Posts Tagged treatment
Blood, Sweat and Smiles
Posted by Mitchell B. Sheinkop, M.D. in Bone Marrow, Hip Pain, knee, Osteoarthritis, Stem Cells on May 31, 2012
It has been said, you never forget the first time and Wednesday was that day. To the best of my knowledge, it was the first time in the Midwest that bone marrow aspirated and concentrated was used in an attempt to manage the pain and impairment secondary to an arthritic hip. The patient, in his early 50s, had previously undergone hip surgery on the left side and was seeking to avoid replacement of the other hip. I am the surgeon who performed his left hip replacement. He had followed my blog over the past several years where I began focusing on regenerative medicine for the management of arthritis. For 37 years, I had replaced hips and knees. When the pain and physical impairment had reached a point as to alter his athletic profile, his work related activities and his activities of daily living; he sought out my assistance again. This time though, in an attempt to maintain and perhaps restore his joint as contrasted to the last time, when I had replaced his hip joint.
After multiple office visits, examinations, documentations and repeated informed consent, the patient arrived at the surgicenter on Wednesday morning. I had dedicated over two years in preparation. He was anxious as was I; the first time, the initiation, the kickoff. Following registration and administrative perfunctory, he was taken into the surgicenter room and placed on a fluoroscopy table, resting on his belly. After scrubbing the low back and pelvis followed by sterile draping, under local anesthesia, using both sides of the back of the pelvis, I harvested 60 CCs of marrow following the algorithm of Regenexx. This was then taken to our lab for concentration and removal of everything but the autologous adult, mesenchymal stem cells; the latter were then transferred under sterile conditions into a 4 cc syringe. 45 minutes following the aspiration of the bone marrow, with the patient now on his back, fluoroscopic guidance was used for positioning those cells within the right hip joint between the femoral head and acetabulum. There are many other small steps to the process including the use of heparin; and following the administration of the bone marrow concentrate, administration of stem cell plasma (PRP). It all went as planned. The patient was taken to the recovery room and sent home with a set of crutches about three hours after he had arrived.
No significant pain during or after, but stay tuned. The patient will be seen next in six weeks with a return to work this Monday and a gradual resumption of physical activity. I will allow him to return to senior ice hockey at three months. The adage is one case does not make a series but we are off to a great start. Will it eliminate pain, restore motion, allow for return to full athletics, postpone or avoid a joint replacement? As in a realty show, stay tuned.
Regenerative Medicine and Stem Cell Informed Consent
Posted by Mitchell B. Sheinkop, M.D. in Stem Cells on May 16, 2012
Assume you have read my blog or learned from the web about our ethos – don’t just recover, conquer. You have scheduled an appointment, undergone the assessment, completed X-rays and the MRI and I have determined that you are a candidate for a regenerative medical procedure for your arthritis. The next step is informed consent.
While there is no data that allows me to promise that I can cause your cartilage to re-grow, there is ample evidence-Regenexx has over 5,000 cases-that allows me to say it is more likely than not that your bone marrow aspirated and concentrated adult mesenchymal stem cells may reduce or eliminate your pain and improve your function. One hope of stem cell treatment is influencing cartilage repair; unlikely though after, age 50. On the other hand, I have a new approach being instituted, arthroscopic debridement with stem cell repair. As an orthopedic surgeon, this will be one of my contributions to the new world. As far though as altering the bio-immune response of the synovium in the arthritic joint, there is little question and that is why I am willing to say that within a reasonable degree of medical certainty, I can minimize or eliminate your pain. Now you ask at what risk? As of now, there are two downsides as no procedure is risk free. Associated with any invasive procedure including minimally invasive needling is the risk of infection. While we only use a needle, it is an invasive procedure. Regenexx to the best of my knowledge has not experienced any deep infections in association with their outcomes surveillance. Second, there are a certain percentage of patients who do not respond as hoped. The revision intervention for superficial infection is an antibiotic; for failure it is a repeat attempt at Regenerative Medicine or a joint replacement. To date in the closely monitored outcomes of the 5,000 Regenexx patients, no tumor growth has been reported. Please keep in mind that your adult cells are reintroduced in to a closed environment, a capsulated joint. I repeat the Regenexx experience and data because theirs is the only outcomes evidence available. All other approaches and all other companies have depended on anecdote in the absence of gathering scientific evidence.
