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Regenerative Medicine For Aging Skin
Regenerative Medicine For Aging Skin   Introduction   Current regenerative therapies available for skin aging are reviewed.   After all, with so many advances in medicine, if our skin is aging faster than we are, then we have got to give it a hand.   Disclaimers   The following is heavily based on a review of the current medical literature. Minimizing opinion, passion does present itself here and there briefly.   Discussion   What can you do for your aging skin instead of lasers and extensive surgery? First a couple of important principles.  
  • Mesenchymal stem cells = adult stem cells that can turn into fibroblasts
 
  • (accent on ‘adult’ stem cells; this is not a discussion of embryonic stem cells, please bear that in mind)
 
  • There are adult stem cells that can turn into keratinocytes
 
  • And keratinocytes and fibroblasts are responsible for elastin and collagen, key to maintaining skin youth, especially collagen three
  Our stem cells, circulating in most tissues, age and diminish as we age. So if our skin is aging, and our stem cells responsible for generating new hair and skin are aging, seems like we are in a bit of a bind.   Fortunately, the reason our bodies respond less and less to our own stem cells and our own growth factors is not as much because our tissues are becoming unresponsive, but more so because our stem cells are becoming less in number and less effective. Our circulating stem cells are aging perhaps faster than we are aging.   Even more fortunately, it turns out that our bodies will respond to outer sources of stem cells quite favorably, be they autologous (our own cells) or allogenic (the cells of another member of our species). Even xenographic sources like from snail can lead to promising results, too.   So, although we can’t really supplement skin too easily... We can sure supplement stem cells and stem cell factors and growth factors.   Luminosity, depth, evenness, lightening, brightening, elasticity, even this thing called beautiful. We all want these in our skin. So as we dive into skin and the concepts involved in it’s aging, let’s start with, the skin organ itself. Sorry, the science part. I’m going to keep it simple, but I’m going to give you what doctors know, because you are entitled to this.   Skin: 2 components, dermis and epidermis. Dermis, one of the big niche areas of stem cell existence in the body no doubt because of the increased turnover there like in the gut, provides stem cells and growth factors and stem cell factors for the epidermis which claws into the dermis in the appearance of a bear claw histologically (the appearance of tissues under the microscope) in younger skin. This bear claw reaching in anatomy is lost in older skin allowing these two sheets of tissue, epidermis over dermis, to just slide over each other because they are flat on flat. Leading to increased sagging, increased sloughing, and increased bruising because the dermis carries blood, we get aged looking and behaving skin.   The particular area of the dermis that contains the most stem cells is the base of the hair follicles, a famous niche area of stem cell preponderance in the body – that is until we start aging. Specifically, it’s the dermal papillae cells at the base of the hair follicle that is the most important to skin and hair maintenance if not regeneration.   So, what if supplementing stem cells locally could lead to stem cells getting directly to these areas automatically. And what if when they get there they could automatically tell that area what to do, even though they were from outside sources.   They can. And they do. Stem cells get there automatically. And... They can tell the area what to do automatically once they get there, even though they are outsiders. These computer-like cells, the adult stem cells, are not rejected even as outsiders because they are immuno privileged. This confuses a lot of people. But, this much has been studied well. And they are so immuno privileged, there is some research and ongoing use of them in host rejection diseases (kidney transplants, like that).   So, we can get mesenchymal adult stem cells from outside donors, specifically umbilical cord structures. And we can get adult mesenchymal stem cells from our own fat. We have the technology to easily and safely extract them our own marrow and fat and deploy them so we can provide our skin such stem cells today. “We have the talent, we have the tools.“ We have the technology. But it requires a little training (OK, so it is a bit of a laborious surgical process, and it must be done in a closed system, meaning we must keep all of this free of infection, but such care is readily available).   So, if supplementary stem cells containing the potential for regeneration and supplementary growth factors from any number of sources help the stem cells work on the skin, then supplementing these should reduce the incidence of if not treat sagging, sloughing, and skin aging in general. Skin creams that contain Xenograft versions of these like snails cells providing stem cells and snail secretions providing growth factors, work well. But deployment in much larger amounts from umbilical stem cell distributors and fat extraction of your own stem cells from your love handles delivered by IV as well as locally help the skin much more so. Think rocket fuel instead of premium gas.   Skin creams get the growth factors and stem cell factors from snail secretions. Skin creams get their stem cells from snail eggs. Not sure what the snail cell counts are. But, you can get healthy, safe human mesenchymal stem cells from FDA approved distributors of umbilical sources in the 1-60 million range. And here’s the best news... You can get your own stem cells from your own fat (with the help of a stem cell surgeon trained in mini-liposuction) in the hundreds of millions.   That’s the cellular part of it. For the human growth factors, we use platelet rich plasma (PRP) easily and safely extracted from your own blood as our greatest source of growth factors. After all, platelets are a little sacks without nuclei containing all the growth factors necessary to help fix tissue. It stands to reason that the stem cells we supplement will need plenty of PRP around to allow the stem cells to do the most they can for us. When it comes to skin at least, stem cells need PRP, PRP needs stem cells.   So in summary, or if I didn’t make it clear, the follicle papillae cells for hair and fibroblasts and keratinocytes for skin work best under the guidance of plenty of stem cells. And supplementing stem cell numbers (especially if you are aging and don’t have enough) is effective therapy. Stem cells can get to those areas automatically if deployed locally, and produce instructions to those areas and cells automatically. Platelets in PRP contain growth factors that help stem cells function and help follicle papillae cells, keratinocytes, and fibroblasts function. But the platelets in PRP don’t get to these areas automatically unless there are plenty of stem cells to guide them in.   The final result from the stem cells and these growth factors, regardless of the source, human or snail, is what we need. Plenty of elastin. Plenty of collagen, type III collagen being the most common type in the skin.   Conclusion   Adult stem cells are critical to regenerate keratinocytes and fibroblasts. These younger keratinocytes and fibroblasts AND stem cells will work better with plenty of growth factors and plenty of stem cell factors.  
  • Growth factors repair and protect, so are considered the extrinsic agent in this formula for skin improvement
  • Stem cells are the intrinsic agent, so they replenish and restore
  So, once again the recurring theme of combination therapy seen in so much of the body reshaping, recontouring, reforming, modalities being used today from body sculpting to tissue regeneration... When you’re talking about skin care... Stem cells (human adult mesenchymal stem cells from your fat or someone else’s umbilical blood versus snail eggs in topical preparations) must team up with growth factors (PRP providing platelets, little sacks filled with growth factors, if you want to be the source, snail secretions if you’re considering skin creams). Both types of sources are spectacular care and recommended by great physicians. For...   As skin ages, it not only loses thickness, it loses the corrugated interface it has between the dermis and the epidermis. Sloughing, sagging, easy bruising follows.   This is just what the body does. And I for one have grown to respect that.   As such... This is not a world of wound healing. Aging isn’t a wound anyway. It’s a blessing.   And this isn’t a world of disease curing. Aging isn’t a disease anyway. And stem cells and growth factors and stem cell factors do not make aging stop. They only make new tissue start. And they prevent old tissue from getting into trouble.   This is a world of tissue and organ regeneration. We know for fact that if adults mesenchymal stem cells are used, it’s completely safe. And the FDA has cleared us to say this. So we all must learn about it together. These are our tissues. Let’s learn about ourselves... Our property… Our adult stem cells... Treating ourselves. Let’s not let anybody take them away as we do.   Stay well, David Allingham, MD, MS
PRP

