In the beginning
Many years ago, there was a
in an enchanting land that is far far away.
When the coach said "push harder, there is no
way you can hurt yourself", I actually believed him.
Exhausted, I pushed harder and harder ---
and then the cartilage was torn in my right knee.
Back in the old days, the prevailing wisdom was "if in doubt, take it out".
It worked for an inflamed appendix, why not a knee cartilage?
In the course of things, surgery was performed. I never really knew
exacty what was done but it certainly didn't make things better.
Indeed, my knee was worse. Still, everyone cheerfully said it was
all for the best and that I'd probably get arthritis by the age of 35 but in
the meantime I should go ahead and make the most of things.
At the age of 35 I was a full-time scientist and a part time athlete.
Perhaps I would be spared the scourge of arthritis?
Optimism is no match for reality and the reality was that
interference with the meniscus is a fine way to induce osteoarthritis.
Ten years later, the knee was worse and my sporting options were becoming
very limited. With each activity curtailed, I put on pounds (or should I
Gaining weight is another excellent way to improve your odds of getting osteoarthritis.
Four years ago, I was a fat 52 year-old giving my axe a workout down
in my little piece of Australian bush. I was rushing to cut through
a hardwood log before being drenched by an approaching thunderstorm.
Too late, it was a doozy, crashing thunder, lightening and belting
rain. One more blow... and I slipped, my right foot jamming between
fallen tree-trunks. The knee twisted, stretched and then made a horrifying
clunk as it snapped back into place.
Well, those were busy times. I had a kid with his whole leg in plaster
and a wife who had just moved to her dream job in Canada.
I gritted my teeth and got on a plane. Months went by and that damn
knee wasn't getting better. It was getting worse. I became
a master of the art of climbing stairs on my bum.
Physiotherapy helped but, by my own standards, I was crippled.
Standing to make dinner or wash a few dishes had become an
unwelcome pain-wracked chore --- as had many other things that I
used to do without a moments thought or hesitation. I was put on a
waiting list to see a specialist. After about 3 months, the specialist
took a careful look and
said, "we need an MRI". After another long wait I finally got close-up
and personal with an
A week later, I got a phone call. Prophesy fulfilled, I had
osteoarthritis in the medial compartment of my right knee.
Palliative care and an uncertain future
The treatment options from Nova Scotia Health were: "Take
and if you want we can give you a cortisone injection.
If it becomes unbearable, we'll put you on a
1-3 year waiting list for an artificial joint."
I also got a couple of good suggestions about what I could
do to help myself. Keep riding that bicycle, the specialist said.
My local GP also told me to get on my bike
and go down to the weight room and strengthen those
And, as an afterthought: "Don't be a wimp, push through the pain."
Exercise is the sort of advice I like to hear.
I'm a bit wary about pushing through the pain, though.
Cortisone was another matter. I'd had a cortisone shot many years ago
for another injury and it had only made things worse.
Cortisone works by killing off a layer of cells.
I wasn't going down that track.
As for a lifetime of NSAIDs, I wasn't sure what to think.
Every second TV advertisement seemed to be pushing one or the other
of the prominant NSIAD brands as being everyones solution for their
osteoarthritic pain. Nothing makes me more suspicious than advice
from the TV. One great thing about Google is that you can quickly get
at many abstracts of scientific/medical publications.
My suspicions were quickly confirmed.
NSAIDs are purely palliative. NSAIDs do nothing to fix the problem.
NSAIDs may even make things worse in the long term...
and it's all FDA-approved.
No wonder the drug companies push this stuff so hard!
I set my old
up on a
wind-trainer, down the basement.
It was a lot more comfortable than ploughing
through the snow outside. (Oh, sometimes I missed Australia --- so bad.)
At first I could only ride for 5-15 minutes at a time, so the boredom was
not unbearable. Neither was the discomfort in my seat. There is a big
difference between riding on the road and riding on a wind-trainer.
A wind trainer does not give you the same gradient in resistance
and this makes it difficult to relieve oneself from the steady pressure
of the bicycle seat on your rear end.
