Are you considering stem cell treatment? Knowing the top 10 questions to ask a stem cell clinic can make the difference between a successful and unsuccessful treatment.
1. Experience – How many stem cell procedures have you performed?
Experience is everything. The more a physician has successfully performed a procedure, the better the outcome and the fewer complications. For surgical procedures, a surgeon typically considers themselves an expert once they have done a procedure two hundred times or more. Some clinics talk about the total number of procedures they have performed including blood platelet procedure numbers.
Tip: Ask specifically how many stem cell procedures they have completed.
2. Outcomes – What outcome data do you collect and report?
No success rate is 100%. Even the most experienced clinics have patients who do not respond well to treatment.
Tip: Ask for the success rate of your specific treatment and where results are published.
Physicians should be reporting on patients’ pre and post-operative function and pain, as well as complications. The reported data should include all outcome results, including patients who did not respond well to treatment. Results should be indexed in a registry, allowing other physicians to review the data and the medical community to improve its techniques and the practice of medicine.
Tip: Ask if they have any publications in medical journals regarding your specific stem cell treatment.
3. Specialty – What is your medical specialization?
Physician specialty matters. Board-certified physicians specializing in sports medicine, physical medicine, or interventional pain treatment, are trained to perform injection-based care for joints. The provider should have extensive training in guided injections, including ultrasound or fluoroscopy, to ensure your cells will be precisely injected where needed.
Tip: Ask what training the provider has in image-guided injections.
4. Source – What type of stem cells do you use?
Not all stem cells are equal. Companies who manufacture stem cell vials are required to actively kill all living cells, so treatments using these vials do not contain any living stem cells. Bone marrow is the richest source of mesenchymal stem cells. Published studies demonstrate that mesenchymal stem cells are the most effective for orthopedic repair, including cartilage and tendon tissue.
Tip: Ask the provider where they harvest stem cells from and what type of stem cells they use.
5. Method – How do you harvest stem cells?
Harvesting is critical. The technique for extracting stem cells differs depending on the source. Bone marrow stem cell harvesting requires a bone marrow aspiration. A great deal of experience and image guidance is necessary to perform a bone marrow aspiration; otherwise, there is a significant risk the physician will aspirate blood without stem cells, instead of bone marrow with stem cells. Additionally, if a physician only harvests from one site, they risk a low yield of stem cells.
Tip: Ask the provider how many bone marrow aspirations they have performed, if they use imaging, and how many sites they extract from.
6. Dosage – How will you count the number of stem cells being re-injected?
Dosing in medicine is key. After stem cells are harvested, they are processed to remove the less useful tissues, including inflammatory agents, producing a highly purified concentration of stem cells. Clinics commonly use small beside centrifuges for isolation, which yield poor stem cell concentrations and cannot provide precise cell counts. This means clinics don’t know how much of what they re-inject is actual stem cells.
Tip: Ask the provider how they isolate, concentrate, and count the number of stem cells.
7. Placement – How will you ensure the correct placement of my stem cells?
To be optimally effective, stem cells must hit the bullseye. Your physician must know how to accurately inject your cells into the damaged or degenerated area. Being off by as little as an eighth of an inch may make the difference between a successful outcome and continued pain and dysfunction of the joint. There are three methods of stem cell placement being practiced; the blind injection, the shotgun approach, and the marksman technique. Unfortunately, blind injection is being practiced by over 50% of clinics. The shotgun approach uses image guidance to target areas easily reached, placing cells “in the neighborhood” of the injury. The marksman method combines advanced training and image-guidance, including fluoroscopy and ultrasound, to place cells in the specific structure.
Tip: Ask the provider what form of imaging they use to guide the injection.
8. Contraindications – What medicines kill stem cells?
Cell health is fundamental. Some common medications are harmful to the health of your stem cells. The most common local anesthetics, lidocaine or bupivacaine/marcaine, kill your stem cells. Make sure the provider is not using these as numbing agents during your procedure. Steroid injections, when injected in massive doses into the joints, kill cartilage and healthy cells, including stem cells. Make sure the provider knows there should be six to twelve weeks separation time between a steroid injection and a stem cell injection. Many prescription medications have negative effects on stem cells, reducing your chances of a successful procedure.
Tip: Ask your physician for a list of prohibited medication, including when you should stop the medication before the procedure and when you can resume post procedure.
9. Laboratory – What is the classification of the laboratory you use?
Not all laboratories are equal. An “open” system exposes tissue samples to open air, where they are susceptible to contamination by bacteria. A “closed” laboratory system keeps tissue samples in a germ-free environment. A dedicated cell-biology lab performs air-quality and sterility checks, and uses protective gear, to provide the highest possible assurance that your stem cells will be safe from contamination.
Tip: Ask your provider if their lab uses an “open” or “closed” system, and how they protect your stem cells from contamination.
10. Candidacy – How do you know if stem cell treatment is right for me?
One size does not fit all. Not every patient is a good candidate for every procedure. An honest physician will tell you whether the stem cell procedure is a good fit for your condition.
Tip: Ask the physician what your expected treatment outcome is and what the evaluation is based on.