To the best of my knowledge, the cost of Regenerative Medicine is assumed by the patient. No insurance carrier and certainly not Medicare at this time will pay for stem cell management of arthritis. If the aspiration of your bone marrow and the concentration thereof is done under IRB oversight, we are in complete accordance with FDA governance. Someday, the indemnification community may choose to cover Regenerative Medicine, especially when our studies demonstrate the cost savings when compared to a total joint replacement. The global charge for a joint implant runs between $45,000 and $60,000; a revision, about $70,00 to $120,000. Should an infection ensue, the costs may go up by another $150,000 additional. Then there is rehabilitation; Regenerative Medicine is a matter of weeks, not months as in a joint replacement
What about outcomes; am I really able to compare those of stem cell management with a total joint replacement? Watch Kobi Bryant in the NBA playoffs or Alex Rodriguez, as third baseman for the New York Yankees. If you want to learn more, call and schedule an appointment. In my new website, where I hope to become your resource for Regenerative Medicine, there will be a section of new patient stories and the results of treatment. Stay tuned.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street . Chicago . Illinois . 60610
847.390.7666 or 312.475.1893
Arthroscopic Treatment of Osteoarthritis doesn’t work
Posted by Mitchell B. Sheinkop, M.D. in Hip Arthroscopy, knee, Osteoarthritis, Stem Cells on May 1, 2012
Might minimally invasive stem-cell treatment for conditions causing knee or hip pain secondary to common injuries or other degenerative problems be a substitute treatment for arthroscopy or even total joint replacement? If you are experiencing joint impairment and the MRI is “positive”, the pain is most probably due to the bio-immune and inflammatory changes of degenerative joint disease and “wear and tear” arthritis rather than a torn meniscus or acetabular labrum. You may want to investigate Bone Marrow Concentrate derived stem cell management rather than undergoing a surgical procedure of the hip or knee.
Traditional options for patients suffering from joint pain and altered life style include arthroscopic surgery or total joint replacement. With both surgeries, months of rehab are required, the outcome is not guaranteed and the patient must be aware of and prepared to take on the risks.
Original Article
Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons
Martin Englund, M.D., Ph.D., Ali Guermazi, M.D., Daniel Gale, M.D., David J. Hunter, M.B.,B.S., Ph.D., Piran Aliabadi, M.D., Margaret Clancy, M.P.H., and David T. Felson, M.D., M.P.H.
N Engl J Med 2008; 359:1108-1115September 11, 2008
Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that the symptoms are attributable to them. The prevalence of a meniscal tear or of meniscal destruction in the painful knee as detected on MRI ranged from 19% (95% confidence interval [CI], 15 to 24) among women 50 to 59 years of age to 56% (95% CI, 46 to 66) among men 70 to 90 years of age. Among persons with radiographic evidence of osteoarthritis (Kellgren–Lawrence grade 2 or higher, on a scale of 0 to 4, with higher numbers indicating more definite signs of osteoarthritis), the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalence among persons without radiographic evidence of osteoarthritis was 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.
Conclusions
Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.
What about the hip? Leah Ochoa published an article in CORR, 2010 that 87% of patients with hip pain have at least one finding of Femoral Acetabular Impingement on X-ray with a high rate of labral tears found on asymptomatic volunteers. The message, if you have less than 2mm of joint space on an X-ray, the problem does not lend itself to hip arthroscopy. If you have any reduced motion of your hip and a “positive” MRI for a labral tear, don’t treat the MRI, look further. Might stem cell management help avoid or postpone surgery? Call to learn more
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street . Chicago . Illinois . 60610
312-475-1893
The Botox for your frame, Stem Cells
Posted by Mitchell B. Sheinkop, M.D. in Osteoarthritis, Platelet Rich Plasma, Stem Cells on April 25, 2012
Musculoskeletal Care of the Mature Patient
The number one reason in the United States for a trip to a physician has to do with pain arising in the musculoskeletal system, especially in the Boomers and maturing athletes. Might regenerative medicine and stem cells provide an extended warranty for your frame? That was my basic question when I attended the American Academy of Orthopedic Surgeons continued medical education course last weekend “Advances in Care of the Aging Athlete”. What was generally reinforced is that the number one way to stay healthy and young is through fitness and sports; stay active on an aging frame. In other words put old on hold. Certainly proper nutrition is a key component as is Resveratrol and maybe testosterone supplementation for Manopause. Woman beware, hormone replacement therapy is generally not good for your health.
