This is my first addition to the website in a couple of years. I am taking time to write because I have an important new way to approach a really “old” problem. Those who have been into room 1 in my office know that I like to climb mountains (a lot!!). I have injured myself in a number of different ways climbing (actually, it was the FALLING that was the real problem…). I have fallen enough that my right shoulder has been “bone on bone” for at least 2 years. My orthopedic colleagues told me to keep using it until the pain became unbearable; then they would replace it for me. They acted sincere, but I sensed that they were secretly looking forward to having their “orthopedic way with me” while I was under general anesthesia! A year ago the pain with range of motion had made tucking in my shirt impossible on the right side; I would cry out in pain putting on or taking off a pullover shirt. In early 2018 I chose to have surgery on my painful right foot rather than my bad right shoulder, figuring it would be easier to get back in shape with a good right foot than a good right shoulder. The first foot fusion failed miserably and I am now waiting to see if the “re-do” is going to work. In the meantime the shoulder became quite debilitating. In April a sales rep offered to provide the stem cells free if I would agree to have his product injected into my shoulder. It didn’t help at all. But on the heels of that offer came another from a different company to inject amniotic growth factors without charge. The first injection was in August and it was followed with a repeat injection 6 weeks later when the first shot hadn’t improved my pain or motion. By early October I could put my shoulder through a full range of motion without pain. I could reach around behind my back and I could comb my hair again. (My hair may not look any better, but I AM combing it….). It has now been 5 months and my shoulder is still going strong. And that is after only two shoulder injections. I wish my foot surgery was healing as well!
The Basics of Regenerative Therapy
The Ultimate act of human regeneration is the creation of a baby. This process is directed by the action of “stem cells”. These are “totipotent cells” which means that they are able to become any needed parts of a new person (corneas, cartilage, bone, brains, etc). Stem cells create growth factors, which, in turn, cause the stem cells to make whatever tissue is needed to create all the parts of a new person. These stem cells can be found circulating anywhere in the body, but the highest concentration is in the amniotic membranes that are discarded with the placenta after delivery. These stem cells are circulating now in each of us, regardless of our age, and will CONTINUE TO CIRCULATE throughout our lives. My stem cells are in their 64th year and seem more interested in collecting Social Security than in repairing much of anything in my body. The entire strategy of Regenerative Therapy is to “reactivate” these old and lazy stem cells to repair parts of our bodies that are worn or wearing out. This option is exciting news for anyone, but especially for those of us whose parts are all “past warranty”.
I am not expecting all new parts, but understanding basic physiology (how our bodies work) reveals regenerative processes that we all know about but take for granted. For example, when a needle is placed in our vein to draw a blood test, a small hole is left in the vein. With little extra care we can safely expect it to heal, but what really happens in that process? Platelets are small “bits” of non-cellular material that convert to sticky particles and converge whenever any damage occurs in the body. They clog up that venipuncture hole and signal all sorts of regenerative cells to gather to the injury site. This includes our stem cells, fibroblasts (to make new fibrous or interstitial or connective tissue), osteoblasts (if the injury is a bone fracture), etc. The platelets elicit chemical signals that stimulate the gathered stem cells to become active in secreting growth factors to stimulate each other to make the needed tissue to complete the repairs needed. Two thousand years ago, Roman soldiers know that careful insertion of needles around sites of injuries would better stimulate the body to heal. This is the reason.