(For the technically-minded, wind-trainers rely on friction resistance
which scales roughly as speed squared. On the road, inertial
forces play a bigger role and they scale according to change in speed.)
After a few weeks, I was riding longer and the knee was giving me less
grief. I'd limp and shuffle painfully downstairs, ride the bicycle for
20 minutes, then walk relatively pain free up the stairs.
But 20 minutes was getting very boring and my bum was deteriorating
faster than my knee was improving.
Finding a bicycle seat that worked for me was frustrating, time consuming,
and expensive... and well worth the trouble when the job was done.
We are all exceptional in some ways and the thing that is truly
exceptional about me is my feet. My feet are so wide and high that
footwear manufacturers find them too many standard deviations off the
chart to believe.
Years of squashing my feet into ill-fitting footwear has
pinched a nerve.
The more cycling, the better my knee, but the worse my nerve.
Again, I got lucky. For a large fee, I got some
custom-built D2 Cycling Shoes.
Wow! D2 Cycling Shoes seem to have fixed my Morton's neuroma!
(Is that practicing medicine without a licence?)
Well, the sore bum and neuroma problems were solved
but I was still bored out of my skull.
The boredom problem was solved by buying an inexpensive TV.
OK, I can hear you, "but TV is boring". Well, yes, it's brain-dead
boring --- it anaesthetises all higher brain function.
So I made a pact with myself to only watch TV when bicycling.
I'd have to say that was about the easiest pact I ever made.
Soon, I was spinning those wheels for an hour or more every evening
and that was sufficient to immunize myself from any desire
to watch more of the infernal boob-tube. It also
greatly relieved the pain in my knee so that I was able to
free myself from NSAIDs.
I could also sleep relatively pain free, providing
I put a cushion between my knees (that's another trick well worth trying).
I was fighting back.
The body has its limits
Adjusting ones lifestyle to avoid the pain of osteoarthritis is
not the same as being healed.
Anything more than a short walk caused pain.
Pain kept me off my feet.
My greatest functional gain was the ability to drive the car without
pain. Don't laugh, that's a big thing. I could drive into Town and buy stuff
providing I could find a convenient parking spot.
I could pick my boy up after school and even shuffle out to talk, briefly,
with other parents before the knee started to bite.
I started to wonder how exactly the bicycle had worked its miracle and
how much more improvement might be possible?
Well, the knee is just another one of those synovial-type joints.
The movement helps flood the joint with nice warmed-up synovial fluid
and that's a great little lubrication system. Cartilage is really very tough
stuff and even when some of it is missing the joint can be
quite functional --- providing the stress on the joint is not too large.
A bicycle on a wind-trainer puts most of the pressure of your weight
firmly on your bum, instead
of on your knee. One can work the muscles quite hard
without punishing the joint.
Synovial fluid is also the joints transportation system. It squeezes in and
out of cartilage, circulating nutrients, waste products, and
Yep, you read me right, I said repair cells. Not many of them mind you.
It's often said, and truthfully so, that if one puts a scratch on the surface
of cartilage then its like puting a footprint on the surface of the moon.
A lifetime later, it's still there. I don't dispute that for one minute,
but this is not the same as saying that the cartilage remains immutable at
the molecular level or even at the cellular level.
- First we need a picture of the cartillage in our joints.
Cartillage is mostly a whole lot of collagen molecules with a
handfull of cells scattered scattered about.
(Only about 15 thousand cells per cubic millimeter,
Stockwell, R.A., 1971, J. Anat., 109, 411-421.)
Collagen is a protein
molecule that is a bit like rope, it can resist tension but is
very pliable. Like rope, collagen is good for wrapping around things
and it wraps around another molecule called a proteoglycan complex.
The proteoglycan complex is a big molecule and I understand that you
can actually see it's structure under a microscope! I've never
seen it, but I'm asking my biologist wife to get me a decent microscope
if I survive until my next birthday. Until then, I'll just rely on this
visualization of the
proteoglycan complex. Now proteoglycan is a molecule that sucks
up water --- like one of those superabsorbent thingys in the
TV advertisement. So now we have a picture of a superabsorbent
thingy all wrapped up in collagen rope... with water being sucked in
and squeezed out so that it cushions your joint as you walk.
