Joint Preservation Blog

September 22, 2010

Ehler Danlos Syndrome Treatment

Filed under: Uncategorized — Tags: , , , , , , , , , , — D @ 2:48 pm

While we have seen a few patients through the years with Ehler Danlos Syndrome (EDS) variants or simply hypermobile tissue (patients that have very loose joints) without a confirmed diagnosis, I recently was asked by a severe EDS patient to consider prolotherapy for her frequently dislocating joints. EDS is a disease where the collagen (the stuff that holds our joints together) isn’t normal and is made by the body much too stretchy (see above picture). In it’s most severe forms, these patients can barely walk or be active without dislocating a joint. They tend to have arthritis at an early age due to the extra motion in their joints. This patient was in her early 20’s and unable to walk more than 20 steps without her left hip dislocating. She wore special rings on her fingers just to keep her finger joints from poping out of place. She wanted to try prolotherapy on the theory that it would beef up her already loose tissue, laying down thicker tissue or more of the same stretchy stuff, but maybe enough to keep her joints more in place. I was skeptical, but she had no other options. I’m happy to say that after several x-ray guided prolotherapy injections in her left hip and the surrounding tendons she now reports that she can walk through a home depot without the need for her scooter and has had a record low number of hip dislocations this past month. The theory here seems to be correct, that in severe EDS patients injecting substances that have been shown to “beef-up” tissue may give them anough added stability to function better.

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January 5, 2010

Steroids and Apoptosis

Filed under: Uncategorized — Tags: , , , , , , , — D @ 6:08 pm

Apoptosis means pre-programmed cell death.  High dose steroids (corticosteroids which are commonly used to decrease swelling) have been implicated in causing this condition.  When I first heard about this issue from chiropractors and physical therapists years ago, I though it was an alternative medicine marketing tactic.  However, as I read more, it became clear that these negative effects of steroids on muscles, bones, cartilage, and ligament were quite real.  I have summarized those here:

Cartilage

Muscle

-Bone

-Ligament

November 3, 2009

An upper back problem that looks like it’s abdominal pain…

Filed under: Uncategorized — Tags: , , , , — D @ 1:16 pm

abdomen_muscles

Jimmy was a teenage baseball player with a history of severe abdominal pain.  I think his case illustrates how many M.D.’s have lost our ability to structurally diagnose patients with chronic pain.  Since he had high abdominal pain below the ribs, he had the million dollar GI work-up for his abdominal pain.  He was ultimately placed on very high dose narcotics and other drugs by a local Childern’s hospital.  When he first came to our clinic, his pain was across the top of his stomach and he couldn’t sleep more than 1-2 hours a night.  He wasn’t eating well and had given up baseball (his passion).  What was striking on initial exam was that if this patient had an internal organ problem, you wouldn’t expect his upper abdomen to be tender, right along the rib cage.  When these lower ribs were followed to his upper back, he had muscle spasms in this area as well.  Since nobody had ever found anything wrong with little Jimmy’s internal organs, it was a safe bet that he had a lower thoracic problem leading to pain in the ribs, which masqueraded as a stomach problem.  Further exam in Jimmy’s case showed that the abdominal muscles had significant trigger points and the area that attached to the ribs had a significant enthesopathy (swelling at the tendons that attach to bone, due to excessive pulling on the attachment by tight muscles).  Our plan was to begin injecting the lower ribs with prolotherapy solution to allow these abdominal muscle attachments to heal and to get rid of trigger points in the abdominal and upper back muscles using an IMS technique.  Within 12 weeks (Jimmy had suffered for two years), Jimmy was back to playing baseball and without pain.  He went off all meds and at one year follow-up, he’s still off meds and without pain.  His case is a good example of how a simple musculosketal pain problem can be misdiagnosed, cost a bunch of money in expensive diagnostic work-up, and if undiagnosed and without proper treatment, would have led to a teenager addicted to narcotics.

April 18, 2009

Can stem cells fix a knee?

pix-knee1

Cartilage is funny stuff.  It’s a shock absorber and filled with cells, so it’s alive.  For a long time, we doctors believed is was so much inert filler so we developed a surgical culture of trimming it and cutting it out.  This was called debridement.  The problem is that arthoscopic surgery for knee pain doesn’t work.  The reason, cutting out living cells turns out to be a bad idea.  So the next step is actually trying to fix cartilage.  We have demonstrated on MRI that using the patient’s own stem cells can help the appearance of knee cartilage (as seen on high resolution MRI) as well as the pain reported by patients.  The secret appears to be taking the patient’s own stem cells and growing them to bigger numbers.  The FDA has taken a strange position on all of this, but doctors and patients have other ideas.  In the meantime, fixing cartilage with stem cells seems like a better idea than cutting it out.

New Physician Group Releases Lab Guidelines for Safe Stem Cell Therapy

Filed under: Uncategorized — Tags: , , , , , , , , — D @ 2:28 pm

The American Stem Cell Therapy Association (ASCTA) announced this week the publication of their lab guidelines.  The group of physicians have come together to oppose the FDA’s position that the patient’s own adult stem cells are drugs.  Why is this important?  The FDA’s believes that classifying adult stem cells as drugs will improve safety.  However, many of the drug manufacturing guidelines don’t apply to the processing of a patient’s own cellular material, a bit like trying a force square peg in a round hole.  ASCTA has put together lab guidelines that will allow for lab safety that is much more specific to adult stem cells.  The first US lab to adopt these new guidelines will be the Regenexx lab in Colorado.  I was privileged to serve on the lab guidelines committee with noted scientists from various medical schools and biotech companies.

April 9, 2009

Patient Group Opposes FDA Position on Adult Stem Cells

Filed under: Uncategorized — Tags: , , , , , — D @ 6:42 pm

Are your adult stem cells drugs?  The FDA has been sparring with physicians and patients over this issue.  Today a patient group registered it’s opposition to this FDA stem cell position.  For a real dose of reality about how good you have it, check out the “Patient Voices” section of this site.  These are people with terminal illness who are dying.  This whole debate started with the FDA’s position that the minimal stem cell culture process of the Regenexx procedure should be classified as a drug.  Why?  No real specifics give, it seems to be a “cause I said so” issue.  This lead to physicians organizing to regulate themselves so that patients can have access to safe adult stem cell therapy now.  Where is all of this going?  Adult stem cells processed with minimal culture techniques aren’t drugs, I suspect the best quote is from a physician from Ft. Meyers Florida who recently joined The American Stem Cell Therapy Association (ASCTA), “This is a patient physician situation and the FDA needs to stay out.  I commend all of you for starting this.”  Enough siad.

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