As a patient who is considering stem cell treatment it’s nearly impossible to tell if your doctor knows what he’s doing, or, has no idea. You can search for things like “stem cell treatment reviews”, but that doesn’t tell you how qualified your physician may be. If you’re getting a bone marrow stem cell treatment procedure, there are four telltale signs that your doctor is not an expert. This four part series will cover those and hopefully provide patients with some insight. The first thing to look for is how many sites your doctor intends to draw the bone marrow from. Let me explain.
Bone marrow aspiration is how the stem cells are harvested, so all stem cell bone marrow procedures begin with this procedure. The back of the hip should be carefully numbed and then under imaging guidance, a specialized needle is inserted to draw an aspirate containing bone marrow. The procedure, if properly performed, should be comfortable. In fact, in 2009 we asked 44 consecutive patients about their procedural pain and about 9 in 10 said the procedure was no big deal.
This past weekend I taught a science based bone marrow aspiration course as part of the Interventional Orthopedics Foundation annual meeting in Colorado. Then earlier this week I was speaking to a potential patient on the phone who had already failed one bone marrow stem cell treatment. I wanted to quickly know the quality of the treatment she had received, because this would help me define next steps for her. I asked one question – how many sites had the doctor drawn marrow from, one site on one side or several from both sides? She quickly responded one site from one side, which meant that she had received a low quality stem cell treatment. Let me explain.
We’ve known since the early 90’s that maximizing the number of stem cells harvested from bone marrow requires taking small volumes from multiple sites rather than the same volume from one site. Despite this, I continue to see physicians who have been taught to take all of the bone marrow from one site. How big a deal could this be? Our own research and that of others has shown that a doctor who draws from a single site is artificially reducing the number of stem cells by approximately half or more.
How did this urban medical education myth that it’s OK to draw bone marrow from a single site get started? Way back when in 2005 when we pioneered the whole orthopedic stem cell phenomenon, there were no courses to take. A doctor doing this kind of work needed to be very knowledgeable about how to draw bone marrow. The only guidance was in the medical research literature. When we began, the research was quite clear that maximizing the number of stem cells was all about a multi-site draw. Much later, in the last few years, the companies manufacturing automated bedside centrifuges hired the physicians they could get to teach bone marrow aspiration courses rather than true experts. Regrettably, these doctors had never read the research showing how to do this correctly, so like a game of bad telephone, garbled information about drawing from one site was passed from doctor to doctor. What’s alarming is that because of this education problem, most physicians performing bone marrow stem cell procedures today are doing this part wrong and jeopardizing patient results.
The upshot? You can immediately tell that your doctor is a stem cell novice if he only draws bone marrow from one site of the pelvis. By doing so, he’s hamstringing the number of cells he obtains and your clinical result. How can you find doctors who know how to do this procedure correctly to maximize the stem cell yield? The good news is that the Interventional Orthopedics Foundation maintains a list of physicians who have been properly trained. Or simply ask the doctor how he or she does it. If the answer is one site, find a new doctor! Later this week, I’ll cover three more ways you can easily see if your doctor is a stem cell novice solely by asking simple questions about how he or she intends to perform the bone marrow aspiration.