It's a bit like that more recent invention; the shock absorber in your car.
- At the molecular level, those cells scatttered around the cartillage
in my knee have a job to do. Their job is to maintain those collagen
and proteoglycan molecules. I suspect that they are lazy little bastards.
My bet is that pushing that bicycle wheel round sends them a message.
Perhaps it comes from a molecule produced by cells in the
and transported by the synovial fluid? Who knows? I am convinced,
however, that by riding my bicycle I'm telling those lazy little
cells to: Get off your collective arses and make me some
- At the cellular level my ignorance is extreme. The prevailing wisdom
is that once you stop growing, those cells scattered around your
cartillage also stop multiplying. I have my doubts about prevailing wisdom.
I bet sometimes a new cell will grow to replace others that die.
Here's how I picture it:
Measurements have clearly shown
that vigorous aerobic exercise
mobilizes Mesenchymal Stem Cells into the blood stream.
The connection between the blood stream and knee cartilage is small, indeed
it is very very small, but it is not negligibly small.
Mesenchymal Stem Cells (MSC) can become bone cells, muscle cells, or cartilage cells.
I bet a few of those MSC leak into the cartillage and the odd one becomes
a cartillage cell --- perhaps only once in a
Higher concentrations of MSC are found within bone marrow
and microfracture surgery works by mobilizing a very small number of MSC, and other cells, into a damaged
portion of the joint. Perhaps micro-injury from
activity plays a similar role --- albeit with far lesser efficiency.
Exercise reduces weight and that takes strain off the joint.
Exercise strengthens muscles and that helps support the joint.
Perhaps, at a cellular/molecular level, exercise can shift the balance between
repair and decay, ever so slightly.
Unfortunately, exercise could only
get me so far. I was stalled, getting neither better nor worse.
I was a man with a problem. Nova Scotia Health didn't have solutions,
so I would look elsewhere. Building upon the joint replacement option,
I figured, well it's only a part of my joint that has a problem --- so
why not a surgical fix for that? Indeed, there were many options
whereby various plugs,
mechanical devices, and tissue transplants that could be surgically fitted.
For a time, I contemplated
a return to Australia where seemingly advanced treatments were available.
But the more I looked at the surgical options, the less I liked them.
I began thinking that some sort of mechanical exoskeleton would
be a far less drastic next step.
Indeed, I found the exoskeleton option on the web
but I was dismayed. It looked so, well, primitive...
Would it help?
One doctor said yes, the other said no.
I looked for scientific publications, and they said yes.
About two thousand dollars later, I had my
exoskeleton --- fitted by a
very nice physiotherapist.
I found that an exoskeleton helps with function under many circumstances
but it isn't really a solution and can sometimes become a nuisance.
A few years ago I stumbled upon a report where someone had grown cartilage
(for an ear) in a laboratory. Further investigation indicated many difficulties:
the culture needed a high pressure environment if it was to grow strong
and how on earth did you get lab-grown cartillage attached to where you needed it?
Obviously, the ultimate solution would be to grow the stuff
Microfracture surgery pointed to some of the difficulties growing
high-quality cartilage within the joint.
Then, quite by accident, I came across some most interesting publications:
The above publications (
and other published applications of autogolous MSC) make
a convincing case for application of autogolous MSC to treat a range
of debilitating conditions.
Studies using autogolous MSC in animal models
have also given positive results.
There is a lot of good stuff.
Wakitani S, Nawata M, Tensho K, Okabe T, Machida H, Ohgushi H, (2007).
Repair of articular cartilage defects in the patello-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. J Tissue Eng Regen Med. 2007 Jan-Feb;1(1):74-9.
