MEDICAL BREAKTHROUGHS RESEARCH SUMMARY

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1 MEDICAL BREAKTHROUGHS RESEARCH SUMMARY TOPIC: STEM CELLS FOR SPORTS INJURIES REPORT: MB # 3975 BACKGROUND: Sports injuries can occur during any sports or exercise activities. The term typically refers to injuries suffered in the musculoskeletal system, meaning the muscles, bones or cartilage. Some of the most common injuries include sprains or strains to a muscle, knee injuries, shin splints, fractures or dislocations. These injuries are caused by several different factors including poor warm-up and stretching, insufficient conditioning, or improper equipment. In fact, 62 percent of organized sports injuries occur during practices. Though it is rare to die from a sports injury, it can take months or years to fully heal from the injury. (Source: /) TIPS TO PREVENT INJURIES: There are three groups that are more at risk of suffering a sports injury: women, children and middle-aged athletes. Here are a few tips to avoid some of the most common injuries: Keep knees bent when jumping and try not to overextend your muscles and joints. Warm up before activities to help condition the muscles and make you more flexible. Wear proper shoes and remember safety gear like knee pads or a helmet. Know your body s limits and start with light exercise before moving to a more intense level. (Source: TREATMENT: For most common sports injuries, treatment can begin at home. The first steps are known as the acronym R.I.C.E.: rest, ice, compression and elevation. By resting the muscle, you are preventing it from further injury in its vulnerable state. Icing the injury not only gives relief to the patient but also stops blood flow to the area, reducing the amount of swelling. It s important to use a towel and not apply the ice directly to the skin due to risk of frostbite. Compression needs to be applied by a bandage or a firmly wrapped cloth to ease pain and keep fluid from rushing to the injury. If the injury is on the ankle or the wrist, the bandage can also help prevent the patient from using that joint while it is still healing. Elevating the injury is the last step in the initial treatment of the injury. The injured area needs to be propped at the level of or above the heart to reduce swelling. The R.I.C.E. process is helpful within the first 48 to 72 hours of the injury to prevent long term adverse effects to the muscle or ligament. If the injury is still swollen and tender after four weeks, the injury should be evaluated by a doctor. (Source: FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT: Mark Markou, DO Markou Medical, Clearwater, Florida markou@markoumedical.com If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

2 Michael Markou, D.O., Doctor of Osteopathic Medicine talks about nonsurgical approaches to arthritic injuries and arthritis. Interview conducted by Ivanhoe Broadcast News in June 2015 Sport injuries, aren t they like arthritis? Dr. Markou: Well, sports injuries can certainly turn into arthritis but many sports injuries could be ligament or tendon problems that occur from the injury. Now, for long term use, injuries normally turn into osteoarthritis. Can you tell us what this stem cell procedure is? Dr. Markou: Yes, sure. It s called the adipose stem cell procedure. Stem cells are cells that go to any tissue in the body and help repair an injury. They can become different tissue, they can become heart cells, and they can become muscle cells, tendon cells, ligament cells, bone cells, hair cells. These are the working cells in your body that go and repair injuries. Now, how do we get them is the question. Well, they re found in the circulation so we can get them by isolating platelet rich plasma which is done by a simple blood draw. We draw blood, we spin it down in a special centrifuge and this isolates the platelets. When platelets are injected they release growth factors that tell stem cells that are in the circulation to come in and heal or to make the tissue thicker, if it s hair or if it s, like I said, a sports injury, to help heal it fast. Imagine if you could get a concentrated amount of stem cells, not just the ones found in the circulation, what that would do, how that would amplify the healing. Well, we can do that. Stem cells are basically concentrated in your fat cells adipose cells, or in bone marrow so we take it from the fat cells. It s a little easier to get from the belly and it involves a simple procedure of numbing a little area about the size of my palm and then basically aspirating out fat cells, about two tablespoons full of fat cells. We then centrifuge it and that spins down and isolates the stem cells from the adipose cells, from the fat cells. Now, we can mix that with what I just told you about the blood draw, with the platelet rich plasma. By injecting both, the combination has an amplified effect. The platelet rich factor, which releases the growth factors and basically tell these stem cells what to do. They re the directors of this repair job. And there are only so many stem cells in circulation, so imagine if they have a whole amplified amount, a whole concentrated amount. They have more workers then so you get an amplified healing. They feel the effects? Does it work pretty well?

