One Patient's Story: Why Stem Cell Treatment Details Matter
POSTED ON 9/27/2016 IN Regenerative Medicine Education BY Christopher Centeno
It's often difficult for patients to understand why the details of stem cell therapy matter. As usual, I often enjoy trying to break down the complex and make it simple, so I'd like to help you learn about stem cell clinic quality through a patient who I evaluated yesterday.
My Patient's Stem Cell Journey
My patient is in his early 60s and a big advocate for stem cell use. He's been following Regenexx for years, but ultimately decided to get stem cell treatment through another company since we didn't yet have a site in his hometown. The outfit he decided on cost him about $30,000 to collect fat and culture it to bigger numbers. After they'd cultured those cells for six weeks, he was then required to go down to Mexico to get the cells injected. The physician down there injected those cells blind, without guidance, into his knee. The procedure failed, so now he's decided to travel from Texas to Colorado to get a Regenexx procedure.
What 3 Things Were Less Than Optimal About His Stem Cell Treatment?
The purpose of growing cells in culture is to end up with many more cells than you had at the harvest. However, growing cells to bigger numbers is a two-edged sword. On the one hand, you can end up with many more cells, but on the other, the longer the cells grow in culture, the less potent they become.
While it's difficult for most patients to conceptualize, adult stem cells don't like to grow forever. In fact, mesenchymal stem cells tend to lose potency after about two weeks in culture. I've blogged on this extensively, as research has shown that stem cells that are used after shorter culture periods produced better results than those that were more extensively cultured. In this case, the cells were cultured for six weeks. Why?
When we use cultured stem cells through our licensed site in Grand Cayman, they charge patients by the treatment. After all, we're doctors focused on how the treatment works. However, a company that is based on the lab and not on the clinic often charges a set fee for a certain number of cells. This latter business arrangement puts the pressure on the lab to grow more cells, as the more cells that are produced, the larger the profit. Hence, we've seen many companies grow their stem cells for far too long. In this case, six weeks was about four weeks too long. This extra time in culture can cause significant cell-quality issues.
Since I've beat this topic to death on the blog, this patient immediately knew that when he got to Mexico he was in trouble as the doctor didn't use guidance to inject these expensive little commodities, but instead he performed the injection blind. How hard was it to document under guidance that the cells were in the right spot? Yesterday I performed a pre-injection with ultrasound and fluoroscopy to guide the needle and confirm placement. However, due to his patellofemoral arthritis, the injection was technically demanding. So how likely was it that the physician in Mexico got the cells in the right spot or even in the joint? Not likely based on my experience yesterday.
While the company has since told him that they have hired a doctor who can use some basic ultrasound imaging to place cells, his initial experience has led him to abandon the remainder of his stem cells and fly to a Regenexx site. Why? He understands from the blog that getting his knee injected by a doctor with limited needle-guidance skills may be almost as bad as getting it injected blind.
Understanding That This Patient Is More than a Knee
The doctor in Mexico only focused on where this patient had pain in his knee joint, but the patient had a fascinating demonstration yesterday of why that's a recipe for a treatment failure. He learned that his back is part of why his knee hurts. He also saw firsthand that despite his MRI, not all of his issues originate in his knee joint.
This patient has had back pain since he was a kid and has evidence of irritated nerves on his exam. Why is this an issue? A recent study demonstrated that patients undergoing knee replacement who had a history of back problems had worse outcomes from the surgery than those without back pain. Why? The back and the knees are connected. What happens to one will impact the other. Hence, we will need to treat his irritated low-back nerves with an injection of his own platelet growth factors when we treat his knee.
The patient also had a demonstration of the fact that his pain isn't all coming from his knee. On exam, his quadriceps muscle clearly wasn't firing correctly. This caused him pain and weakness walking up the stairs in our office. So I performed some simple trigger-point dry needling (IMS) into this muscle to get rid of trigger points there caused by longstanding irritated nerves in his back. This simple treatment allowed him to climb stairs with less pain and more strength. Hence, we will also treat that quad while he's here and then connect him with an experienced physical therapist at home who can continue that work.
Why wasn't any of this done in Mexico? The above is not something the average orthopedic surgeon knows how to do. In addition, the doctor contracted in Mexico by the stem cell lab had no skin in this game, meaning this wasn't his patient but someone he was being paid to see by a third party.
The upshot? While I can't guarantee that we can help this guy, I can plug all of the holes of his original and very costly, orthopedic stem cell treatment. As you can see above, everything from how the cells are handled to how they were placed needs to be fixed. In addition, medical providers who understand how his low back has been impacting his knee are critically important if this patient is to get a positive result.
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