You know what they say: It’s a bear getting old, but it beats the alternative. And if you really want to look at the glass half full, you would admit that we’re pretty lucky to live during a time and in a place where medical innovation moves at relative lightening speed. If you don’t believe it, read on.
regenerative medicine
Placing the patient’s blood or fat cells into a painful joint to reverse the effects of osteoarthritis and prevent surgery sounds like science fiction, doesn’t it? But like so many medical developments, it has sped into the realm of accepted practice.
changing the status quo
“Regenerative therapies are changing the way we repair joint pain,” says Dr. David Crane, a regenerative orthopedic specialist at Blue Tail Medical Group in Chesterfield. “The stem cells regulate the chronic inflammation, which helps keep the cartilage nutrition healthy,” he says.
“More providers are becoming proficient at regenerative medicine, and the body of evidence showing its benefits is growing as well,” says Doug Bouldin, a certified nurse practitioner and partner at the Ozzie Smith IMAC Regeneration Center in Creve Coeur. The center is affiliated with the Integrated Medicine and Chiropractic Regeneration Center in Paducah, Kentucky. Regenerative treatment of a knee can cost one-tenth as much as a joint replacement, Bouldin adds.
Not long ago, scientists believed that embryonic tissues were the largest source of precursor cells, or stem cells. But then stem cells were found in therapeutically usable volumes in adult tissues, too. Their remarkable nature is due to the potential to develop into many different cell types, in essence replenishing other cells.
the aches and pains of age
“People can experience joint pain because of osteoarthritis, which can be a wear-and-tear issue or can be precipitated by a traumatic event,” Bouldin says. Human knees are particularly prone to arthritis, and for decades the inevitable treatment was replacement with an artificial joint.
“The advice used to be to wait until the joint pain gets as bad as possible, then have your knee replaced,” Crane says. “Now we try to catch it early, when the joint first begins to lose its structural stability.”
The knee, however, needs two years to renew itself with its own natural resources, Crane adds. “It has only so many reparative cells at its disposal, and your joint will degenerate if you don’t have enough local resources for the repair. If we catch arthritis early, regenerative therapy is usually very good at keeping you from needing a joint replacement.”
The innovative field has come a long way, Crane notes. “When we started with regenerative therapies 12 years ago, we had only platelet-rich plasma (PRP). Now we have the gamut from PRP to bone marrow autograft to fat-derived stem cells.
how it works
“PRP is derived from the patient,” Bouldin says. “A blood sample is spun in a centrifuge and the platelets are harvested. These contain blood-clotting, anti-inflammatory factors and growth factors that help heal and repair damage.”
Obtaining bone marrow stem cells involves drawing the cells through a needle inserted into the pelvis, Crane says. Surprisingly, belly fat is our friend here, because it’s one of our biggest stem cell reservoirs, he adds.
“Those cells are derived from adipose tissue in the abdomen through a mini-liposuction,” Bouldin explains. “The cells are processed the same day and then injected back into the patient. The benefit they provide is a higher degree of regeneration.”
The source used for stem cells is determined by which joint needs treatment and the stage of arthritis development. The cells are injected into the injured joint, usually under a local or topical anesthetic. “Most people experience anti-inflammatory response within a few days,” Bouldin says.
kidney stones
In your middle years of life, it becomes increasingly likely that you are going to get stoned. Painfully. Kidney stones are a common event, necessitating trips to the emergency room and days (at least) of painful waiting for something the size of a grain of sand to ‘pass.’ What gives?
why me?
Health issues arising during the later years may indirectly be responsible for these pesky little granules. “One in 11 Americans will have kidney stones during their lives,” says Dr. Alana Desai, assistant professor of urologic surgery at Washington University School of Medicine. “The incidence is rising globally because people are becoming more overweight, their lifestyles are more sedentary, and they are more dehydrated.”
Adds Dr. Sophia Ford-Glanton, a SLUCare urologist at SSM Health Saint Louis University Hospital, “The elderly may be more predisposed because they may not drink enough fluid or may have more salt in their diet. They may be cutting back on fluids because they do not want to go to the bathroom as frequently, or a medication could be affecting them.
hard as a rock
Kidney stones are composed of minerals that usually remain diluted and pass from the body in urine. “Kidney stones are collections of debris that coalesce,” explains Ford-Glanton. Some stones are not painful because they’re not moving from the kidneys. “The ones that cause pain block the ureter, the tube that connects the kidney to the bladder,” she says. “Because the kidney is still making urine and the stone is backing urine up into the kidney, that distension and pressure causes a lot of pain.”
