Stemcelldoc's Weblog

July 20, 2009

BMI and Road Wear

BMI not BMW.BMW

BMI is statistical measurement which compares a person’s weight and height.  It can be a useful tool to estimate a healthy body weight.

A recent study examined the knees of 336 overweight patients over 30 months.  20.2 % of the patients showed a slow loss of knee cartilage and 5.8% had rapid cartilage loss.  The Boston University researchers concluded that for every one-unit increase in body mass index, the chances of rapid knee cartilage loss increased 11%. Bottom line: stay lean.

If you have knee pain knee as a result of cartilage loss, there are non-surgical options.  Mesenchymal stem cell therapy involves the use of a patients own stem cells, avoids all of the risks associated with srugery and anesthesia and does not require extensive rehabilitation commonly associated with surgical procedures.

July 15, 2009

Colorado Stem Cell Therapy Makes News

Colorado based Regenerative Sciences was the focus of a recent New York City news segment.  Dr. Max Gomex discussed the Regenexx procedure where a patient uses their own stem cells to heal a variety of orthopedic conditions.  Examples outlined included non-surgical therapies for rotator cuffs tears, mensical tear, loss of cartilage in the knee and hip as well as degenerative lumbar discs.  Dr. Gomex also discussed the opportunity to bank stem cells for future use.

New treatment opportunites now exist in the Rocky Mountains…..lostlake colorado

July 13, 2009

Stem Cells Can Stop the Progression of Lumbar Degenerative Disc Disease

Degenerative disc disease is a common disease which affects millions of people.  Fan et. al. recently demonstrated that mesenchymal stem cells can stop the progression of lumbar disc degeneration.  Furthermore, the authors demonstrated that injected mesenchymal stem cells led to significant regeneration of the central portion of the disc.  Regenerative Sciences has been utilizing this same cell line in their lumbar disc procedures. Please see MRI of a patient who underwent Regenexx therapy.

March 24, 2009

Vulcan Shoulder Support

vulkan-half-shoulder-supportVulcan Shoulder supports are commonly used for dislocated shoulder, frozen shoulder, broken collar bone, and  rotator cuff injuries.  In concept the neoprene support provides therapeutic heat, support and shoulder pain relief. The compression and warmth can also provide pain relief following shoulder surgery.

How does it work?

The support fastens securely around the shoulder with the Velcro straps to provide support and re-assurance following injury.  If the injury is mild and you are of good health and not taking any know toxins to your own stem cells, it is possible for some of these injuries to improve.  Unfortunately as we age, the vitality of our stem cells and their ability to mount a successful response to injury declines.  The result is continued pain due to incomplete healing.  Immobilizing the joint also goes against the finding supported by Sen who demonstrated mechanical stress led mesenchynmal stem cells to change into cartilage and bone as opposed to fat.

 

At the Centeno-Schultz Clinic we are committed to identifying and correcting the underlying program.  Prolotherapy often used  successfully to treat rotator cuff injuries, AC joint and shoulder dislocations if damaged has occurred to the supporting ligaments.

A non-surgical alternative for  partially torn rotator cuff tendons, dislocation of shoulders and acromio-clavicular injuries is the use of your own stem cells. At Regenexx a patient’s own bone-marrow-derived stem cells are isolated, expanded and then injected exactly into the area of damage under intermittent x-ray guidance. 

Intermittent X-ray to ensure accurate placement of MSC

Intermittent X-ray to ensure accurate placement of MSC

 Utilizing your own stem cells (autologous) prevents the transmission of disease.

Please review testimonial of a patient who had bilateral rotator cuff tears who previously underwent surgery on one side and elected stem cell therapy for the other side.

shoulderholsters.vulcanshouldersupport.omotrainshoulder support.mcdavidshouldersupport.campshouldersupport

March 20, 2009

Exercise Directs Path of Mesenchymal Stem Cells

Mesenchymal stem cells(MSC) can morph into ligament, cartilage, bone or fat.   How and why they differentiate is critical.    Sen et. al., recently demonstrated that mechanical stress (the laboratory equivalent of exercise) lead mesenchymal stem cells to differentiate into bone instead of fat, even if they are given chemical signals to become fat.  What does this mean?  MSC can become fat cells simply by lack of exercise.  There are other factors which give MSC’s clues to turn into fat vs cartilage, bone or ligament.

If you are a patient with worn knee cartilage and are restricted as a result of pain, one surgical option would be micro-fracture. knee-cartilage-23

This is a surgical procedure where multiple small punctures are made into the femur(thigh) bone in an effort to stimulate cartilage regeneration.  A fragile thin clot is formed at the site which mandates a period on 6-8 weeks of non-weight bearing.  No running, golfing, cycling.  No fun! 

