Stemcelldoc's Weblog

February 21, 2014

Autologous, Allogenic and Artifical Stem Cells

Opening Flower Bud

At the Centeno Schultz Clinic we utilize a number of regenerative therapies which include bone marrow derived stem cells.

Regenexx utilizes a patient’s own bone marrow derived stem cells to treat common orthopedic conditions which include:

Knee osteoarthritis

Knee meniscus

Hip osteoarthritis

ACL injuries

Non-Union fractures of long bones.

Stem cells can be divided into two principal classes:  autologous vs allogenic.

Autologous cells are a patient’s own stem cells.  One individual is both  the donor and  the recipient

Allogenic cells are cells that are from someone else.

Artificial embryonic stem cells from natural cells are receiving increased attention.  There are two principal methods to create artificial stem cells:  IPSC(induced Pluripotent Stem Cells)  and STAP (Stimulus-Triggered Acquisition of Pluripotency) which are discussed in Dr. Cenento’s video.

October 16, 2013

Regenexx Patient Completes 2013 Kona Ironman

Image your day consisting of a 2.4-mile (3.86 km) swim, a 112-mile (180.25 km) bicycle ride and a marathon 26.2-mile (42.2 km) run.  This is without breaks and all events must be completed in 17 hours.

To participate you must have completed prior Ironman competitions under certain and strict guidelines.

kona ironman

Welcome to the Kona Ironman, which is the world championship of all Ironman.

TG is a patient who presented to Centeno-Schultz Clinic with the aim of successfully completing Kona despite ongoing knee pain.

TG is 54 y/o avid athlete and professional with a 15 month history of right knee pain localized on the medial aspect without radiations and  associated with  limp and intermittent swelling.  Treatment to date included unloader brace, steroid injection, PT, massage, trial of NSAID and two knee arthroscopies with partial resection of the medial meniscus.  MRI was significant for mild scarring of the ACL, tear of the medial meniscus, partially extruded medial meniscus , edema in bone on medial femoral condyle and thinning of cartilage in medial and patella femoral compartment and laxity of MCL.

Physical examination was significant for asymmetric calf girth, quadriceps weakness, decreased sensation in right big toes, laxity of the ACL and MCL( medial collateral ligament) and right knee swelling.

Lumbar spine x-ray demonstrated disc space narrowing and 3 mm anterolisthesis.(slippage)

What! Why the back? Refer to SANS in free Ortho 2.0 text

Treatment included:

x-ray guided prolotherapy of ACL and MCL.

Regenexx cSCP into the lumbar epidural space at L4/5 and L5/S1.  Regenexx PL-Disc

Prolotherapy of the supraspinous,  intraspinous, and iliolumbar ligaments.

Regenexx cSCP injected into ACL, MCL.

One of TG’s largest concerns prior to the competition was his knee and he reports that he ‘had no problems”.

We acknowledge all the time, hard work, commitment and dedication it took to qualify and complete in the Kona 2013 Ironman.  Thank you for allowing Regenexx to assist you in achieving your goal.

CONGRATULATIONS !!

April 15, 2013

Successful ACL Repair With Stem Cell Therapy

At the Centeno Schultz Clinic we have previously discussed treatment of anterior cruciate ligament (ACL) dysfunction.    Anterior cruciate tears have been successfully treated with stem cell therapy.

Below is another successful case of ACL repair utilizing stem cell therapy.  BT is an 18 y/o college football player who sustained an acute anterior ligament tear.  He declined surgical repair and underwent Regenexx SD with placement of his own stem cells into the ACL in November 2012.  Three months post injection a repeat MRI was performed at the same imaging center.  Below are the pre and post images of the ACL along with the MRI reports.

The ACL in the pre-procedure MRI is irregular and disorganized with a visible tear.  After Regenexx treatment the ACL fibers are uniform and well-organized.  The postprocedure MRI formal report notes “previously described anterior cruciate ligament tear appears to have resolved”.

This corresponds to BT’s clinical presentation who describes no pain or swelling.  Regenexx SD enabled BT to avoid a major surgery and extensive rehabilitation.  A new option is now available for ACL dysfunction.

ACL Stem Cell Regeneration pre

ACL Stem Cell Regeneration Pre 2

Slide1

November 25, 2012

Back and Leg Pain Regenerative Treatments: Platelets vs Steroids

At the Centeno-Schultz Clinic we acknowledge that lower back and leg pain can be debilitating.  Treatment options include epidural injections utilizing platelet growth factors (Regenexx PL-Disc) which are intended to increase blood blow and decrease inflammation.  Stem cell therapy is an alternative to low back surgery.

Our most recent data comparing the Regenexx PL-Disc procedure to traditional steroid epidural is shown below. The interesting points are that while 11 patients didn’t respond to steroid epidurals and switched over to the Regenexx-PL-Disc procedure, none switched the other way. In addition, note the dramatically higher increases in patient function with the Regenexx-PL-Disc.

Traditional steroid injections have signficant risks:

Increased risk of bone fracture

Changes in cortisol levels lasting weeks

Cause ligament breakdown and failure

Cartilage degeneration

Suppress stem cell function

Also alarming is the increase risk of osteonecrosis (bone death) associated with oral steroids.

September 9, 2012

Peroneus Tendon Tear Successfully Treated with Prolotherapy

At the Centeno-Schultz Clinic we acknowledge that ankle pain can be disabling.  Ankle pain can arise from multiple sources which include ankle osteoarthritis, ligament laxity, tendon tears and  degenerative lumbar disorders.   Stem cell therapy is an alternative to ankle surgerySurgery is associated with risks and can often times accelerate the degeneration. 