PRPIntroductionPlatelet rich plasma (PRP) is rapidly rising as a source of growth factors to help in many clinical situations. Only an absolute basic few principles are reviewed here.DisclaimersThe big disclaimer in this walk through of PRP today is that it is ultra minimal.There are distributors and scientific reviews that are much more comprehensive than this. But this should give you a good overview to start out on understanding a safe treatment option available to you instead of so many dangerous surgeries and dirty medicines for so many things.DiscussionPRP, platelet rich plasma from you, contains platelets. Platelets are little sacks of growth factors, similar to cells, but contain no nuclear material - - no nuclei at all.So if there is no nucleus in a platelet, it contains all of these growth factors, but doesn’t know exactly what to do with them. The platelet instinctively goes to areas of inflammation and wounds to help heal wounds and resolve inflammation.But it must get instructions there. Cells that are healthy locally can give it instructions. The wound has ailing cells that can give it instructions. And stem cells are probably the best “computers” in the body that can give platelets instructions.So I guess that’s one of the big take-home’s: PRP works best if there is an abundance of high-quality stem cells nearby. Conversely, PRP doesn’t work well if there’s not many stem cells. One situation in which there are not many stem cells is aging. As we age, our stem cell numbers and quality decreases. So the extrapolation is, you guessed it: PRP does not work well in the elderly.So, if an elderly person is considering PRP for its many indications, many of which are reviewed below (and I know that’s why you’re probably reading this) (so, we’re almost there!), then that elderly person might higher prioritize getting some stem cells on board first.Another situation where PRP won’t work by itself no matter how many times you try it (John Wall) is in the joint which is highly nonvascular, so often times doesn’t contain many stem cells. Such an athlete might consider getting stem cells first which will last in their body 30 months including deployments directly into a knee… And then administer some PRP if you want. But many scientific journals are pointing to the fact that all things like knees need is stem cells alone without the PRP. But that’s another subject.So I’ll repeat this first big principal and all its repercussions: PRP requires stem cells to work. PRP will work better in young people than elderly. PRP will work better in people who have received stem cells recently. PRP will work better in people who receive stem cells concurrently, although many argue that the stem cells alone would suffice in that setting. PRP won’t work in avascular areas where there are not many stem cells like joints.PRP is obtained using PRP kits provided by many distributors in the US and Canada. PRP is extracted from venous blood - - just a regular blood draw folks. So when we talk about giving you PRP, we are giving you back platelets we pulled out of you, same day, usually same hour.Different PRP kits very in quality, and I’m not saying it isn’t always high-quality and safe. It pretty much is. PRP kits vary in how much white cells that they contain as if it was a strength, and I’m not saying that it always isn’t. And PRP varies in platelet concentration. And PRP kits vary in terms of whether they are activated or not.A source of some confusion to the novice, PRP also varies in activated versus non-activated. This is a much more important distinction you must understand - - and it’s easy. Activated PRP (activated for their prime function to help a damaged area of tissue) means that the platelets have been exposed to calcium salts such as in an active wound where cells are exploding and dumping out calcium salts. If platelets are exposed to calcium, they start working, and quickly - - they start getting sticky, leading to the formation of a fibrin clot - - and that’s what a wound needs. The other thing that happens when the platelet start getting sticky and Jell-O like instead of free-flowing is that they stay around. That is, they don’t migrate off.So. Activation when it comes to PRP means formation of fiber matrix. So some people would rather not worry about that fiber matrix with the PRP they are using. And they use other scaffolding or matrix sources, some of them allogenic, a term that literally means from a non-homologous source, i.e., from someone else.Some clinical situations have enough inflammation and activity from cell death that the platelets will be activated when they get into the body part. In those situations, they don’t need to be activated. The body will activate them. What do you like it or not, that activated PRP will stick around in that area.In other clinical situations, there is no cell break down, and you want the PRP to stick around. So you have to activate that PRP before administering it. Usually exposing it to a calcium salt like calcium chloride or cost include gluconate activates the PRP. The PRP is deployed; the PRP sticks around that area.And yet other clinical situations, there is no cell break down and you DON’T want the PRP to stick around locally. You were interested it and it defusing a little further away. Growth factors to encourage hair regeneration require this.So two more big principles. 1. PRP should be activated to keep locally (not for hair) (not for the P shot) (not for the O shot). In all of the situations, you don’t want to keep the PRP local. You want it to spread to the surrounding tissues. 2. If there is inflammation, you will want the PRP to stick around. But the bar is inflammation will activate the PRP, so it doesn’t need to be activated.Whether or not to activate the PRP that’s about to be used as important because as soon as you activated before deployment, you have a ticking clock. The stuff thickens very quickly, and it makes it harder and harder to administer by the minute after activation has been done outside the body in those situations that require it.And there is another distinguishing feature of PRP types. You can have a high density concentration, or you can have a low density concentration of platelets. Depending on how the PRP is mixed. Not all that significant as far as I can tell. After all, when you get your blood drawn for your PRP, your quantity of platelets is going to vary day to day depending on so many factors. Luck of the draw really. Ha. Pun intended.Indications for PRPJoints, Tendons, LigamentsHair, Skin problemsSexual function, so for the Penis it’s the P shot. The O shot in womenInflamed joints, arthritis, the situations benefit from PRP. But many argue that when it comes to joints, all you really need is stem cells. I’m going defer discussion on this.Hair. You might think with no inflammation or active wound, we might want to activate the PRP before deployment. But, no. The PRP should not be activated and that’s so it can spread around. It will activate in the body soon enough. The deployment is extremely superficial, just a couple of millimeters. And it’s leading to great things. Again, stem cells will be required for the PRP to help a man or woman regenerate hair or prevent hair loss. So, strongly consider investing in stem cells first, then PRP second if you are trying to regenerate tissue is the alopecia arena.The P shot with PRP, done in conjunction with shockwave therapy, is dramatically helping erectile dysfunction, as well as Peyronie’s disease and other more rare indications. The P shot, which is actually several shots along the shaft and glans of the penis, in conjunction with an increase vascularity treated with shockwave therapy, is leading to maximizing penile function not only severely impaired men, but even in fairly normal men. The results have been spectacular. We are just beginning to see the safe care effects in this strong indication for PRP.The “O” shot with PRP, which is actually two shots, one to the Skinners gland, and one elsewhere (different discussion on that) is helping with dyspareunia and lichen sclerosis, two serious conditions which affect women’s sexual health. But it is also helping much more healthy women increase general pubis color (consistent with increasing blood vessels there), thus leading to increased sensitivity during intercourse. So... Exciting advances in both of these arenas, in the highly unfortunate clinically ill, as well as the nearly healthy trying to optimize or improve an already fairly healthy sexual system. PRP is truly helping a lot of couples.ConclusionSo we begin to see a general principle that recurs again and again in all considerations of regenerative medicine. It is that you need growth factors from things like PRP, and you need guiding computer-like agents - - things like stem cells, and you need a matrix or scaffolding on which regeneration (some still call it healing, but that’s probably not entirely correct) can occur.PRP, so rich in platelets required for the traditional clotting of wounds, is going to be filled with growth factors. That’s really all they bring to the table. Pretty simple.And if you want your PRP growth factors to remain in the area of the deployment sustained for days instead of hours, you think of activating the PRP before deployment. If you in contrast prefer that the PRP defuse to the surrounding tissues for your particular application like hair maintenance and regeneration, you avoid pre-activation, so as to allow PRP to diffuse, and then the fiber matrix is created by the body later when it activates the PRP in a slower fashion allowing spread to more remote areas from the site of deployment.Stay well,David Allingham, MD

Shock Wave Therapy

Shock Wave TherapyIntroductionShock wave therapy (SWT) or therapeutic ultrasound therapy or acoustic energy transference therapy is reviewed briefly here.DisclaimersThis discussion is for educational purposes only. Please have all care administered by a well trained physician excited about doing a team approach with you the patient and them.Humble opinion is kept to a minimum, I promise. Some ranting and raving.DiscussionSWT has been around as a physical therapy modality for 20 years. Probably its most established indication is plantar fasciitis. Professional athletes in respected organizations like the NBA plagued by such have received SWT for such indications with great success for many many years.More and more uses have been found for it, and new uses are discovered every day. Anything with soft tissue damage may benefit from it. Clinicians try it, it works, and they continue doing so privately. Formal research funding for prospective research has been limited for two reasons. One, it’s completely safe. So there’s no danger to research in turns of lack of safety. Two, there is a lack of funding for research trials, largely coming from big Pharma, because big Pharma has no interest in it. There’s nothing they can patent, so they don’t invest a single dollar. Not only does it not help them, it is likely to hurt their markets if they accidentally prove that it works. So... They stay clear of it. Academic institutions like universities have pursued a great deal of peer reviewed studies that justify its worth fortunately. So we salute sports and health minded pro American institutions like Duke, the Ivy leagues, Texas, California, Virginia... Thanks to them, it’s here to stay.IndicationsPhysical therapy for all soft tissue damageErectile dysfunctionFemale incontinence syndromesFemale sexuality, increases sensitivity, increases pinkness, increases orgasmPlantar fasciitisCelluliteBody sculptingAfter other noninvasive body sculpting lipolysis techniquesAfter surgical liposuctionPost surgery (in general)Aesthetics (in general)Delayed granulomas following surgery, indicated or electiveSome of these indications, only a single 20-30 minute therapy is necessary to fully resolve the problem. In others, 10-20 such therapies may be required.Physiology, pathophysiologyEdema from damage tissue increases lymphatic drainage, driving up blood flow.Repeated use of SWT leads to collagen production and blood vessel production.So, SWT increases the vasculature of the area providing for this increased need.Tissue damage leads to traffic jams. SWT leads to increased roadway production.SWT works by bubble formation. That bubble bombardment stimulates angiogenesis, blood vessel production.So:Most if not all of these clinical indications mentioned above are nicely complemented by concurrent use of PRP, platelet rich plasma, as an adjunct to provide growth factors. Stem cells as an adjunct can augment PRPs ability to help SWT, especially if the patient is low in their supply, i.e., the elderly.ConclusionThese beneficial outcomes are consistent. You combine that with spectacular safety, and you find that SWT is a terrific therapy choice whenever there is some sort of soft tissue damage involved with the medical condition you are trying to treat.

 

Stay well,

David Allingham, MD

Electromagnetic Body Sculpting

Electromagnetic Body Sculpting

IntroductionElectromagnetic body sculpting is the latest modality for transferring energy into the subcutaneous fat to burn fat for the purpose of aesthetic body contouring.Pros and cons reviewed here.

DisclaimersHumble opinion for the purposes of learning here.The big disclaimer would be to discourage anyone from generating a body sculpting treatment plan without a physician.Also, make no attempt to achieve these results with anything you might buy at Brookstone or the like.And, as exciting as electromagnetic body sculpting is, as with any body sculpting treatment plan, dual therapy with multiple modalities is always encouraged. And proceeding in a team approach, you and your physician, always produces the best results. You must find a physician that favors a team approach to this health care.

