks 1-4 post-treatment. Results To date over 420 of an anticipated 470 Registry enrollees have been treated. This is an interim analysis of the first 181 patients to attain 30 day follow up and the first 51 to attain 90 day follow up visits, with 15 of 23 investigational sites reporting. WOMAC Pain subscore average improvement over baseline was 62.1 percent (150.9 mm) and 62.3 percent (151.2 mm), respectively at 30 days and at 90 days. VAS average improvement over baseline was 58.9 percent (37.7mm) and 62.5 percent (40 mm) at 30 and 90 days, respectively. All other WOMAC scores showed similar improvement.
OMEGA Statistics, Murieta, CA On average, patient outcomes improved significantly compared to basel
Tags: Amniotic, arthritis, athletes, Bone Marrow Concentrate, Clinical Studies, Hip Replacement, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenexx, stem cells, treatment, Ultrasound Guided Injection
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
