Stemcelldoc's Weblog

March 9, 2014

Another Reason to Avoid NSAID: Delayed healing in rotator cuff after surgical repair


At the Centeno-Schultz Clinic we acknowledge the negative impact of NSAID on repair.

NSAID have been reported to affect bone metabolism,  fracture healing and increase the risk of sudden death heart attack.

Unfortunately NSAID medications continue to be prescribed for musculoskeletal pain including pain subsequent to surgical rotator cuff repair.

Does this medication make a difference in healing?

Checkik in a recent article examined the impact of NSAID on rotator cuff healing after surgical repair.  39 rates underwent rotator cuff injury and surgical repair.  Group A received meloxicam for the first 10 days whereas Group B recived meloxicam from postoperative day eleven.  Group C received saline injections.

Results:  Group B displayed lower maximal load which is consistent with delayed healing.

Bottom Line:  Avoid NSAID as they delay healing.

January 26, 2014

Effect of Amide Local Anesthetics on Stem Cell Viability: Patient BEWARE !

At the Centeno-Schultz Clinic ongoing research and publication is a cornerstone of the practice.

Multiple articles have been published in peer-reviewed journals.

A new article just published examined the effect of amide type local anesthetics on human mesenchymal stem cell viability and adhesion.


cell death

Local anesthetic are commonly utilized in joint and injections.  Local anesthetics combined with high dose steroids are commonly injected into the joint.  The local anesthetic provides numbing which gives the patient several hours of pain relief.

Do the injected local anesthetics affect stem cells?

Four amide local anesthetics were examined in varying concentrations:  ropivacaine, lidocaine, bupivacaine and mepivacine.

Each anesthetic in different concentrations was incubated with human mesenchymal stem cells for 40 minutes, 120 minutes and 360 minutes and 24 hours.  Cell viability was assessed at each time point.


Extended treatment with local anesthetics for 24 hours or more had signficant impact on both stem cell viability and adhesion.

Stem cells treated with lidocaine, bupivacaine and mepivacine resulted in cell death via apopotosis after brief exposures.

Amide local anesthetics induce stem cells apoptosis(cell death) in a time and dose dependent manner.

Bottom Line

Patient beware!  Know that injected local anesthetics can negatively impact your repair cells.  If you medical provider wants to inject your joint ask why and with what acknowledging that your repair cells and cartilage are at risk of damage.

August 22, 2013

Common antibiotic associated with possible permanent nerve damage: Beware

Antibiotics are used frequently for a wide variety of medical conditions.

Ciproflaxin is a common antibiotic that has been associated with signficant complications: tendon rupture.

Salt has recently been added to this wound.


The FDA has recently added an additional warning to this class of antibiotics referred to as fluoroquinolones.

They are associated potentially permanent nerve damage.

Statin medications are another example of a commonly used medications that has signficant complications and also negatively impacts your stem cells. This has been previously discussed.

Here are 10 things to do to improve stem cell function.

September 13, 2012

Narcotics, Addiction and An Alternative in the Treatment of Pain

At the Centeno-Schultz Clinic we acknowledge that chronic pain can be devastating.  It impacts all facets of life and can lead to depression, inactivity and loss of connection.

Treatment options for chronic pain are extensive.

At the Centeno-Schultz Clinic we believe that identification of the pain generator is critical in the successful treatment of pain.   The pain generator is that tissue or structure that is responsible for the patient’s pain.  A thorough history and physical examination is starting point. Diagnostic tests may include  x-rays, MRI, MSK ultrasound, facet injections or selective nerve root blocks.  Once the source of the pain is identified a treatment plan can be established.  As discussed in Ortho 2.0 there are four critical elements : stability, articulation, neurologic and alignment.

Treatment options at the Centeno-Schultz Clinic include IMS,  prolotherapy, PRP and autologous stem cell therapy

Unfortunately narcotics have been used extensively in the treatment of chronic pain.  Narcotics do not identify the source of the pain but rather mask it.  Complications include addiction and death as discussed in medpage Today.

 Highlights of the article:

“The first decade of the 21st century has been a good one for makers of prescription painkillers as sales quadrupled from 1999 through 2010, but even in a growth industry OxyContin stands out — ringing up sales of nearly $3 billion a year.”

In 1998 Purdue Pharma’s marketing of OxyContin included a video in which 7 patients provided their glowing testimony on the benefits of oxycontin. 

10 years later two of the seven patients died as active opioid abusers.

A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose.

Bottom Line:  Narcotics are not the answer.  Identify the pain generator.

June 2, 2012

Chocolate: The Sweet Medicine for Cardiovascular and Stem Cell Health

A recent blog discussed 10 ways to improve your stem cells.

#1 was to reduce sugar intake and adopt a low glycemic diet.

The glycemic index is used to categorize carbohdydrates according to how they influence your blood sugars.  Low gylcemic foods results in a small and steady rise in your blood sugar levels.  This in turn is associated with a healthier body weight, higher energy levels and better performance.

Dark chocolate has a low glycemic index  dark chocolate so it won’t make your blood sugar levels peak and then crash a few hours later.  Dark chocolate is  chocolate with a cocoa content of 70 percent or higher.

In addition a recent study demonstrated that daily consumption of dark chocolate  help prevent cardiovascular events in patients at risk for heart disease.  With 100% compliance, treatment would prevent 70 non-fatal and 15 fatal cardiovascular events per 10,000 population.

Bon appetit !

