Superkids Charity

A friend of mine back in NY told me about a wonderful charity. Her brother and sister in law (Stephen and Janet Fink) started this organization after they adopted their daughter from China.

Superkids is a non-profit organization that sends physical therapists and volunteers to the Shanghai Children’s Home. They work directly with the children, donate equipment to the orphanage, and work in partnership with the orphanage staff to incorporate easy, fun therapeutic exercise games in the children’s daily routines. These kids range in age from infant to teen and their medical problems range from minor to serious. Most of the children have mild and routinely correctable problems such as club feet and cleft palate. More serious problems include cerebral palsy and spina bifida. Because of their medical conditions, most of these children show delays in motor and/or speech development.

Special needs orphans are also called "waiting children." Their age and medical conditions make them difficult to place. They wait longer to find homes. Many are never adopted.

Janet and a group of occupational therapists returned from Shanghai 3 weeks ago and met four teen orphans with spinal cord injuries. She has been trying for months to get them the appropriate wheelchairs.

Wheelchair companies will not donate or give discounts. Charities that can donate wheelchairs do not have the appropriate type of chair. These teens are already starting to develop scoliosis and breathing problems because they are not in good chairs. They have found a company that will make good, pediatric wheelchairs for only $3,000.

They are trying to raise money to purchase chairs for all four teens. If they can raise the money and have the chairs shipped to the orphanage, Janet will go to the orphanage in china with the therapists to make sure that the chairs are fitted properly to these children.

Please spread the word about these terrific kids and their need for good wheelchairs. If anyone is interested in making a donation, log on to the Superkids website http://www.superkidscharity.org/

New Article on Osteoarthritis and Platelet Rich Plasma

A European Study from Oct 07' by Anitua & Sanchez et al. injected 10 osteoarthritic patients with PRP & studied the cellular effects of PRP. They found an increase in hyaluronic acid concentration, balancing cell proliferation (angiogenesis). However, there was no effect on IL 1-B, which generally plays a role in osteoarthritis. This information gives us insight into how PRP may potentially benefit arthritis.

Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem234v1

It's important that we better understand the mechanism that PRP may potentially benefit arthritis. New insights may direct more specific treatments in the exciting realm of Biologics.

Autologous Blood Use in Horse Osteoarthritis

Another subset in "biologics" is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.

A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.

http://avmajournals.avma.org/doi/abs/10.2460/ajvr.68.3.290?prevSearch=allfield%3A%28autologous+conditioned+serum%29

The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.

This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.

We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.

U.S. Professional Soccer Athlete Injected with Platelet Rich Plasma

In addition to chronic (long term) injuries, Platelet Rich Plasma is being applied to the high level athlete to accelerate recovery. Numerous professional athletes have received PRP for a common knee injury, an MCL (medial Collateral Ligament) sprain. While I'm not an elite athlete by any means, I received a similar injection following a surfing accident. I just ran full speed tonight without any limitations, now appx 9 wks post injection. http://prpinjection.blogspot.com/2007/10/prp-knee-injection-8-wks-post-injection.html

http://www.latimes.com/sports/soccer/chivas/la-sp-chivas15oct15,1,3735874.story?coll=la-sports-chivas
Another athlete was injected by myself & my colleague Mike Gerhadt MD. This positive outcome was reported on CBS Evening news with Katie Kouric.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html

American Academy of Orthopedic Surgeons New Article on Biologics

"Orthobiologics" or "biologics" are quickly becoming recognized amongst the sports medicine/orthopaedic community as one of the fastest growing industries with tremendous potential. Merging our understanding of how the body heals itself with cutting edge modern technology, we are developing exciting alternatives to standard care.

In the Sept 07 AAOS (American Academy of Orthopedic Surgeons) Now Magazine, there was an article discussing this very subject matter. "Biologics in sports medicine: from BMPs to bone formation."

http://www.aaos.org/news/bulletin/sep07/clinical5.asp

The article describes this Field of "biologics" and cell based therapies to create new approaches to treating old injuries. Tems introduced include BMP (bone Morphogenic Protein and mesenchymal stem cells). These may be paramount to facilitating healing in various injuries including rotator cuff cuff tears in the shoulder and knee arthritis and meniscal tears. As the community of "babyboomers" and recreational ahletes grow, we are seeing younger patients with cartilage injuries that are too young (<60) years for knee replacements. Thus biologic solutions provide promise in this population base.

At my practice, Santa Monica Orthopaedic & Sports Medicine Group we are beginning to treat patients with knee arthritis with a series of PRP injections. I have been corresponding with Physicians from Bologna Italy to learn from their early experiences as well. There is a link to their data on my blog. We are conducting outcome studies on the many patients we have injected for various injuries. Furthermore we hope to perform a knee arthritis PRP study in the near future. In general we are seeing tremendous outcomes in patients that have failed conservative treatments and were considering surgery or activity modification.

http://prpinjection.blogspot.com/2007/10/new-studies-on-platelet-rich-plasma-and.html

New Platelet Rich Plasma Article in the American Academy of Orthopaedic Surgeons Now Magazine

As PRP use is increasing, we are seeing more articles surfacing discussing it's potential benefits. In a monthly publication for orthopaedists, the AAOS (Amer Academy of Orthopaedic Surgeons) released an article titled "Clinical use of Platelet-rich plasma in orthopaedics."

http://www.aaos.org/news/bulletin/sep07/research2.asp

In general, the article familiarizes the reader with the science behind it's uses and advocates is use in soft tissue and wound repair, while cautioning it's application in bone grafting. Once again, further research is encouraged.