To investigate the effectiveness of autologous culture-expanded bone marrow mesenchymal cell transplantation for repairing articular cartilage defects, we transplanted autologous culture-expanded bone marrow mesenchymal cells into nine full-thickness articular cartilage defects of the patello-femoral joints (including two kissing lesions) in the knees of three patients, a 31 year-old female, a 44 year-old male and a 45 year-old male. Three weeks before transplantation, bone marrow blood was aspirated from the iliac crest. Adherent cells were cultured with media containing autologous serum. Single-passaged cells were collected, embedded in a collagen solution (5 x 10(6) cells/ml), placed on a collagen sheet, gelated, transplanted into the defect and covered with autologous periosteum or synovium. Six months after transplantation, the patients' clinical symptoms had improved and the improvements have been maintained over the follow-up periods (17-27 months). Histology of the first patient 12 months after the transplantation revealed that the defect had been repaired with the fibrocartilaginous tissue. Magnetic resonance imaging of the second patient 1 year after transplantation revealed complete coverage of the defect, but we were unable to determine whether or not the material that covered the defects was hyaline cartilage. Autologous bone marrow mesenchymal cells transplantation may be an effective approach to promote the repair of articular cartilage defects.
R. Kuroda, K. Ishida, T. Matsumoto, T. Akisue, H. Fujioka, K. Mizuno, H. Ohgushi, S. Wakitani, M. Kurosaka, 2007.
Treatment of a full-thickness articular cartilage defect in the femoral condyle of an athlete with autologous bone-marrow stromal cells.
Osteoarthritis and Cartilage, Volume 15, Issue 2, Pages 226-231
Human bone-marrow stromal cells are believed to be multipotent even in adults. This study assessed the effectiveness of autologous bone-marrow stromal cells, which were embedded within a collagen scaffold, to repair a full-thickness articular cartilage defect in the medial femoral condyle of an athlete.
Patient and methods
A 31-year-old male judo player suffering from pain in the right knee was reviewed. A 20×30-mm full-thickness cartilage defect (International Cartilage Repair Society classification (ICRS) grade IV) was revealed in the weight-bearing area of the medial femoral condyle. With the informed consent of the patient, the defect was treated with autologous bone-marrow stromal cells. Bone marrow was aspirated from the iliac crest of the patient 4 weeks before surgery. After removing the erythrocytes, the remaining cells were expanded in culture. Adherent cells were collected and embedded within a collagen gel, which was transferred to the articular cartilage defect in the medial femoral condyle. The implant was covered with an autologous periosteal flap.
Seven months after surgery, arthroscopy revealed the defect to be covered with smooth tissues. Histologically, the defect was filled with a hyaline-like type of cartilage tissue which stained positively with Safranin-O. One year after surgery, the clinical symptoms had improved significantly. The patient had reattained his previous activity level and experienced neither pain nor other complications.
Our findings indicate that the transplantation of autologous bone-marrow stromal cells can promote the repair of large focal articular cartilage defects in young, active patients.
Christopher J. Centeno, MD, Dan Busse MD, John Kisiday, PhD, Cristin Keohan,
Michael Freeman, PhD, and David Karli, MD. 2008.
Increased Knee Cartilage Volume in Degenerative Joint Disease using Percutaneously Implanted, Autologous Mesenchymal Stem Cells
Pain Physician 2008; 11:3:343-353.
Background: The ability to repair tissue via percutaneous means may allow
interventional pain physicians to manage a wide variety of diseases including
peripheral joint injuries and osteoarthritis. This review will highlight the devel-
opments in cellular medicine that may soon permit interventional pain manage-
ment physicians to treat a much wider variety of clinical conditions
and high;ight an interventional caser study using these technologies.
Objective: To determine if isolated and expanded human autologous mes-
enchymal stem cells could effectively regenerate cartilage and meniscal tissue
when percutaneously injected into knees.
Design: Case Study
Setting: Private Interventional Pain Management practice.
Methods: An IRB approved study with a consenting volunteer in which mes-
enchymal stem cells were isolated and cultured ex-vivo from bone marrow aspi-
ration of the iliac crest. The mesenchymal stem cells were then percutaneously
injected into the subject's knee with MRI proven degenerative joint
disease. Pre- and post-treatment subjective visual analog pain scores,
physical therapy assessments, and MRIs measured clinical and radiographic changes.