In the end though, the real problem is cartilage deterioration with age be it from genetics, congenital, developmental insult or trauma. The recent media attention to stem cells has introduced a clinical possibility of changing the natural history of progression of degenerative arthritis and perhaps even reversing the programmed death of cells. Peyton Manning went to Europe for stem cells in the neck, Governor Perry chose Asia for his back and Terrell Owens returned to football after stem cell intervention in Korea. You all probably are aware of the Fred Couples, Kobe Bryant and Alex Rodriguez having returned to top performance with the assistance of regenerative medicine. By harvesting Mesenchymal Stem cells form you bone marrow and concentrating them, the injectate is the best of all potential immune modulators with the greatest possible ant-inflammatory effect. There are a large number of animal studies confirming the efficacy of stem cell management of cartilage; such clinical treatment is now the standard of care in the veterinarian world, particularly with the injured or arthritic hoarse. As well, there is an emerging body of science to support adult mesenchymal derived stem cell management of the aging human joint appearing in peer reviewed medical journals. The International Journal of Rheumatic Diseases to illustrate, recently published an article concerning four patients with moderate to severe osteoarthritis of the knee who experienced marked improvement with mesenchymal stem cell therapy. The problem is that for the most part, human clinical trials are taking place outside the United States. Enter Regenexx and its IRB clinical trial. That’s why I joined the Regenexx Network. To learn more, schedule an appointment.
On Restoration, Regeneration and Resurrection
Posted by Mitchell B. Sheinkop, M.D. in Hip Pain, knee, Osteoarthritis, Stem Cells on April 3, 2012
Musculoskeletal Care of the Mature Patient
I feel the pain. This weekend was spent with my wife chasing trout in the Driftless Area of southwestern Wisconsin and I am hurting. Walking down a creek for miles is an adventure that is unlike no other. I have no idea what this has to do with stem cells so let’s get back to the week to be, actually the month ahead.
Passover begins in the evening of Friday, April 6 and ends in the evening of Saturday, April 14
Easter is Sunday, April 8
Regenexx visit is Monday, April 9 to Wednesday, April 11
Biovision needlescope introductory to regenerative medicine, April 12
American Academy of Orthopedic Surgery course “Advances in Care of the Aging Athelete” April 20 to April 22
I am undertaking an entire new direction as an orthopedic surgeon who performed and pioneered joint replacements for over 38 years. All I had to do was read the newspaper and listen to the media reports on orthopedic implant recalls to remind myself that someone from the orthopedic surgical community has to look ahead to alternative options for pain solutions. The AAOS course will address issues from stem cell and adjunctive therapies, nutrition, performance enhancing drugs, cutting edge regenerative and restorative treatments, and the application of other anti-aging substances and supplements for the shoulder, hip and knee-all with the goal of keeping patients well and at the top of their game. If you are severely impaired, then you still may need a joint replacement; but if you are still functional, there are viable alternatives to surgery. For the female athlete, I am developing an expanded approach to treatment and maintaining the opportunity to participate. My focus is personal and is somewhat brought about by my own interests, anti-aging and managing the aging process. Normal physiologic effects of aging affect participation in sports; reader, you are left to define the word sports. There is not necessarily a predictable positive impact of a joint replacement on function even if the implant is not recalled. If you want to analyze how cartilage regenerative techniques may apply to you in the new world of regenerative stem cell based medicine, call for an appointment. I will work with you to determine appropriate non-operative and minimally invasive stem cell treatment plans for mature adult “athletes” with traumatic, degenerative and arthritic conditions particularly related to the knee, hip and shoulder.