New Acupuncture Literature Supports Acupuncture in Low Back Pain

Although acupuncture has been used for thousands of years, it is difficult to study under or western system of evaluating research. However a large study from Germany needled over 1100 patients and found favorable results. 47% improved with acupuncture versus 27% in conventional treatments (Physical Therapy Meds etc.). Interestingly, 42% of sham acupuncture (fake acupuncture where the needles were placed in the skin at random non-acupuncture points had relief as well. This insn't too suprising to acupuncturists, as the needling itself stimulates a natural reaction in the body releasing endorphins, increasing blood flow, and temperature.

Acupuncture is appealing because it is safe and focuses on treating the patient as a whole, rather than just a knee or a hip etc. For example when we treat a patient with knee arthritis we place needles & electricity around the knee, but also around the hands, ear, feet, scalp etc to address the whole person to adress other issues like fatigue and anxiety. This invloves some unorthodox interviewing of the patient inquiring about childhood illness & personality details.

The East believe that illness is a result of blocked Qi (chi) that normally flows from teh feet up to the head, and back down to the feet in a cycle. Acupuncture promotes the flow of qi.

Electroacupuncture with a knee arthritis may be combined in a PRP protocol to maximize benefits.

Heading to PRP Ultrasound Conference Nov-2nd-3rd, 2007

On Nov 2nd & 3rd, I will be at a PRP course in Ohio. To my knowledge it is the first of it's kind in the US. Several field leaders and those Physicians interested in learning about PRP will gather there to exchange ideas and further our understanding of PRP. Also, there will be needle guided ultrasound tutorials. Musculoskeletal ultrasound is being used increasingly by docs performing PRP injections. I have performed some injections under ultrasound with enhanced ability to guide the needle to precise areas of injury. I will post info following the course.

New Spine article on biologics "Orthokine" Use in Lumbar Epidurals for Sciatica

A common treatment for a herniated Disc or "Sciatica" that fails physical therapy and conservative treatment is an epidural steroid injection. Nowadays they are performed under an x-ray machine, called fluroscopy which ensures proper needle placement and safety.

A study from Spine compared steroids/cortisone which is commonly used in epidurals to decrease nerve inflammation with Orthokine. http://www.orthokine.com/Orthokine is a biologic agent known as a Cytokine. It specifically blocks Interlukin-1, which plays a role in inflammation and pathology. Similar to PRP, whole blood is drawn from a patient and placed in a centrifuge aftrewards. However there is an additional step with incubation of the processed blood for 24hrs which creates IL1-RA an antagonist that blocks pain/inflammation.

The study suggests that after 3 months of receiving a series of 3 injections, those with Orthokine injections had more dramatic decreased pain scores than those with cortisone. Furthermore, there are less adverse effects associated with autologous blood versus steroids.

http://www.spinejournal.com/pt/re/spine/abstract.00007632-200708010-00002.htm;jsessionid=HflXqpy0GQGZYyvc3GpvY1NQ4QYjnk1xjNGmlLqmQpXN1BmjGKZV!1071114923!181195629!8091!-1

Orthokine and PRP are part of an emerging industry that combine modern technology while maximiizing the body's natural ability to heal itself. This field is known as Orthobiologics.

New Study on PRP use on Rabbit Cartilage

In the Journal of Oral & Maxillofascial Surgery, September 2007, A
Cartilage cells, (chondrocytes) were harvested from a rabbit ear and was added to PRP and injected into rabbits. After 2 months, histological slides and MRI suggested increased cartilage production.

PRP is seeing increased usage in cartilage defects, with many docs reporting promising results. However studies like this may lead to a more refined approach to PRP and knee osteoarthitis. In time, individual growth factors may be filtered out and applied for specific indications. For now, PRP contains a "cocktail" of potent healing properties. This exciting new field is termed, "Orthobiologics."

http://www.joms.org/article/PIIS0278239106021070/abstract

Dental Applications of Platelet Rich Plasma

Early roots of PPR use lie in Dentristy and Plastic Surgery. Initially, it was thought that platelets act exclusively by forming wound clots. However, we have learned that PRP also heals soft tissue.

Below is a link to dental applications.

http://jada.ada.org/cgi/content/abstract/133/10/1383

Furthermore there are few textbooks on PRP. This book was written by Robert E. Marx, a pioneer of PRP usage.

http://www.amazon.com/Dental-Craniofacial-Applications-Platelet-Rich-Plasma/dp/0867154322

Racing Horse Treated with PRP and Hyperbaric Oxygen

PRP has been used in Vetrinary medicine as well. Recent studies have shown that PRP strengthens and heals tendons and ligaments that are frequently injured in race horses. PRP has been modified for horse application.

http://www.equinesite.com/articles/modules.php?name=News&file=article&sid=1178

A case report was just released documenting accelerated recovery of a professional race horse, Wearable Art.

http://www.standardbredcanada.ca/news/iss1007/wearableart1002.html

Platelet Rich Plasma Patient Education Brochure

www.smog-ortho.com/prpguide.pdf