Results: At 24 weeks post-injection, the patient had statistically significant car-
tilage and meniscus growth on MRI, as well as increased range of motion and
decreased modified VAS pain scores.
Conclusion: The described process of autologous mesenchymal stem cell
culture and percutaneous injection into a knee with symptomatic and
radiographic degenerative joint disease resulted in significant
cartilage growth, decreased pain and increased joint mobility in this patient.
This has significant future implications for minimally invasive treatment
of osteoarthritis and meniscal injury.
Autogolous MSC therapy appeals to my way of thinking because:
I also add that MSC have some very nifty features:
- It actually aims to fix the problem --- whereas all the commonly available
options merely mask the problem, or compensate for the problem,
or replace the problem with an engineered lesser problem.
- It uses MY cells and MY growth factors in MY body to fix MY problem.
In a real sense, THIS IS A SOLUTION THAT I OWN.
Big Pharma must hate it. It's the exact opposite of their business
model, and it actually works!
- The risks are real low because:
- My body is the result of 3.5 billion years of evolution.
My cells have a long history of getting along with each other.
Contrast that with the barbarity of getting body parts from someone else
or engineered implants and being fed designer chemicals from Big Pharma.
- The surgery is at the level of minimally invasive or no more than
a bit of needle work. Contrast that with the scary
extremes of joint replacement surgery!
- They adhere to surfaces, quite firmly, which makes it "easy" to put them
exactly where they are needed.
- MSC are hard-working little beavers as they grow on the damaged surface
but, in the language of population dynamics,
they are self-regulated surface-growers.
That means that they don't grow willy-nilly out of control.
They have their own in-built regulatory system --- and the
MSC regulatory system
works far better than the FDA and all the lawyers in the USA.
- MSC come with their own little localized suppression system, so they
can do their work relatively unimpeded --- but not disrupt the
functioning of other cells. (Contrast this with the incredibly clumbsy
option of a joint replacement, where you will probably need to take
antobiotics, that disrupt your entire body, just to protect the joint from
infection when you get a bit of dental work done!)
- Finally, MSC are multipotent but moderate their own behaviour
so that it remains within reasonable limits. Contrast that with
the politicians, bureaucrats, and special interest
groups that jump on the back of anyone who has the courage to
do something useful!
I started trawling the web looking for stem cell clinics.
There were a few out there that made big claims but they didn't publish
their treatment methods in convincing detail and also failed to
publish the results that they obtained. (Perhaps I shouldn't say "failed",
more that I couldn't find evidence of credible publication.)
Eventually, I "discovered" Regenexx
They seemed like a relatively open outfit, compared to all the rest.
Practitioners that publish, wonderful!
Before getting too excited, it's always worth doing a back-of-the-envelope
calculation to check whether or not a treatment passes a basic sanity
The Regenexx proceedure isolates MSC from
a 60 ml bone marrow draw and cultures them to yield about 5-100 million
MSC for re-injection.
Let's estimate how many MSC are required to
fix a cartilage defect that
is 2.5 mm deep and 10 mm wide and 10 mm long.
Well, measurements show that each cubic millimeter of cartilage has about
15000 cells scattered amidst a lot of collagen.
Let us assume that all the MSC cells construct a little house
for themselves out of proteoglycan complex wrapped up with collagen rope
and then turn themselves into a cartilage cell.
That means we would need
2.5x10x10x15000 = 3.75 million MSC.
This number compares favourably with the 5-100 million MSC cells that
the Regenexx procedure makes available for re-injection.
Of course, some of the injected MSC might be duds or some might
reproduce further within the joint --- who knows?
Regardless of complicating details,
I figured Regenexx passed my back of the envelope sanity calculation.
Nevertheless, I was extremely cautious and I hovered around on the web
checking out Regenexx
for the best part of a year --- studying all the good stuff and well as all
the muck. I stayed totally on the outside, looking, never speaking.
Everyone who does anything of consequence will be criticized.
Dr Centeno seemed to answer his critics with remarkable poise.
(If I'd been in his position, I would have gone straight for the jugular.)
Probably the most common criticism was the lack of a large
double-blind comparative study.
