There are a number of misconceptions that have continued to propagate themselves. Perhaps the first of these legends is that we are not really performing stem cell therapy. When we are typically utilizing bone marrow aspirate we are using the “soup” of the bone marrow. To say that we are doing a stem cell transplant is not really accurate. Granted there are stem cells in the aspirate but the majority of cells we are transplanting are not stem cells. These cells include a host of many different types of cells which work in concert to achieve regeneration. I myself am guilty of calling these procedures stem cell transplants as can be seen later on in this blog.
Another misconception is the fact the one can not take anti-inflammatories when utilizing Platelet Rich Plasma (PRP) injections. This idea came about from the premise that the anti-inflammatories (NSAIDs) will interfere with the platelet function. This is simply not the case. When we are dealing with PRP injections and utilize NSAIDs this will affect the clotting of the platelets but not the release of growth factors which is what we desire. We must realize when we are doing a PRP injection we are not concerned will clotting but the release of growth factors. The growth factors are released when the platelets come in contact with collagen which is found in most tissue. So we can see that anti-inflammatories will have no significant effect in the function of a PRP.
There is another concept out there that red blood cells cause significant inflammation in the joint, tendon, or soft tissue. There really are not many good studies that will back up this misconception. There are several good clinical examples on how red cells do not seem to make a difference. One striking example on how this is not that significant comes from an orthopedic procedure called a micro-fracture technique. This is a arthroscopic technique used in the treatment of osteoarthritis.
In this technique holes are made in the joint surface when there is no longer any cartilage (bare bone). The idea is that some stem cells will “leak out” from the bone marrow and help to grow new cartilage. This is the precursor to many modern day “stem cell” procedures that are performed for musculoskeletal joint conditions. The significance of the micro-fracture is that the bleeding from the holes will the joint fill up with whole blood which has a large number of red blood cells. The blood in the joint does not typically cause an inflammation. Another example of red blood cells not causing inflammation is when a patient suffers an injury such as a torn anterior cruciate in the knee. This will produce a good bit of bleeding in the knee resulting in what is called a hemarthrosis. This blood in the knee does not cause an inflammation. Furthermore when the blood is removed the pain (caused by pressure) goes away. The last example is when someone has a spinal tap and they continue to have a headache from a spinal leak. The method to eliminate this problem is to take blood from a vein and inject it into the spinal canal so that it is in direct contact with the spinal cord. It plugs the hole but it does not cause an inflammation to the spinal cord. Would it make sense to put something that causes inflammation next to something as delicate as the spinal cord? As can be seen there is some good clinical evidence that red blood cells cause no inflammation yet little if any studies that show otherwise.
Another myth concerns supplements. When I first become involved in performing PRP and “Stem Cell” injections I had enough ridicule from the fact that I was involved in this science. Even more ridicule was laid upon me from the fact that I was advising the use of supplements. Many people involved in this field also feel that supplements are of no importance. Like usual I like to look toward the world of science to see the true value of supplements. One need to look no further than certain supplements that we advise to our patients. There is solid science behind these supplements. One supplement which we use is StemXcell. This is a supplement that was born out of the laboratories of the Univ. of South Florida. This supplement was show to significantly increase the number of a certain type of stem cell from the bone marrow. Another supplement is Neo-40 which hails from the labs of the Univ. Texas. Neo-40 has been shown to dramatically increase nitric oxide levels in the body. Taking this one step further we know that increased levels of nitric oxide have many different effects including the release of stem cells. The list of supplements goes on and on.
The last myth i would like to address is the use of hyperbaric oxygen. There is still a misconception that hyperbaric oxygen works mainly by donating extra amounts of oxygen to the cells. This is not really the case. The true mechanism of hyperbaric oxygen is that it will dramatically increase nitric oxide release which in turn significantly increases stem cell release. The stem cell release is what heals the diabetic foot ulcer or other problem that is being treated.
Hopefully this blog will clear up some misconceptions that keep cropping up. I am sure that there will be many more to come. Thanks DR. P