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How Not to Draw Stem Cells

POSTED ON IN Latest News stem cell therapy BY Chris Centeno

Over the last few years, we’ve seen an explosion in the number of clinics offering stem cells to treat orthopedic and spine issues. Being the first in the U.S. in this space, it’s often a bit painful to watch. However, it’s often difficult to help patients and doctors understand that this isn’t as easy as it looks, so any idea I get that can quickly get the point across is important. Last week, I saw a YouTube video “course” on how to perform a bone marrow aspiration. When I watched it, I knew that this was a great education tool in what not to do.

What Is a Bone Marrow Aspiration?

A bone marrow aspiration, or BMA, is a procedure where a physician harvests the liquid portion of the bone marrow. A specialized needle is used, and the procedure, if done correctly, is generally pretty comfortable. The doctor obtains what looks like thick blood, but it is actually a mix that contains many different stem cell types and other cells. This aspirate is then processed to concentrate the stem cells before reinjection into the problem area.

Given that the success of a stem cell procedure likely depends on the number of stem cells the doctor can harvest, the techniques used must maximize that number. Regrettably, it’s very easy for the doctor to cut corners and consequently reduce the number of stem cells obtained. If that happens, it doesn’t really matter how good the processing is since the procedure and patient are hamstrung from the outset.

What’s Wrong with the Bone Marrow Aspiration Video “Course”?

First, the video I critiqued was found on a website for a distributor of kits and amniotic fluid. The video was listed as a way to improve your practice’s income by adding stem cells! So right off the bat, you have to wonder what’s going on. The verbiage supporting the video seems to make the point that doctors should use this as a course to perform the procedure. I know how disconcerting this is to a physician, so I can’t imagine how this sounds to a patient. Just so we’re clear, doctors don’t usually learn new procedures like a bone marrow aspiration on YouTube.

As I watched the video, it was clear that many of the things the doctor was doing were clearly wrong, based on what’s been published in the peer-reviewed medical literature. In addition, given that my partners and I have spent 11 years mastering and studying this technique, most of it was also wrong based on the data we’ve collected.

So How Hard Can a BMA Be? Is It Difficult to Take Stem Cells from the Iliac Crest?

If you’re a doctor or a patient, the answers to those questions can be found by watching the two-and-a-half-minute video critique above.

The upshot? One of the things that really upsets me is seeing how the knowledge that we’ve put together over the last 11 years has been lost in a game of telephone. Just like the early Xerox machines where a copy of a copy of a copy no longer bears much resemblance to the original, the same has happened in stem cells. It’s scary to me that physicians aren’t learning how to draw stem cells correctly, so my partners and I are putting on a nonprofit course through the 501(c)(3) organization the Interventional Orthopedics Foundation. The goal is to teach physicians the right way to do these procedures so they can avoid learning everything they think they need know from a YouTube video!

 

To find out if you might be a candidate for a Regenexx stem cell procedure, complete our Regenexx Procedure Candidate Form online.

    comments

    Dick brenner says

    My only comment is what is keeping the Insurance people from excepting these procedures?

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    Chris Centeno says

    Dick,
    The Insurance Industry still considers stem cell treatment experimental despite the fact that there is more peer reviewed published evidence that these procedures work than the surgeries that they replace. Complicating the issue is that recent changes to the Healthcare system have left doctors less able to make decisions based on what they know is best for a particular patient when working with insurance, and towards formulaic decisions based on what is good for most. The hope is that eventually they'll figure out that a stem cell procedure costs an average of one tenth the cost of a joint replacement and is safer for the patient. http://www.regenexx.com/knee-meniscus-surgery-outcome/

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    Theresa Hartmann says

    That's what I would like to know especially since you've stated that surgical procedures do not have premier research evidence that supports them as properly treating the injury while your research does a better job.

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    Chris Centeno says

    Theresa,
    Insurance being a risk adverse industry takes a very long time to respond to changes. Add to that the fact that government has become increasingly involved in Healthcare. When working with insurance, doctors are told how much time they can spend with a patient and what they can and can't prescribe, and what procedures they can perform based on formulas and guidelines developed by people who have never met the patient. So a Regenexx Orthopedics 2.0 exam in which we actually work to not only figure out what the problem is, but what caused it, and then customize treatment for that individual's problem, definitely does not fit into the check box medicine being forced on doctors today. http://www.regenexx.com/the-least-common-denominator-paradox/ The hope is that eventually the insurance industry will figure out that stem cell procedures cost about one tenth the cost of joint replacements and are safer for the patient - and that might be enough to change the course.

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    Dee Higgins Mueller says

    Ditto the same question. How close is the Regenexx procedure to being covered by insurance and for those 65 and older, Medicare and supplemental? We await you reply. Thank you!

