Sunday, October 12, 2014

Proposition 46 Jeopardizes California Medical Excellence

California offers its citizens excellent health care.  It has over 100,000 hard working physicians dedicated to taking superior care of their patients in conjunction with well-trained nurses, medical assistants, technicians and support personnel. (Ref)  According to US News and World Report, 17 of California's hospitals are nationally ranked in specialities such as oncology, cardiology and orthopedic surgery.  Fifty-six other hospitals meet standards for strong performance within the state. (Ref

Proposition 46 is a direct threat to our superior California healthcare.   It would undermine a physician’s ability to best care for patients and result in dramatically higher costs—$9.9 billion annually according to one study (Ref)   Doctors already concerned about malpractice would face increased pressure to practice defensive medicine.  If this measure passes it will also be difficult to recruit and retain specialists who are in high risk specialties including OB/GYN, trauma surgery and neurosurgery. 

Proposition 46 further creates a disincentive for physicians to implement novel solutions to challenging diseases.   Medical innovation is needed to attack arthritis, cancer, diabetes, and the emerging Ebola epidemic.  If Proposition 46 passes, physicians will be less inclined to pursue new transformative solutions for fear of being sued and medical innovation will stall.  Instead of California physicians and hospitals being recognized as worldwide leaders in medicine, we may no longer be able to offer patients cutting-edge care within our state.   

Unfortunately, many Californians are unaware of the significant issues that will arise if Proposition 46 passes.  Over the past several months, I have had discussions with dozens of people about 46 and have been surprised at how little they know about this onerous proposition.  Their lack of awareness is frustrating because the trial lawyers completely understand the implications of the proposition they drafted.  As we approach the upcoming election, I strongly urge California residents to read and analyze proposition 46.    Prop 46 Info

One concern imbedded in the proposition that should be addressed is the need to curtail multiple prescriptions from being written and filled by deceptive patients.  The solution to this problem is not to pass the three-headed monster known as Proposition 46.  The better answer is to improve tracking technologies such as CURES that eliminate duplicate prescriptions from being ordered or filled at a pharmacy and at the same time increase the criminal penalties for patients that fraudulently try to  
obtain multiple narcotic prescriptions.

If you wish for California to maintain its worldwide leadership in the delivery of outstanding medical care, I urge you to Vote NO on Proposition 46.


Friday, October 03, 2014

Survivor Blood to be used as an Ebola Treatment

The Ebola epidemic is spreading and there is no cure.  Treatment options even in the United States are limited because there are no approved drugs and even the supply of experimental ones have been exhausted.  (See Washington Post Article)

Is it possible that blood could cure Ebola?

That is exactly what the New York Times (read full article here) is reporting as a possible treatment.  The concept is actually pretty simple.  Patients who have been infected with Ebola and survive develop antibodies to the virus.  These virus destroying proteins live in the serum of the blood.  A transfusion of serum or perhaps even whole blood may be the best option as a stop gap measure to treat the expanding number of patients with the disease.  The World Health Organization even has a specific guidance document on the topic.  (WHO convalescent blood for Ebola)

In this space over many years, I have discussed how to use blood therapeutically for regenerative medicine.  Discussions about platelet-rich plasma, bone marrow concentrates and stem cells from peripheral blood have focus primarily on orthopedic injuries and disorders.  Blood as a treatment for Ebola will receive more attention in this blog.  Anyone with blood expertise of any kind should do whatever they can to help.  Please post comments or send me information about how blood is being used to treat Ebola:   @bloodcure on Twitter.

The potential restorative powers of blood are considerable and if it is possible to stop the epidemic or at least slow it down by using the serum of survivors as a treatment, we should do everything we can do execute on that strategy in addition to pursuing containment, supportive care, and experimental drugs.

AM
TotalTendon

Wednesday, October 01, 2014

Concussions and the Michigan Football Program

Was he briefly knocked out?

It is appalling what happened on the Michigan football field last weekend.  A young man, quarterback Shane Morris, already suffering from an ankle injury, gets absolutely rocked by a blitzing defender.  The video shows how Morris's head snaps back and he falls to the ground like a rag doll.
(Detroit Free Press Article with videos)

It is absurd to excuse anyone on the Michigan sidelines for not knowing that Shane Morris may have had a concussion on that play because a major roughing the passer penalty was called.  He was also clearly staggering.  I am a double Michigan alumni (BS, MD) and love the school and its athletics.  I have also been on the sidelines of many high school, collegiate and professional football games as one of the team physicians.  The reason the physicians are there is to watch the game and scan the players for any real or potential injuries during or after each play.  It is difficult to understand why a serious roughing the passer penalty was not a clear indication for Morris to be evaluated especially before reinserting him into the game.

It is equally amazing that Hoke did not know about the potential extent of the injury the day after the game.  He may be incompetent as a coach given Michigan's record over the last few years but he is clearly dangerous when it comes to executing his responsibilities to protect his players.

What is even more telling than the even the video are still shots from the video.  

