Thread: FKNA!!!! I Had Stem Cell/PRP/HGH Injections in Two Knees and One Shoulder Yesterday

Splat, great thread and fun to read about the continued successes you are experiencing. I did not read it word for word, but was curious, was this all out of pocket for you, payment wise, or were you able to get insurance to cover any part of it?

As a large animal vet, sometimes it sucks to be able to get my patients this type of therapy and not have it available to myself, or my dad (bad rheumatoid arthritis, 2 artificial knees and all 10 artificial knuckles). Also, for you or Patches or the lovely aforementioned doctor, what are your thoughts on fat derived stem cells vs. bone marrow derived stem cells? In equine models and clinical cases, both that I have seen, and when I have spoken with the research vets up at CSU's orthopaedic research center, they feel that the bone marrow derived stem cells are showing better results. I don't know it that is due to # of stem cells, or something to do with the character of the stem cells, but just curious what you have found out through this whole process. I know I want this done to my knees someday, but wanted to see if I need to start saving out of pocket or if there is any chance to get insurance to pony up some of the expenses.

Thanks ahead of time, and please keep the updates coming, it makes for good reading, and I think makes for some good inspiration for a LOT of Maggots out there destroying their joints on a daily basis, myself included.

I'm sure you could get insurance to cover it if a doctor prescribes it and refers you to a doctor that does it. A lot of people don't realize they can do that, though it might require some insistence on the patients part. If I could afford it, I'd pay out of pocket to have it done annually. It's been that good for me.

I had a follow up PRP injection in both knees and my shoulder last week. I happened to break my arm and screw up my hand and wrist on a rock May 28 while skiing. The PRP injection to my shoulder made an overnight difference to my wrist and especially my fingers, which had been stiff and sore since I stuck my hand down to keep from breaking my hip. Essentially, though it is injected into a joint, it still gets into the bloodstream and goes everywhere. On another side note, the stem cells also go into your bloodstream and the first stop is your lungs. I've heard of people getting cured of emphysema from stem cells. Well, it cured my hay fever, too. This stuff never ceases to amaze me!

SSD:

Have you checked out the guy in Denver?
http://www.regenexx.com/

He seems to have a lot of information out there and post a fair amount on the web?
I would value your opinion?



I have UHC and they aren't in my PPO. I doubt UHC would pay anything without a fight?

I was reading everything I could find on that guy and Dr. Stone in SF before I found a stem cell doc that could treat me in my neck of the woods. You should go see them, ssd. Get your doc to write that script.
I'm going to write a piece on stem cells and would love the testimonial.

Just so you know, Patches, the cost of stem cells are 1/10 of what my acl/menicus repair followed by a meniscus clean up on me. I can't help but think it's more like 1/20 of a joint replacement. Plus, you get to keep your parts. I was well on my way to a knee replacement when you and your beautiful redheaded wife saved my knee. Have I ever said THANK YOU!!!?

Splat, is there any visible evidence of cartilage growth that shows up on an MRI?

I don't know. Since my knee injury went on a workers comp policy, the only way I could afford another MRI is if I go tell the doc it still hurts and I want an MRI. I don't have anything other than traveler's insurance right now, which covered my broken arm last month and, since my knee doesn't hurt, I haven't been inclined to ask for one.

Splat,

Can you comment on the normal trajectory to deciding if you should use PRP or Stem Cell? I'm guessing full tears=surgery partial tears, tendonitis, etc=stem cell? Just trying to decide if another MRI is worth the effort or just go for the stem cells for a grade 2 tear

I did my own shoulders last week (I''ve had issues from previous mountain bike and rock climbing stupidity) and chose to use adipose rather than bone marrow. I think adipose yields superior results, but you can get in a huge argument over it and the answer is uncertain. Most people have switched from bone marrow to adipose.

There are a number of different methods used for isolating stem cells from adipose or bone marrow. I think they are all pretty good with a couple of exceptions, but those just appear ineffective to me, not dangerous. The multiple methods are hard to compare, and make evaluating adipose vs. bone marrow more difficult. A well-done adipose isolation will work better than a poorly-done bone marrow isolation, and a well-done bone marrow isolation will work better than a poorly done adipose isolation.

I posted a couple of times last week and almost immediately deleted them. I'm super excited about this stuff but until it's more accepted (and covered by insurance) I think I need to hold back a little on my enthusiasm. This post has been edited to make it more dispassionate.

I'm enthusiastic because the patients are very happy with the procedure and most people we have treated are pleased enough with their results they are trying to get friends/family to come in for treatment.

