Adventures in stem cell based regenerative medicine—Part 1: The consultation

When my Orthopedic doctor basically told me “call us when you want to schedule surgery”, I decided to look into cutting edge regenerative procedures.

A little history

I’ve had chronic shoulder issues for the last 4 years—particularly in my right shoulder. According to my Orthopedic doctor, it has some minor damage in the form of a frayed tendon (Supraspinatus), relatively  minor ‘wear and tear’ tears, and arthritis. This is largely just the result of decades of martial arts, fitness training, and age. (There wasn’t a single major injury that I could ever recall.)

About 3 years ago, I had surgery on my right shoulder. My surgeon largely ‘cleaned out’ the arthritis in my shoulder joint, but opted not to re-attach the bit of frayed tendon because he didn’t want to drive screws into the humerus (the standard fix for this type of tear).

After about 9-12 months of recovery my right shoulder was pretty good again. And it seemed pretty normal for the next 2 years.

But around Thanksgiving 2016, I put in a lot of jiu-jitsu training over the course of 3-4 days. It was great and I felt good—but very sore. But both my right and left shoulders never forgave me. They have been chronically painful ever since.

Recognizing the signs, I started Physical Therapy almost immediately. I made appointments with my Orthopedic doctor after a few months of PT didn’t seem to be helping. I also had an MRI done on each shoulder. Amazingly, my shoulders didn’t appear to show any massive trauma or new damage. That’s the good news.

But where do we go now?

The bad news is that this basically resulted in my Orthopedic doctor telling me that, aside from surgery to fix the frayed tendon in my right shoulder, there wasn’t much he could do for me. “Call us when you want to schedule surgery.”

So I decided to look into PRP (Platelet Rich Plasma) therapy, which in recent years has increased in popularity thanks to various high-profile athletes (Tiger Woods, Chris Canty (a defensive tackle for the New York Giants) and the Phillies’ pitcher Cliff Lee, to name a few) using the procedure. (Joe Rogan, UFC announcer and himself a highly skilled fighter/martial artist, has also spoken glowingly of the process and how it helped him with shoulder issues.)

At first–about a year ago–I spoke with a doctor about the procedure but never pursued it. More recently with Dr. Attaman at the Washing Center for Pain Management. (I found Dr. Attaman while looking into a procedure branded as Regenexx, which he recently became certified in.)

As it turns out, there are various “flavors” of PRP and similar therapies, but they basically seem to boil down to the following:

  • Blood only: Blood is drawn, spun up in a centrifuge to generate a rich platelet solution, and then injected directly into the problem areas to help heal and regenerate tissue.
  • Blood + Body Fat: A little body fat is extracted and mixed with the platelet rich solution, which is then injected directly into the problem areas to help heal and regenerate tissue.
  • Blood + Bone Marrow: Bone marrow is extracted (from which stem cells are extracted) and mixed with the platelet rich solution, which is then injected directly into the problem areas to help heal and regenerate tissue.

The Consultation

I’ll be honest. I like my Orthopedic doctor, but appointments with him are relatively expensive and I rarely get more than 10-15 minutes of his time. And I rarely came away with anything more than I expected going in.

Dr. Attaman not only discussed my history and performed a variety of movement tests, he also took an ultrasound and imaged both of my shoulders, noting all the tears and other places where there was damage. The appointment was at least 30 minutes, maybe 45. At any rate, the examination felt much more “thorough” than those I experienced with my Orthopedic guy.

The Treatment

So my treatment for my Right Shoulder will consist of the following procedures:

  1. Day 1: Prolotherapy to RIGHT supraspinatus tendon, subscapularis insertion, biceps tendon, AC joint, SLAP tear, inferior labrum. A dextrose solution is injected into various areas to induce inflammation. Apparently stem cells respond better to ‘damaged’ or inflamed cells.
  2. Day 2: Bone Marrow Aspiration from Iliac Crest, i.e. they go through through the hip and ‘mine’ (suck out) some bone marrow. Sounds not very awesome.
  3. Day 2 (later same day): Regenexx SD to RIGHT SLAP tear, inferior labrum. Regenexx SCP to supraspinatus tendon, subscapularis insertion, biceps tendon, AC joint. In other words, then inject the solution created from my bone marrow into the targeted areas.
  4. Day 3: Regenexx post injection for RIGHT sub deltoid bursa. They take blood, spin it up in a centrifuge to yield a high concentration of platelets, and then inject that into the targeted areas.
shoulder
Credit: WebMD

 

 

 

 

 

 

Bottom line: Over the next week and a half my right shoulder is going to be a medical dart board.

The science and outcome data for PRP and related therapies is generally good but hardly 100%. I spent a lot of time researching the data. Medically, it’s minimally risky—the only real risk is the financial one. My right shoulder, for all of the treatments above, will cost around $8000 when it’s all said and done.

It’s not a cost I bear lightly, but after months of chronic pain and no real solutions other than doing nothing, continuing Physical Therapy (which I’m doing but hasn’t helped much), or surgery—I’m ready to try it.

My first appointment is August 1st 2017. Stay Tuned.

I have a lot of friends and family (many of whom also suffer from chronic injuries) who are very curious about the outcome, so in a way my adventure into experimental medicine will be “taking one for the team”.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s