Being a scientist, who has published across several disciplines,
this is an issue that I can address, albeit briefly.
Television and radio frequently report large studies where this or that
drug or disease has been studied by comparing the responses of large
numbers of people who have been divided into two (or more) groups that have
received different treatments.
Large numbers of people and dollars are an excellent
way of catching public attention.
The public (and FDA?) seems to have been conditioned to think that this is the
only way to scientifically address a medical question.
Indeed, such studies can be the best way to address
most questions that arise in some scientific disciplines.
Specialists often make the mistake of thinking that their favoured methods
are "the best method". It's human nature, if your only tool is a hammer
then every problem is a nail.
The scientific method is not so single-minded.
A good scientist adapts his/her methods to the problem and knowledge at hand.
When Big Pharma comes up with some new drug they routinely do large
double-blind tests. They have to. That's because they are introducing a foreign
pathogen into extremely complex machines (your bodies) and
all of those machines are different, and they all have a 3.5 billion
year history that we have barely begun to know and probably
will never really know.
Treating you with your own MSC is a very different matter, as previously
Do you really need to test a new drug/treatment on a huge number of people before
you can have have confidence in it? Yes and no, for at least two reasons:
- The drug might have many unknown and very different side effects
with different people. Given that everyone is different,
you need to test the drug on lots of people
in order to estimate its safety. Further, you need to test it for a
long time because problems may take a long time to develop.
These things are obviously much less likely to be an issue
for autologous MSC.
- The number of measurements depends very much upon what is actually being
measured. Let's compare two topical examples:
- The Zambosi treatment for Multiple sclerosis (MS)
treats a disease that has a huge variety of symptoms that often
come and go to varying degrees from time to time for reasons that
are poorly known.
Further, the connection between symptoms and some physical metric
that can be objectively measured is, at best, tenuous or not even
possible. There is no mechanistic understanding for this disease.
Really, all that is known is just a mish-mash of syptoms and these
symptoms can be quite different for different people and can
wax and wane in unpredictable ways.
So, when Dr Zambosi "unblocks" a vein and the patient says "I feel
better" we really don't know what to think. The treatment is not
connected to the disease by some well understood mechanism.
Some symptoms don't even seem to lend themselves to objective measurement.
Changes in the symptoms of the disease are difficult to measure
in any objective way. Perhaps one can assess such fuzzy data by
making a huge number of measurements on many patients who have
had the treatment and making a comparison with patients who have not
had the treatment. Perhaps one can compare measurements made
before and after treatment. Obviously, to assess this treatment one
needs to measure the outcomes for many people over an extended period.
Frankly, even a large data set may not really provide a
scientifically satisfactory understanding of
the Zambosi treatment and MS.
- OK, now let us consider the Regenexx/Wakitani/Kuroda
autologous MSC treatments of people who
have knee pain subsequent to some traumatic injury. We have an
MRI that shows cartilage damage consistent with the trauma and
pain. There is a clear mechanistic connection between unambiguous
symptoms, a physical cause, and an objectively measurable
physiological defect. If a dozen knees are treated and in each case an
MRI shows the defect is diminished and the pain subsides and
function is restored then we know that we have a viable treatment.
Heck, in one case we even have histology to back up the MRI!
Remember, a scratch on the
cartilage is like a footprint on the moon.
We know damn well that such injuries don't spontaneously heal
themselves (at least not in adults).
Any reasonable person would say that the
autologous MSC treatment has a good scientific basis.
In my non-specialist scientific view, enough was known to begin
the practicable application of MSC
to treat some osteoarthritic problems and a variety of common injuries
that often degenerate into osteoarthritis.
Also, I'm thoroughly convinced that present therapies will be greatly
improved upon by experience gained
through clinical applications of MSC.
In this sense, by becoming a patient at an MSC clinic, I would also be
a guinea pig. But I would be a knowledgable guinea pig with a very
real chance of getting a positive outcome and a very low chance of
suffering harm --- compared to the damage done by cortizone, or even NSAIDs.
I'm not a medical practitioner.