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    Chris Centeno says

    Dee,
    Unfortunately, it doesn't look like this will happen soon. Medicare and Supplemental Insurance tends to follow the The Insurance Industry and they still consider stem cell treatment experimental despite the fact that there is more peer reviewed published evidence that these procedures work than the surgeries that they replace. Complicating the issue is that recent changes to the Healthcare system have left doctors less able to make decisions based on what they know is best for a particular patient when working with insurance, and towards formulaic decisions based on what is good for most. The hope is that eventually they’ll figure out that a stem cell procedure costs an average of one tenth the cost of a joint replacement and is safer for the patient.

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    chris says

    If a patient starts regenerative therapies young, is there an upper limit to how many times they can get a bone marrow aspirate? How quickly does the liquid portion of the bone marrow replenish if someone needs multiple injections? Do the sites replenish with the same type/concetration of cells as before the original BMA?

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    Chris Centeno says

    Chris,
    Not a problem as the body replaces the bone marrow quickly and at the same concentration. When two treatments are being done, like for instance two knees and not enough stem cells can be harvested for both, we wait 6 to 8 weeks between treatments. Patients generally require only one treatment to a given joint. When they do require more than one treatment that is generally several years later. Many regenerative therapies don't use stem cells at all and use blood products like platelets. So handling problems when they come up from a younger age is a net positive, rather than a net negative! See our Proactive book: http://www.regenexx.com/library-complimentary-regenexx-resources/

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    Dennis says

    Another eye-opening post! Thanks again Dr. Centeno (and team) for your commentary on the way our health care system works (or doesn't). This helps to explain the brief interactions I've had with my doctors/surgeons. It does seem they work from a formulaic template. They would never want to take even 5 minutes to discuss the research I've found in PubMed. Not that they are bad people, or even bad doctors, but likely because they are pressed for time and know my HMO wouldn't cover more cutting edge procedures.

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    Chris Centeno says

    Dennis,
    Correct!

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    Beth says

    Why don't you use adipose tissue to retrieve your cells, from what I read you get many more cells from a draw from belly fat as opposed to bone marrow?

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    Chris Centeno says

    Beth,
    I understand that's presented as fact, the only problem is it's not true at least for stem cells that can treat orthopedic conditions: http://www.regenexx.com/fat-chance-top-3-stem-cell-controversies/

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    Michael More says

    Hello Dr. Centeno. I'm a 74 patient of Dr. Tambar in Chicago. I just received the 3 step PRP & Stem Cell treatment for my right knee and lower back. That was four weeks ago. I just finished my 30 day follow up yesterday. I can sum up my experience in one word "MIRACLE!" I couldn't walk for more than a block or so without my knee giving me trouble. I also couldn't go up, or down, four steps without having knee pain. In the four weeks since the procedure, I am now walking over three miles, and climbing over thirty steps, literally pain free! Only four weeks!!
    Dr. Tambar is one of the most professional, and caring, doctors I've ever experienced. So is his staff.
    Seeing what is in this video you posted makes me sad. The "short-cuts" some of these doctors are using need to be stopped. Also the harvesting of stem cells from fat.
    Keep up the great work. I'm so happy I turned to the Internet after two doctors told me to get the knee replacement quickly.

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    Chris Centeno says

    Michael,
    Wonderful news! Thank you for sharing it! We agree about Dr. Tambar and his team! If only we had the chance to intervene every time someone was told they need a knee replacement....

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    Gustavo says

    How effective is the ultrasound guided injection on the knee?
    As a liquid, the stem cells will spread inside the joint, am I correct?
    So, wich is the purpose of ultrasound guided injections?
    Thank you,
    Gustavo

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    Chris Centeno says

    Gustavo,
    High level imaging guidance, extensive training in using it, and extensive training in injection technique is an important part of the very intensive training Regenexx Physicians go through. We're never just injecting "into the joint" but rather injecting into specific structures and target areas of the joint. So think of the knee as a shoebox with an orange an apple and a banana in it. Injecting "into the joint" would using a syringe to squirt the stem cells over the fruit in the shoebox. What we do is inject the stem cells into the orange, the apple and the banana. Some examples: http://www.regenexx.com/knee-acl-stem-cell/ http://www.regenexx.com/can-a-precise-stem-cell-injection-work-where-surgery-fears-to-tread/ http://www.regenexx.com/knee-osteonecrosis-alternatives/ http://www.regenexx.com/bone-healing-help/

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    Marcia O'Callaghan says

    Thank you so much for your informative website and all the comments from patients.

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    Chris Centeno says

    Marcia
    Thanks...we appreciate that!

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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