Marc Darrow MD,JD

In his 2011 paper published in the International journal of general medicine, (1) Christian Schneider, MD, Ph.D., explains Traumeel injections as an alternative to Non-Steroidal Anti-Inflammatory Medicines. He describes the treatment in this way.

“Traumeel is a fixed combination of diluted plant and mineral extracts. It has been available over the counter in Germany for over 60 years and in Austria for over 40 years, and is currently available in approximately 50 countries, including the USA. The combination is currently used to treat acute musculoskeletal injuries, such as sprains and traumatic injuries, and as supportive therapy in pain and inflammation of the musculoskeletal system. It can be used in the form of tablets, drops, injection solution, ointment, and gel.

The ingredients of Traumeel have been used for many years for therapeutic purposes, such as for pain (Atropa belladonna), inflammation (Echinacea), bruising (Arnica montana), wound healing (Matricaria recutita, Calendula officinalis), bleeding (Achillea millefolium), edema (Mercurius solubilis), and infections (Hepar sulfuris). Based on such observations, Traumeel was developed by the German physician, Dr Hans-Heinrich Reckeweg in the 1930s; he combined botanical and mineral substances to produce this natural medicine to treat musculoskeletal injuries and inflammation.”

As described on the website drugs.com, “Traumeel® Injection Solution is an anti-inflammatory, analgesic, anti-edematous, anti-exudative combination formulation of 12 botanical ingredients, 1 mineral substance and 1 animal derived substance. Traumeel® Injection Solution is officially classified as a homeopathic combination drug.”

The purpose of Traumeel injections is to be an alternative to Non-Steroidal Anti-Inflammatory Medications and Cortisone

The goal of Traumeel is to act as an anti-inflammatory and be a safe alternative to NSAIDs and Cortisone

A study published in 2017 in the European Journal of Integrative Medicine (2) showed that Traumeel injections could be beneficial in pain and inflammation reduction in patients with knee osteoarthritis who fail to respond to standard-of-care pain treatments, (anti-inflammatories and cortisone)  who are at risk due to the side-effects these medications cause. However, further research is needed to determine if Traumeel injections can slow and/or prevent progression of knee osteoarthritis.

1 Schneider C. Traumeel – an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. International Journal of General Medicine. 2011;4:225-234. doi:10.2147/IJGM.S16709.

2 Lozada CJ, del Rio E, Reitberg DP, Smith RA, Kahn CB, Moskowitz RW. A double-blind, randomized, saline-controlled study of the efficacy and safety of co-administered intra-articular injections of Tr14 and Ze14 for treatment of painful osteoarthritis of the knee: The MOZArT trial. European Journal of Integrative Medicine. 2017 Aug 1;13:54-63.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:

1 Garcia JB, Rodrigues DP, Leite DR, do Nascimento Câmara S, da Silva Martins K, de Moraes ÉB. Clinical evaluation of the post-laminectomy syndrome in public hospitals in the city of São Luís, Brazil. BMC research notes. 2015 Dec;8(1):1-7.
2 Bailey JC, Kurklinsky S, Sletten CD, Osborne MD. The effectiveness of an intensive interdisciplinary pain rehabilitation program in the treatment of post-laminectomy syndrome in patients who have failed spinal cord stimulation. Pain medicine. 2018 Feb 1;19(2):385-92.

Marc Darrow MD,JD

You go to the doctor with a complaint of severe shoulder pain. The pain is at the top and side of your shoulder. You tell your doctor that the pain is much worse when you do anything where you have to reach over your head. You also have a hard time sleeping at night because the pain is worse when you lay down. You may get an MRI or an examination. Your doctor may be looking for a full range of motion in your shoulder even with pain at every point. For us, in our office, full range of motion, even with pain, is a good sign we can help with stem cell treatments.

Once the pain is determined to come from subacromial space of the shoulder, that is the area of the rotator cuff tendons and the subacromial bursa, then rotator cuff tendinopathy, (shoulder impingement) is often diagnosed. The impingement occurs when the Acromion’s underside, presses against the rotator cuff tendons, wear and tearing at them.

