Stemcelldoc's Weblog

March 14, 2010

Off Shore Stem Cell Report Card

The International Cellular Medicine Society is an independent nonprofit organization dedicated to the advancement of safe and effective adult stem cell therapies through research, education and oversight.

The ICMS  publication is a first of its kind report on off shore stem cells clinics. The report provides a summary of cells used, diseases treated and treatments costs of nearly a dozen non-US based stem cells clinics. The report also details the specific procedures, methods and practices of each clinic and evaluates them against the ICMS clinical and lab practice guidelines.

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February 21, 2010

Regenexx makes Headlines Again

Filed under: American Stem Cell Therapy Association — Tags: , — stemcelldoc @ 8:18 pm

Regenexx was featured in the Broomfield Enterprise .  Click here for full article.

February 10, 2010

Theraupatic Lumbar Discogram?

Lumbar discography is procedure in which a needle is placed into the disc at two or more levels to determine whether of not a specific disc is the  source of pain.  Is the pain coming from the L4/5 disc or the L5/S1 disc?  The procedure is performed with intermittent x-ray.  Once the needles are in the center of each disc,  contrast is injected into the disc.   A patient’s response is graded as follows:

P0:  no pain:  a common response in a healthy disc

P1:  painful, but not identical in quality or location to the patient’s daily pain.

P2:  painful, identical in character, quality and location.

Discograms are strictly a pre-surigcal procedure which tells the surgeon which level to operate.  They have no therapeutic benefit.  I have had two discograms and they HURT!

A recent study demonstrated that lumbar discograms accelerate disc degneration.

Patients are often  misinformed about discograms.

AJ was a 23y/o with 6 month history of low back pain following a rear-end motor vehicle injury.  Pain was constant in duration, 6/10 in severity, progressive in nature and  localized in her lower back, right =left with radiations into her buttocks.  MRI was significant for mild degeneration of the L5/S1 disc. Physical examination was significant for tenderness in the lower lumbar spine with extension and rotation.  She had no treatment to date:  no physical therapy, chiropractic care, trial of good quality fish oil, massage or evaluation by a pain specialist.  Her PCP referred her to a surgeon for evaluation of her back pain.  She was scheduled for a discogram which she thought was going to help here back pain.

 Evaluation of all possible sources of pain is essential.  For lumbar back pain common causes include:

myofascial: dysfunctional muscles 

facet dysfunction:

ligamental dysfunction: treated with proloterhapy

SI joint dysfunction:

Disc dysfunction.

The Centeno-Schultz Clinic is committed to identifying the cause of a patient’s pain and designing an proper treatment plan utilizing state of the art therapies.

February 4, 2010

Normal MRI: No therapy Indicated

 NG is a 34 y/o patient who presented with a 5 year history of left knee pain which was constant in duration, 3/10 in severity, progressive in nature localized principally at the knee cap and deep within the joint.  Her large German Shepard ran into her  left knee 5 year earlier which resulted in onset of severe pain.  Treatment included physical therapy, E-stimulation, steroid injections and one surgery( lateral release).  Surgery unfortunately increased her pain and frustration.  Postoperative MRI of the left knee was normal .   NG was informed that no more therapy was indicated.     

Physical examination was significant for tenderness along the patellar tendon, slight limp, muscle tightness in her lumbar spine and tenderness and pain with palpation of her sacro-illace jont.  Most significant however was the instability of her knee which her husband noted from across the room. The anterior cruciate ligamant(ACL),was very loose suggestive of a tear.  Review of the MRI demonstrated a chronic tear in the ACL.     

The anterior cruciate ligament is one of four major ligaments in the knee.  It originates from the back portion of the thigh bone( femur) and attaches to the front portion of the shin bone ( tibia). It prevents forward movement of the tibia in relation to the femur.  It provides critical stability to the  knee.  Tears of injury to the ACL result in instability of the joint with resultant pain.     

   

 

  

ACL: Thick Black Band

           

 

There is no substitute for a complete physical examination.  MRI’s alone can not make a diagnosis.  Putting the physical findings together with MRI results is the standard of care at The Centeno-Schultz Clinic.       

Utilizing a patient’s own stem cells, repair of a partial tear of the ACL is possible.  The Regenexx procedure affords patients the opportunity to use their own mesenchymal stem cells to treat common orthopedic conditions.