PRP (Platelet Rich Plasma Injection)
This therapy is based on the significant regenerative effect of activated platelets. A patient’s blood is taken and centrifuged (spun) down which separates the blood components by weight. The white and red cells are the heaviest, so they are spun down to the bottom of the tube; the serum is lightest so it will settle out at the top half of the tube. Just above the cells, at the bottom of the serum, a fuzzy or “brushed” area is where the platelets will be found. This platelet rich plasma is collected and injected into the damaged joint or area of the body. This stimulates regeneration of that tissue by activating the body’s “repair and regenerate” system as described above. I first ran into this when my wife, Candy, a Master Aesthetician, was micro-needling women’s foreheads and faces after layering their own PRP on the skin first. The needling itself is helpful alone, but the outcome is far superior if the PRP is needled in with the procedure. The skin turns soft and elasticity is restored; they look much younger. The same regeneration occurs with PRP injection into a joint or near any injured tissue. It can be done as a single injection or, better, in a short series of injections over weeks. This is the process Tiger Woods underwent that got him back to playing competitive golf a year ahead of schedule back in 2014 after ligament and cartilage injuries that were thought to be career-ending. These treatments can be very effective in stimulating regeneration. They are also less expensive than the growth hormone injections I had done.
Growth Factor Injections
Injections of Stem Cell growth factors seem to be the most regenerative of all therapies. Although more expensive, they are also most effective. The growth factors call in the body’s own stem cells and turn them into eager 2 year old stem cells that are the most restorative of all. It was this approach that gave me back my right shoulder. I had my remarkable result after two injections of growth factors about 6 weeks apart. I tell my patients to expect similar effects.
The only thing better is to mix the growth factor with PRP injections. This combination is the most effective at a higher rate than either approach individually (> 75% complete response). We can now do either approach or mix them for the best result.
The choice for most of us is to decide what we can afford, although that may not be as straightforward as you might think. PRP injection is $800 per single injection or $1200 for two in a series. Growth hormone injection is $1250 per 2 cc vial plus a $500 injection fee. Large joints (knees) will require 4 cc or two vials ($2500) plus the $500 injection fee. That may need to be done twice 6-8 weeks apart. That seems terribly expensive until you consider your deductible and co-pay for joint surgery (my foot surgery was $41,000; total shoulder replacement would be similar but then require a year of rehab to be left with a joint that is nowhere near the range of motion or effect of the original joint). I spent $2500 on materials to get my original right shoulder back).
Whichever intervention you choose, follow up “prolotherapy” is recommended. The term comes from the Latin “proli” which means to repair or regenerate”. Prolotherapy is the injecting small amounts of a mild stimulating fluid into the joint or near the injured tissue. It goes back to what the Romans did with injured soldiers, but is now done by sterile technique with D5W (weak sugar water) injected to stimulate better growth. The injections are weekly for 4-6 weeks after the initial intervention is completed.
Why Not Just Use Steroid Injections?
The current standard answer for injured joints is the one I got from my Ortho colleagues—“use the joint and inject as needed with steroids until you can’t stand the pain anymore. Then replace the joint.” Steroids (often referred to as “Cortisone”) injections have been commonly used for well over 50 years to control joint and tissue inflammation and pain. Steroids are good anti-inflammatory medicines. Unfortunately, they also impair tissue repair and speed the deterioration of those tissues. They move a patient closer to the ultimate joint replacement that Orthopedists make much of their living from. Joint replacement would only be considered as “the last option” by most of us, especially if there were effective, less invasive, and less costly options available. Remember, steroid injections do improve pain and inflammation in the short term, but they lead to earlier degradation of the involved joint and more rapidly to surgery. They should be thought of just before surgery, but AFTER REGENERATIVE THERAPY for the reasons explained above.
Summary
All of us will eventually feel pain in arthritic or injured joints and tissues. Regenerative Therapy is a new and exciting branch of Medicine that should precede the usual approach of injected Corticosteroids or surgery. It can regenerate and restore damaged joints to normal function with minimal intervention and no rehab. And, although seemingly expensive, it costs much less than surgery and carries no risk of harm. It utilizes our body’s abilities to regenerate and restore naturally. Please call (208 356-8883) and make an appointment to learn how you can utilize it to help with your chronic pains. Get your questions answered and your painful “Old Parts” restored! Our only reason to exist at Upper Valley Family Practice is to help you, our patients, feel good and be happy! We now include these services because many of you need them to feel better and keep functioning as you must. Our commitment has been and always will be to you, our patients. Thank you for your confidence in the care and kindness we provide!
Dr. Jeff Hopkin and Staff