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New Treatment (in USA) Available Soon
Old 04-24-2011, 12:01   #1
swatsurgeon
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Exclamation New Treatment (in USA) Available Soon

I have the good fortune of being an experiment for my trauma orthopedic surgeon.
I tore several tendons in my right elbow several years ago, did the standard: PT then 2 cortisone injections then a very long and difficult surgery reattaching several tendon and rebuilding part of the annulus of the radius...long story short, it was FUBAR'ed, acute on chronic injuries. The post op recovery kept me out of surgery for 2 months, rehab sucked and now it works fine but if re-injured, we've burned the bridges and would need cadaver parts to rebuild it.
So recently the left elbow has the same thing....lucky me. My new ortho out here in PHX, shows me a European Journal article about a non-FDA approved treatment with a 90% success rate of avoiding operative repair at 1 year!! The US literature has about a 40% success rate for avoiding surgery, so I was interested to say the least. The process is to take 30mL of your blood, spin it down to separate the components, take the platelet rich plasma off and inject that (about 4 mL) into the injured area.....OH MY GOODNESS PAIN (10:10) despite lidocaine before the injection....a blow torch sensation was about right....2 days of torture then it settles down to a 5:10 pain which is baseline for me recently. Can't take antiinflammatories because the
injection is meant to inflame and heal the injuries....Platelet derived growth factors and ? stem cells?? like reaction in the joint. The nice thing is that it should be FDA approved by summer and available for all joint areas....very expensive but high probability of avoiding surgery = a deal for me.

So wear the brace and limit motion for a month...no stressing the joint, but can use the arm, just no lifting, etc and the injected joint is still swollen and limited with range of motion. By 3 months you generally know if it worked.
Hopefully, if it does work, it will be available to fix severely injured joints/tendon lacerations, detachments/bursitis, chronic inflammation,etc.

Will post updates as they occur. I love being an experiment!!

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 04-24-2011, 12:53   #2
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Quote:
Originally Posted by swatsurgeon View Post
I have the good fortune of being an experiment for my trauma orthopedic surgeon.
I tore several tendons in my right elbow several years ago, did the standard: PT then 2 cortisone injections then a very long and difficult surgery reattaching several tendon and rebuilding part of the annulus of the radius...long story short, it was FUBAR'ed, acute on chronic injuries. The post op recovery kept me out of surgery for 2 months, rehab sucked and now it works fine but if re-injured, we've burned the bridges and would need cadaver parts to rebuild it.
So recently the left elbow has the same thing....lucky me. My new ortho out here in PHX, shows me a European Journal article about a non-FDA approved treatment with a 90% success rate of avoiding operative repair at 1 year!! The US literature has about a 40% success rate for avoiding surgery, so I was interested to say the least. The process is to take 30mL of your blood, spin it down to separate the components, take the platelet rich plasma off and inject that (about 4 mL) into the injured area.....OH MY GOODNESS PAIN (10:10) despite lidocaine before the injection....a blow torch sensation was about right....2 days of torture then it settles down to a 5:10 pain which is baseline for me recently. Can't take antiinflammatories because the
injection is meant to inflame and heal the injuries....Platelet derived growth factors and ? stem cells?? like reaction in the joint. The nice thing is that it should be FDA approved by summer and available for all joint areas....very expensive but high probability of avoiding surgery = a deal for me.

So wear the brace and limit motion for a month...no stressing the joint, but can use the arm, just no lifting, etc and the injected joint is still swollen and limited with range of motion. By 3 months you generally know if it worked.
Hopefully, if it does work, it will be available to fix severely injured joints/tendon lacerations, detachments/bursitis, chronic inflammation,etc.

Will post updates as they occur. I love being an experiment!!

ss
Hopefully this works well for you.

Growth factors and cytokines yes; stem cells, no. Those are in the buffy coat with the white and other nucleated cels.

Looking forward to your follow up.
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Old 04-24-2011, 16:34   #3
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I wish you the best SS. I'm wondering if the pH of the injectate was altered enough to make the Lidocaine useless?? I also wonder if this will cause and adhesive changes in the joint, or change the surgical approach should that be down the road for you? I hope that this does not keep you out of the OR for too long. Keep us posted, this is really interesting.