February 1, 2010

Is there a Cancer Risk with Stem Cell Therapy?

Mesenchymal stem cells can differentiate into many types of tissue including muscle, bone, cartilage and tendon.

Because mesnechymal stem cells are multipotent, there has been concern that implanted stem cells could form cancer cells.

Studies have demonstrated chromosomal abnormalities in mesenchymal stem cells that have been cultured for extended periods of time.  Other studies have demonstrated that mesnenchymal stem cells expanded  for less than 60 days poses no detectable risk of cell changes or cancer formation.

The critical question is whether mesenchymal stem cells are safe ?

Centeno et. a.l. have shown that they are safe.

Centeno, in a prospective study examined 227 patients and found no evidence of cancer formation at re-implantation site.  This finding is consistent with others who failed to find any evidence of cancer formation in mesenchymal stem cells culture expanded for limited periods.

Landmark study.  Stem cell therapy has a green light!

SAFE TO PROCEED

 

The Regenexx procedure utilizes minimally expanded autologous meenschymal stem cells to treat common orthopedic conditions.  This affords patients a non-surgical option with no extensive rehabilitation or the risks associated with anesthesia and surgery.

January 28, 2010

Abnormal Head Position with Neck and Shoulder Pain

Dystonia:  Abnormal muscle tone characterized by prolonged muscle contractions.

RV is 53 y/o patient with a 1.5 year history of left neck and shoulder pain which is constant in duration, 5/10 in severity, nonprogressive in nature localized exclusively on the left. Pain is throbbing in character, aggravated by extension and rotation to the right.  Patient has no significant past medical or surgical history and denies any trauma.  Patient had involuntary muscle contractions which pulled her head to the left making walking straight, operating a car and sleeping difficult.

 Treatment to date included chiropractic care, neurologic, orthopedic and physical medicine consultations.  The orthopedic surgeon diagnosed a tear in shoulder and recommended surgery.  The neurologist injected Botox repeatedly on both sides of her neck which resulted in head and neck weakness precipitating nausea.   Facet injections provided no significant relief.  MRI of the brain, cervical and thoracic spine were all normal except  mild degenerative changes at C5/6.

Physical examination was significant:   left rotation of head, downward  gaze , left shoulder and neck was tender to the touch with multiple muscle nodules.  Most striking was her right sternocleidomastoid muscle (SCM) which was contracted, thick and very painful.

Cervical Dystonia is a movement disorder in which sustained muscle contractions cause abnormal postures.

Insertion of several small needles (IMS) into the right SCM provided the patient with complete resolution of her left sided neck and shoulder pain along with a significant reduction in her involuntary head rotation. 

  Understanding the complexity of the musculoskeltal system is essential.  It was contraction of her RIGHT SCM which led to the left head rotation and stretch of left shoulder and neck muscles.  Injection of the left side, the side where the pain was would only have increased her head rotation and pain. 

The Centeno-Schultz Clinic is committed to the highest level of  diagnostic and regenerative medicine.

January 27, 2010

Achilles Tendon Pain Unresponsive to Therapy

EC is a 80 y/o patient referred for platlelet rich plasma (PRP) injections of his inflamed left Achilles tendon.  Patient was active with no significant past medical history.  He denied any traumatic injury but had a 6 month history of severe left Achilles pain which was constant in duration, 6/10 in severity and progressive.  Treatment to date included physical therapy, trial of non-steroidal anti-inflammatory mediations and massage.   PRP therapy was considedered due to patient’s failure to improve.

PRP therapy is the injection of a patients own platelets into the damaged/irritated tissue.  RPR therapy is aimed at accelerating the healing process. 

Physical examination was significant for the following:  reduced  flexion/extension of lumbar spine secondary to pain,   decreased sensation along the left big toe and outside aspect of foot, decreased strength of left big toe and significant muscle banding in both the back and leg.

 After the initial evaluation, an x-ray of the lumbar spine was obtained which was significant for instability of the several vertebral bodies(anterolisthesis) along with marked reduction in the disc height at L5/S1.

EC’s Achilles tendon problem was not responding to conventional therapy since no have bothered to look beyond the tendon itself.  He had irritation of the left L5 and S1 nerve root which required treatment in addition addressing the Achilles tendon inflammation.

