Transcription:
Can Regenerative Medicine and Lipogems Help with Arthritis?

Melanie Cole (Host):  Today we're talking about the promising field of regenerative medicine. We're also talking about arthritis, orthopedics and Lipogems which is part of that regenerative medicine thing and it's really pretty exciting when you talk about it. My guest today is Dr. Wasik Ashraf. He's an orthopedic surgeon at St Luke's Cornwall Hospital Center for total joint replacement. Welcome to the show Dr. Ashraf. Let's start with arthritis. There's different types. People have heard about rheumatoid and osteoarthritis. What are those?

Dr. Wasik Ashraf, DO (Guest):  Well, great question. Thank you for having me on the show. So, you know one thing that I deal with all the time is arthritis and arthritis comes in many forms. You know it two things that you've already kind of mentioned, is osteoarthritis and osteoarthritis is one of those things where a lot of it is genetics, you know your family has it, it runs in families and you know the old saying you can pick your friends but can't pick your genes in your family. So, the main type of arthritis osteo. You know rheumatoid arthritis is a way where your body kind of breaks down the cartilage in multiple parts of your body. It doesn’t always have to be the big joints, it could be the hand. And then there's other types where you see commonly is a thing called traumatic arthritis where you have injured a part of your body, you have damaged a cartilage and way down the line maybe ten, fifteen, twenty years after that injury; you start to see the repercussions of that injury.

Melanie:  So, as a physician, and an orthopedic surgeon, people come to you with a lot of arthritic pain and what do you do for them first? Do we start around the line of NSAIDs and maybe some physical therapy, heat and ice, those kinds of modalities? What do you do for them?

Dr. Ashraf:  Sure great, so the first way I really start off is trying to figure out how it's affecting their quality of life; because you know you can have severe arthritis on x-ay and their symptoms are minimal at most. And other times, you have severe symptoms and the arthritis on x-ray are very little. So, every patient is – you have to kind of change or treatment plans per patient, but the usual modalities include anti-inflammatory to decrease the inflammation and we can get into the positive and negatives of that and then physical therapy to strengthen the muscles and increase mobility. Sometimes people do need an assistive device, cane, crutches. Those are my first initial and then we talk about different injections like cortisone, gel. And those are the initial way we kind of start things going for the arthritis.

Melanie:  So, you've tried all of these interventions and maybe they work for a while or maybe they don't. Tell us about Lipogems and how you came to find out about this innovative technology.

Dr. Ashraf:  Sure, so one thing was as I was treating, and you know you go through residency, you go through fellowship and you see how things pendulum swings treatments come and go. One thing that we were noticing more and more is the problems with what we're doing now. Anti-inflammatories, NSAIDs. You know it's a great way of decreasing anti-inflammatory, but the negative side is you could upset your stomach, get a bleed from your ulcer and really irritate reflux. So more and more of us orthopedists are staying away from high dose anti-inflammatories. So, the way we got around us to use natural anti-inflammatories like turmeric and plant-based products. Then we came to cortisone injection and more and more my patients are more active. They want to do more with the advent of Cross Fit and everything else super active, people want to stay active. That's the goal. Knee replacement or a hip replacement or shoulder replacements is not in their mindset currently. So, we had to find a way where the cortisone injections when they don't work what other options are there? For me personally, it really came down to my Mom who was having knee pain and she's a working individual currently and she needs to work three more years before she can retire and that's when she's planning to have her knee replacement and the question was hey, Wasik, what can I do, and we've gone through cortisone, she’s a diabetic can't get too many cortisone shots. Her blood sugar goes up too high and so we have tried the therapy, the braces and she was very frustrated and so I started looking online and I first started looking online in Europe there's a lot of being new technology that comes out it does come out in Europe first and it makes its way into the U.S. and I came across Lipogems and Lipogems, specifically it's basically taking, harvesting fat from individuals. It could be from abdomen, the hip and you then treat this fat get rid of the oils, the red blood cells and then take it down and inject it into the joint that's causing pain.

Melanie:  So, if you're using a patient's own fat cells or adipose tissue is this necessarily something that won't be rejected it's pretty safe because it's ours or are other some things that you know you need to be careful of?

Dr. Ashraf:  So, there are risks and benefits to everything and the risk of Lipogems as far rejecting it is minimal. I mean there's actually zero because we're not adding anything to the fat so the fat it's a closed loop system. It's a done under local anesthesia to harvest the fat. It's your own fat, you're not going to be allergic to it and then we don't add anything to it only thing that you do in the system is you basically rinse the fat with some saline and once that's done there's zero chance of being allergic to it. The risk of this is with any type of fat harvesting is you get a little bruising around the abdomen, you get a little sore around the abdomen. But that's the only risk.

