Everything You Need to Know: Knowledge and Love Conquers Fear!
The Definitive A – Z Stem Cell Guide
Because you have made the courageous decision to have Stem Cell treatment for your joint problem, you need a detailed road map.
You have many questions and concerns, which we will now put to rest. Together, we can now talk through each, and every, step of the procedure. This will help you to feel comfortable knowing where you are in the process, and what we will be doing next. And, since you will be spending much of the day with us, I want you to know that you are in control. Fear Not. In summary, a stem cell procedure involves collecting your blood, fat cells and bone-marrow, preparing your cells correctly, and then reinjecting your cells back into the problem area.
Your cells can then begin to do their work of rebuilding and reinvigorating your joint.
Day one: You may have significant pain from the procedures, but some people who are very lucky have almost no pain
Day two: Definite discomfort but no massive pain
Day three: Many people feel well enough to stop taking the pain medications
Day seven: Most people are feeling much better than Pre-Procedure
First you will need to set up an appointment to see Dr. Coleman, so that he may take your history, do a thorough physical exam, review your labs and x rays, if applicable, and discuss the various treatment options for your unique condition. There are 3 main components to a complete stem cell treatment. The first is PRP, the second is Adipose (or fat) derived stem cells and the third is Bone-Marrow derived stem cells. If your joint problem is moderate to severe, you will likely need all of the above. This is called a complete stem cell treatment. Let’s break it down step by step.
On the day of your procedure, you will be greeted by our very dedicated and caring staff. If you have a loved one or companion that would like to accompany you please let us know. You will need someone to drive you home after the procedure. We can arrange this if no one is available to help you. Once you are checked in, we will answer any other last minute questions or concerns. Please let us know at the time of your consultation if you are nervous or anxious about the procedure. If so, you may be given a mild anxiolytic medication, to take the edge off of your anxiety. This could be xanax or other medications. This is perfectly normal and safe and in no way impedes our performance of the procedure.
All procedures done in the office are defined as Level 1 procedures. This simply means that we use the safest local anesthetics and we monitor how the patient is feeling. Next you will have a blood pressure check and a glucose check if needed. We want your day to be safe and pleasant.
Getting Your PRP and Blood Related Factors
The next step will be to have you comfortably sit, while we draw your
blood. The purpose of this is to give us the raw material (your very own blood) that we will use to derive your Platelet Rich Plasma or what is called PRP. Your PRP will be used just a little later when we are injecting your cells back into your body. Once your blood is drawn the technician will take it to the lab and begin to derive your PRP. This involves spinning the blood in a very special way and then Activating it with light, to rev up the platelets to make them especially ready to help your body heal your joint. And that is not all. The next two things we will add to your unique joint injection are your extra fat cells and something truly special….your bone marrow liquid, which contains many, many special cells and growth factors. This fantastic and totally natural concoction is the conductor that organizes and directs the symphony of healing that is about to begin.
Getting Your Fat Cells
The next step is a little bit more painful, since it involves getting a “bee sting” which is Lidocaine with epinephrine. This diluted solution is used to reduce pain, and also to reduce bleeding within the fat cells. This is called Tumescent anesthesia. Fatty tissue is full of very small blood vessels. The diluted epinephrine nearly eliminates all bleeding, which makes the procedure safe and the recovery quicker, with less bruising. Once the anesthetic is instilled, we will put a small catheter on a syringe and jiggle it around, to withdraw some of your yellow fat. These cells are called Adipose Derived Stem Cells.
Don’t worry, it sounds worse than what you will likely experience. As many patients have told me, the anesthetic is the worst part. Think of it as a free mini-mini liposuction procedure, which it is. This only takes a few minutes and then you will have a sterile dressing applied. Later in the day you should expect a little leakage of clear or slightly blood tinged fluid from the site where we injected you. Isn’t it good to know that there is a reason why those extra fat cells exist? Yes! Just for us to use to help your body heal itself. So far so good. On to the next step.
Getting the Gold
The last step before we re-inject your cells is to “Get the Gold”.
Your bone-marrow is like “Gold” for you. It is the super special ingredient on the road to your recovery. This is the most uncomfortable part of the procedure, but the most crucial. Again this sounds much worse than it actually is, so I want you to understand, and not fear this key step to your healing.
First you will be placed comfortably on a treatment table with your face down and back side up. We will be working on your lower back area to either the left, or the right, of your spine on a very prominent bone called the Iliac Crest. The reason we use this specific bone is many fold.
It is easy to find, It is easy to anesthetize and easily gives the very maximum amount of bone marrow juice that we will need. There are very few other things near this bone site. There are no major arteries, or veins, or nerves near it, which is very good news. This makes it an ideal site to get the golden bone marrow, while not endangering any other structures.
