Nov 3, 2014
From time to time, I consult with patients who just don’t meet the inclusion criteria regarding Bone Marrow Aspirate Concentrate intervention for arthritis. At the same time, some of those patients are so pharmacologically dependent owing to medical conditions demanding maintenance that I am unable to offer them autogenous hope from their own Platelet Rich Plasma or that which may be created from a patient’s own platelets. While in the minority, as an orthopedic surgeon offering Cellular Orthopedic interventions for arthritis in those unable to undergo a joint replacement wherein the internist deems the procedure unsafe or who seek to avoid or at least postpone a joint replacement; weight loss, physical therapy, cortisone injection and visco-supplementation are short term fixes and not necessarily without potential risks. The real damage to stem cells from cortisone injections became the subject matter of several recent scientific publications. First no harm is what I was first taught in my orthopedic training.
Over the past several months, I have sought treatment alternatives for patients as described above; not candidates for current interventions with standard autogenous procedures. Enter the new alternative, allograft. Derived from Amniotic Fluid, the intervention is FDA approved, safe, and in some cases, even covered by third party indemnification. There are many companies offering this treatment alternative and I am investigating the multiple options. Please be aware, amniotic fluid alternatives are not a substitute for Bone Marrow Aspirate Concentrate derived stem cells ; but there may be a place for this anti-inflammatory alternative when established Cellular Orthopedic options can’t be used in an arthritic because of medical co-morbidities such as heart disease, chemotherapy, kidney disease, liver disease, obesity, Diabetes, etc, etc, etc. Amniotic Fluid usage in Orthopedic is not new; there are publications dating back to 1938 in the orthopedic scientific literature. It wasn’t though until the last five years evidently that allograft investigation led to the development of currently available products.
If you fall into the category of patients who do not meet the inclusion criteria for Bone Marrow Aspirate Concentrate or in whom your Platelet Rich Plasma would not be a suitable alternative, you may be a candidate for Amniotic Fluid Concentrate intervention. Under certain circumstances, the allograft may be covered by your insurance. To learn more, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Osteoarthritis, Pain Management, Regenerative, stem cells, Synvisc, treatment
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
Sep 11, 2014
From time to time, I feel it my responsibility to call the readers’ attention to the writings of others because of the constantly changing knowledge concerning Musculoskeletal Care of the Aging Athlete. The September issue of the Journal of the American Academy of Orthopedic Surgeons, featured a Review Article from the Department of Orthopaedics, Warren Alpert Medical School of Brown University: The Effects of Fitness on the Aging Process. The last sentence in the abstract states “A large segment of older sedentary adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles”; and that’s why I am writing this Blog
Decades of research support the fact that much age-related deterioration is the result of the effects of sedentary lifestyles and the resultant medical conditions rather than aging itself. A continually growing body of scientific and clinical evidence demonstrates how active persons modulate physical decline through training. There is a well recognized age related decline in the musculoskeletal system as bone looses density, the strength and flexibility of muscle decreases, ligaments and tendons stiffen up, and the structure of cartilage degenerates. At the same time, the aging process is accompanied by obesity, cardiovascular disease, type 2 diabetes and other leading causes of infirmity and death.
Earlier this week, I spoke with a patient whose family I have taken care or for over 35 years including having performed hip replacement surgery on her husband some years ago. Her chief complaint had to do with her knee discomfort that was increasingly limiting her fitness and recreational profile as well as her activities of daily living. I had requested that she complete imaging and I was following up with my recommendation. Her principle concern had to do with accelerated aging if she did not maintain her fitness regime.
In summary, a growing body of scientific evidence supports how active adults modulate age-related decline in various areas of the musculoskeletal system. Bone Marrow Aspirate Concentrate derived Mesenchymal Stem Cells may help intervene in a chronic and progressively limiting arthritic process or hasten the healing in an acute injury. For those who have tried MSCs once and not enjoyed the sought after outcome, come on back and let’s do it again. This time though with a full commitment to modifying the aging process though stem cell intervention and the pursuit of fitness.
Tags: arthritis, athletes, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Mature Athlete, Orthopedic Care, Osteoarthritis, Regenerative, stem cells
Mar 25, 2014
Several months ago, I was reading a scientific article in the orthopedic literature and I realized that much has changed in the field over the four years since I stopped doing joint replacement surgery. Then I wondered how much has changed in the other sub specialties within orthopedic surgery since I completed my residency training and received my orthopedic board surgical certification. After contacting, the American Academy of Orthopedic Surgery to determine the best way to assure that I was offering contemporary skeleto-muscular care to my patients, be it for regenerative medicine or the occasional second opinion for which a patient seeks consultation, I committed to the thousand page Orthopedic Knowledge Update, (OKU) dedicating several hours a day to each of the 64 chapters. Best stated in the Preface, “ We orthopedic surgeons face a challenging conundrum: we are driven to sub-specialize because of rapid technologic advances and patients seeking very specific expertise, yet we must remain knowledgeable across the full spectrum of orthopedics in order to deliver optimum patient care and pass certifying and recertifying examinations.”
Last week, I took the 200 question multiple-choice examination to measure competence and whether I had mastered the contents of the Orthopedic Knowledge Update initiative. Yesterday, I received notice of having passed the exam with flying colors. The material reward is 70 Continued Medical Education credits. The emotional and self-satisfaction reward is beyond description. The last multiple-choice test I had taken was when I passed my Boards in 1974. What does this have to do with Regenerative Orthopedics?
Again and again, the patients come to the office with pain, limited activity and altered life style with a diagnosis of osteoarthritis. An orthopedic surgeon has told them: ”you have bone on bone; I am scheduling you for a joint replacement.” In my office, a full history, physical examination, and review of X-rays and MRIs are completed. It has been well established that the indication for surgery in arthritis is not an altered X-ray. The patient with Grade 2 or 3 osteoarthritis is then given an informed consent regarding Bone Marrow Aspirate Concentrate derived Stem cells.” I will call you to schedule” is a common response when the patients are really telling me that they intend to discuss stem cell intervention with their primary care physician or orthopedic surgeon. Why the subject matter of this Blog? I can tell each and every patient that my recommendation is based on my knowledge, experience, credentialing, research and database. Ask your second opinion “expert” concerning Regenerative Orthopedics for his or her experience, credentialing, research, and data base after you receive the “it’s too early”; “that stuff doesn’t work”;” it’s ten years away” before making your decision.
Tags: arthritis, Hip Replacement, Interventional Orthopedics, Knee, Orthopedic Care, Osteoarthritis, stem cells