DiscussionBody sculpting by transferring energy non-surgically to burn fat is taking off. We have many modalities that produce energy transfer lipolysis including laser, heat, cryo-, and ultrasound, as well as the not completely non-invasive needle administration of chemicals that burn fat. All of these produce lipolysis secondary to fat burning. But while all of these produce the desired effect in that all of these burn fat, all of them have their pros and cons. Similarly, electromagnetic body sculpting has its advantages and disadvantages.Electro magnetic energy is transferred in electromagnetic body sculpting. Fairly expensive machine, it surfaced for the first time publicly this year, after extensive trials showing great success and safety.How does it work? You first need to understand the concept of supramaximal muscle contraction. The average person is able to contract their belly muscles or gluteal muscles about 20%. Olympic athletes, maybe 30%. With supramaximal contractions, electromagnetic body contouring technology can contract your muscle 95%. Now we’re talking! And it does so without a relaxation phase, so there is not a build up in lactic acid. Fascinating is that we are talking about the voluntary muscles here. But electromagnetic body sculpting techniques in current use are also helping to eliminate some visceral smooth muscle. That’s a deep burn, I’ll tell you what.Patients who describe how they feel after therapy say it’s not unlike the best workout they ever had - - times four hours. But this takes 30 minutes folks! (and in truth it’s much more!). Kind of makes you wonder what the Olympics is going to say about it.So. A brief review of advantages and disadvantages in a bit of a heads up fashion against other body sculpting modalities that have been available to us for years.Advantages. Of course, completely non-invasive. With no consumables, by the way. And... It’s effects are impressive, so that’s a big advantage over some modalities that have not stood the test of time.But perhaps the biggest advantage over essentially all of the other treatment modalities to eliminate fat burning is that it also increases muscle mass. And not only does it increase muscle mass by hypertrophy (Swelling of the muscle cells without actually increasing number of muscle cells), it actually leads to brand new muscle cells. So actually new muscle fibers come forward following this therapy. Fat elimination, plus increasing muscle mass? By hypertrophy and hyperplasia both? Patients (and doctors) are thrilled. All of the other modalities wish they could claim this. This one finally can.Disadvantages are few fortunately. Certainly, you cannot increase certain muscle mass areas like the pecs in an aging man or woman. The heart muscle lives under there; the risk is too great.Also, this modality, like many of the modalities, produces heat generation. Heat generation In the subcutaneous tissue leads to inflammation. Inflammation leads to swelling, and this in turn leads to induration. Such induration can compromise motion. So there is some down time. Of all the fat burning body sculpting modalities, only nonthermal ultasound fat destruction can make the claim that it produces no heat generation. But you can’t have everything!And perhaps another maybe not so subtle disadvantage: it’s brand new. I’m not the kind of physician that bandwagons. At least never too quickly. Let’s see what exciting testimonials its first year out brings, sure. But… What’s going to happen long term? It will take a few more years to figure out.As in all of its other cousin modalities, it’s tolerance seems to be excellent. The body seems to handle the increased fat load heading to the liver with no remarkable abnormality seen in bloodwork in all of these body sculpting patients to date. It’s certainly an increased fatty acid load. But our bodies have been handling such in stride for years. It’s called weight loss. And our bodies know what’s good for them. To give you completely reassurance, those increased fatty acid loads are indeed headed to the liver, and not to some blood vessel to clot off. Fat loss this way is safe, folks.

ConclusionPerhaps the best studied modality for body sculpting lipolysis pre-roll out to date, electromagnetic body contouring is now available if you want fat burning with muscle building. Investigators included CT, MRI, and ultrasound imaging in their pre-and post treatment studies In there before and after pictures. Patient satisfaction was tremendously high. Tolerance is good. And other than being slightly expensive, it’s limits are minimal. It’s first year out this year, it seems to be doing well. And it shows a lot of promise for the future.

Stay well,DAVID ALLINGHAM, M.D.

Ultrasound in Body Sculpting - Lipolysis, But Also Angiogenesis

Ultrasound in Body Sculpting -Lipolysis, But Also AngiogenesisIntroductionThe health benefits of removing fat are widely known.Ultrasound as a modality to provide shockwave therapy using acoustics to eliminate tough to get at fat in the overweight and not particularly overweight is reviewed here.DisclosuresDon’t conduct any of these therapies on your own for yourself or your loved ones. Consult with a physician. A team approach with a physician who believes in a team approach, you and her, is the best approach.DiscussionNonsurgical body sculpting is here to stay.Results are exciting. But a 600% increase in body sculpting modalities in general in the past 20 years is only half the story. The really exciting thing is that slimmer and slimmer patients with excess fat finding it difficult to mobilize fat in certain body areas are joining in, and are super happy about the results they have seen from having entered into this care...Body contouring. By now, it is becoming more widely known that there are multiple nonsurgical, so non-invasive, energy transferring modalities that are being used to burn fat (lipolysis) in medical therapy generally known as body sculpting. Cryo-therapy is really gaining popularity. And laser therapy and heat therapy are also widely used. Electromagnetic therapy is also being used to impart an energy form into fat containing tissue to burn fat. It’s the newest kid on the block, and everybody’s waiting to see the pros and cons as it makes its debut this year.Slightly more invasive, needle therapy is also somewhat popular because it allows the physician to inject fat burning chemicals into very specific areas where lipolysis is desired. This therapy of course thus provides chemical burning. Obviously, there are a few downsides with needle therapy - pain, needles, chemical burning. In contrast, we can provide all of the other energy imparting body sculpting modalities noninvasively.Body sculpting is the term loosely used to describe destroying fat in areas where it has always been tough to destroy fat. These areas usually overlie muscle, so what is left is well-defined muscle, and the patients really dig it.In addition to cold, heat, and laser energy, there is yet another energy modality that can be transferred noninvasively to burn fat. And that’s acoustic energy; and it’s generated with ultrasound. Ultrasound at one range of settings is widely known for imaging techniques. Well, at other settings, it destroys fat. It also has been discovered to increase the vascularity in the tissues where it is applied, if the correct settings are used — but I’m getting ahead of myself. Fat burning properties of ultrasound or shock wave therapy first. In ultrasound therapy, acoustic waves are generated which are sent directly into the skin. Depending on the settings, scatter can be minimized or maximized, but depending on the effect you want to achieve, it is most safely exploited.If those waves produce bubbles of a certain size that cause a certain type of impact, blood vessel growth is stimulated and produced. At different settings, ultrasound acoustic, shockwave therapy actually destroy fat. So it brings both of those things to the table.And there’s another advantage to ultrasound. Unlike other modalities being used for non-surgical body sculpting, ultrasound produced fat destruction does not produce inflammation. With non-heat generating ultrasound techniques, there is no heat generated (clever name, right?). If there’s no heat generated, there’s no inflammation. If there’s no inflammation, there is less induration. If there is less induration, there is less downtime. If there is less downtime, the patient can continue to work out, critical for weight loss and staying in shape and toned, as everyone obviously knows. So the fat exodus is not only faster because of the increased vascularity allowing the body to rid itself of the dead fat quicker . There is less pain. And there is less downtime for the patient.So for two separate reasons, increased vascularity and decreased inflammation, ultrasound shockwave therapy produces faster body sculpting results that are nicely effective. Every patient can be excited about this.ConclusionMany nonsurgical modalities now exist to burn difficult to get at fat. Alternatively, ultrasound is yet another nonsurgical, thus noninvasive modality used for body sculpting to burn fat. But in addition to burning fat, it also increases the vascularity of that tissue, albeit at different settings. And it does all this non-thermally, without generating heat, so as to improve tolerance, increasing speed of response and recovery even more. This increased vascularity increases the speed of fat elimination after lipolysis. So, instead of leaving the fat in place for the body to deal with more slowly on its own with its limited vascularity, ultrasound’s increased vascularity eliminates the traffic jam.And the other big distinction of ultrasound acoustic shockwave therapy in comparison to other non-surgical body sculpting modalities, it is nonthermal so you don’t get the inflammation. So you don’t get the induration, you don’t get the swelling, you don’t get the pain. So the patient appreciates that! Plus sees results faster. (Note: this type of ultrasound, nonthermal, US care must be clearly distinguished from heat generating ultrasound which is also available today for lipolysis.)Most body sculpting conducted by physicians is being done in dual modality modes. To choose ultrasound as one of those paired modalities would seem wise.Stay well,David Allingham, MD