3 Dr. Markou: That s a good question and the goal of this is to get quicker healing, and yes, it does work very fast. Patients can feel effects any time from days later up until six to twelve weeks later when they get their maximum effect. But most patients within a couple of weeks are feeling better, they re back on their feet, they re back on the field and that s the goal. So quicker recovery? Dr. Markou: Quicker recovery. You know, for ball players this means they stay off the bench. They get off the bench much quicker and back on the field. And for Pat s situation, can you tell us why he was a candidate for this? Dr. Markou: Yes, Pat has arthritis in both knees and this is from years of catching. Eighteen years of major league catching will do that to you. What we are trying to do with Pat today is rather than going and having surgery, which he does not want to do and I don t recommend it unless you ve done all the conservative efforts first, we re going to basically put the healing cells in to the area to help rebuild cartilage. To help make that cartilage rebuild and smooth out and decrease his pain level so that he can do the things he s used to doing easier. Is this a relatively new procedure? Dr. Markou: Believe it or not, it s not new. It s been around for several years but it s become more popular lately and that s probably to do with more of the ball players using it. There is just more medical patient alertness to what s going on in the medical community. I started doing this six years ago, at that point, there were very few doctors if any in my area that were even using platelet rich plasma, which are the circulating stem cells. Now, we find many more doing that but not many using the adipose tissue yet, which allows a more concentrated stem cell effect and will be more effective. How unique is this procedure? Dr. Markou: It s fairly unique but it s gaining more publicity. It s gaining much more acceptance. It is considered experimental by Medicare so insurances don t cover it. Unfortunately patients have to pay for this and many patients end up in the orthopedic surgeon s office because it s covered. But they don t save money after they have their co-pays, the surgery, the hospital stays, and the rehabs, and sometimes they don t always get better. What is the cost for something like this? Dr. Markou: The cost for just the platelet rich plasma, which is just the blood draw, would cost around six hundred to nine hundred dollars. But with the adipose tissue, it s upwards of thirtyfive hundred dollars. It s much more involved. Obviously worth it though for somebody who needs it? Dr. Markou: Oh yeah, patients come in and the relief they receive is just amazing. I mean some come in, in tears. They never realized they could feel that much better without some surgical procedure.

4 The alternative would be knee replacement? Dr. Markou: At that point, they re looking at a possible knee replacement or arthroscopic surgery. Those are the alternatives they re looking at. By the time they see me for this, they ve already had a cortisone injection at the regular doctor s office, they ve been on anti-inflammatory medication, and they ve been on glucosamine. All these things and, you know, it s just not helping them, they re still suffering. This is truly an alternative to a rather invasive surgical procedure. Can it be used for shoulders and other things? Dr. Markou: Absolutely yes. It could be used in shoulders and elbows in pitchers or low backs for patients with low back pain. That s probably the most common visit to the doctor s office in the United States, low back pain. And it works great for that. It could also be used to thicken hair. Why do you think this is something that should no longer be an experimental procedure? Dr. Markou: Well, I don t know that I could say that. You understand the way medicine works in this country. We rely on several studies, you know, double blinded studies to compare a treatment such as this with perhaps injecting saline. Well, you got to take in to account that different patients respond differently. It might be a different amount of injury with one patient versus another. I m not sure that we could ever get a real great study but there s just a whole lot of anecdotal studies out there. And with what you ve seen with your patients, you would highly recommend it? Dr. Markou: Absolutely, what I ve seen for six years are amazing results. So it could take anywhere from weeks to months to feel the effects? Dr. Markou: Days to a few weeks. Again, depending on the severity of the injury, how acute the injury is versus chronic. The goal of this type of procedure, the goal with just the platelet rich plasma with circulating stem cells is to have the patient get anywhere from sixty to eighty percent relief from their symptoms. Now, with the stem cell procedure on top of that, it should enhance that even further. Now, we often surpass that, a lot of patients do much better than that. And did it typically last for a while, the effects? Do they have to come back and get another? Dr. Markou: Well, theoretically you re healing tissue. However, keep in mind the body continues to age, to wear, so depending on how active the patient is, what they re doing, are they still doing activities that cause their injury, they may end up coming back in a year or two or even in six months to a year to get a boost injection. How long does that whole procedure take?

5 Dr. Markou: It takes it takes about an hour. To draw the patient s blood, spin them down and re-inject them And then they just walk out? Dr. Markou: They basically walk out, exactly. We re going to inject Pat s knees and he s going to walk right out of here and he ll be back at work tomorrow. He s going to take it easy with activities for about a week but usually daily activities, the usual daily activities are okay. Anything else you think we should touch on? Dr. Markou: Well, let s see. I think we ve touched on a lot of it. I think it s important to also mention different physicians have different protocols. Do most patients do one injection or several? Some physicians have a protocol where they do a couple within three months. I think it depends on the patient. With the everyday weekend warrior who plays a little golf or tennis on the weekend, if they get that sixty, eighty percent relief, they re usually so happy and they re good to go. But some patients do strive to get even better relief and they may try a second injection, especially with just the platelet rich plasma. But again, most patients will do one depending on the injury. Is this what a lot of the pro athletes would do to get right back in the game? Dr. Markou: Yes, it s being used a lot. My thought is it should be used to prevent injury. Imagine if a pitcher is just starting to feel off on his elbow, they can get the MRI early or they can detect early inflammation. Rather than wait for the injury, this is safer. It might be worthwhile to inject and prevent that injury. Maybe miss a couple of rotations rather than a couple of months. That s where it would make sense if a sports team wanted to be aggressive with this and keep their players on the field. END OF INTERVIEW

6 This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters. If you would like more information, please contact: Dr. Michael Markou 1266 Turner Street Clearwater, FL (727) Sign up for a free weekly on Medical Breakthroughs called First to Know by clicking here.