The published literature on autologous stem cell treatments in people is still thin, but the results of veterinary studies are quite good. Animals don't exhibit placebo effects.

As Splat suggests, It is very difficult to get people to get post-treatment MRIs. Even people who are quite wealthy don't want to block out a day and spend $2K+ to get one if they are feeling better.

There is no reason to leave the US for treatment of joint issues. The only reason to leave the US for stem cell treatment is if you are want the cells injected systemically, which is illegal here - and also pretty sketchy from a safety standpoint.

If anyone thinks this seems overly enthusiastic/unprofessional/inappropriate please let me know and I will edit it.

Oh - I'm not aware of anyone in the US getting an insurance company to cover an autologous stem cell procedure. They may cover a diagnostic MRI beforehand, but won;t cover post-treatment imaging.

Would any of this be recommended for a still kinda loose feeling shoulder? Repeat injuries to the labrum. Tears were repaired, but then I fell and almost tore it again. Rheumatism adds a little complication.

What is prp? Too lazy to read back.

Sent from my cell phone. no, a cell phone.

Originally Posted by stuckathuntermtn

Would any of this be recommended for a still kinda loose feeling shoulder? Repeat injuries to the labrum. Tears were repaired, but then I fell and almost tore it again. Rheumatism adds a little complication.

What is prp? Too lazy to read back.

Sent from my cell phone. no, a cell phone.

PRP is like GSA. FKNA. But made from your own blood.

PRP is "Platelet rich plasma." Basically, they draw some blood, stick it in a centrifuge to separate out the "healing elements," and inject said healing elements into your problem area. Results seems to be all over the board with some people having great success and others not feeling any difference. I had two PRP injections that never did fix my patellar tendon issue, but it turns out there was bone fragment imbedded in the tendon that didn't show up on any scans. I wouldn't hesitate to try it again before having another surgery, though I'd definitely want to give it a shot with stem cells as well. Another thing: the first PRP I has was done by hand by my surgeon, but the second one was ultrasound guided by a specialist at the Hospital for Special Surgery in NYC. I'm not sure if Patches' wife uses ultrasound, but I'd be cautious about trusting anyone to do it blind now that they have the technology. Oh, and I was able to get insurance to cover the second PRP, but it was a pain in the ass.

I'm not sure what you mean by a "tweaked" labrum. Seems like a labrum is either torn or it's not. I'm not sure what the injection can fix, but if it's down to having another surgery or an injection, I'd definitely do the injection first. I was able to play soccer, climb, ski, etc on a torn labrum (hip) for 4 years by having extremely strong stabilizing muscles. Not that I recommend doing that if it's torn as I'm still dealing with the compensation issues, but just trying to say that being strong makes everything a hell of alot better regardless of what injections you decide to get.

Hope this helps a little bit...

We use ultrasound, but... my understanding is the common injections (knees, shoulders, hips) are easy except for the actual glenohumeral shoulder joint, which is quite small. Particularly for knees I wouldn't get concerned if your doctor doesn't use guidance.

Not a fan of x-rays, so I would refuse fluoroscopic guidance, too much radiation for me.

More later...

This is pretty exciting stuff treatment wise, I saw a news blurb on TV today about an FDA approved stem cell treatment that was administered to spinal injury/paralysis patient in FLA, IIRC. Are any of the above treatments effective for arthritic knees? My wife's got arthritis in the knees, especially bad in the left one, forcing her to use a cane occasionally.

PRP: Some docs talk about it like its the best thing ever, but I'm not convinced its that great for stand-alone treatment. I've never had a patient (including myself or my wife) get a big benefit from it. It is fast, simple, and safe though. My wife and I do it on ourselves quite a bit but we're not having to pay for it. In other words I think it has a positive risk reward but most people will regret the expense.

Some people like Splat love it, but they've already done stem cells. I do think the analogy that the stem cells are the grass seed and the PRP is the fertilizer has some merit. I do like the idea of suspending the stem cells in PRP for the initial treatment, and then doing follow up PRP-only treatments in the weeks/months afterwards. That's our current protocol.

I think PRP is probably beneficial to improve and hasten recovery from an acute injury. But if you have a chronic problem that had years to heal and it didn't, I don't think PRP is going to do much. No reason not to try I guess, if the price tag doesn't bother you.

I felt compelled to do the tgr translation for huntermtn to boil down all that doctor-speak to skier lingo.