Cellulite
Cellulite   Introduction   What affects 95% of all women (over puberty) and 10% of all men? Cellulite.   Nonsurgical treatment options today I review here.   Disclaimer   Nonsurgical yes. But at the same time, not you - should be guiding his care. Do not try to simulate any of this care with any Brookstone gadgets from your local mall.   Yes, you should consider it. In a team wise approach with a physician you can trust.   Having said that, the physician you team up with should be able to accept a strong working partnership with you that allows both you and him to guide your care.   Discussion   And here’s your pneumonic, right up front. “The three F’s“ - Fat, Fiber, Fitness. Or fit’nass, like my more vulgar Beverly Hills counterparts like to say. Because it’s all about the derrière “in the end”? (sorry I couldn’t resist). But I’ll save that for... The end. Okay, okay... Enough. I’m a get myself in trouble.      1. Fat. For the fat component… There’s always liposuction. That has complications. Not just the classic fat embolus concern, but other surgical complications. Edema? Yeah. And it hurts more. And it’s more expensive. And the results aren’t always that great, not that even, there can be dimpling, there’s wound care, and there is a variability in the surgical teams you have across the land.   So, what has taken off for the past 10 years in the world of body sculpting are various nonsurgical modalities that produce lipolysis, death of the fat cells. These range from injecting chemicals into fatty areas that destroy fat (needles); to completely noninvasive nonsurgical options like laser, heat, and cold therapy.   And the brand new kid on the block, electromagnetic, high impulse, therapy that not only kills fat cells, but also increases muscle cells in size AND NUMBER. Very exciting. Olympic athletes train 30% of their muscle most the time. This fat killing, first ever muscle augmenting nonsurgical body sculpting modality works out muscle 100%! Crazy. But it’s new. And that in my mind is about the only thing working against it. Let’s see what the next year or two shows...   So. Non-surgical, fat killing modalities. Too good to be true? No. And clearly cheaper. Arguably safer, no doubt. And nicely effective. And you don’t have to miss any work. No downtime at all really. You don’t even have to stop working out, which will help one of the “F’s” below.     2. Fiber. There are these nasty, tenacious fibers that occur around dimpling areas of fat from some prior trauma and what not that must be broken up. Unfortunately, often require surgery, or at least needling techniques that take some time and training to master. Probably little if any ways of getting around that.   Fibrous bands from some long ago forgotten injury that must be dealt with... Versus skin laxity... Which should be dealt with differently. Versus some important blood vessel you don’t want to damage! The world of the plastic surgeon! Gentle retraction on the skin by the hand of a trained surgeon produces difference effects, allowing them to distinguish between these important different things. Hence on to the right kind of surgery...   But wait! There IS a non-surgical modality doctors can use to break up fibrous bands in dimpling cellulite. Shockwave therapy (SWT) provided by acoustic ultrasound machines can indeed break up some banding underneath the tissue of the skin if done aggressively enough. So, no needles. No surgery. And you can get rid of those fibrous bands over time — with a little persistence. And ultrasound SWT.   And another nice advantage to shockwave, ultrasound, acoustic therapy like this is that it increases new blood vessels in that area! Bonus! So, whatever fat has been destroyed by the non-invasive fat killing modalities mentioned above can have a faster, smoother exit from the subcutaneous tissue because of new increased vasculature. Rather than just wait for the body to rid the fat that has been killed by one of the nonsurgical modalities above by it’s regular pokey, slow rate (something the body doesn’t ever seem to want to do; am I right ladies?), ultrasound therapy increases vascularity in whatever tissue it is aimed at so the fat loss is faster. Faster fat elimination. That always sounds good.     3. Fitness. The doctor does his part with the other two “F’s”. Here’s where the patient has to do her part. Here, I have to sell the cellulite patient on eating better than they ever have done before, exercising, non-impact of course (biking, not motorbiking —swimming, yeah you have to get wet, or kayaking, just kidding, but an option). Okay, okay, I’ll be nice. Anyway... I’m not sure why, if it’s the increased teamwork the genuinely interested physician fosters with his or her fat conscious patient, or maybe it’s increased investment the patient has finally made into their temple… But, bit by bit, the body sculpting patient tends to start doing the right thing! Really going to that gym they joined months ago, genuinely eating less because they are actually following calorie counts finally...   (That’s right. The only way to genuinely eat less is to do calorie counts. I’ve spent time with people who swear they don’t eat much at all. They have no clue. To eat less, or less enough to make a difference anyway, you must do your calorie counts! Then... Stick to what you discover for 1 to 3 months, make a change downwards 10% if you are not losing weight. Etc. Easy.)   Conclusion   So, now it’s time to do your Internet search for the modality of your choice! Aesthetics are important! And if you don’t think so, think about self-esteem. And don’t forget about eating less and exercising more.   Stay well, David Allingham, MD
Suboxone for Chronic Pain?

Introduction

 

Chronic pain is gradually becoming acceptable as an off label indication for the prescription Suboxone.

 How great would it be to have an opiate for the opiate dependent patient that can be used for maintenance in the setting of chronic pain where that opiate is 1000 times less addictive, far less abusable, and far cleaner with regards to the standard opiate side effects like constipation, erectile dysfunction, liver dyscrasias, and obesity, not to mention a myriad of other end organ damaging effects that include even decaying dentition. Such an opiate exists. It’s buprenorphine or Suboxone which is available in 2 and 8 mg doses of sublingual tablets. Approved by the FDA for detoxing from opiates in the settings of misuse and abuse including heroin addiction, it may also be used at smaller doses for chronic pain (among other things; future topics of discussion on this site) in a manner of prescribing that is considered “off label” but allowed by the FDA.

 

Disclaimers

 

  1. This discussion is geared towards patients on traditional opiates like oxycodone that are stable and wish to consider Suboxone as a much safer option. The discussion is also aimed at physicians who would like to prescribe the Suboxone for the traditional opioid patient that is not demonstrating addictive malignant behaviors on their opiate simply because they want to enter a safer world that includes this opiate, Suboxone, that is much less addictive, much less abusable, and has much fewer side effects than any traditional opiate before they get into problems.
  2. The obvious disclaimers that patient should not self prescribe Suboxone or any traditional opiate without a doctor’s a specific written prescription who knows about and who is licensed to prescribe Suboxone (those special DEA license Suboxone prescribing doctors can be found in all major cities).

 

Discussion

 

The whole discussion of when you need Suboxone in terms of requiring it as per federal guidelines, so in other words, acceptable, in label use prescribing versus off label prescribing has become muddy and unclear. So let me start first with approved FDA prescribing about Suboxone. There are folks that really should be on Suboxone. Those would be folks getting their prescribing because they have shown misuse problems with traditional opiates. They’ve shown a problem. And their Suboxone prescribing doctor knows it will stabilize them with their opioid dependence.

 

Then there are the folks that have not shown any problems with their traditional opiate prescribing, but feel that they might eventually, or their doctor feels like they might eventually, or they are escalating on their traditional opiate unnecessarily, without any obvious signs of addiction or dysfunction; yet. Oddly, the circumstance for patients that are not experiencing problems that are on opiates and could benefit from Suboxone, is, unfortunately for them, considered off label prescribing.

 

It’s unfortunate because their insurance may not cover them for the Suboxone since they are showing no need to detox. The FDA considers that prescribing Suboxone for them is off label.

 

However, some insurances are covering that more and more often now. Insurances are gradually realizing that opiate dependency can be treated with Suboxone whether it is dysfunctional opioid dependence or functional opioid dependence. And after all, functional opioid dependence is a ticking time bomb waiting to become dysfunctional. If those folks want to be on Suboxone and have not shown any signs of addiction or problem, they should be entitled to use the Suboxone before the addiction behaviors and problems begin. It’s fortunate then that insurance is starting to favor this.

 

So, the whole discussion of when does opioid dependency move into opioid addiction becomes purely academic. If they are dependent and not putting a gun to a pharmacist’s head or stealing prescription pads, why should they be denied the use of Suboxone instead of oxycodone or methadone or morphine. These folks can respond nicely to Suboxone even though they’ve never had to use it as per federal guidelines. They find that it has much less constipating in fact, affects and destroys erectile function much less, destroy his teeth much less than other opiates, and so forth. Suboxone is a much cleaner opiate. Suboxone is also much harder to abuse. So if they have not had problems yet and they move into the world of Suboxone for maintenance, they can live on Suboxone knowing of course that if they have a breakthrough problem or a surgery or fall out of a burning building, they can return to the world of oxycodone and such as needed. As long as they understand that their pain will always be cared for and that switching to Suboxone is not a “do not use oxycodone anymore” world, they are comfortable to make the switch to Suboxone.

 

Many of them that make the switch know that they have regularly taken a little extra oxycodone here and there and have escalated on traditional opiates. They are happy to be in a world where that is much less likely.

 

Now there are a few chronic pain patients that make the switch to Suboxone that simply never find that the Suboxone works as well as their oxycodone or the like. The explanation is that they had usually been on very high doses of traditional opiates. So a standard 8 mg of buprenorphine provided by a tablet of Suboxone may not tend to their chronic pain. Fortunately, these patients tend to require larger doses of Suboxone simply because of the previous history of high doses of opiates. So adjusting the Suboxone higher in them tends to be indicated before just giving up on Suboxone as an alternative to oxycodone or the like for chronic opiate pain management.

 

Increasing some of these patients to two or three Suboxone 8 mg per morning (single first thing in the morning dosing is this the correct administration of that medication; another online seminar to follow will discuss this in greater detail), unfortunately never allows them to feel benefit from the Suboxone. They want their oxycodone back.

 

If those folks are cooperative with an exhaustive trial of Suboxone that uses higher doses and truly do not get a response in their chronic pain, they should be allowed to go back to the world of oxycodone maintenance if they are responsible with it at conservative doses.

 

In summary, opioid dependent patients maybe divided into two groups. One group that uses their traditional opiates safely. And another group that doesn’t use their opioid medication safely. Both of these groups stand to benefit from changing to Suboxone for maintenance. The latter group that must be changed because of addictive maladaptive behavior is called the approved in-label group in terms of federal guidelines for Suboxone. The previous group that is stable on their traditional opiates and wants to go to the world of Suboxone just for less side effect and also to keep them out of harm because they feel like maladaptive behavior or side effects could come anyway and they might be at risk for them — they should be entitled to the elective use Suboxone before problems start. That is called off-label prescribing, even though Suboxone would be safer than their traditional opiates! Fortunately, insurances are finally covering that more now and even pharmacists are even treating it as acceptable prescribing. Both groups of patients do well on Suboxone, and everyone involved including the patients, their families, the pharmacists, and the insurance companies, are all slowly coming around.

 

It’s important to note that both groups have patients that never do well on Suboxone. There are patients that are doing poorly on traditional opiates showing signs of addictive behavior that must be switched to Suboxone that hate their Suboxone and never grow to like it. And there are patients that never show problems on traditional opiates that want to try Suboxone (the off label group) that never like it, and return to their oxycodone or what not.

 

But those that do well grow to truly appreciate their switching to Suboxone. The approved in label addicts that know they don’t have much choice, so they appreciate that Suboxone keeps them out of trouble and compliant with the law. And the ones that are using Suboxone electively for their chronic pain, knowing they can return to their oxycodone for any exacerbation, elective surgery, nonelective injuries. Both groups tend to be very happy campers.

 

But there are some that never seem to respond to the Suboxone for their chronic pain even when used at high doses. Fortunately, it’s only a small group. Diversion (the term used when selling is suspected) needs to be suspected in that latter group. The feds certainly look at it that way.