Multiple Puncture Sites From Micro-Fracture

Multiple Puncture Sites From Micro-Fracture

Regenexx offers patients the opportunity to use their own MSC’s to generate cartilage via a needle-in, needle-out procedure.  No surgery is required.  Most importantly, the physical restriction are minimal.  In contrast to micro-fracture technique, the Regenexx patient is encouraged to exercise.  The mechanical loading associated with exercise gives the stem cells signals to change into cartilage.

Please review knee MRI of a patient who underwent stem cell therapy at Regenexx with radiographic evidence of increased cartilage as well as complete resolution of her severe  knee pain.

pix-knee1-1024x777

March 18, 2009

Thumb Joint Pain and Diagnosis

The joint at the base of the thumb allows for the swivel and pivoting motions of our thumb which we take for granted.  The joint is referred to as the carpometacarpal joint (CMC) and is prone to arthritis and degneration of the cartilage. 

Arthritis of the Base of Thumb

Arthritis of the Base of Thumb

It is subjected to a large amount of stress as the thumb must be strong enough to conteract the force of four fingers put together.  Excessive wear on the joint can lead to disruption of the supporting ligaments with displacement of the joint(subluxation).

Displacement of Thumb Joint

Displacement of Thumb Joint

Commom symptoms of CMC arthritis include pain and swelling at the base of the thumb which are typically worse in the morning.

Diagnosis is made by physical examination and confirmed with plain x-rays.

Conservative Treatment options include anti-inflammatory medications, rest and splinting.  Surgical options include fusion of the joint or removal of the joint and insertion of a tendon or plastic spacer.  The disadvantage of surgery is loss of motion of the joint, extensive physical therapy, failure and the inherent risks associated with surgery and anesthesia.

Rather than cut the damaged joint out, patients now have the option of repairing the cartilage utlizing their own stem cells.  Regenexx is a simple needle-in, needle-out procedure which allows patients to use their own mesenchymal stem cells to repair damaged cartilage without the risk of disease transmission or rejection.

Please review testimonal of a patient who underwent Regenexx stem cell therapy for her thumb pain:

cmcarthritis.basalthumbpain.stemcelltherapyforthumbarthritis.

March 16, 2009

Lumbar Discography

Lumbar Discography is a pre-surgical procedure to identify whether one of more of the lumbar discs is a “pain generator’.  It is a procedure that should only be undertaken if all other possible sources of pain have been excluded and the patient is prepared to undergone surgery.  Other sources of lower back pain include lumbar facets, sacroiliac joint dysfunction, ligamental instability and trunal dystonia.  At the Centeno-Schultz Clinic we are committed to evaluating all possible sources of pain prior to proceeding with discography.

Lumbar discography involves placing a needle under sterile conditions into the center of the disc at two or more levels.  For example, one would place one needle at the L5/S1 level and another at the L4/5 level.  Once the needles have been successfully placed, a small but increasing amount of pressure is applied to a single disc by injecting contrast through a hand held manometer.  The patient is awake and asked a series of questions which include whether or not the increasing pressure recreates his or her daily pain.lumbar-disco

A surgeon will use this information to plan the appropriate surgery.   A lumbar fusion is most common, involving one or more levels where the supporting muscles are resected from the bone and the lumbar disc is removed and replaced with bone.  Screws and rods are often utilized to stabilize the fusion.

Lumbar Fusion with Hardware

Lumbar Fusion with Hardware

An alternative is to use bone marrow-dervied stem cells to regenerata the disc.  Regenexx is a simple needle-in, needle-out procedure which allows the patient to forgo the risks of surgery, anesthesia and the extensive and painful rehabilitative period. Regnexx enables a patient to use their own stem cells thereby eliminating the risk of disease transmission and rejection.

Please review the MRI below of a patient who had undergone lumbar surgery without reduction in their pain. The L5/S1 disc is outlined by the dashed circle.  The picture on the left is pre-procedure whereas the image on the right is 13 months after injection of patient’s own stem cells.  Note that the disc has gone from dark (dehydrated) to bright(holding onto the fluid).  The more the disc is able to hold onto water, the better the disc is able to absorb the forces of daily activity. Finally the red arrow on the left,  points to a disc bulge which contacted the traversing nerve root.  13 months after therapy, as seen on the image on the right, the bulge and nerve root irritation is gone.

