PRP vs. Stem Cells: Which Regenerative Therapy Is Right for You?

Foreign. Talk about the differentiation of different regenerative therapies for degenerative arthritis. So regenerative therapies for degenerative arthritis, osteoarthritis, djd, kind of typical wear and tear arthritis. They're available and we use in our clinic so we can break it down into basically three components. First one is using your body's platelets. Now, these platelets are generally a little smaller than a typical cel circulate in your body. And they are designed to heal things. They have three key ingredients or three key growth factors that stimulate repair of tissues, which is why we might use it in certain degrees of arthritis and even in some things like tendon tears and rotator cuff tears and that sort of thing. So platelets are the cell, are the cells or cellular structures that cause healing. So when you have a cut, the platelets rush in, they give out growth factors called vegf, that's vascular endothelial growth, tgf, transformative growth factor and pdgf, platelet derived growth factor that basically causes cells to migrate in stem cells in particular and have them differentiate in the proper tissue. And we see this being used for years in sports injuries and tendon injuries. I did my rotator cuff back in 2011. I had a 70% tear in the platelet derived growth factors. And platelet rich plasma, platelet rich fibrin was used. It actually cured it. It's gone. It's been gone for 14 years. We also see improvements with arth with platelet rich plasma and platelet rich fibrin. And I'll tell you, from a practical standpoint, we can call PRP platelet rich plasma and PRF platelet rich vibin, basically the same thing. Because in most cases we're using really technically what would be called prf, even though the common term might be prp. I want to get into the difference between them. They're very subtle. So PRP and then stem cells and stem cells. We commonly. There's really three most common use. We use two of them. One would be bone marrow stem cells. I've talked about that with other doctors. We don't do bone mar cells in our clinics, but we do umbilical cord drive stem cells from what's called Wharton's jelly. That's the spongy layer that is in the umbilical cord. This is from donated umbilical cords and fat derived stem cells, which your fat cells are very rich in stem cells. We'll talk about, are we going to use prp, slash prf, umbilical stem cells or fat derived stem cells. What are the pros and cons of each and what is the most appropriate selection, you know, based on your condition? If you have degenerative arthritis, let me say they all have benefits, they have very limited drawbacks over doing something else like living with it, which can increase, impair your mobility. Repeated steroid injections, which certainly work but cause the cartilage to degrade further. And then surgery, which is, you know, that can solve the problem. But you're left with significant issues such as you can no longer be as active because the joints are not designed to go under extreme stress. So if you're younger, in particular 40s, 50s to 60s, you want to stay in active life. We really want to put that joint replacement surgery off as long as possible. So let's talk about the different characteristics of each of these. PRP prf. I'll use those interchangeably. I'll call it prf, usually a pure PRF at allure umbilical stem cells or what's called Wharton's jelly, stem cells and fat derived stem cells and something called nanofat, which is something we'll, we'll get into kind of exciting. So platelet rich fiber and I talked about that already briefly. That's where we take your blood and we separate out the platelets from the blood. So we have white blood cells, red blood cells, platelets, and then we have something called plasma, which is the liquid, the juice that holds these things together. And if we put it in a centrifuge with a certain type of tube that keeps the platelets from clotting, we can separate out the platelet rich fibrin separate from the white blood cells and the red blood cells. We'll still have some white blood cells in there, but mostly the red blood cells are gone. And we've got this nice healing tissue and we use this into a joint that has arthritis. Really, regardless of the degree of arthritis, from mild art, bone on bone, we get some improvement of symptoms. And typically the PRP PRF has done a series of three injections about two weeks or a month apart. We typically see improvement for about a year or so in symptoms. We have ways that make that work better, such as adding something called cross linked hyaluronic acid to it. Acid is really not an acid, it's more of a sugar, but it's cross linked ha and sugar alcohol to keep that from breaking down. So we can even augment that further to make it work, say more better. So PRP PRF would be done a series of three Treatments to get moderate improvement for about a year. And that could certainly put off the need for a knee replacement. And typically, your pain reduction will be, you know, substantial, clinically significant. And let's talk a little bit more about what PRP and PRF does. This actually does regenerate the tissues. There's been studies showing there is some halting of degeneration. So that's good. And there's some regrowth of cartilage and joint space. Now, the regrowth, cartilage and joint space has not been super well established until recently. Recent years, where we see cartilage does actually start growing again in the presence of the growth factors