 

But I believe that there are some genuine, clear candidates for maintenance on things like oxycodone that have failed the highest safe doses of Suboxone for their chronic pain.They need to be watched closely for evidence of diversion, of course. Genetic testing can be done to see if they might just be rapid metabolizers of opiates. It’s clearly indicated. If this is found to be the case, they should be carefully restarted on their oxycodone at a much lower dose. While they’re switching back to oxycodone, in addition to watching counts more closely, more effort needs to be exerted to lowering their opioid demands, more effort needs to be exerted to document their genuine opioid need. Anesthesiology consults bring a lot to the table because they provide so adjuncts that lower opioid doses. When sending the patient in for an anesthesiology consult, the patient and referring physician need to assertively instruct the anesthesiologist been consulted that they don’t want higher dose of opiates, that they don’t want prescribed opiates at all unless it’s some sort of intrathecal deployment of an opiate. Steroid injections, stem cells — these adjuncts are great to lower opioid demands in the patient that simply refuses to tolerate Suboxone for whatever reason.

 

Case study

 

Patient XY. This young man has a history of nerve damage from a motor vehicle accident that perhaps did initially justify chronic traditional opiate maintenance therapy. As is the current guidelines, he does not have to have an end-of-life situation nor cancer to be maintained on traditional opiates. The feds are OK with this. That’s how he’s been living. He’s always remained stable. If he continues to use oxycodone at conservative doses, and doesn’t show signs of addictive behavior, he should be entitled to his ongoing oxycodone, with occasional consults to anesthesiology or stem cells to lower opioid prescribing. Adjunctive non-opioid prescribing to keep him healthy will also lower opioid dosing. But this is a healthy young man so needs very little of any of that. If he starts showing up to the clinic earlier and earlier for routine refills, the escalation is absolutely not acceptable with further work up. If the behavior becomes more odd (e.g., en route to the pharmacy, he alters the prescription), the doctor documents this as addictive behavior. Immediately, that doctor has to offer Suboxone or referral to a doctor allowed to prescribe it. He has become a candidate for Suboxone, and Suboxone should be started. This is in-label prescribing. If this patient had presented before for tampering with a prescription asking for Suboxone, it would’ve been called off label prescribing. And he should be allowed to get Suboxone.

 

If he follows up with his doctor two weeks later, doing well on Suboxone, excellent vital signs even claiming that he did well, but wants his oxycodone back, and doesn’t state exactly why — suspicion for diversion must occur. Oxycodone and the like should be avoided. The physician should keep him on the Suboxone, optimizing its efficacy for him by tweaking the dose, adding adjunctive therapy, strong arming him into an anesthesiology consult to lower opioid demand, with a plan to continue Suboxone until further notice. If this angers the patient, that’s obviously consistent with divergence. If the patient is agreeable with this, he is less up suspect for that likelihood. Either way, he is maintained on Suboxone until further notice. Patients like this occur all the time. They are clear-cut candidates for Suboxone before Suboxone in an off label setting before Suboxone becomes clearly indicated in an in label, as per federal guidelines setting.

 

Conclusion

 

Belbucca, with maximum doses of less than a milligram of buprenorphine, the prodrug in Suboxone, is now available as a form of buprenorphine approved by the FDA for chronic pain. So pharmacists are aware that Suboxone is entering the world of chronic pain management even though it per se is still off label for it.

 

Stay well,

David Allingham, MD

Welcome to the stem cell surgery component of our practice

Introduction

I have always been a big believer in benign neglect . Let the body heal itself. And like the surgeon’s classic mantra teaches, “don’t just do something, stand there,” I have always given the body a chance to heal itself first for almost every patient I come across. Stem cells do just that. They let the body heal itself. So, me transplanting your stem cells for your wellbeing, in sickness and in health, is a good fit .

I’m  sure you’ve heard a lot about stem cells, and, right about now, may be very confused. Sources of stem cells, types of stem cells, safety of stem cells, efficacy… Baby cord blood vs. embryos, marrow vs. other body tissue sources, random strangers vs. people you know. There are even high priced supplements endorsed by physicians that help the body make them because if you make even a single one, you have indeed done your body a great deal of good. Encouraging stem cell growth with supplements that have been proven to give you a stem cell or two is great.

We are giving you millions of stem cells. In same day surgery, we give you extracted cells that your body stores away in your fat. Plus, by growing more of your own stem cells in a bank, optional but which we recommend, we can grow out lines of your own stem cells for later use when your body degenerates as a result of natural aging or for injury or illness in years to come.

Questions that surround stem cell care take hours to answer . Bottom line, we are transplanting back into you adult stem cells that come from you and you alone, and it’s extremely safe. Not fetal sources. Not from other people. Just you. And the other bottom line, we are not using the painful , ever depleting marrow source. Using safe, mini-liposuction, we are tapping into a source of healthier adult stem cells in a source that, unlike marrow, doesn’t diminish as much with illness and age, your own fat .

Again, we are also not using the higher risk, “fetal” stem cells employed by practices in Costa Rica, Panama, Venezuela ,  and the like that must be manipulated to avoid harming you. No. We are harvesting from a source that hardly even appears in textbooks written five years ago -- your own fat (I in fact just finished a textbook published in 2011 with an illustration of adult stem cell sources that does not acknowledge the presence of adult stem cells in our fat at all and gives little more than a sentence about the possibility of fat storage in it’s fifth chapter!). And you do not have to be enrolled in any university-affiliated study that might give you a control arm with no stem cells at all. No on that as well.

And the care is being provided in a national network sanctioned clinic right here, near your nation’s capital.

To care for what ails you, including aging if you are healthy, you will get millions of stem cells in same day surgery, they will be only adult stem cells, and they will be your own.

History And Terminology

There are two types of stem cells: embryonic stem cells and adult stem cells. Stem cells exist wrapped around all vessels in all tissues, including the most vascular of all tissues, fat. We originally didn’t know what they did, so their name was based on this anatomy -- “pericytes.” We couldn’t study them until we could grow them in a lab. Then, finally, 20 years ago, when we were able to cultivate and maintain lines of stem cells alive in a laboratory, their function was elucidated, and they were renamed “stem cells.”

The first stem cells studied, just 20 years ago, were embryonic stem cells, and so stem cell knowledge began with embryonic stem cells. The embryonic stem cells, not truly representative of all stem cells, came from aborted fetuses volunteered for use by in vitro clinics under strict guidelines dictated by the politics and ethics of the past 20 years. But we soon realized their adult counterparts, the adult stem cells, existed in every tissue from baby to child to adult as well. It is generally believed that almost all tissues have there own different types of stem cells. And, nicely, even those stem cells can back-differentiate into stem cells that will help other tissue types.

We rapidly came to realize that there were vast differences between embryonic stem cells and adult stem cells. Embryonic stem cells come from only embryos and fetal cord blood. Adult stem cells are in all tissues in all living mammals. Embryonic stem cells are prone to cause benign tumors (20% incidence); adult stem cells do not cause tumors. Thus, embryonic stem cells require extensive manipulation to reduce their harm while maintaining their ability to help the body. In sharp contrast, when extracted from a tissue, short of washing them off, adult stem cells require no manipulation to help us. Once largely extracted from marrow, fat is rising as a better source because stem cells deplete in function and number with age and illness from marrow; and marrow extraction is more painful and risky than liposuction.

Physiology

How do stem cells work? They automatically find the areas of inflammation in your body, areas of disease, destruction including trauma, illness, and natural degenerative aging, and they set up shop. Setting up shop means three things, reproducing themselves for an ongoing presence there, turning into progenitor cells which can turn into the correct types of cells that the diseased area requires, and ordering the tissues there to do the correct things. Progenitor cells, the progeny of adult stem cells, are fascinating. They can go on to form any other tissue type the adult stem cells require them to transform into; or, they can revert to become adult stem cells again!

Regular wear and tear regularly makes the body produce and mobilize stem cells every minute of the day. For example, blood cells don’t last too long, so stem cells in the blood come in from the marrow. Intestinal cells, which take a beating from digestion, need a constant source of stem cells, so stem cells are made in the intestines’ lining. Skin is constantly being replaced so has multiple niche areas in it to create replacements. And so forth. Trauma, usually major, is the only thing that really gets the rest of the body to naturally mobilize the more hidden stem cells to start working. Until trauma, they are saved, year after year, many of them lingering inaccessible to our body in our fat. If we can harness them, and we can now, we can use them for other disease processes including aging, illness, and smaller trauma. So, the only side results of their use for illness and aging is younger skin, more hair that is no longer gray, better gut function, hematologic improvement, like that. Yes. This is a very exciting time.

Politics

Many of you have come to recognize me as one of the areas top twenty-five physicians, a person of vision and passion, and I appreciate that. Please bear in mind however that lots of what I say below about stem cells comes from others. Plain and simple, the body already produces them, and nobody can say that we are introducing foreign living objects if they came from the same body receiving them. In the FDA game of tolerances required showing no harm to human health or environment, I along with all physicians have always dealt with known testing rules and final regulations. To get to this point of safety and efficacy with anything they had invented, big Pharma would have had to spend literally millions of dollars and 10 to 20 years proving their chemicals in protocols developed by laboratory companies in all likelihood, because they can’t match the safety of what your body makes for you. When it comes to regulation from Congress, massive deposits and ongoing disbursements to the FDA exist just to play in the game, and still no promises are ever given or taken. Just look at the handout sheets given with any new drug. Impressive.

Remember that mankind with his drugs and civilization created most diseases. The only source of our demise that nature recognizes as something that it wants to fix is trauma. It doesn’t recognize many of our diseases because it didn’t make them, so it doesn’t perceive many of our diseases. So, it doesn’t try to fix them. We made them. Now we can fix them, each patient fixing his or her own self.

Adult stem cell surgery, unlike drugs, is you supplementing you. No data is required for them and no label review is required prior to shipping in interstate commerce for use on just you in the future if needed. All that is required is an association of stem cell doctors, scientists, and researchers who have published in scientific magazines. Cell Surgical Network is my network, and I hold to all those references. I believe what I say according to them is biologically sound, but data is still necessary to be generated as per the regulatory bodies of the US government and practice of medicine, and I agree we need to continue to compile evidence. Notwithstanding, care must be taken to address the limits of non-government entities so that such self-motivated falsehoods do not enter the non-scientific literature, opinion papers, and Internet.