I sought advice from my local GP and the specialist who had diagnosed me
(and helped push me onto my bicycle).
They were both interested and supportive but plainly
admitted the limits of their experience.
The Regenexx cultured MSC therapy seemed to offer a good chance
of a postive outcome without burning any bridges.
Above all, Dr Schultz and Dr Centeno were not just practitioners,
they were researchers. I knew enough about their
methodology to have confidence that it was scientifically respectable.
My participation in their program, even if it didn't help me, would
make a small contribution towards advancing the state of the art.
I checked my bank balance and started filling out forms...
My application, MRI, and various other reports were assessed
by Dr Centeno. I was assessed as a "Fair Candidate".
The basic plan, draw some marrow
and try to culture enough MSC for three re-injections.
I travelled from Halifax to Chicago and on to Denver on 4 April 2010.
I flew United Airlines because they break guitars.
The next morning, oh too early, I was at the Centeno-Schultz Clinic.
I've never been stuck with so many needles in such quick succession.
Blood samples, prolotherapy, IMS, and then the bone marrow draw.
Dr Schultz is an expert needle man so it wasn't anywhere near as bad
as you are imagining.
I was sent off with instructions to get IMS therapy for the neuro-muscular
knots in my thigh and prolotherapy for all those stretched ligaments
in my knee.
Upon arriving back home, I discovered that prolotherapy wasn't well regarded
by the local medical system. IMS,
being a Canadian invention, seemed to be held in higher regard.
That being said, in the whole of Nova Scotia there was only one guy who did it.
I must say, that IMS treatment was real helpful... although not for wimps.
Since getting my muscles unknotted, I'm now careful to give myself
a deep massage from time to time. (I know, I should get someone else to
do that, but she's always too busy.)
Meanwhile, Regenexx was busy helping my MSC to go forth and multiply.
Multiply they did, enough for two re-injections.
Eventually I managed to find a bit of spare time for myself and on
24 June 2010
I flew back down to Colorado to reclaim my body-parts.
This would be a longer stay. I had prolotherapy on the 25 June
and waited until 30 June to get my MSC re-injected.
With time to kill, I checked out a Better Bodies gym that was only a short walk
from the hotel.
They gave me a free pass for the week. So I'm giving them a rave.
Better Bodies is the best gym I've ever worked out in!
When not at the gym, I used my time alone to focus and solve
a computational fluid dynamics problem that had been bugging me for a couple
Even without the re-injection, it would have been a successful trip.
The re-injection procedure was straightforward. I didn't have my glasses
on, so I only got a blurred look at those little MSC before they were
painted on one of the bald spots where there was full-thickness chondral loss.
We'd paint the other bald patches on another day.
After a couple days taking it easy, I flew home.
Once home, I got back onto the bicycle, vacuumed up large doses of
Collagen MD, applied heat to my knee in spare moments
(no more than 30 minutes at a time), and waited to get better.
Now here I have to confess a couple of personal shortcomings.
I'm not much good at changing my routine.
I couldn't use the infra red heat pad when I was working
because I'd forget it was there and end up overbaked.
Most days, I managed to set aside a half hour of quality time
with the dear little the infra red unit, but not always.
By late August I had noted improvements to my knee.
I could stand for much longer without pain so kitchen work was
a nuisance but not dreadful.
Walking the dog had become almost enjoyable!
A couple of times, while watching my boy play soccer, I felt myself on the
edge of breaking into a run.
There was improvement but it is the sort of improvement
that only Old Crocs
might appreciate. I was far from "healed".
I became anxious to get my next re-injection.
Of course, I only had enough cultured MSC for 1 more re-injection
and it had always been clear that I would need more than that.
I figured I'd make an appointment to get another bone marrow draw
along with my re-injection. If Regenexx could culture up enough cells
for another 2 or 3 re-injections, heck, I might even be able to get
my torn rotator cuff patched up. (The rotator cuff is another story
for another day.
Suffice to say that strengthening exercises maintain most function
but don't actually heal the problem.)
Thwarted by bureaucrats
So I sent a message of to Jen to see if she could get shuffle me in
for treatment. Checking my email, late at night,
I read her reply. It knocked the wind right out of my sails!