Melanie:  So, can you treat multiple areas with it that as you harvest this?

Dr. Ashraf: Yes. So, usually you know when we are doing the procedure we harvest about sixty ccs of fat from the area from the abdomen. Once that's done we then go through a cleansing process of washing it through the normal saline, washing away the oils, the red blood cells and the fibrous tissue, we get about twenty ccs of injectable stem cells and Lipogems. Each joint, we average about 6-8 ccs of Lipogems based on the size of the joint. So, from a knee, shoulder and hip, they are considered large joints, while the elbow and ankle or are smaller and you can absolutely inject multiple joints the same time. On average when I do these procedures in the office, I inject about two to three joints per session.

Melanie:  And Dr. Ashraf what are you seeing? How is it working and are people getting some relief from it and if they are how long does that relief last?

Dr. Ashraf:  Great question. Initially, you know when we first tried this and I tried it on my mom and I was skeptical. I was saying hey you know you're taking this stem cells, you know it has a great history you know, when it first came out they were actually using it in Europe on canines and horses; that's how it started off in Europe and then they started using ten years ago on humans and they were tracking the results. My personal results so far has been about 80% improvement of pain for up to two years. We track that by giving patients a pain scale before the procedure, then I see them back at six weeks and then at six months and following and I see how their pain scale is going up or down. Pain improves. It takes about six weeks to kick in, the procedure but when it does people are having you know some great results. I think what it does is it provides patients some options. Because you know I have patients that are say 85 years old, they no longer want to go through a big surgery and they say listen I need to do something about this pain and I don't want a surgery, but I can’t live with this, what are my options and that's a patient group that's done really, really great with this procedure. The other group is where kind of my mom fell in where she needs to keep working, she knows she has to get a replacement some time, but she just needs to buy some time and I have had some great results. But I will tell you is there some patients are not good for this in the sense that if you're bone on bone arthritis, there's no space in the joint, it's severe, then these patients don't do as well as the ones with mild to moderate arthritis.

Melanie:  It's absolutely fascinating and regenerative medicine to begin with is fascinating. Where do you see it going Dr. Ashraf in the field of orthopedics? We hear about it in the field of you know genetics or oncology, in many different fields where do you see it as an orthopedic surgeon going from here?

Dr. Ashraf:  I think this is exactly where the world or orthopedics is going this is the topic and where the most research in orthopedics is currently. You know we talk about say a fracture, breaking a bone, putting the pieces back together with plates and screws is the easy part really, but now to have the bones to heal they were finding different factors down to the molecule what we could do to help the bones heal. We see patients that are not great healers because of diabetes and smoking and we want to tip that balance bar for healing and so things like biologics where we put in live cells into the areas of the fracture to help the two bones to weld together, that's really where technology is taking us and I’m really excited to be part of this technology during these times. With biologic you know it goes from using a system like Lipogems after a repair. So there is a study out that shows that in a rotator cuff injury or rotator cuff tears are very common injury for a lot of patients to have and one of the biggest complication of the surgery is that idea of re-tear you know when I tell my patients is that heh listen to you if you could tear something that God gave you can retire something that we fix but we want to give us the chance to have the least amount of re-tear. So, another thing I do with my Lipogems is once I have fixed the rotator cuff arthroscopically, I inject the Lipogems on top of my repair to augment the healing and what studies have shown is there's a 50% decrease in re-tear rates after fixing. So, more and more research is going into biologics and I'm really coming with some great results.

Melanie:  That's so cool and what an innovative thing that you're doing especially for rotator cuffs which so many people suffer from. Wrap it up for us Dr. Ashraf with your best advice and what you want people to ask their orthopods if they've got arthritis, they're suffering from pain, they've tried these other interventions and they want to know about Lipogems, they want to know about when it becomes surgical and what they can do.

Dr. Ashraf:  So, first and foremost is with arthritis you have to maintain a balanced life you know you have to maintain your weight, stay active and keep the weight down. I mean that's really the foundation of all things with arthritis. Sometimes the pain of the arthritis is bad enough where knee replacement or a joint replacement is the answer but what I would ask and what my mom asked was hey what other options are there and that's what you want to ask to your orthopedist, your physicians is what other options do I have besides the joint placement and the keywords that most people kind of refer to Lipogems with the stem cells, but Lipogems is much more than stem cells. And that's you have to do your research, go online, Google it, ask the doctors and word is getting out.

Melanie:  Great information. Thanks so much for being with us today this is Doc Talk presented by St. Luke's Cornwall Hospital. For more information please visit www.StLuke'sCornwalHospital.org that's www.StLuke'sCornwallHospital.org   This is Melanie Cole. Thanks so much for tuning in.