Adult Vs. Embryonic Stem Cells

As we continue to learn about both types of stem cells today, much scientific data exists in the literature that continues to confirm that adult stem cells are safer than embryonic stem cells. We have learned that, unlike embryonic stem cells, adult stem cells need no manipulation at all (none) to directly help us immediately. Embryonic stem cells in contrast must be manipulated, contorted, stimulated, chemically prodded, and genetically fashioned to minimize their harm to us. It is thus easy to understand big pharma’s fascination in them. If they require manipulation before they can be made safe, then industrial patents can be involved in their use, and money can be made.

Since patents aren’t required for adult stem cell medical use, big pharma can’t make a dollar in their use. In fact, because they lead to an increased response to big pharma drugs as a result of illness being reduced, they lead to a reduced use of big pharma drugs, and big pharma anticipates losing big money as a result of their ability to help us all, thus, both short and long term. Want to reduce your dependence on drugs?

It’s easy to understand that little investigation is being made by big pharma. It’s not dollar driven for big pharma, so it’s not something they’ll study. It is dollar and health and longevity driven for us. So, we must learn about them by researching them through patient funded investigation. And that is what we are doing, patient funded investigation. Governed by doctors and patients, we are keeping a North American database of all of our findings. As a result of the first six years of harvesting and deployment in approaching a million harvests and deployments, that they are safe is now a given. But, we must confirm their apparent anecdotal efficacy by generating protocols and fine-tuning what works into methodology that improves their worth for each subsequent use or trial. In a network, this collaboration of thinking leads to accelerated advancement as we work together to help each other improve annually at meetings and presentation, monthly with conferencing, daily in a close network with an open database designed to help patients instead of win a political prize. For example, the protocols of standard operating procedures for harvesting and deployment have improved three different ways just this year alone because of findings by network providers leading to the procurement of millions of more cells as an immediate result.

Most simply put, adult stem cells, unlike embryonic stem cells are found in every one of us, so we can actually heal ourselves. Big pharma has less if any interest in using and researching these exciting cells that are found in every single person even though they help us, not just because they cannot secure a patent to make them money, but because they will allow us to use less drugs in the long run.

Most research in this country is dollar driven. That is, if it isn’t making someone money, we won’t find out about it from that research money. How utterly demoralizing and pro-American must it be for pharma to watch us taking care of ourselves without being able to put limits that benefit them either immediately or down the road. Immediately, they can’t put a patent on this care, so can’t make a dime. Down the road, as we improve our health, we need to use less and less of their dirty drugs, if at all.

Stem Cells May Explain Many Myths

Stem cells may explain some previously misunderstood phenomena. For example, why do pregnant women with asthma, diabetes, and other distinct disorders suddenly become well or at least permanently improve a few months after pregnancy? Stem cells? It’s not immediate. It’s 2 to 8 weeks, but these illnesses have been documented to resolve after a woman becomes pregnant. It is well established that stem cells from the baby along with the baby’s other blood cells mingle in the mom’s bloodstream. Are these baby stem cells finding their way to mom’s inflamed or ill tissue automatically and healing them?

Why does exercising to the point of muscle destruction lead to longevity and agelessness in those athletes? Stem cells? Maybe the old “what doesn’t kill you makes you stronger” adage is now easier to understand. Similarly, why have warriors of yesteryear that destroyed their battle warn bodies skirmish after skirmish managed to outlive their contemporaries and remain healthier than those who remain sedentary or just exercise routinely? Stem cells? Everything we are doing is investigational. We’ll have answers soon.

Procedures

Self-Surgical? Yes. It’s all about you. From you, for you, because of you. Often on the same day, cells are harvested from you for return to you in a way that will help you the best.

Mini-liposuction harvesting from your love handles then deployment into areas of illness like knees or shoulders are all done in a sterile out-patient setting in a single day, usually in less than an hour. You need not be fasting. You are encouraged to get a snack after harvesting and prior to deployment.

Following deployment to your site of injury, inflammation, or disease or aging, I provide the rest of your millions of stem cells by IV. These stem cells find their way to only the areas of greatest inflammation starting with the lungs and onward to all the other body tissues.

These are the ultimate repair parts.

Specifically, the stromal vascular fraction (SVF) derived from the fat in your back has stem cells that go to the tissues to stimulate the tissues to help themselves including make more tissue. The SVF also has progenitor cells that go to the tissues to become the tissues. The progenitor cells, early offspring of stem cells, have the ability to back differentiate into stem cells of more tissue types possibly easier than stem cells can forward differentiate into different tissue types.

Candidates For Stem Cell Surgery

Any child or adult with any degenerative illness or trauma of any kind including elective surgical can benefit from a dose of their own stem cells. This includes aging with the clinical term frailty if you’re into labels.

While we cannot provide patient testimonials because of HPPA violations and federal restrictions due to the lack of research to date, we can report anecdotal stories. Young children with autism are sticking their arms out for their next stem cell shot because they know it will make them feel so much better with regards to digestion and sickness, not to mention happiness in themselves and their families, and even in the way their skin feels. The NFL (“not for long”?) may have new life with quarterbacks getting back memory after years of symptoms. 50% of men with erectile dysfunction post fully ablative prostate surgery for cancer is changing lives were able to penetrate again. Knee cartilage in the worst of studies improving 85% in a period of 2 to 8 weeks, 95% in more cherry picked groups over a period of months, all in all approximating the benefits of full knee replacement without the six months of disability incurred by such drastic surgery. Long time cardiac patients shocking their cardiologists at annual rechecks with normalized EKG‘s. And the list goes on and on and on.

Stem cells should be attempted no more than three times in a patient that is not responding to them. After treatment failure in that setting, consideration should be made to the possibility of immunocompromise, and the patient should consider receiving adult stem cells from a family member.

How Long Does It Take To Work

If it’s going to work, every testimonial so far claims some improvement in two weeks. So, 20% improvement by two weeks is the rule. Remember, you are talking about a therapy that has to change cell processes. Even medications that change cell processes take two weeks before they start working at all (of course, medications will be loaded with side effects which stem cells do not produce). But any therapies that affect cell processes must send signals to get into the cells DNA which lives in the nucleus and the mitochondria we have now discovered, changes what the DNA is ordering the cell and surrounding cells as a result to do, then those changes must be effectuated in those surrounding areas including cells, i.e., so membranes must change, talking between cells must change. You can imagine that all of this takes at least two weeks to start.

If you have struggled with illness and treatment failures, you have to ask yourself three questions: do you want to try something that resets your clock to what your body could do when it was a child; do you want to try something with a spectacular track record of safety that is helping staggering amounts of people that use it anecdotally trial after trial; or do you want your condition to advance further and further without knowing?

If you are generally healthy, you have to ask yourself these three questions: do you want to live longer, better, and more attractive? That’s whether or not you have any medical condition or disorder. Yes, even frailty and aging are degenerative processes. So these regenerating cells turn them around as well. If you want to defy aging, and some people don’t, we want to investigate how we can safely do that, too.

How Long Does Their Effect Last

How long do adult stem cells survive? How often do I have to get IV infusions? Longevity is good with stem cells. The studies again are limited, since most research in this country is only done on things that will make money for big pharma. However, some incidental biopsy studies have been strongly indicative of exciting longevity. Studies looking at biopsies of women with hepatitis nine months after delivery showed their daughter or son‘s stem cells in her liver. This has three huge implications. One, the immuno-privileged nature of the cells keeps them from being rejected (in fact, stem cells are being used to treat host-versus-graft disease). Thus, daughter or son cells are only half like mom, and thus different from her. But the body preserves them; and for a long time. Even nine months after delivery, viable stem cells are still found in the mother’s liver. Three, that the cells found their way to the mothers ill liver means they automatically found their way to this area of illness.

Treatment response in most protocols is assessed at two and eight weeks. Repeat IV infusions and specific site deployments based on re-harvesting or banked cells are strongly recommended if response is not as strong as desired. Rechecks continue. Protocols currently in use for certain illnesses clearly call for monthly infusions. Other settings seem to indicate an infusion every 2 to 7 years will be sufficient.

Their longevity is it expected to be in the thirty-month range. Remember, the body continues degenerating. So, how long the therapy lasts is not an indicator of stem cell function. Function and response dictate care which may include indication to revise protocol to say, come back in two months rather than two years. Like that. Stem cells last in your body multiple years it turns out. It is my feeling that we underestimate the power of a stem cell. We are currently underestimating the durability of stem cells in order to help patients. I believe they last a long time in your body.

Clinically, eight weeks as a point of maximal response, which is usually at least 50% and often (knees especially) 85-95% improvement, is what we hear again and again in testimonials that claim response.

Certain numbers keep popping up, as if there is a pattern of response based on what we know about the body’s ongoing natural ability to regenerate vs. the natural pathophysiology of a disorder’s tendency to degenerate us. Many disorders show 25% response at 2 weeks, 85% at 8 weeks. And there are two general classes of these disorders that benefit from stem cells. One group tends to require repeat stem cells every 2 years, and these seem to be disorders where a body part is degenerating. Another more normal group of disorders, if you will, pertains to normal aging only probably, and these will probably require stem cells every 6-7 years. I think everyone knows the old elementary school science fact that our body regenerates itself completely every 7 years. Maybe these disorders are on that timeline of need and disability producing that kind of response and success. It’s hard to say for sure. We do see both these sets of numbers again and again, though, and further investigation will tell.