Initial Hit

Head Snaps Back

Clearly he sustained some head trauma


At the very least, Michigan needs better injury procedures in place and a coach that isn't frankly dangerous to his players' short and long term health.







Tuesday, September 23, 2014

PowerKnee Hamstring Stretch Video

Hamstring stretching is crucial for your knee and overall leg function.  Too often this simple exercise is ignored or done only occasionally.  In order to improve flexibility and function of your knee, hamstring stretching should be done multiple times per day.

The video below is a simple one minute instructional video about how to perform the PowerKnee Hamstring Stretch.  It is demonstrated at a track but this stretch can be done by simply placing your foot and leg on a chair, step or other support.  



Check out the video  for details about how to perform the PowerKnee Hamstring Stretch,  As always, please consult your personal physician prior to beginning any exercise protocol.

AM
TotalTendon


Sunday, September 14, 2014

Kobe returns to Germany for another Knee Arthritis Treatment

KobeTeam.com
Kobe Bryant returned to Germany this past week to be treated with a blood derived treatment (Orthokine) again for his knee.  He has had this treatment in the past at least twice before.  It involves drawing blood and incubating it over a 24 hour period and then reinjecting a component of blood that has anti-inflammatory properties.  It is similar but not exactly the same as platelet-rich plasma therapy.  It would be most interesting to learn about how this has helped him over the years and in what specific ways. He clearly has thousands of miles of basketball on his knees and is also recovering from multiple other injuries.  We do not, however, have any data about the status of his knee cartilage or joint before or after any of these treatments.  Here is a detailed description of the "Orthokine" treatment.  

Kobe has with his travel and his wallet voted in favor of this treatment.  It will be quite interesting to see how he plays this year in the NBA.   It will also be instructive to follow Kobe's future medical interventions as a way of measuring the value of the one he just had in Germany.

Tuesday, September 09, 2014

Biologic Orthopedics, Forbes, Sports Illustrated and ESPN



This week the Rothman Institute in Philadelphia has organized a meeting dedicated to exploring biologic orthopedics and sports medicine in a unique format.  The group has invited researchers and clinicians from around the world to participate with elite media representatives from Forbes, Sports Illustrated, and ESPN among others.  Dr. Noriyki Tsumaki from the the 2012 Nobel Prize winning CIRA Center in Kyoto Japan will also be lecturing.  Discussion about the FDA regulation and economics of biologic orthopedics will also occur.

Stem Cell and Biologics in Sports Medicine Summit

The meeting represents a special opportunity to bring together a unique group of individuals that are interested in how to best treat tendonitis, arthritis and other orthopedic conditions with stem cells, platelet rich plasma and other biologic therapies.  The moderators of the scientific panels will be editors from world renowned publications.  I expect to have spirited discussions about the state of the art in 2014 in addition to perhaps identifying novel pathways that lead to transformative treatments for professional, collegiate and weekend warrior athletes.

I will report my finding in this space and will tweet out real time information via:  @BloodCure

AM
TotalTendon



Monday, September 01, 2014

Why patients are seeking out platelet rich plasma and other biologic treatments.


Platelet rich plasma (PRP) and adult stem cell treatments derived from bone marrow are rapidly evolving into the mainstream of medicine.  As you can see from the chart above, the number of hits for "platelet rich plasma" is rising dramatically.  There are also over 7400 PRP references on PubMed.org.  Let's explore why.

Patients are seeking out less invasive treatments.  When presented with the option of surgery or an office procedure, patients typically will choose the office procedure.  Surgery often carries significant more risk and certainly more cost.

Patients want to return to sports, work or life as quickly as possible.
Botox and Lasik eye surgery provide patients with almost immediate improvement for wrinkles and vision.  Patients now expect other specialities to deliver similar almost instantaneous success.   Elite athletes are especially interested in returning to the highest level of function as quickly as possible.  They have been one of the primary drivers of PRP and other biologic treatments.

Patients are dissatisfied with the surgical treatments we have been offering them.
This is particularly true when it comes to knee arthritis.  Presently, there is very little definitive evidence supporting the use of many common treatments and there is a Grand Canyon size hole in our ability to effectively manage tens of millions of patients.  Biologic therapies will likely fill this void within the next five years.

Patients intuitively understand the regenerative abilities of your own blood and bone marrow.  Evidence is mounting across a several specialties supporting the use of blood and bone marrow to treat a variety of conditions.  A new study will begin this fall evaluating the utility of giving Alzheimer's patients blood transfusions from healthy volunteers under 30.  (Stanford Blood-Alzheimer's study)

Patients are willing to be treated without perfect supporting data.
Patients do not often understand the need for large clinical trials and are impatient with the time and effort it takes to generate meaningful clinical data.  The use of their own blood (PRP) or bone marrow simply make sense to them and they are willing and often eager to try a new treatment instead of undergo surgery.