Mitchell B. Sheinkop, M.D.
847-390-7666 or 312-475-1893
1564 N. La Salle St
Chicago, Illinois 60610
Saving umbilical cord blood
Posted by Mitchell B. Sheinkop, M.D. in Cord Blood, Osteoarthritis, Regenerative Pain Center, Stem Cells on March 15, 2012
In the beginning, there was an umbilical cord. The blood in that cord was and is an invaluable source of stem cells that is unique to your body and family. These cells may be used to treat nearly 80 serious medical conditions at last count including leukemia, other cancers, and blood disorders. Cord blood stem cells are showing significant potential to treat conditions that have no cure today as juvenile diabetes and brain injury. Saving your baby’s or your grandchild’s cord blood secures the best treatment option for a healthy future.
According to the U.S. Department of Health and Human Services, “This revolutionary technology (regenerative medicine) has the potential to develop therapies for previously untreatable conditions. Examples of diseases regenerative medicine can cure include diabetes, heart disease, renal failure, osteoporosis, and spinal cord injuries. I am now ready to announce my personal entry into the new world of regenerative medicine in conjunction with the Regenerative pain Center by having joined the Regenexx network of physicians. I will start screening patients for bone marrow concentrate pilot study as of March 25th. The actual clinical process will be introduced at the beginning of May at the Regenerative Pain Center. There is as yet no assurance that bone marrow concentrate rich with autologous mesenchymal adult stem cells administered in to an arthritic joint will reverse arthritis or even stop progression but with the anecdotal observations around the country, I believe that as an orthopedic surgeon, I might or could be able to delay or avoid a joint replacement. Our pilot study will be the first step. In order to qualify, a patient will need to meet certain criteria determined by history, physical examination, X-ray and MRI. At times, a diagnostic out patient arthroscopic examination or prior treatment may be part of the program. For those who don’t qualify for the study, the patient may still seek treatment with a self-pay alternative.
Transplant medicine uses stem cells to help treat serious diseases, such as cancers and blood disorders. Regenerative medicine is a new and rapidly advancing area of medicine focusing on developing treatments using stem cells to repair damaged tissues and organs. The estimates to date that someone in your family will use stem cells in a lifetime include:
Transplant Medicine: 1 in 217
Regenerative Medicine: 1 in 3
I am thrilled to announce my entry in to the emerging stem cell application regenerative process. To learn more or see if you qualify, call the number listed below.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle St., Chicago, Illinois, 60610
Surfing the Internet for stem cell updates
Posted by Mitchell B. Sheinkop, M.D. in knee, Osteoarthritis, Stem Cells on February 29, 2012
The New York Times (2/27, A8, Wade, Subscription Publication) reports, “Researchers at Massachusetts General Hospital say they have extracted stem cells from human ovaries and made them generate egg cells.” The report, “if confirmed, might provide a new source of eggs for treating infertility, though scientists say it is far too early to tell if the work holds such promise.”
The AP (2/27) reports that lead researcher Jonathan Tilly of Massachusetts General Hospital “collaborated with scientists at Japan’s Saitama Medical University, who were freezing ovaries donated for research.”
Bloomberg News (2/27, Flinn) reports “stem cells from the ovaries were injected into human ovarian tissue that was then grafted under the skin of mice, which provided the blood supply that enabled growth.” In less than “two weeks, early stage human follicles with oocytes had formed.”
The Boston Globe (2/27, Johnson) reports, however, that “scientists not involved with the Mass. General research said such an approach – if it is even possible – sits far in the future and will require considerably more work.” A number of “scientists said Tilly, who cofounded a company focused on developing novel infertility treatments, had not yet made a convincing case that the stem cells he discovered can yield viable eggs, a critical first step.”
The Wall Street Journal (2/27, Naik, Subscription Publication) reports that the research, published in published in Nature Medicine, was funded by the National Institutes of Health, among others.
HealthDay (2/27, Goodwin) reports that although “it was long believed that women were born with a lifetime supply of eggs, which was depleted by menopause,” an increasing “body of research,” such as this study, “suggests egg production may continue into adulthood.” Also covering the story are MedPage Today (2/27, Bankhead) and WebMD (2/27, Goodman).