associated with the platelets. When we put the platelets in, they're actually helping with pain and discomfort, but also helping to heal the injuries. Now, whatever caused the degeneration in the first place, your genetics, the way you're walking, your gait mechanics, that's still going on. So there is some ongoing maintenance with this. Unlike a knee replacement, which might last, you know, five to 20 years, this is something that might last more like a year or so, but you could just do another shot. Okay, so that would be a common practice, as we do series of three and then one a year, just for kind of prevention with. With arthritis, and get moderate improvement of symptoms, clinically significant improvement of symptoms, and a good duration out of it, and then put off an unnecessary surgery. So that's. That's one option. Next option stepping up from there would be the use of some kind of stem cell. Now, the stem cells are typically obtained from some body tissue. We talked about stem cells being derived from bone marrow, which we're not doing in our clinic. That's not. Nothing wrong with that. We just don't do that. We get it usually from umbilical tissue that's been donated or from your own fat. And I'm going to talk about umbilical tissue first. So umbilical tissue, it's called Wharton's jelly. And we buy that comes frozen. We have a way to store that. And the little bottle of Warner Jelly has about 10 million active STEM cells when they're thawed out, and we can place that right into the joint. And we typically. And this is one treatment versus platelets, which might be more like three treatments. And typically we see a meaningful improvement. You know, clinically significant reduction in pain scores for more than a year. More like two years, maybe three. There's even studies showing up to seven years. I'm skeptical about that because there's still things going on that are injuring the joint. Again, you know, you're still having the same gait or whatever, but typically longer duration of improvement of symptoms than platelets and little bit improved outcomes over plate. So it's better results for a longer period of time. The disadvantage is a little bit more expensive. The advantage is you're doing it once, get a better results lasting longer. They do screen these umbilical cords for communicable diseases, but we are buying it from, you know, from another person, from a baby, from an infant whose mother donated, mother's parents donated the umbilical cord. And there's labs that collect those and they separate out the Wharton's jelly, which is the cushion tissue around the blood vessels of the umbilical cord. So umbilical cord has three little blood vessels in it, arteries and veins, and it's got to be cushioned so it doesn't kink up. And this is called Wharton jelly. And it's just loaded with stem cells and other, other tissue, other things. That's a common use for stem cells. We've been doing that for about 10 years. It's been studied for more like 20 years on arthritis and very effective for reducing arthritic pain and seeing some degree of joint remodeling and improvement of the joint structure over time. And the last one is fat derived stem cells, which we've also been doing over a decade. And there's been many variations of that. So the first fat cells we're using, we had our own lab set up where you take the fat, liposuction it out. We're used to that because we have a plastic surgery practice. We get the fat, I only need a bud, but two or three teaspoons of fat and we enzymatically degrade the fat. So it's. We put an enzyme, collagen, which breaks the stem cells separate from the fat cells, and then we put in a centrifuge, take out the stem cells, wash the collagen. It was really a big process. And the government's even said, hey, we think you're making a drug, so don't, don't do that. So we got away from that. That was about, probably six or eight years ago. And we started using something called nanofat and then an outside lab that separates the stem cells out for us. Now, for fat derived stem cells, it was first doing this complex lab procedure. Then we found we can create what's called nanofat, or breaking the fat up to where the fat cells are separated from the stem cells mechanically. There's kits out there called Lipogens and other that have numerous clinical studies showing it seems to work just as good as regular stem cells without all the cost and complexity of stem cells that historically we've seen, which some people are flying down to Panama and other countries. You get stem cells done for tens of thousands of dollars. And we could do this nanofat procedure. It's very inexpensive, it's done mechanically and it works as good as other stem cell products for joint arthritis, such as the knee, which would be the classic prototype for arthritis. So when we're doing fat derived stem cells, we do it in a two phase process. When we're treating something like a joint, first off, we obtain the, the micro fat or nano fat and then retain the fat that we need in the same procedure to bank your cells and to expand or grow the stem cells through a third party lab. How does that work? Come in? We've assessed you and look at your X rays and whatnot. Typically our patients get diagnosed somewhere else and they come to us for something besides surgery. And we prep the skin and usually in the abdomen or somewhere like that, and we liposuction with a small little cannula. It gets done awake. You don't need to be knocked out for it doesn't hurt. Numb the tissues up, let it sit for a half