Axial Images Pre and Post Stem Cell Therapy

Axial Images Pre and Post Stem Cell Therapy

March 4, 2009

Another Strike Against Big Pharma

Zonegran, a commonly used medication for arm and leg pain secondary to nerve root irration was placed on the FDA medication watch list due to its significant life threatening side effects.  Updated clinical data has demonstrated that Zonegran can cause significant changes in acid-base balance (metabolic acidosis).  The list of medications with significant side effects continues to get longer.  In an earlier blog, I referenced the flouroquinolones, a class of antibiotics, which demonstrated the increase the risk of tendon rupture.  Sode et. al.,  demonstrated that the antibiotic tripled the risk of Achilles rupture.

sciatic-nerve-illustration2

Illustration of Nerve Root Irritation

Rather than masking the arm and leg pain associated with nerve irritation, at the Centeno-Schultz Clinic we are committed to identifying the cause of the pain and correcting it.  When a lumbar disc protrudes or herniates, often times there is compression of the nerve root with resultant lancinating electrical pain down the extremity. 

Nerve Root Irritation Due to Disc Herniation

Nerve Root Irritation Due to Disc Herniation

 Treatment options include x-ray guided injections of local anesthetic and steroid in an attempt to decrease the pain and inflammation along the disc and nerve root. 

Epidural Injection Under X-Ray

Epidural Injection Under X-Ray

 Another option is the injection of concentrated growth factors derived from a patient’s own platelets in an attempt to increase the blood supply to the damaged disc.  This therapy would aid in repairing the disc as opposed to simply decreasing the inflammation.

lumbar-disc8-regenexx1

Before and 3 Months After Stem Cell Therapy

A novel new technique allows injection of expanded bone-marrow-derived mesenchymal stem cellsinto the disc to repair the damaged lumbar disc.  Please review MRI below of a patient who underwent injection of stem cells into his L5/S1 disc.   On the left, the arrow points the disc protrusion before treatment.  Three months after the Regenexx therapy there was a  reduction of his disc bulge as seen on image on the right, along with complete elimination of his leg pain.

March 3, 2009

Are All Mesenchymal Stem Cells The Same?

Filed under: Stem Cell Basics — Tags: , — stemcelldoc @ 10:34 am

Stem cell therapy continues to expand and gain the attention of patients and politicians.  For many patients, the complexity of the science makes simple decision making difficult.  There are many different types of stem cells.  Mesenchymal stem cells differentiate into cartilage, ligament and bone.  So if you have any orthopedic problem, the stem cell of choice is mesenchymal.

Mesenchymal Stem Cell

Mesenchymal Stem Cell

But are all mesenchymal stem cells of equal potency?  Koga et. al., recently answered this question.   Mesenchymal stem cells from muscle, synovial fluid, bone marrow, and adipose (fat) tissue were examined for the potential to differentiate into cartilage.  The mesenchymal stem cells obtained from bone marrow and synovium had far greater potential to differentiate into cartilage than did the cells obtained from fat and muscles.  What does this mean to you?  If you have an orthopedic problem, your best bet is to utilize bone-marrow-derived mesenchymal stem cells.

Regenexx exclusively utilizes bone-marrow-derived mesenchymal stem cells.  The stem cells come from the patient, and therefore there is no risk of disease transmission or rejection.  Regenexx is a novel needle-in, needle out technique which allows patients to use their own stem cells to repair damaged ligaments, cartilage and bone.

February 19, 2009

Mesenchymal Stem Cells

There are various types of adult stem cells. The type of adult stem cells which are associated with tissue repair are called mesenchymal stem cell (MSC). These specific stem cells are capable of repairing damaged tendons, ligaments, intervertebral disc and fractured bones. There are two major sources of mesenchymal stem cells:  bone marrow derived and adipose (fat) derived.  Bone marrow stem cells are obtained via a needle which is inserted into iliac crest.  Adipose stem cells are typically collected during a liposuction.

Why is this important?  Bone marrow derived mesnechymal stem cells has been demonstrated to be superior in their ability to repair cartilage, tendon and ligament when compared to adipose derived cells.  Bunnell demonstrated  that  adipose stem cells are biologically similar, although not identical, to mesenchymal stem cells derived from the bone marrow. Vidal demonstrated that equine bone marrow derived mesenchymal stem cells have far greater regenerative properties for damaged cartilage than adipose derived cells.  Kisiday also demonstrated  that bone marrow derived mesenchymal stem cells have superior ability to repair and change into cartilage.

If you have an orthopedic condition and elect to use stem cell therapy, bone marrow derived stem cells offer the best success.  Regenexx exclusively utilizes autologous bone marrow derived mesenchymal stem cells  for damaged  ligaments, tendon, and cartilage.

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