Looking at the bigger picture is essential for maximal clinical outcomes.  This is the essential paradigm required as we move from joint replacement to joint restoration. Ortho 2.0 presents  four principal elements previously discussed.

This is the standard at Regenerative Sciences and  The Centeno-Schultz Clinic.

Ed underwent PRP therapy in addition to injection of platelet derived growth factors at the L5/S1 and S1 levels.  He had  reduction of his debilitating Achilles pain  and headed off to florida for the back nine. I will report back upon his return.

January 26, 2010

New Perspective: Ortho 2.0

Everyone told Christopher Columbus that the world was flat.   

 Friends told the Wright brothers that birds were the only creatures capable of flight.  

    

A paradigm shift was required.  This also applies to medicine. The time has come to focus not on joint replacement but on joint restoration and repair.     Dr. Centeno has termed this Ortho 2.o.   Ortho 2.0 has a bigger focus beyond just fixing one part of the musculoskeletal system (bone, joints, muscles, tendon, and ligaments).   When the focus shifts to repair, the amount one needs to know about the joint increases exponentially.  There are four principal elements which are addressed when evaluating a gvien joint: (S.A.N.A.)   

ORTHO 2.0 : S.A.N.A.

  S: stabilization   

A: articulation   

 N: neurologic   

 A: alignment   

 Injection of magic stem cells alone is not sufficient for joint restoration.  Multiple studies have shown that just injecting stem cells into a joint blindly is not that effective.  For the best clinical outcomes, each of the factors listed above must be evaluated and treated. At Regenerative Sciences and The Centeno-Schultz Clinic this is the standard.  Case examples utilizing the S.A.N.A. paradigm will be in future blogs.   

It is truly a new day:)    

January 25, 2010

Resolution of Thumb Pain with Stem Cell Therapy

LK is 60 y/o patient who presented with a 1 year history of bilateral thumb pain, constant in duration, 4/1o in severity, progressive in nature localized at the base of the thumb.  Pain was sharp and stabbing in character and preventing him from buttoning his shirt.  Prior therapies had included a trial of NSAID and chiropractic care.  MRI of the thumbs was significant for moderate to advanced arthritic changes at the base on the thumb(CMC joint).  LK was told that surgery was his only option:  fusion of one joint and tendon wrap at the other.  Both surgeries are significant with extensive rehabilitation and poor outcomes.

Patient elected to proceed with the Regenexx procedure which allowed him to use his own mesenchymal stem cells.  At six months post injection of his own stem cells,  LK reports a 90% reduction in pain and  increase in range of motion.  Friends and work associates have stopped asking him about his swollen thumbs.  Buttoning a shirt is no longer an issue.

 Through the use of his own stem cells, LK has had significant reduction in his thumb pain, increase his range of motion and avoided a significant surgery. The time has come to embrace joint restoration instead of all therapies directed at joint replacement.

January 24, 2010

Non-Surgical Options to Shoulder Osteoarthritis

JM is 47 y/o athletic patient who had a 1.5 year history of severe shoulder pain and restriction in movement.  He was unable to shave or lift objects from the kitchen cabinet with the affected arm.  MRI was significant for advanced osteoarthritis, degeneration of the labrum and tears in the rotator cuff.  Total joint replacement was the only option presented.  This is a major surgery with extensive rehabilitation and relatively poor outcomes.

Patient elected to undergo a non- surgical stem cell therapy:  the Regenexx procedure. The patient’s own stem cells (autologous) were injected into joint, labrum and rotator cuff tears.  Mesenchymal stem cells have significant repair and regeneration properties. JS made significant improvement after multiple sessions.    13 months after starting the Regenexx procedure, an MRI was obtained for comparison. The most striking changes are below.  The top picture show multiple tears in the supraspinatus tendon identified by the red arrows. The extensive light-colored areas in the tendon represent swelling and tears.  The bottom picture is significant.  It shows significant reduction in rotator cuff tendon swelling  as evidenced by the much improved dark-colored signal in the tendon which is identified by the yellow arrows.  The corresponds with JS’s clinical improvement.  JS was able to avoid a major surgery through the use of his own stem cells.

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