The Technique is Very Specific
Once you are in position we will very carefully clean the area where we will be working. This is done with 99 percent alcohol and Hibiclens mixture. Using sterile gloves, the solution is poured onto sterile gauze and the area is scrubbed in a widening circular pattern from center to the outer area, beyond the furthest point we will be working. This is repeated carefully three times, or more, if there is any thing evident on the gauze. This ensures absolute sterility of the skin for the duration of our quick procedure. Next, the area is draped with a sterile cloth, which looks like a very clean white towel with a hole in the center. This allows us to keep the center sterile while our hands rest and position the needle. Once again we have a “Bee Sting” of Lidocaine local anesthetic to deal with. This goes on the skin and then deeper, all the way down to, and on top of, the bone surface. This is the most unpleasant part of the day, but the most important. This takes several minutes to let the anesthetic fully work. No rushing here. Once the bone surface is put to sleep, we can finish.
Next we use a small scalpel, to make a tiny nick in the skin and a bit deeper into the fat layer. The next part is a bit unsettling, because you will hear us and feel us pushing the special needle down and in to it’s exact position. There is some discomfort, but it is tolerable. We place the special bone-marrow needle on top of the bone. To get through the outer portion or “Table” of the bone, we use a tiny hammer to Tap, Tap, Tap our way into the bone cavity. It is done this way for maximum control, minimum pain, and speed. The quicker the procedure is done, the less it hurts. This technique also gives us the very best quality and quantity of Bone-Marrow. Gone are the old methods which were much more painful and took longer. One, two, three… tap, tap, tap, and we are in. Much less pain and much quicker to heal.
Once the Bone-Marrow liquid begins to flow, we know we are in the right spot and we then gently suck the bone marrow out with a syringe. We need several cc’s , so this will take a few moments.
Some patients report an odd discomfort as we remove the liquid. It has been described as a dull pressure type pain. Luckily this part takes just a few moments and we can withdraw and be done. Next we apply pressure to the incision area to minimize pain, swelling and bruising. Lastly, we apply a sterile dressing, and you are on your way to the last step. While you now rest, our work has just begun.
Preparing Your Cells for Their Super Critical Mission
Now that we have your PRP prepared by super gravity spinning, and light activation, the PRP is ready for injection. Next we turn our attention to your fat cells. They will be divided and sterilely placed into syringes for injection. Your freshly harvested Bone-Marrow, has been mixed with heparin to prevent degradation, and is also now ready for injection. Please note that according to the Food and Drug Administration, we can only do minimal manipulation of your cells prior to treating you. So, of course, that is what we have done. Our credo is to be FDA compliant, FTC compliant and Medical Board compliant. Since six out of ten patients getting Stem Cells are being treated for knee pain, we will use a knee as a typical example of a joint injection.
Preparing The Knee for Injection
The patient is comfortably seated on an exam table and the doctor can roll around on a low stool to enable him to see the knee at eye level. The knee area to be injected is sterilely prepared again with alcohol and Hibiclens, which studies have shown to be the best at sterilizing skin. Please note: there are many, many ways to inject the knee. There are simple techniques done by nearly every orthopedic surgeon and there are more advanced techniques used by doctors trained in Prolotherapy, like myself.
Nearly every structure in the knee can be targeted for injection if necessary. But many times a “general” knee injection, called an intra-articular injection, is the best choice. Some patients will also get a knee “wash out” (joint lavage) with sterile saline, prior to Reinjection of their cells. Some patients may also opt for additional healing factors called Cytokine Therapy to be injected simultaneously. Please ask us directly if you are interested in this treatment also.
The Last Lap: Reinjecting your Cells
Today, we will be using the Antero-Lateral approach for injection. Tomorrow, it might be the Antero-Medial approach. It just depends on the condition of the knee , which is to say where is there a space with less arthritis, allowing us to get the needle placed. This is why it is called the Art of Medicine, not the exact science of medicine. So, once the knee is cleaned again we inject the three different types of cells in the three different syringes: Bone Marrow, Adipose Derived Stem Cells, and PRP. The Bone Marrow provides stem cells and growth factors. The adipose tissue provides expansion of the joint space, lubrication and stem cells. The PRP provides the “Jump Start” of Healing cells and Factors (the concentrated platelets)
Wrapping It Up
The knee is then given a sterile dressing and an elastic wrap to keep the knee stable. After you are given post procedure instructions and supplements, you are ready for your ride home. You must have a driver on the way home. You have had a very big day, and we want you to rest comfortably this evening. We will see you for follow up in four weeks. If you have any problems, which is rare, please call the emergency contact number. You will likely be in a considerable amount of pain for the first several days after the procedure. Unless contraindicated, we will give you pain medications. We advise you to take the written script, even if you don’t think you will need or want it. These medications cannot be called in later that night. They must be a written prescription. You can always wait to have this filled, but we do encourage you to take the written prescription with you. We would hate to have to see you go to ER for a pain problem that could have been treated at home. Knowing you have the option to take these medications, may prevent you from needing it. True.
Yes, this is a complex process and anyone who says it is easy, has never been a patient that has been through it, or a doctor who has performed it. Hopefully you will find that the final results are well worth the discomfort, the cost, and the time involved. If this procedure helps you to avoid a major knee replacement surgery in the future, it surely will have been worth the trouble.
Steven Coleman D.O.