The surgery to fix this is not effective – surgeons suggest not even offering it

In the late 1980’s and early 1990’s Arthroscopic subacromial decompression (ASD) was developed to be able to go in and shave away the Acromion and give the tendon’s more space.

Initial reports indicated good success rate. A 1987 study from the Department of Orthopaedic Surgery, University of California at Los Angeles wrote: “Eighty-eight percent of the cases were rated “satisfactory” (excellent or good), and 12% were rated “unsatisfactory” (fair or poor),” when performed by experienced physicians.(1)
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Marc Darrow MD,JD

Many people email us about their hip and back pain. Some have been recommended to a hip replacement, some have been recommended to a spinal surgery. Some have been recommended to both surgeries and they are in the process of choosing between one or the other and exploring options to help them avoid one or the other surgery, even both. Some at this point are not even deciding which to get first, they may simply take the first one that is available.

The question that comes in to us is about stem cell therapy as an option and “which would you treat first? My hip or my back?” The benefit of stem cell therapy is that in the same visit, if you are a good candidate for treatment, we can treat both of your pain challenges at the same time. In this scenario, both areas can begin a simultaneous healing process. You do not have to wait for you hip to heal to start spinal treatments, you do not have to wait for your back to heal to start hip treatments. Below I will discuss the science behind these treatments.

Research: The question of which to have surgery on first, the hip or the spine, is much more complex and risky than thought

The option to have lumbar spinal surgery and hip replacement at the same time is clearly one that is not recommended for obvious reasons. So a decision has to be made. Spinal surgery or hip replacement surgery? One has to come first and one has to wait.

At Washington University School of Medicine, Departments of Orthopaedic Surgery and Neurology and Physical Therapy, surgeons and therapists wanted to examine patients who had hip osteoarthritis and back pain. The hip-spine complex can be a tricky and complex area to diagnose. Finding the true source or sources generating a patient’s pain can be equally complex. This makes the first surgery decision even more difficult.
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Marc Darrow MD,JD

In this article I will offer a brief explanation of how stem cell therapy can work for hair growth.

In a May 2019 study in the medical journal Cells (1), researchers discussed the use of stem cells to improve hair regrowth, including reversing hair loss by regeneration of hair follicles.

The learning points of this research are:

• Stem cell therapy is a new approach to treating hair loss.
• Methods using donated stem cells are being tested in cell treatment clinical trials.
• Intra-surgical cell treatments that incorporate autologous cell-based treatments (such as bone marrow) with a one-step approach (cell harvesting, minimal manipulation, and immediate injection) into a single technique “offer tremendous potential” to patients with hair loss

In our office we offer bone marrow derived stem cells and PRP therapy alone for hair loss. This article will not necessarily compare one treatment to another. This discussion is best offered in the examination room when we have had the opportunity to access the hair loss of the patient. What this article will focus on is the common aspects of these three treatments and how they can promote hair growth.

A brief explanation of the three treatments.

• Bone marrow stem cells are taken from your bone marrow drawn from the iliac crest of the pelvis in a simple procedure. The bone marrow contains stem cells and the healing growth factors found in PRP therapy.
• PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected into an area of thinning hair. This stimulates hair regeneration in many people. The treatment is aptly named Platelet Rich Plasma therapy as it is blood plasma that is rich is platelets.

GETTING THE STEM CELLS IN YOUR HAIR FOLLICLES AND “BULGE,” TO START GROWING HAIR AGAIN.

In August of 2018 researchers writing in the journal Stem cells international (2) discussed the role of stem cells in treating Alopecia by way of hair follicle regeneration and neoregeneration.