JW is an active nurse who sustained an ankle injury while participating in Cross-Fit. Her pain was constant with weight-bearing, non progressive in nature, localized on the lateral aspect of the ankle with radiations into the little toe.  Physical examination was signficant for tenderness in the lateral ankle, laxity and multiple trigger points in calf and lumbar spine.

MRI was signficant for a partial tear in the peroneus brevus tendon and injury to the anterior talo-fibular ligament.

She declined surgical recommendations and opted to prolotherapy which is the injection of an irritant intended to initiate an inflammatory response and strengthen ligaments.

At the Centeno=Schultz Clinic prolotherapy is performed utilizing MSK ultrasound guidance which ensures accurate needle placement.  Treatment was targeted at both the peroneus tendon but also the other critical ankle ligaments.  Stability is a central element as discussed in Ortho 2.o.

Adjunct therapies included IMS, flexion/extension examination of the lumbar spine, deep water immersion exercises and low carbohydrate diet. Carbohydrate restriction and proper nutrition has been linked with improved stem cell numbers and function. 

After three prolotherapies, IMS treatment and 15 lb loss JW reports a 90% improvement and has resumed her running and cycling.

Great job Jennifer.

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 !


May 5, 2012

Posterior Calf Pain: Medial Gastrocnemius Injury

At the Centeno-Schultz Clinic we acknowledge that there are many sources of posterior calf pain.  Meniscus injuries, osteochondral defects and ACL tears have been previously discussed as a cause of knee and posterior calf pain.  Stem cell therapy is an alternative to traditional knee surgery.

The gastrocnemius muscle is a large muscle in the posterior calf and is commonly injured in sport activities such as hill running, jumping and tennis.  The condition is sometimes referred to as tennis leg and is more common in men than woman.  Mechanism of injury is typically  an acute, forceful push-off with the foot.  An audible pop is often heard and is accompanied by pain in the calf with radiations into the ankle and restriction in range of motion.

The gastrocnemius muscle has two heads which originate respectively from the medial and lateral condyle.  The  two heads join and then merge with the soleus muscle-tendon complex to form the Achilles tendon.

The principle actions of the gastrocnemius muscle are ankle plantar flexion and knee flexion.

At the Centeno-Schultz Clinic MSK ultrasound is available within the office for evaluation of injuries.  Below is an ultrasound image of the posterior knee.

April 24, 2012

Deltoid Ligament: Medial Ankle Pain

At the Centeno-Schultz Clinic stability is a central theme as outlined in Ortho 2.0.

The lateral ankle ligaments have been discussed in prior blog. Treatment of ankle sprains at the Centeno-Schultz Clinic includes a diagnostic MSK ultrasound where the ligaments visualized and their integrity assessed.  Treatment options for loose, partially torn or degenerative ligaments include prolotherapy, PRP and autolgous bone marrow derived stem cells.

A video discusses the use of stem cells as an alternative to ankle surgery.

15-20 % of all athletic injuries involve the ankle.  20-40% of ankle injuries will lead to chronic instability.

The deltoid ligament supports the medial side of the ankle joint and is composed of 3 principle ligaments.  They all attach at the medial malleolus.

Tibionavicular Ligament is the most anterior and inserts upon the navicular bone.

Tibiocalcaneal ligament is the middle ligament and inserts upon the sustentaculum tali of the calcaneus.

Posterior Tibiotalus are posterior fibers that connect to the talus.

An eversion sprain is a tear in the deltoid ligaments.  It occurs with excessive inward rotation and is often accompanied by a fracture of the fibula.

An ultrasound image of the tibiotalar  ligament is displayed below.

December 10, 2011

Orthopedic Stem Cells Sources: Autologous vs Donor

At the Centeno-Schultz Clinic we acknowledge the regenerative potential of stem cell therapy for common orthopedic conditions.  Stem cell treatment utilizing Regenexx C and Regenexx SD has been used successfully as an alternative to

shoulder surgery

knee surgery and joint replacement

Peer reviewed studies have demonstrated its safety.

Regenexx utilizes a patient’s own stem cells which are referred to as autologous.

Stem cells can also come from donors and are referred to as allogeneic.

Is there a difference?

Yes as discussed in Dr. Centeno’s recent chapter on Stem Cell Therapy.

Autologous stem cell cells do not have the same communicable disease transmission risk as donor cells since they are the patient’s own cells.

Donor stem cells have the following concerns.

Gene transmission:  Stem cells transplanted from the bone marrow of mice bred to have osteoporosis were able to induce osteoporosis in healthy mice.

Immunosuppressive potential is reduced in mismatched settings.

December 3, 2011

Orthopedic Stem Cells: How they work

At Centeno-Schultz Clinic we acknowledge the regenerative potential of stems cells in treating common orthopedic injuries.   Dr. Centeno authored a chapter on stem cell use in orthopedic injury.
Regenexx C & Regenexx SD are alternatives to knee surgeries.

How do stem cells work?

Three principal ways:  differentiation, paracrine affect and regulation of inflammation.

Mesenchymal stem cells are multipotent and can differentiate into cartilage, tendon, bone and ligament.

Paracrine means that mesenchymal stem cells release certain growth factors to assist in tissue repair.  Mesenchymal stem cells  can be viewed as construction managers as they recruit other cells to the local area and coordinate the repair of damaged tissue.  The growth factors include TGF-beta, VEGF and FGF.

Finally MSC’s have been demonstrated to regulate inflammation.  Inflammation is not all bad and is the first step in healing.

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