January 9, 2012

Narcotic Risk: FDA issues public health advisory

The Centeno-Schultz Clinic acknowledges the dangers of utilizing narcotics in managing chronic spine pain.  These include addiction, tolerance requiring escalating doses. cognitive and behaviour changes and death.  The Centeno-Schultz Clinic offers comprehensive spine care including facet and epidural injectionsunder x-raySI joint injections, prolotherapy and radiofrequencyStem cell therapy is an alternative to traditional spinal surgeryRegenexx PL utilities platelet derived growth factors to enhance blood flow and reduce inflammation. Previous blogs have discussed the successful use of stem cells for spine pain.

Medication mix ups or mislabeled has potentially serious consequences.

Today the FDA has issued a warning that pills, tablets, or caplets of Percocet and eight other opioid products packaged by Novartis for Endo Pharmaceuticals may have been mixed up, with one drug being packaged as another.

Patients beware!

August 1, 2011

Is Local Anesthetic Toxic to Cartilage Cells?

Our tap water is filtered for toxic elements such as lead and mercury.

Our food is inspected and is free of toxic bacteria and harmful micro organisms.

Is the same true about common orthopedic injections?

Local anesthetics (numbing medications) are commonly used in knee and other joint injections. Typically they are used in conjunction with steroids. The two most common local anesthetics are Marcaine (Bupivacaine) and Lidocaine.

Are they toxic?

A recent study has demonstrated the Marcaine is toxic to cartilage cells.   Chu demonstrated that 6 months after a single intra-articular injection of Marcaine there was a 50% lower density of chondrocytes (cartilage cells) compared with cartilage in control joints.

What about Lidocaine?

Jacobs demonstrated that  Lidocaine was significantly more toxic to mature human articular cartilage cells than a saline 0.9% control group.

What about local anesthetics when mixed with steroids?

Farkas demonstrated the combination of glucocorticoids(steroids) and local anesthetics have an adverse effect on articular cartilage.

At the Centeno-Schultz Clinic we acknowledge the toxicity of local anesthetics and steroids.  We abandoned the use of Marcaine in our clinic three years ago.  The association of apoptosis and steroids led to our discontinuation of  high does steroids.


Please be responsible.  Don’t let friends or family members get steroid and local anesthetic injections.  There are other options available at the Centeno-Schultz Clinic.

March 13, 2011

Nutrition and Stem Cell Therapy

Is there a correlation between nutrition and osteoarthritis?


At the Centeno-Schultz Clinic and Regenexx we acknowledge the critical role between the two.

1 in 5 patients have metabolic syndrome characterized by central obesity, hypertension and elevated lipids and serum glucose. This syndrome results in the release of detrimental chemicals into the joints which can lead to the breakdown of cartilage matrix.

These same patients do poorly with knee and hip replacements due principally to the systemic proinflammatory state.

Obesity and hyperglycemia are associated with increased infection rates after knee replacements.

Diets rich in carbohydrates, refined sugar and processed food can promote a pre-diabetic state.   SIRT-1 gene expression plays an important role in circulating blood sugars levels and joint health.   Activation of SIRT-1 gene by dietary restriction and Resveratrol is associated with healthy cartilage.  Inactivation of SIRT-1 gene, commonly seen with aging and diets high in refined sugar and carbohydrates results in increased body fat, decreased energy and cartilage cells becoming less stable.  This can become the perfect storm for the onset of osteoarthritis.

In counseling deconditioned and overweight patients with osteoarthritic and musculoskeletal injuries, the Centeno-Schultz Clinic recommends at a minimum diet modification and increased activity levels.  These efforts are taken in an effort to optimize clinical outcomes from Regenexx SD, Regenexx AD and Regenexx SCP therapies.

September 14, 2010

An NSAID a Day May Accelerate Knee Cartilage Degeneration

Non steroidal anti-inflammatory drugs (NSAID) are widely prescribed for joint pain.  What is the long-term effect of these common medications on knee cartilage?

Ding et al examined 395 patients with a mean age of 62 over 2.9 years in an effort to answer the question.  MRI’s were performed which evaluated both knee cartilage volume and cartilage defects.   Patients taking NSAID’s had increased knee cartilage defects and more loss in cartilage volume than patients who did not take NSAID.  Bottom line is that NSAID’s have a detrimental  affect on knee cartilage.

The Centeno-Schultz Clinic recognized this several years ago when mesenchymal stem cells in patients on NSAID’s failed to grow in a similar fashion as those who were not on these types of medication.  Mesenchymal stem cells, plasma rich platelets (PRP), prolotherapy and APC are several of the treatment options at the Centeno-Schultz Clinic.

October 28, 2009

Diet: Its Impact on Stem Cell Growth

Despite their terrible taste, disgusting odor and foul texture I followed by mother’s instructions: EAT your brussel sprouts.

Brussel sprouts

Mom insisted that diet was essential for our growth.

Does diet have an impact on stem cell growth and differentiation? (what type of cells they will become when they grow up)

Vanella demonstrated that high blood sugar levels, those commonly seen in patients who eat sugar based diets, lead mesenchymal stem cells to turn into fat instead of bone.

There are many factors that can affect stem cell growth and differentiation.  Regenerative Sciences understands the importance of these variables in their evaluation and treatment of orthopedic disorders with stem cell therapy. The Regenexx procedure provides patients a non-surgical option of the treatment of non-healing fractures, lumbar disc protrusions and degenerative conditions in knee and hips.

Bye, bye sugar and hello greens…..


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