Here are their learning points:

• Hair follicles have a niche for mature stem cells—hair follicular stem cells (HFSCs)—a so-called “bulge” in the attachment region of arrector pili muscles, (the small muscles attached to hair follicles). (Note: There are stem cells in your hair. They are just not active – see below).
• HFSCs can take part in the regeneration of epidermal cells and the structure of hair follicles and sebaceous glands (these glands secrete the hair oil that healthy hair needs.)
• The researchers explain that: Stem cells of the “bulge” can remain in their niche where they self-regenerate, but they can also move down to the hair matrix region, where they become progenitor cells which then form an internal hair follicle and the hair stem.
  • In other words, the stem cells can become the building block of new hair when active.
• There is a second type of stem cells within the hair follicle. The dermal papilla cells (DPCs) DPCs play an important role in induction and regulation of hair growth and the formation of new hair follicles Signals from DPCs activate stem cells in the “bulge” to start hair growth.

The researchers point out that most of these stem cells live in a “dormant state,” and that their activation is essential for hair growth.

ACTIVATING THESE STEM CELLS

In numerous articles on this website I discuss how stem cells and growth factors introduced into damaged joints activate the native stem cells in that joint to restart the healing process. This is no different when it comes to hair. We know that there are many stem cells in the hair follicle, so the problem is not the number of stem cells, BUT, a problem of getting these dormant cells active again and growing hair.

In the research we started this article with from May 2019, a listing of the common growth factors of stem cells and PRP therapy is given: Here is a description of these growth factors and what they do. This is how we can get the stem cells in the hair and the stem cells introduced in the treatment active – by the introduction of growth factors and “communicator” cells in the treatment.

• Hepatocyte growth factor (HGF) and HGF activator enhance the proliferation of hair follicle epithelial cells. (The stem cells send signals for hair to grow).
• Epidermal growth factor improves the activity and growth of follicle outer-root sheath cells
• Basic fibroblast growth factor b-FGF  improves the advancement of hair follicles
• Vascular endothelial growth factor (VEGF) improves peri-follicular angiogenesis (new blood vessels to get new blood and more growth factors to the site prior to and to get ready to support new hair growth).
• Transforming growth factor beta TGF-β stimulates the signaling pathways that manage the HC (Hair growth cycle). TGF-β gives structure to the hair growth cycle. It orders the new blood vessels to “barren” areas. It creates the communication network between the native and new stem cells and growth factors so “everyone is working in unison.” It orders the stem cells to get to areas where growth can occur.
• Insulin-like growth factor 1 (IGF-1) improves the migration, survival, and proliferation of hair follicle cells. It does so with the help of Insulin-like growth factor-binding protein-1 to -6 which manages the IGF-1 effect and its connection with extracellular matrix proteins (collagens) at the hair follicle level.

There are many other growth factors involved, the list above are some of the primary ones. As you can see from this list the introduction of these growth factors whether from the bone marrow stem cells or from the PRP treatment alone, stimulates native stem cells and native growth factors to “reboot,” the hair growth mechanism.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

Marc Darrow MD,JD

In recent years doctors have found that by utilizing the growth factors found in the blood (specifically the platelets), a physician can activate stem cells already in the skin to grow new, younger-appearing skin.

Keypoints:

• PRP injections can increase youthful skin thickness and elasticity
• PRP injections can reduce yellowish skin appearance
• PRP injections can lessen appearance of wrinkles

There has been a lot of research suggesting how PRP works on damaged skin and wrinkles. A September 2017 study in the Aesthetic surgery journal (1) found that after an injection of PRP (Platelet Rich Plasma, see video below), doctors observed an increase of reticular dermis thickness (the lower of the two layers of the dermis (skin)). This thickening of the skin was caused by deposition of elastic fibers (the stuff of skin elasticity) and collagen, with a fibrotic aspect (skin regeneration). The researchers concluded: “PRP injection could lead to trophic (bringing blood) alteration of the skin and the precocious (premature) aging process.”

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Marc Darrow MD,JD

Someone will email an MRI of their hamstring problem. They will talk about the microtearing in the hamstring tendons and pain and soreness with certain movements and especially sitting. They have had a cortisone injection and anti-inflammatories. They have rested it and rested it and it is still not improving. Can PRP treatments help? Over the years we have seen many patients with hamstring injuries and we have helped many achieve their treatment goals. Let’s look at the research.