FDA and Regenexx were locked in a
According to FDA my cultured autologous MSC were drugs!
OK, to be honest, I should have been more prepared for this outcome.
From early times it seemed that FDA had been confused as to what, exactly,
a drug was and what exactly they should be doing about
cultured autologous MSC therapies.
I saw all the stooges trolling around the web
--- you can recognize them by the slime they leave behind --- making
idiotic claims that culturing autologous MSC turns it into a drug.
It seems that the FDA has made the mistake of believing such drivel!
FDA takes the position that when
my MSC are grown in an extract of
my blood then my MSC become drugs.
Well, I might agree if my MSC were injected into someone else.
But they are being re-injected into me!
For crying out loud, why can't the
FDA tell the
difference between a
homecoming and a
Look here Mr FDA, this is how I tell the difference between a drug and
my body parts.
Don't get me wrong.
I think that all aspects of medicine should be subject to
some sensible measure of regulation.
Regulation should, however, be relevant to facts and outcomes.
My MSC, presently on-ice at Regenexx, are not drugs.
It is farcical to regulate my MSC as a drug.
- My body is a complicated machine with many many parts. All the parts
evolved to work together over 3.5 billion years! My machine is unique,
others may be vaguely similar but none are at all the same!
- A drug is manufactured material that is foreign to my body.
A drug need not be manufactured within a laboratory
in order to be a drug. Foreign chemicals can be introduced into my
body and then combine within my body to create a drug --- perhaps
one that gives me a headache, perhaps something worse.
- In short, it is not where the manufacturing happens that makes
something a drug.
- What makes something a drug is how it relates within the scheme
of 3.5 million years of evolution that produced all those things
that cooperate together to make up my unique body.
- MSC are part of my body. If a single MSC is cultured using growth factors
obtained from my blood then it might divide into two MSC.
Both MSC are mine. Both MSC are wonderfully
self-regulated when put back into my body.
Neither of them will be foreign to my body. Both of them carry
my unique genetic code and no one elses.
Two of them might get a repair job done that one couldn't.
As far as I'm concerned, the facts and the outcomes
should determine the rules.
FDA behaves as though
outcomes are nothing and procedures are everything.
I only hope that Courts and politicians can imbue
bureaucratic procedure with a little more scientific sense.
Remember I said the "the ultimate solution would be to grow autogolous MSC in vivo".
Seems that is what Regenexx is going to do.
I'll be giving that a go. In the words of the Terminator, "I'll be back".
FDA, take a pill and bug out!
Look, I am a prematurely broken down old crocodile.
It would take a miracle to cure me.
I'll be real happy with a patch up job that lets me be a bit more
active and keeps me away from the surgeons knife.
It would make much more sense for young people to get
autogolous MSC therapy when first they are injured rather than waiting
20-30 years for them to prematurely degenerate into old crocs.
All these old injuries cost a fortune in lost productivity and
joint replacements. In the very near future it should be far less
expensive to fix the problem early using autogolous MSC therapies.
Insurance companies (and Canadian taxpayers) should be jumping with joy!
It seems that MSC do better in patients who exercise.
In a very real sense, the message of autogolous MSC therapy
is: You can heal yourself, with a little help from Regenexx.
What a wonderful philosophical break from the pill-pushing
antics of you know who!
Reverse Medical Tourism
Scientifically, it is obvious that the autogolous MSC therapies have
a real future.
Bureaucratically, the FDA seems to be determined to crush autogolous MSC therapies in USA.
This opens up opportunity for other nations to profit.
Whichever nation can provide a competent regulatory framework for this
entirely revolutionary type of treatment will stand to profit handsomely.
Perhaps can we encourage Regenexx to set up a laboratories and clinics in
Or perhaps they might be persuaded to set up in one of my other homelands:
New Zealand or Australia?
Regenerative medicine is much more sensible
than more expensive options like knee-replacement surgery or
nursing a nation of cripples and feeding them palliative drugs.
Regenerative medicine is the future and the future is now. Do it!
Interesting URL's from Australia