The sum total of my injuries over the centuries is prolly comparable to those of a lifelong rodeo cowboy. I think I'm a pretty good barometer of pain, treatments for pain, gauging the effectiveness of those treatments and incoming storms. I've literally spent decades healing and am pretty much in pain from one injury or another all the time. So when I am pain-free, I immediately try to think of what got me there. My number one therapy is moving. Motion is lotion.

The improvement stem cells gave me is so measurable in my mind, it's off the any imaginary or real charts. I limped for two and a half years, long enough that it was starting to screw up my hip and back. I was a little worried at 95 days after the stem cell/prp/hgh injection. Then, like an old plug coming out the backstretch in the Kentucky Derby, the effect kicked in almost overnight and it was as if my knee was the strongest part of my entire body.

I am still amazed to this day. My chronological posts here were kinda cool to do. I'm glad I continued posting on my progress. It's all real.

Almost all of our stem cell patients have been people with horrible joints - advanced athritis, bone-on-bone, missing chunks of meniscus, avascular necrosis. Almost all have had surgery before, and almost all had enough pain that they were considering joint replacement or fusion. Lots of really ugly x-rays and MRIs. Most of them improved substantially, which is extra impressive given how much damage they had beforehand.

We are now really comfortable with the procedure's safety profile - thousands more procedures have been done by us and others, and the patients who had these done 5+ years ago are holding up well.

In my opinion the criteria has changed from "are you considering a joint replacement or huge surgery?" to "do you have pain that is impacting your life?" -keeping you from sleeping, preventing you from doing the things you want to do.

That's for treatment with stem cells.

For treatment with PRP, like I said before, I haven't been that impressed, but the process is fast and simple. My biggest problem with PRP is that I don't like doing something unless I'm pretty sure its going to work. I have that confidence in stem cell therapy but not PRP therapy.

Also, Splat's experience is typical in that it takes quite a while to take effect. 3 months is typical, in older patients (late 70s+) closer to 4. We've had a couple people get better right away but not many. That's part of the logic behind doing multiple sessions of PRP after the initial treatment- clearly the stem cells are in there working so we're trying to give them a boost.

And- before you do anything with poking the sequence of things you try before:

Get more sleep
Fix your diet*
Quit the nicotine & booze
Go to a couple good physical therapists

Only then should you consider a medical procedure.

*"Fix your diet means minimizing refined carbs and packaged food. Every meal should have hearty vegetables (cauliflower, brussels sprouts, spinach, peas, tomatoes). Eat a few pieces of fruit every day.

Awesome info Patches, particularly that first post. Two questions:

1. Any experience with wrists? I tore/stretched/fucked up my 'radioscaphocapitate' ligament which has resulted in carpal instability and a slight edema in the lunate (shown on MRI). Talked to the surgeon about stem cells/PRP and he seems to indicate that's not an option because that ligament isn't accessible with a needle. A shot of cortisone seems to have fixed the problem temporarily, but if/when it wears off, I'll need the surgery.

2. In terms of the sequence of things, what specifically about one's diet to you recommend changing? I ask because I've never had a doc or anybody mention that my diet could affect healing. I feel like I eat a fairly clean and balanced diet (not into paleo or anything specific), so do you have any specific recommendations for those of us who are dealing with injuries but are otherwise quite healthy? And frankly, I'm surprised you didn't include adequate sleep in your list because that's one of my own personal indication.

Thanks in advance for your time. Hope these questions are appropriate—I feel like the more info about this procedure that's out in the open, the better.

Originally Posted by Moeghoul

This is pretty exciting stuff treatment wise, I saw a news blurb on TV today about an FDA approved stem cell treatment that was administered to spinal injury/paralysis patient in FLA, IIRC. Are any of the above treatments effective for arthritic knees? My wife's got arthritis in the knees, especially bad in the left one, forcing her to use a cane occasionally.

Moeghoul - My knee was going arthritic. Ortho said it was the result of my knee continuing to try to heal itself, producing bone in the process. The arthritic condition is apparently just a part of what was causing my pain. As I stated before, post op xrays showed my knee joint as 3-4 mm's out of line. That's a shitload in a knee joint, considering 1 mm of misalignment on a patella can cause super painful osteoarthritis.

Added "Get more sleep" to the list above. "Fix your diet" means avoiding refined carbs and packaged foods. Eat lots of high-quality protein. Cook for yourself, and first plan the vegetable dish(es) before you start chefing up the pasta or rice. Eat a few pieces of fruit every day, learn how to cook beans as a carb rather than jumping to pasta. No need to be super militant though - this should be stuff that leads you to eating tastier food, not bland nasty hippy food.