It’s possible for stones to grow quite large in the kidney without causing a blockage,” says Desai. “I take care of patients whose kidneys are full of stones. The stones that send you to the emergency room tend to be smaller.” Most stones can be attributed to heredity, lifestyle or medical co-morbidities like diabetes, gout or being overweight, she adds, but “some are idiopathic, meaning we don’t know why they formed.”
The really bad news? “If you have had a kidney stone you are more likely to get another,” Ford-Glanton says. Dehydration and poor diet can increase the risk of occurrence. Many are simply prone to the disease. “Sometimes it is out of your control, and no matter what you do, your kidneys produce stones and you need medication to help prevent them.”
If a stone does cause a urinary blockage, “usually you can pass it by drinking lots of fluid if it is small enough,” says Ford-Glanton, “or you can have a surgical procedure to have it removed.”
what to do?
“The solution to pollution is dilution,” Ford-Glanton says. “Drinking lots of fluid is the No. 1 prevention if your body is making the most common type of stone. Another valid prevention is lemonade therapy or using lemon juice in your water.”
The lemon adds citrate, a natural stone inhibitor, Desai explains. “We want you to drink enough fluid to produce two to three liters of urine per day. For a normal-sized person, that is 90 to 120 ounces of fluid. We prefer water for the majority of your fluid volume, but your cup of coffee and glass of wine add to your goal, too.”
Diets high in salt or animal protein can contribute to kidney stone formation, Desai adds. “Try not to add salt and remember that some canned, processed and fast foods are high in sodium. You don’t need to become a vegetarian, but you do want to keep your animal protein intake down to one or two small servings per day.
medicine mix-ups
Sometimes we’re our own worst enemy. That’s especially true once we get older and won’t admit that keeping the medicine routine straight is a challenge. Adverse drug events account for 700,000 emergency room visits and 100,000 hospitalizations annually, according to the U.S. Agency for Healthcare Research and Quality (AHRQ).
the great cover-up
“Medication mix-ups definitely are something we see,” reports Tony Roberts, pharmacist and owner of Greentree Pharmacy in Kirkwood. “It’s probably more common than we are led to believe, because a lot of people don’t want to admit their mistakes.”
The AHRQ lists four types of medications that account for half of emergency visits: benzodiazepine sedatives (including Xanax, lorazepam and Valium), antidiabetic agents such as insulin, oral anticoagulants such as warfarin, and antiplatelet agents such as aspirin and clopidogrel (Plavix).
“It is not uncommon for some seniors to be on eight medications,” says Angie Kloeppel, a pharmacist at Ladue Pharmacy. “Seniors may not know ingredients, so they might accidentally duplicate things. People don’t realize there is Tylenol in some medications, for example. Some medicines just shouldn’t be taken together.” It’s important to let your pharmacist help you avoid harmful medication interactions. “We always check for interactions when we get a new medication,” Roberts says. “ If there is a possibility of it, we will call the patient or doctor to discuss the issue.” People who use multiple pharmacies, however, may miss that safeguard.
otc danger
Patients may not realize that over-the-counter medications also can cause problems. A common example, Kloeppel says, is aspirin taken with blood thinners. “ If you are on blood thinners and taking aspirin on your own for headaches or arthritis pain, it can lead to bleeding,” she says.
And people also don’t always realize aspirin is in the same family as ibuprofen and some other pain medications, and combinations can lead to ulcers, she adds. Patients who decide to take an over-the-counter medication regularly should talk to their doctor or pharmacist first, Kloeppel says.
Plastic pill boxes are a great tool for sorting medications by day and time, helping to keep seniors and seniors-in-training on their correct pill schedule, Roberts says. “Some pharmacies have programs that can package medications into monthly planners for patients. We have a machine that packages according to day, date and time so everything is organized and you won’t mistakenly take the wrong things.
addictions
Missouri is the only state that does not conduct a computerized prescription drug monitoring registry to reduce abuse of opioid painkillers. This year’s session of the state legislature was the sixth in which a bill designed to create such a program was defeated. “With a program, you can’t go to a new physician or an emergency room to get another prescription for hydrocodone,” Roberts says. “ The pharmacist has real-time access to the data and can see that you just got another prescription filled someplace else. In other states, it has really helped to deter abuse. There is a legislator in western Missouri who is a physician and consistently blocks it, claiming privacy reasons.”