Cost

Yes, expensive . So, we want you to consider not doing this -- because we are selling life. We are selling longevity. We are selling 2 to 3 more decades with your family .  2 to 3 more decades working on your second career. 2 to 3 more decades working on your dreams.

This is your opportunity to choose less invasive treatment, less surgery, less drugs. This is your opportunity to thus avoid side effects, some even harmful. This is your opportunity to choose less convalescence, less recovery time, less down time, less pain.

Look at cost, but in terms of probably less memory loss, less dysfunction, less weakness, less aging, and less frailty that you will get as an added benefit. So, if one disorder or indication leads you to stem cells, you are likely to get all the rest of their therapeutic responses at that tissue’s expense.

Less lost time at work. Less follow-up care due to surgery, surgical failures, or follow-up surgeries or surgical complications including infection (orthopedic surgery is notably prone to infection).

Insurance will probably not cover it .  It should. It is more cost effective for the insurance company, and they are looking into it. That will take years. Everyone should have the option to do it. They don’t. You do.

True, some don’t see it this way, and that’s fine. I have one particular patient who can easily afford stem cell surgery, but says he’d rather just keep his $10,000, get old, and die. If getting older to you only means getting more brittle and fragile, and dying sooner than later -- we get it. Stem cell therapy is not for you. But if getting older means having more time to do the things you love to do or to do the things you never did, give us an hour of your time for stem cell surgery right away. The same way Adult Swim and Disney discovered, hey, we as adults still really like cartoons, some of us have discovered, we never really wanted to grow feeble and unable in the first place. For those of us who don’t want to grow older and older and older, keep your user friendly, neighborhood stem cell team in mind. We got your “back”.

Precautions

Fortunately, they are few. Contraindications including cardiomyopathy especially congenital cardiomyopathy limit the use of stem cells. Cancer must be ruled out. No patient can receive the cell surgery within two weeks of any dental work including dental office cleaning. Smokers cannot receive this surgery. The physicians performing such surgery must follow these same guidelines.

If you’re curious, smoking affects stem cell health, viability, and thus function. As a result, a close smoker friend of mine asked if smokers could get extra to overwhelm the blood contamination from smoke. I’m afraid not. I can help you quit, if you’re interested. Then, we can give you your stem cells.

Complications

My patients know me. I would never recommend something unsafe for a patient. Major problems have been extremely rare. The only major limit is that your natural disease progresses, the arthritis in your knee, the arthritis in your shoulder, and so forth, is no better two months after you’ve done the stem cell surgery. But it would have certainly progressed if you had never tried stem cells. And worsening of your natural disease process could happen with a dozen traditional drugs, with their added side effects to boot.

Other problems include divots, especially in thin women. So, for them, we do harvesting on both love handles. This is liposuction, folks. It’s mini-liposuction at that. It produces a desired result in and of itself, and most of the people are happy to get it for it’s own nicely body sculpting effect. “Go ahead and take a little extra” is what most of the ladies (and gentlemen) signing up say, thin or otherwise. There’s only one real risk of liposuction when it’s extensive, which this isn’t. Fat embolus. Nearing 800,000 harvestings in the US and Canada to date, there has been only one documented fat embolus that followed a stem cell surgery. In that situation, it is unlikely that the stem cell surgery produced it. Trauma that occurred following the stem cell surgery weeks later was a much more likely cause of the fat embolus. The stem cell procedure was held accountable, probably incorrectly. The fat embolus was treated.

Exacerbation of cancer is a risk. Cancer must be ruled out aggressively in all patients about to receive stem cell surgery. That work up is included with this care. Blood testing is required for this and is extremely sensitive. That is required. While stem are currently being used to treat cancer with great success, your non-manipulated stem cells deployed directly into you, which this is, shouldn’t be done in a cancer patient that isn’t in remission. Elegant studies are pairing stem cells with cancers and cancer killing agents including viruses outside the patient’s body and formulating treatments that can be administered to the patient with great results. Cancer in you however must be ruled out before proceeding with stem cell surgery.

One final extremely rare effect is worth mentioning. Exacerbation of fibrosis around the eyes can follow deployment directly behind the eyes in certain rare conditions. In only one case to date, following harvesting, stem cells were deployed by an ophthalmologist to both patient’s eyes. It led to permanent blindness, presumably from white cells drawn to that area associated with the stromal vascular fraction component that contains the stem cells. I am not an ophthalmologist. I do not work in or about the face.

Alternatives

Alternatives for aging

Don’t be fooled by things like testosterone. It’s just another dirty drug that pharma wants to sell you with tons of real side effects like life threatening and painful limb disfiguring clots that you can get even if used “properly” – it’s a terrible answer for most of us, especially if you’re healthy.

Wellness. What if aging could be turned around? If you’re generally healthy, and just afflicted from all the things that take a toll on us in aging… Think about the possibility of doing something for your health that can, if you are healthy, possibly double how long you live, which can make you as strong and athletic as you were over 10 years ago. Consider stem cell therapy. The clinical indication is frailty if you want to put a name to it. But what you called wellness ten years ago isn’t what you call wellness today. And you can get it back.

Alternatives for illness

There is no guarantee stem cell therapy will work. And while stem cell therapy will likely turn out to be the most ideal thing for your injury or disorder ESPECIALLY BEFORE you start standard therapies with proven lack of efficacy, steroids, NSAIDs, risky surgeries, federal guidelines do not allow us to encourage that. These cells may not make you better. But, they are more likely to make you better if other things are not.

Those unproven methods are well-established to not work. They are also well-established to allow your disease to continue. They are also well-established to hurt your body in their own distinct ways with unwanted effects on many of your end organs that must be exposed to them not seeking benefit from them.

Stem cells are your body’s mother cells as they are called in South America – they are what your body does to heal itself. We are supplementing you with your own stem cells by the millions.

Side effects? If you’ve been fighting an illness, mild or even severe, with no help from ineffective drugs that almost always have side effects, consider this an option. Because it’s so safe, the mostly likely worst thing it can do is not work. In almost 800,000 deployments, there have been practically no major reactions.

Availability. No one else is providing this strictly monitored investigational review board (IRB) driven care in the state of Virginia. No one else in the state is in a North American network that accumulates data daily that goes into refining the care that you receive here. In that anyone else experiences great difficulty in this country and isolated other parts of the world finding this care, your power to do it here so close to your home makes you pretty lucky. Not for 20 years, maybe much longer, should it become quite commonplace. But for now, you get to do it easily right here in the mid-Atlantic, close to our nation’s capital, seven days a week.

I understand that I am not the only clinic providing adult stem cells in Virginia. But, I am the only clinic in Virginia that is in a collaborative network consortium of 2000 physicians in the US and Canada providing adult stem cells extracted from your fat and deployed back into you in same day surgery.

Stem cells are great, yes. The word is out. But, be careful about bogus products that reference the stem cell’s greatness. Yes, stem cells are great, but most if not all of these products do not contain stem cells. And if they do, they’re definitely not yours. So, question the source. Question the type. Always read the transcript, and be careful about buying them before doing so. It's usually about a bottle of pills that favors stem cell health. Not a single stem cell will be involved in the product or service.

References

This website shows no database of positive testimonials because the FDA frowns upon it. But, take a look on line and you will find only positive patient testimonials. I have not been able to find any negative testimonials on line from patients, only the occasional negativism from pharma and insurance companies, and the occasional physician -- threatened authors that fear the effect this will have on their profession.

The fact that the transplant plastic surgeons that developed this surgery are doing the exact same surgery on their wives and themselves points up their faith in both its tremendous value as well as its complete safety.

And ask your doctor. If she’s read up on it, she’ll tell you. It’s completely safe. But just wait ten to twenty years for all the confirmatory data to show exactly what it will work on and for how long. If she hasn’t read up on it, ask her why not. That’s okay. Big pharma hasn’t shopped it to her in the form a suit in heels selling the next cash cow that you’ll need to stay on for decades so it can help you (i.e., so it can help them is more like it in their dollar driven world). But, I’ll bet she’s up on the latest cash cows and all their side effects. See, your doctor hasn’t had the standard million dollar ad campaign a drug gets they’ve discovered for the latest thing they’re shopping – so they won’t know about stem cells. And that’s because pharma is not studying it. And they’re not researching it because it won’t make them money. It can’t. Bear in mind, even if Tom, Dick, and Harry can cure Tom, Dick, and Harry without manipulating some chemical into safety and possible efficacy, big pharma can’t put a patent on it. And if they can’t put a patent on it, they won’t study it. If they won’t study it, no one will -- unless doctors and patients do. And that’s what we’re doing. Patient funded investigation.

In patient funded investigation, we network with hundreds of other clinics currently following our exact same protocol. So, we refine together. All the information goes onto a shared but private database in a day-to-day fashion if someone discovers something, semi-annually at meetings, and yearly at presentations. Of course, there is some non-patient funded research looking at it as well. And it’s very limited. That research is available and safe if you’re interested in helping. Please remember that if you want to get into such trials, there’s a 50% chance you’ll wind up in a control arm that receives no stem cells.

Experimentation is what big Pharma does with chemicals known as drugs because they have side effects they are trying to assess and minimize. This is not a drug. It’s same day transplantation back into you. This is called investigation because safety as a given, we now need to study specific worth. We all look forward to a day where a pamphlet with this wording becomes obsolete because all of medicine is doing this. For now, we would rather you do this because you feel you have to do this, not because you want to. Great safety. Minimal risk. Consider that the downsides of not doing it by far exceed those of trying it.

The Future

One starts thinking after hearing about one satisfied testimonial after another in the ill, injured, and healthy aging, what happens if you give stem cells to completely normal people, young adults that are completely healthy? Do they become superhuman? If we’re talking average intelligence, do they start thinking at an Einstein level? If they’re always making it to the playoffs, will they win championships consistently instead? And if their family tree says they will live well into their 80’s, might you get them into their 140’s instead? 150’s? Who knows. This patient funded investigation will help find out.