an hour. We make a little hole in the skin, a little thing called a punch, about a millimeter or 2 millimeters and a little cannula goes in. A cannula is a little, kind of like a rod that is thin, has little holes on the side of it and just sort of break the fat out and stuck it out through this device. Once we've done that, we harvest a certain amount of fat, typically about 10 teaspoons or so, and we take portion of it and we prepare it and we send it to a lab that's in a, a stem cell banking lab where they'll take the fat, separate out your stem cells through a process and then they store stem cells really for the rest of your life because they can keep growing them over and over again. And so there's a annual fee to maintain your stem cells. You can have your own. You know, if your parents bank your umbilical cord for stem cells, you can bank your own through getting it through your fat. Very low fee, annual fee. And then we take a portion of the fat and we use a special device to emulsify the fat, to basically break all the fat cells. So now it's this oil and some cellular debris and then there's a rich supply of stem cells, something you we used to call svf. Whereas now there's SVF plus oil and cellular debris that's non toxic. It just breaks down. We take the slurry that looks different than fat, it's white rather than yellow, and we inject it right into the joint and we see response pretty much the same as other stem cell products lasting, you know, more than a year, better results than prf, longer duration. And then you've got your stem cells banked at a third party lab. So if you decide to do stem cell treatment again in a couple years because you know you're continuing to have degradation of your joint, we can order those stem cells from the lab, they'll ship them to us and you don't have to go through, you know, to pay for liposuction again. You know, to go through liposuction again. It's really just a one time liposuction procedure. Then you have your own cells. So how does one decide what they should do with their provider? Be it platelet rich plasma, platelet rich fibrin, we call those the same thing. Umbilical stem cells, bone marrow desired drive stem cells or nanofat and fat drive stem cells. Well, they all work pretty good. And if we say we're break this into two categories, we're going to go with platelets, which are, some people refer them as cells. People don't because they don't have a nucleus. But basically let's call those certain type of cells that have healing properties but they're not stem cells. However, they can bring stem cells in and then actual stem cells, which is a different category. There's a little issue with costs. The platelets tend to be less expensive. The downside is you have to do it more times, three times typically, and it's not going to last as long. It's not going quite as good as stem cells typically in clinical studies. But it's a good first step for somebody that's sort of, you know, skeptical about this or you know, you're paying out of your pocket for this, your insurance won't cut it, cover it. So somebody might say, well I just want to see if this works a little less expensive. And my values are not duration and success, it's more about saving money. Well, that's, there's a camp of people that are, that's really a concern. Or they're skeptical or they want to save money. And playlists are a good place to start because it's pretty effective. Pretty effective has Good narration and very safe. That's something you can do. You can even enhance it like we talked about with the HA's and the sugar, alcohol to make it even work more better. And that's a good option for people who, you know, again, are skeptics and are new to regenerative therapy and haven't done a lot of research on it. And they just want to do the, say, the lowest impact thing. Okay, I get it. That's probably your first step. Next step is, you know, you come in and you want to get a stem cell treatment done. You think you just want to try it one time. You don't really want to go through liposuction surgery. It's a minor procedure. Somebody might not want to do it. Or maybe you have some risks for liposuction. I mean, much older, they're on a blood thinner. Well, yeah, we're going to go to umbilical dry stem cells, which call Wharton Jelly. That's something we can buy, buy as much as we need. And we open these up and we can use those same day. And you typically get a response rate that's substantial, significant, and most people respond to it. And it's going to last, you know, on the order of one to three years. Improved function and discomfort, some regeneration of your tissues. And then there's people who want to go a little step further. They really want to slow down aging and they're intending to keep up with this. They also want to use tissues from their own body. They might even want to do other things like intravenous or whole body stem cells. Now we're looking at fat derived stem cells. This is the most abundant source of stem cells that we have. And we would do the liposuction procedure to harvest or obtain the stem cells, take a portion of it and do the nano fat for the affected joint or joints, and then ship it off to a lab. Takes about six weeks. Let them extract the stem cells out of the additional fat that we didn't use today, and they'll bank it for you, which you can order anytime you want. And then they can ship to the clinic when we want. Every clinic you're choosing. And you can get intravenous stem cells, stem cells and other joints, other purposes for stem