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Old 04-24-2011, 19:50   #4
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I wish you well. I'm also shaking my head in disbelief. 22 years ago I watched a veterinarian inject a horse with (its own) blood extracted from a neck vein for exactly the same reason - to excite inflamation and "trick" the body into accelerating the healing process. When I questioned her (that's really why I was there ) she quoted an English Equine Vet manual from the 1880's (lot's of strange things in that one - wish I could remember the name but she had an American reprint from the 20's IIRC that she showed me). No centrifuge involved - it was whole blood - but remarkably similar in method and purpose. Fascinating that it's now available from Europe for humans.
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Old 04-24-2011, 20:19   #5
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Quote:
Originally Posted by Peregrino View Post
I wish you well. I'm also shaking my head in disbelief. 22 years ago I watched a veterinarian inject a horse with (its own) blood extracted from a neck vein for exactly the same reason - to excite inflamation and "trick" the body into accelerating the healing process. When I questioned her (that's really why I was there ) she quoted an English Equine Vet manual from the 1880's (lot's of strange things in that one - wish I could remember the name but she had an American reprint from the 20's IIRC that she showed me). No centrifuge involved - it was whole blood - but remarkably similar in method and purpose. Fascinating that it's now available from Europe for humans.
I believe they are doing whole blood injections for, among other things, cosmetic procedures as an alternative for Botox now.
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Old 04-25-2011, 00:22   #6
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If you could take a guess about how it would work with osteoarthritis of the spine and DDD, I'd like to hear more about this procedure.
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Old 04-25-2011, 17:22   #7
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Best wishes on your recovery, swatsurgeon. I hope this works out for you!
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Old 04-25-2011, 17:36   #8
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Originally Posted by PedOncoDoc View Post
I believe they are doing whole blood injections for, among other things, cosmetic procedures as an alternative for Botox now.
We have been doing this for decades to treat post dural puncture headaches, aka spinal headaches. 30 ml of the patients blood injected into the epidural space at the site of the dural puncture. I've not seen one fail if the diagnosis is correct.

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Old 04-25-2011, 18:53   #9
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Originally Posted by Red Flag 1 View Post
We have been doing this for decades to treat post dural puncture headaches, aka spinal headaches. 30 ml of the patients blood injected into the epidural space at the site of the dural puncture. I've not seen one fail if the diagnosis is correct.

RF 1
Isn't that commonly called a blood patch?

TR
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Old 04-26-2011, 20:33   #10
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yes, that is a standard blood patch, what I had was just the platelets in serum.
This type of technology has been used in spine surgery...when I was doing the anterior exposures of the spine for a neurosurgeon, he would routinely aspirate bone marrow and mix it with autologous bone and pack it into the fusion area for a better /faster fusion around the implanted device.
Injecting it into a working joint for osteoarthritis may cause fibrosis, but I'm not an expert in this field. My use is to fibrose the torn tensons in the hopes of avoiding surgical repair.

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 04-26-2011, 23:54   #11
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Quote:
Originally Posted by swatsurgeon View Post
So wear the brace and limit motion for a month...no stressing the joint, but can use the arm, just no lifting, etc and the injected joint is still swollen and limited with range of motion. By 3 months you generally know if it worked.
All the best to you, ss.....I'm sure you'll make a fine, overachieving guinea pig.

So what kind of desk jockeying (online shopping for more knives) do you have to look forward to as you "limit motion for a month"? Or will you still be somewhat functional since you are right-handed...
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Old 04-27-2011, 15:49   #12
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learn to overcome.....and achieve the stated objective, demonstrate leadership, teamwork, creativity, and buy more knives!!

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 04-28-2011, 06:29   #13
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SS,
The Physiatrists at our practice have been using the process for about 8 months with varying success. This is totally anecdotal. Their most successful pt's seem to be the ones that have been the least injured. I.e. the tendonitis, bursitis seem to do well whereas the more traumatized the tissue the less likely it is to help. Unfortunately I don't have any numbers for you and am not sure if and or when they will publish their results. I do know that in my foot and ankle clinic we seem to get the failures for plantar fasciitis and achilles tendonitis. A surgeon with upper extremity issues can be in a bad way. I wish you all the best. If I hear of any consistantly successful protocols I will get them to you. Good luck.
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Old 05-11-2011, 15:02   #14
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update time....
it's been 3 weeks since injection and significantly limiting use and range of motion. Some days it feels better and some days it hurts. The information we read about is that you need to give it 30 days of little/no use and 2 months of limited use and then you see whether or not it worked.
I can now say I have experienced, from this, the entire pain scale range of 10 out of 10 to a 1 out of 10. The last week it's about a 3:10 whereas the first 2 days it was a 10:10, a blow torch on the elbow is the best description i can use.
I was hoping for more constant relief by now (I still get flairs of pain to 6-7:10 in the joint) but time will tell. I'm not ready to tell everyone to go get this done for tendon injuries but after the 3 month mark, I'll let everyone know if it's a success or a way to delay surgery.

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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update
Old 05-12-2011, 10:28   #15
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update

Thanks for the update. Wish the news were better but, the verdict is still out....
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