Research

How long stem cells last in your body should be a major focus of research to follow at this time, both clinical and lab. Both types of research are necessary. For now, all we have is fully legal patient funded investigation.

Protocols must be generated. Research and ongoing investigation will use of stem cells at this time will lead to protocols in the next 10 years. For now, we just don’t know. Evidence-based medicine is all we have. And that always represents great care. In other words, you should get stem cells and continue getting them at intervals where your body is advancing it’s disease faster having shown response to the stem cells in the past, immediate past or several months ago.

This is very specifically designed to lower your demands for medications including opiates in patients requiring them. But it can also help opioid naïve patients from ever escalating to those needs.

More speculatively, don’t you think that a system that is so lenient on a big pharma that pushes opiates in a country riddled with this addiction might favor the greatest innovation to reduce our collective opioid demand of the past 100 years? You would think. But thanks to our own adult stem cells, we can do it on our own.

Where most of the research is currently headed is towards research that will allow Pharma to harness proteins being released by manufactured cells that are largely derive from embryonic stem cells that they feel have super powers. Unfortunately, this is there a downside to this. Embryonic stem cells in contrast to adult stem cells have the most potential for harm. Pharma still feel that they want to latch onto them as a research tool because they have the most potential for regeneration. However without potential for a generation, they have the most potential for tumors. Farm still wants to hang onto them as the tool for their success because they will be able to produce proteins and enzymes that will allow them to secure patents so that they can make money. Big Pharma simply cannot secure patents to Tom Dick and Harry and Suzie Betty and Jane producing cells for Tom Dick and Harry, and Betty and Jane. We are taking care of ourselves if we use adult stem cells. There are the safest. And they are all the body needs to regenerate with the body has made As an adult. We are taking care of ourselves. Big Pharma cannot put a patent on that.

Pharma is focusing on embryonic stem cells, the dangerous type, because using them they have found they can manufacture specific organ cell types. And if they can do this, they can patent how they manipulate cells to become specific organ cell types and they can patent the proteins they discover that the embryonic stem cells create to talk to other cells. They can only patent chemicals and how they manipulate cells. They cannot patent you or me or your neighbor or your loved one. And because they can’t patent us, they are not interested in helping us that way. The agents they use in the growth media two minute manipulate cells, manipulate their ability to differentiate the cells, growth factors, culture medium specificities specificities that increase the number desired types of cells, all of that they can patent. And that will you will get cells from other people, so they can manipulate that as well. And it’s hard to imagine that any sales other than yourself will have less side effects than you.

Pharma however can patent different special growth agents and special cell differentiation agents and special culture medium agents that manipulate the cells to increase their ability to divide, increase their ability to become desired cell types, increase their ability to last, increased her ability to change. That way they can make money. And that way they can use stem cells from other people on you. Engineered neurochemically, anatomically, and physiologically, Pharma continues to spend millions of dollars on research on embryonic stem cells that they can change and patent…

With little or no interest in the cells that are available to you and me for you and me. They cannot ever make a patent on you or me. And this angers them enough to not study it, even though it’s cleaner, safer, healthier, and possibly more effective at treating a number of different diseases.

So: this is not snake oil. There is a great deal of research that has been done in the past decade, and a great deal more that is underway. What we do know for certain as a result is that adult stem cells are very safe and adult stem cells work. How safe: completely. How much they work and how to use them in each and every medical disease we have discovered their value must be delineated.

Conclusion

Why are we hearing about stem cells now and not 20 years ago? We have known about stem cells for many decades. Originally called pericytes - cells with no obvious function with finger-like processes holding onto the outside of blood vessels everywhere in the body - they were renamed stem cells when we realized the body used them for turning into any tissue in the body to help healing when there is tissue injury or disease. They were renamed adult stem cells when they were found to be different from embryonic stem cells.

A brief timeline summarizes their history. 20 years ago, 1998, the first embryonic stem cells were kept alive in a laboratory. As a result, we were finally able to study them. Ten years later, those studies reveal that adult stem cells are different from embryonic stem cells. Five years after that, just five years ago, we begin to find adult stem cells in fat. Thus, the newness of adult stem cells in surgical therapy.

Patient Heal Thyself

If this is still frightening to you, it’s probably because you are either big pharma that can’t access it to make a dollar or fear it will diminish future markets; or you are centralized, corporate government that wants to own our health and thus fears they will have to take care of you longer; or you fear change; or fear progress…

Or maybe you are concerned that it is something new.

Sure, you can wait the 10 to 20 years it’s going to take to generate the exact protocols required to optimize the benefits of the extremely safe care. Or you can get that care today. Join us on the frontier of help, of patients helping themselves get better using their own cells without drugs filled with toxic side effects.

Providing Great Hope for Our Ever Aging Country

Adult stem cells are about safety and not surplus for Pharma. Adult stem cells are about patients and not patents. Adult stem cells are about self-care and not unknown donors and manipulated cells.

When you think about health care, you can say, yes, I have another option.

When you think about stem cell care, you can say yes, I have another option.

Improvement is the key word. What if you don’t? You will never ask yourself that question if you get stem cells. You will always ask yourself that question if you don’t.

Stem cell surgery. We are doing same day transplantation surgery of our own cells, sterilely freeing them from one vascular area of our body and placing them at a needy area of injury or illness or frailty. And you can grow in a lab and store in a bank your own stem cells. Personalized medicine is here. It is no longer merely a buzzword. The future arrived.

Some are advising sharing cells from outside donors. This may be unsafe at this time. Further, some are advising fetal sources, which are not only not you they are not even adult stem cells. They are embryonic stem cells. While safe and free of allergic risk, embryonic stem cells still need manipulation to minimize the risk of benign tumor formation. There are 2 lines of rejection, both cellular and immunogenic, that reject outside donor stem cells after 2 or 3 transplants. That foreign DNA creates donor tissue after numerous transplants that should be avoided as far as we can tell, especially in the first decades of this care, especially in light of the super safe great outcome system that has been developed that only requires you. You will only be getting you.

Self-help

We are doing this with a team of two thousand American and Canadian physicians doing it primarily in our continent at a hundred clinics. There is a reasonable but low risk of divots forming from the harvesting process. This is increased in thinner patients. Every effort is made to avoid them forming.

Your own stem cells can do no harm in any new area of your body. These are the repair and regenerate, Maytag repairman cells already in use everywhere in your body. There is no doubt in my mind that us accessing our own stem cells for our own use is the greatest innovation to improve our health care since antibiotics and vaccinations. Not unlike antibiotics and vaccinations, they are being met with some uncertainty. But unlike antibiotics and vaccinations, we will not require the involvement of big Pharma. As a result of these similarities and differences that adult stem cells bear to the greatest innovations in health care, I welcome adult stem cells to our practice.

We love life too much. There’s still so much we want to do, and a second life would be just fine, even if we were never ill. So now, thanks to safe, modern medicine that lets you care for you, adding on years doesn’t have to mean getting grayer and falling apart and moving rapidly towards death any more.

Commensal Organisms Can Protect Against Pathogenic Bacteria

OCT 17, 2016 | NICOLA M. PARRY, BVSC, MRCVS, MSC, DIPACVP

Recent studies published in Science Immunology and Science have shown how a commensal intestinal bacterium produces an enzyme that can help protect against pathogenic bacteria. 

“In our studies, we characterize both epithelial and commensal microbial contributions to a protective mechanism in the mammalian intestine that reduces early pathogen invasion and tissue damage,” write Virginia Pedicord, PhD, from Rockefeller University, New York, New York. “Our results suggest that the commensal bacterium [Enterococcus] faecium triggers enhanced epithelial barrier function and pathogen tolerance through its expression of a unique secreted peptidoglycan hydrolase, SagA [secreted antigen A].” 

The microbiome plays an important role in human health, and changes in its composition can help to promote either resistance to, or infection by, pathogenic bacteria. However, the specific factors in modulating host susceptibility to infection, as well as the mechanisms involved, have remained poorly understood. Researchers from Rockefeller University therefore conducted experiments to study the probiotic potential of the bacterium Enterococcus faecium, using Caenorhabditis elegansworms and mice infected with Salmonella bacteria.

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Lyme Disease Reminder!

To read the entire article, click here.

The Virginia General Assembly, in its 2013 Session, passed legislation that became law on July 1, 2013. Currently in the Code of Virginia at Section 54.1-2963.2, this law requires certain communication with patients who are tested for Lyme Disease. The obligation to provide the information is for all licensees of the Board of Medicine or an in-office designee that orders a laboratory test for Lyme. Below is the law in its entirety. 

CME Required for Certain Practitioners

Law was passed this year that authorizes the Board of Medicine to require certain prescribers to obtain 2 hours of continuing education on topics related to pain management, the responsible prescribing of opioids and other controlled substances, and the diagnosis and management of addiction. The licensees selected to obtain this focused continuing education will be determined by data from the Prescription Monitoring Program (PMP). In October, members of the Board will define the thresholds that will be used to identify these licensees. The thresholds will be reviewed by the Board’s Executive Committee on December 2, 2016. Notifications will be sent prior to January 1, 2017 to the licensees that are required to obtain this continuing education in the next biennium. Here is the bill that passed the House, the Senate, and was signed by Governor McAuliffe. To read more...

Opioid Educational Opportunities

One Care of Southwest Virginia, Inc. is teaming up with the Virginia Department of Health to offer free Category I CME programs around the state on pain management, proper prescribing of controlled substances, and substance abuse. Please consider taking advantage of one of these opportunities to enhance your knowledge, sharpen your practice skills, and provide safe and effective care to your patients.