The hamstrings comprise a group of muscles at the back of the thigh. Among the muscle group is the semitendinosus muscle, semimembranosus muscle and the long and short head of the biceps femoris.The semitendinosus muscle, semimembranosus muscle and the long head of the biceps femoris hamstrings attach to the pelvis at the ischial tuberosity, the bony prominences sometimes referred to as “sit bones.” So named because they are the bones we do sit on. They are also often referred to as the Proximal hamstrings (the center hamstrings) because of their attachment or insertion at this “center” point.
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Marc Darrow MD,JD

Traditional methods of treating Carpal Tunnel Syndrome include wearing a splint at night or injections of cortisone to reduce swelling. If these measures are not successful, carpal tunnel release surgery, which sections the tough transverse carpal ligament and relieves pressure on the median nerve, may be performed. Despite some people having good success with surgery, there have been many patients who have presented to my office with worse symptoms after they had the carpal tunnel surgery.
Study: Surgeons confident Carpal Tunnel Surgery is a good option for patients, but not for them.

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Marc Darrow MD,JD

Many patients we see, have been researching their options in treating their chronic knee pain. These people come to see us because they are exploring non-surgical alternatives and have investigated various forms of regenerative medicine techniques. This includes the use of their own blood platelets as a healing solution, (more commonly referred to as Platelet Rich Plasma Therapy) or stem cell therapy which we will discuss below in relation to hyaluronic acid injections.

Many of these patients, perhaps including yourself as well, have had prior discussion with doctors about hyaluronic acid injections. These injections can provide a good amount of pain relief, temporarily. But ultimately they do not regenerate tissue and they are only a stop gap measure to delaying inevitable joint replacement.

• Hyaluronic acid is a naturally occurring substance that is a major component of the protective synovial fluid that surrounds the knee. In its natural form it is also a key component of wound healing. In its processed form used for injection purposes, hyaluronic acid is NOT a key healing component as attested to by suggestions and recommendations that these injections are stop gaps until knee replacement can be performed.

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Marc Darrow MD,JD

We receive many emails from patients who have undergone numerous spinal procedures. These people are in continued pain and are looking for help. Because of the complexities of spinal surgery, especially in patients with numerous procedures, this question must be answered following a physical examination and consultation where realistic healing options can be discussed.

When a person contacts our office looking for options to a second or even third spinal procedure we do want to help them because research has made it clear the more surgeries, the worse off the patient is.Let’s explore the research in support of that statement.

The more surgeries the worse off the patient

Some people will get benefit eventually from surgery. Some will not. Doctors, including those from the University of Bern in Switzerland published their research findings (1) on patients who had to undergo multiple spinal surgeries. When they examined patients 12 months after their last surgery they found that the more surgeries a patient had, the less likely they would have clinical success.

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Marc Darrow MD,JD

As we see more patients looking for alternatives to knee surgery who are being pain managed along with anti-inflammatory medications or NSAIDs (non-steroidal anti-inflammatory medications), and painkillers, one question they all seem to have is: “What are these medications doing to my knees.” The simple answer is, they are destroying your knees, and the research to support this goes back a long way. In fact it was in 1993 that Dr. MJ Shield wrote in the European journal of rheumatology and inflammation (1) that “Growing evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), while able to alleviate inflammation, may damage articular cartilage.” How? By preventing the growth of new cartilage.

Nothing has changed in 27 years. These medications are continually shown to accelerate knee damage.

But, NSAIDS can make knees feel better in the short-term, and in the long-term in greater doses. In the over 20 years that we have treated patients with knee problems, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.

This simple statement, that inflammation is Nature’s way of healing has been the subject of decades long debate in the medical community. Many doctors argue that you have to shut down inflammation to prevent more damage. For decades, cortisone became the weapon of choice. Cortisone as doctors would later find out, would destroy joints and contributed to the great surge in joint replacement surgeries.

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