You can get super detailed with finding the optimum diet, but for many people just cutting white flour and sugar and adding in hearty vegetables like Brussels sprouts and broccoli and spinach and peas and squash, and eating fruit, will drive out a lot of the bad choices.

If you don't like vegetable unless you slather them in butter, slather them with butter. Better than not eating veggies at all!

I'm guessing you do great- but lots of guys are nuking lean pockets for dinner or eating burritos made from hydrogenated junk at the local taco joint.

For all of these below remember I'm not a doctor. And a doctor would need to do an exam and see imaging before giving advice.

Originally Posted by auvgeek

Any experience with wrists? I tore/stretched/fucked up my 'radioscaphocapitate' ligament which has resulted in carpal instability and a slight edema in the lunate (shown on MRI). Talked to the surgeon about stem cells/PRP and he seems to indicate that's not an option because that ligament isn't accessible with a needle. A shot of cortisone seems to have fixed the problem temporarily, but if/when it wears off, I'll need the surgery.

Usually you don't directly inject the tendons or ligaments. In the case of the wrist, all that stuff is contained in bursa, or fluid filled sacs. You would inject the stem cells into the bursa; since the ligaments and tendons run through the bursa the stem cells will get where they need to go. This is how your doc injected the cortisone. If you got benefit from the cortisone shot (even short-lived) you should be able to treat with stem cells too.

Originally Posted by Moeghoul

Are any of the above treatments effective for arthritic knees? My wife's got arthritis in the knees, especially bad in the left one, forcing her to use a cane occasionally.

Yes, stem cells seem to work well for typical arthritis.

Originally Posted by whatcomridaz

Can you comment on the normal trajectory to deciding if you should use PRP or Stem Cell? I'm guessing full tears=surgery partial tears, tendonitis, etc=stem cell? Just trying to decide if another MRI is worth the effort or just go for the stem cells for a grade 2 tear

This is how I look at it. If you have a full-thickness ACL tear or a bad partial and its super stretched out, you need surgery. If I had a partial tear I would do stem cells first and see how it turned out before having surgery.

Originally Posted by stuckathuntermtn

Would any of this be recommended for a still kinda loose feeling shoulder? Repeat injuries to the labrum. Tears were repaired, but then I fell and almost tore it again. Rheumatism adds a little complication.

I would consider stem cells for the labral tears but I don't know if they will "tighten up" the shoulder. I did stem cells on one of my shoulders because its "kinda loose feeling" two weeks ago but I would recommend (and did) lots of PT to tighten it up before doing anything else.

I'm a relatively risk-averse person (anyone who has skiied or climbed with me will verify I am chicken). But I'm very comfortable with the safety profile of this procedure; I've done it on myself, my mother, my step-dad, and friends and their parents. We'll probably treat Dr. MrsPatches once she musters up the courage to do lipo on herself.

Patches:
I for one appreciate your opinion and I'm sure others do as well.

Are you familiar with Orthokine Therapy and how does it differ from the stem cell procedures?

I haven't observed an Orthokine procedure but I have some understanding of the process. It is a PRP variant, not a stem cell procedure.

In traditional PRP, the joint is injected with plasma and platelets. The theory is that the platelets will release growth factors and stimulate healing.

In Orthokine, the PRP is incubated in the lab to activate the platelets and cause them to release their growth factors. The platelets themselves are then discarded and the actual injection consists of only plasma and growth factors, no platelets or cells are included.

Orthokine could turn out to be better than regular PRP, or worse, or the same, but I don't see as being magic or all that different from what other PRP companies do. I haven't seen any good studies.

Again, this is much different from using stem cells. None of the PRP variants, including Orthokine, contain stem cells.

Originally Posted by splat

Moeghoul - My knee was going arthritic. Ortho said it was the result of my knee continuing to try to heal itself, producing bone in the process. The arthritic condition is apparently just a part of what was causing my pain. As I stated before, post op xrays showed my knee joint as 3-4 mm's out of line. That's a shitload in a knee joint, considering 1 mm of misalignment on a patella can cause super painful osteoarthritis.

She's seeing an ortho at Rothman Institute, basically she's bone on bone in the knee, cortizone was no help, and some other injectable stuff was suggested but my research on it showed marginal efficacy and needed repeated treatments at a high co-pay rate. She's been dropping weight for the past month and if she makes good progress with that maybe that will give her some relief. I'm still reading up on this stuff and did find a medical center in Cherry Hill, NJ that does PRP. Thanks again for all the insight guys, especially Patches.