Regenexx Web Site KJ is in his late 70′s and was evaluated by us in 2008, after a lifetime of knee problems since a torn meniscus in the 1960′s. After multiple failed arthroscopic knee surgeries through the 2000′s, he was told he needed a knee replacement. His MRI showed complete loss of the meniscus in the left knee (which had been surgically removed in the 1960′s) and severe cartilage loss (bone on bone), so he was told that he was a fair-poor candidate for the procedure (his knee is featured in this prior blog post). He didn’t want a knee replacement, so he decided to give the procedure a try. We treated him with the Regenexx-C knee stem cell treatment as well as a barbotage procedure to remove bone spurs and some injections to tighten his very loose ACL knee ligament. His last update on how the knee did with stem cell treatment is here. I examined him today, more than 2.5 years after his knee stem cell injection and his knee still feels great. He walks several miles a day, climbs ladders and stairs, and works on home improvement projects, all without significant pain other than mild stiffness now and then. His exam showed no significant tenderness or swelling. Looks like KJ was able to dodge the knee replacement bullet long-term because of an injection of his own stem cells and an Interventional Orthopedics approach
I am off to Regenexx on Friday.
Stem Cell Crier
Posted by Mitchell B. Sheinkop, M.D. in Regenerative Pain Center, Stem Cells on January 30, 2012
Musculoskeletal Care of the Mature Patient
I’m back from a short Blog sabbatical, refreshed and with much to discuss. During the time away, I spent a week skiing in Colorado with my wife, read a book, The Immortal Life of Henrietta Lacks, a must read for anyone interested in or considering regenerative medical care, and kept up on issues that I believe would be of interest to readers. While I was gone, my staff continued to work and both finalized and submitted the request to The Institutional Review Board that will enable us to begin The Bone marrow Aspirate Concentrate Stem Cell (BMAC) management of osteoarthritis. I will share with you what I read, watched and observed.
From the American Medical Association Morning Rounds of Tuesday, January 24, Leading the News “Stem cell treatment may help patients with macular degeneration”
On NBC’s The Doctors-Jan 25, a Regenexx stem cell procedure is featured for a patient with a failed microfracture in a woman with an arthritic knee seeking return to an active life style.
The Immortal Life of Henrietta Lacks , written by Rebecca Skloot is the fascinating biography of a woman whose cells were harvested without her knowledge in 1956 at Johns Hopkins; and ultimately became responsible for the world of regenerative medicine today. Along with the factual history of how the first cell cultures of human cells has evolved into the practice of medicine as we know it today, one learns about the evolution of medical ethics, government mandated patient protection and informed consent processes that govern contemporary medicine. You will better understand my approach to regenerative medicine when you finish this book named by more than 60 critics as one of the best books of 2010.
We arrived in Vail on Saturday afternoon, January 21, just as a snowstorm was starting. By time we ventured out on Sunday morning, there was 12 inches of fresh powder at the top of Rivas Ridge. It snowed again two more times during the week with another 14 inches of fresh powder by time we headed down Shangri-La in China Bowl. During the week, a friend came over from Breckenridge with his snow- board. By the end of our Wednesday skiing, I needed regenerative care for my entire body; almost no one was on the slopes besides us.
Over the next two weeks, I am scheduled to do site visits to observe and compare notes with centers involved in BMAC. If you want to move forward with learning whether you might be a candidate for regenerative medical care of your arthritis before scheduling that joint replacement, make an appointment or make a call. While no authority can promise success, there is an accumulating body of global information suggesting autogenous, autologous, adult bone marrow derived mesenchymal cells my be an effective, long term, anti-inflammatory and perhaps alter the natural history of degenerative arthritis.
Mitchell B. Sheinkop
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
REGENEXX CANDIDATE FORM
Dr. Mitchell Sheinkop is now performing Regenexx Procedures in the Chicago area. To learn more about these procedures, visit regenexx.com.
To find out if you are a candidate, please complete the Regenexx Candidate Form, or call us at 312-475-1893 extension 15.