cells. You know, we're seeing stem cells being used for spinal cord injury, for brain function, for autoimmune diseases, for a lot of other purposes for stem cells. And typically we're using, you know, your own stem cells for those other purposes. So the three choices, we have platelets umbilical stem cells and fat derived stem cells, platelets. The person that's kind of skeptical just want to give it a try. It's a good first start. Little low impact, there's drawings in blood and do it three times. A little less expensive for more better. Let's say we go up to enhance that with hyaluronic acid and mannitol. One step above that would be umbilical stem cells. More duration, more success rate in terms of success rate, better reduction of discomfort. And then for the person that's doing more wellness is going to want to maintain multiple joints, might want to use it for other purposes. When you go up to, you know, your own fat derived stem cells and we can have a bank storing your fat cells for indeterminate amount of time as long as you want to keep them. And they're going to order them on as needed basis. And we're seeing more people kind of going in that direction. So those are the three options. You discuss with your provider what's right for you. And any one of the cases can be done this pretty much the same day as your consultation if you so choose. A lot of people coming from out of and you don't want to do consult and do the procedure separately. Or you could do a telehealth with one of our providers where they can look at your X rays, your images, your diagnostic information and schedule you for a procedure. I think the real take home message is that we have at our clinic anyways. We have three regenerative therapies available that aren't necessarily superior to surgery. I don't want a bad mouth surgery at all. That's certainly an option for a lot of people. Re tends to be kind of quote unquote freeze your insurance is paying for but it is very expensive for the insurance companies. Got some major morbidity in other words major complication rate. The joints are. We're seeing people getting surgery at younger and younger ages which is really a scary trend because these joints are not designed, designed to last forever. They become loose over time. And let's say you have a joint replacement. You're really not supposed to jump or run anymore because they wiggle loose and they fail at a certain much earlier. So for the person that really wants to get away from surgery, we do have alternatives. Now the biggest downside being is they're not going to be free. Your insurance is not going to cover these. Probably be a decade or so off before they do. I know there's some companies trying to work on that now but I don't see that happening in the near future. And this is something that you have an opportunity. If you love yourself and your health more than your possessions, this is an opportunity for you to take care of yourself. We know that statistically when somebody has single joint arthritis, their lifespan has a shortened duration, about 1.8 to 3.5 years. Less lifespan because of the limited mobility. So arthritis is affecting their knee. They're parked closer to the store and walk less. They're not going to run upstairs, not going to be as active, play with their kids as much or grandkids as much. This is something as a kind of an anti aging option is to reduce your pain. And the steroid injections are something that were commonly done. I think, you know, now there's pretty much it's, you know, frowned on doing that multiple times because it does cause there's major side effects with steroids in addition to having the joint deteriorate faster. So we should be looking at alternatives to something that's you know, been have been standard maybe 30 or 40 years ago. And then if you do stem cells and you're just not getting results, you know that that is an option for surgery. But in large studies most people that get stem cells in the next several years do not require surgery. So people that were candidates for surgery, the failure rate even of platelets, the failure rate is very low. It's about 15% of people that are canister surgery will still have surgery in spite of using platelet rich plasma. These are people that are bone and bone arthritis. And it's say failure rate with stem cells. The person ultimately still needs surgery in a given number of years. So I think that's really a take home message. Is that not which one is best. It might be what's more practical for you, what's available through your medical provider. Some providers do bone marrow drive stem cells. These are work pretty much the same as umbilical or fat derived stem cells. So what's available, what tools available? And then even platelet rich plasma which is more widely available is effective. Not effective as stem cells, but it's still effective. And based on where you live, what's available that might be do a little more often, but it'll still give you a relief and better than leaving things as is. So if you love yourself more than your possessions, then you can afford to pay for this like you pay for other things that affect your quality of life. And sometimes people get really frustrated that insurance doesn't cover it. They may get mad about it. Nothing I can do about that. Nothing you can do about that. That's just. Just the way it is. So we can look at these regenerative therapies as a way to take care of ourselves potentially, like their health span and lifespan, enjoy a better quality of life. So thank you very much.