We are presently scrambling to figure out how to develop, execute and pay for the clinical trials needed to best understand how to utilize biologic orthopedic therapies.  The good news is:  hundreds of clinicians, researchers and medical device professionals are working diligently on dozens of new treatment options.

Please post any comments about why you may think patients and clinicians are using PRP, stem cells or other biologic treatments.

AM   (@BloodCure on Twitter)
TotalTendon

Friday, August 08, 2014

Billion Second Challenge

“Billion Second Challenge” 
How would I live if I treated every second as precious? 

This is a post about time, not regenerative medicine.

A shiny crimson card was waiting in my snail mail pile when I returned from a special birthday vacation.  I actually had to Google “AARP” to confirm the acronym stood for “American Association of Retired Persons”.  Did this new piece of bloody colored plastic mean I am now “retired”?  Or, did it simply confirm I am officially old and beyond the highly desirable 18-49 demographic?

I quickly picked a number out of the air and said to myself, I’ll make it to 85 years old.  That would mean I have about 35 years left. That is 12,775 days, 306,600 hours, 18 million minutes or about 1.1 billion seconds.  It turns out the Social Security Actuarial Life Table pegs my remaining time at 29.45 more years or about 928 million seconds.  I, therefore, averaged the two numbers and came up with about one billion seconds left on the planet.

To sharpen my time focus, I have started measuring how I spend my seconds.  Each 1000 seconds equals about 17 minutes.  Each 10,000 seconds equals about 3 hours.

Simply measuring how you spend your seconds, much like calorie counting, will alter your behavior. 

How would I live if I treated every second as precious? 

Perhaps you have more or less seconds left in your life than me.  Carefully consider how you spend them.  

I call it the Billion Second Challenge

Post suggestions about how to best spend your next hundred, thousand, million or billion seconds and please share this post with your connections.



Thursday, August 07, 2014

Golf, Back Pain and Disc Surgery

Tiger Woods had to withdraw from a golf tournament last week and is struggling as he starts the PGA championship today.  Just now, Matt Kuchar, another elite professional golfer had to withdraw from that same major tournament.

Hopefully, he won't have to have micro disc surgery.  See video of that procedure below.



The surgery can be quite successful.  We still, however, need better ways to prevent spinal disc degeneration especially in elite golfers.

AM
TotalTendon

Wednesday, August 06, 2014

Biologic Orthopedic Society crosses over 2500 Member Mark



The Biologic Orthopedic Society (BOS) is a group of professionals dedicated to the research and development of biologic treatments for musculoskeletal injuries and disorders.  This group has now grown to over 2500 members worldwide.  Much of the group's focus has been on the use of platelet rich plasma, stem cells and bone marrow concentrate (BMC) for tendonitis, arthritis and degenerative spinal disc disease.

The growth of the Biologic Orthopedic Society (BOS) is a testimony to the rapidly rising interest in biologic solutions to difficult musculoskeletal problems.  Significant progress has been made in terms of better published data supporting the use of biologic therapies in the last 2-3 years.  Clearly, more information and research is still needed.  As the group continues to grown, more and more connections are being made.  Ideas and projects are advancing.  All of this should give hope to those patients in search of better treatments.  Many hard working professionals are striving to deliver better biologic options.  

I'll predict within another 5-10 years, we will be staggered by how much will be accomplished.

Thanks to my many colleagues and friends within the BOS for a fantastic journey so far.

If you are a professional working in the area, please consider joining the group.  

Sunday, August 03, 2014

Hamstring Injuries Treated with Platelet Rich Plasma Return to Play Faster than Rehab Alone

Hamstring muscle injuries are very common in a variety of sports including track, soccer, football and basketball.  A recently published study in the American Journal of Sports Medicine (AJSM) found athletes that were treated with platelet rich plasma (PRP) injections returned faster to their sport when compared to rehabilitation alone.  In the study, the PRP patients returned at an average of 26.7 days compared to 42.5 days in the control group (P = .02).  (reference) This greater than two week difference in time to return to play after this common injury is clinically and competitively important.

Another recently published in the New England Journal of Medicine (NEJM) found no difference between PRP injections (2 injections spaced about a week apart) and a control group.  Interestingly, both groups in this study returned to play at 42 days, very similar to the control group in the AJSM study.  (reference)

Why are these results conflicting?

One important difference between the two studies is the type of PRP used to treat the patients.  In the study that did show a difference, white blood cell enriched PRP (leukocyte enriched PRP) was used.  In the study that did not show a difference, white blood cell  poor PRP (leukocyte poor PRP) was used.  This is a clear example of why PRP formulation matters.

The data published in elite, peer reviewed journals suggests leukocyte enriched PRP helps return athletes more than two weeks faster than rehabilitation alone after an acute hamstring injury.  No difference in return to play can be expected if leukocyte poor PRP is used in this patient population.

As PRP and other cell therapies continue to evolve, it will become increasingly clear that formulations much match indication.  Patients, researchers, and clinicians need to realize not all PRP is the same.

AM
TotalTendon

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