Caring for pain - Floyd Valley adds stem cell therapy to treatment options
Tuesday, March 10, 2015
By Amy Erickson
Floyd Valley Hospital began offering stem cell therapy as part of its pain services about nine months ago. So far about 12 people have utilized the treatment.
Treatment of chronic pain is something Floyd Valley Hospital's pain services team takes seriously.
Nine months ago the Le Mars facility began offering stem cell therapy as another treatment option.
Dr. Steven Saulsbury, radiologist, Gary Tillman, certified registered nurse anesthetist, and DeeAne Otto, advanced registered nurse practitioner, make up the pain services team at Floyd Valley.
Saulsbury explained what a stem cell is.
The body constantly regenerates different types of cells such as blood, muscle or nerve, Saulsbury said.
"We're using the body's own cells in a way to help heal injury in different areas," Saulsbury said.
A stem cell is basically a cell that can not only regenerate itself, but also mature into a another more specialized cell like blood, muscle or cartilage, he said.
"What we work with are adult stem cells," Saulsbury said. "This has nothing to do with embryonic stem cells and those medical and ethical considerations."
The stem cell therapy used at Floyd Valley has been validated as safe and effective for specific procedures, he said.
"They've been shown to be extremely helpful, but have to be done in the right way and with the right application," Saulsbury said.
Patient evaluation
Tillman explained the process he, Saulsbury and Otto use to determine if stem cell therapy is an option.
Individuals first visit with Otto who discusses what stem cells are and the process used to remove them.
She also does some testing as far as what their pain is like and what treatment has been done in the past, Tillman said.
"From there, they come to Dr. Saulsbury and I, and we discuss the process which the patients go through for removal and re-injection of stem cells," he said.
Tillman and Saulsbury review imaging studies available of the problem and further review their treatment history, Tillman said.
Each individual's needs are carefully studied to determine if stem cell therapy is a good option, he said.
There have been "a fair number of people" who have been evaluated, and it was determined that other therapies would be more acceptable, Tillman said.
Mike Donlin, Floyd Valley Hospital administrator, noted the stem cell therapy is individualized.
"This isn't really a scenario where you come knocking on the door and say 'I'm here for stem cells,'" he said.
It's more like someone who has had pain for a long time and tried a lot of other treatments and is looking for help, Donlin said.
"Maybe it's that and maybe it's something else," he said. "This isn't the only thing we can do to help."
Floyd Valley's pain services team offers other therapies and treatments for patients dealing with pain.
Stem cell extraction
There are two area in the body where stem cells are in largest abundance -- bone marrow and fat, Saulsbury said.
"Currently we harvest stem cells from the fat, which is a liposuction-type of procedure," he said.
It is a surgical procedure done under local anesthetic, with the patient awake throughout, Tillman said.
The stem cell harvest takes about an hour, then the cells go through a processing and isolation period, Saulsbury said.
That is followed by re-injection of the stem cells into the area of the pain, Tillman said.
"We do imaging to know precisely where it needs to be," he said, noting other facilities don't always use that technique.
"There is good evidence from places doing this the longest, that you need to put the cells exactly where the injury is," Saulsbury said.
For example, with a cartilage fracture in the knee, cells need to be in that area versus somewhere else in the knee, he said.
"There's only one way to do that. You can't do it by feel," Tillman said. "You need to see it."
Saulsbury said stem cell harvest and re-injection is done in the same facility and is very well tolerated.
"They are laying there talking to us while we are doing it," Tillman added.
He said sedation could be used.
"We've found in the cases we've done so far, no one has wanted it because the harvest procedure is not uncomfortable," Tillman said.
Saulsbury and Tillman said they take only the amount of stem cells needed from the fat.
"We take equal amounts of fat from both sides, in the flank or abdomen," Tillman said.
They estimated about 60 cc's, equal to about one-half cup or a stick of butter, is removed.
Out of that, some 20 million stem cells are harvested, Tillman said.
Patients will need a ride, but will go home in about four hours, the day of the procedure, Saulsbury said.
"The patient will have bandages on, no stitches," he said. "They will go home with basically no restrictions other than light activities."
Saulsbury said recovery time is an advantage over other treatments such as surgery.
Along with stem cells, every patient receives Platelet Rich Plasma, or PRP, said Saulsbury.
That adds nutrition for the stem cells to reproduce and differentiate, he said.
How it works
That is being studied extensively, Saulsbury said.
What is known is there are two main things cells are doing, he added.
They are reproducing and differentiating into the type of cells needed, whether cartilage, ligaments or connective tissue, Saulsbury said.
That regeneration is not something an adult can typically do, he said.
"The cells can repair and regrow significant amounts of new tissue that can be detected with imaging," Saulsbury said. "As important as generation, the cells affect the inflammation in that area."
For example, degeneration in a joint can lead to pain, which causes inflammation, he explained.
"These (stem) cells modulate that inflammation, meaning they decrease it and change that environment," Saulsbury said.
It decreases the pain generators in the body, he said.
"That seems to be relatively long term," Saulsbury said. "These patients have multiple years of improvement."
Tillman said another aspect is that improvement is often very quick initially and then becomes a gradual process over a number of years.
He noted at a recent meeting he attended a pain management specialist, who had done more than 1,000 stem cell therapy treatments, drove that point home.
"His patients are studied out 10 years," Tillman said. "He's had continued steady improvement on those patients."
Therapy benefits
Since beginning stem cell therapy, about a dozen patients have had been treated, Saulsbury said.
Most of them have resided within the hospital's coverage area.
When considering adding stem cell therapy to the hospital's pain treatment options, the pain team did its research.
Tillman added that Saulsbury was the one who introduced the idea of adding stem cell therapy to pain services options.
"We wanted to look at this and we spent a long time evaluating it," Saulsbury said.
There are multiple places around the country where it can be done, and there will be more, Saulsbury said.
He said if he could have the stem cell therapy, he would have it done at Floyd Valley versus going to other states or out of the country.
"I can say with confidence, and Gary can say with confidence, you're not going to have it done at a facility where it is done at a higher level than at this hospital," Saulsbury said.
He has twice attended training at an institute in Florida that specializes in stem cell therapy.
Tillman has also attended a training program for stem cell therapy.
In addition, both men have years of experience in their fields, which complement one another, Saulsbury said.
"So far, we have had excellent results," he said.
Tillman echoed that statement.
"From a pain provider experience of what I've been able to do for patients and not do for patients, this was really exciting," he said.
Tuesday, March 10, 2015
By Amy Erickson
Floyd Valley Hospital began offering stem cell therapy as part of its pain services about nine months ago. So far about 12 people have utilized the treatment.
Treatment of chronic pain is something Floyd Valley Hospital's pain services team takes seriously.
Nine months ago the Le Mars facility began offering stem cell therapy as another treatment option.
Dr. Steven Saulsbury, radiologist, Gary Tillman, certified registered nurse anesthetist, and DeeAne Otto, advanced registered nurse practitioner, make up the pain services team at Floyd Valley.
Saulsbury explained what a stem cell is.
The body constantly regenerates different types of cells such as blood, muscle or nerve, Saulsbury said.
"We're using the body's own cells in a way to help heal injury in different areas," Saulsbury said.
A stem cell is basically a cell that can not only regenerate itself, but also mature into a another more specialized cell like blood, muscle or cartilage, he said.
"What we work with are adult stem cells," Saulsbury said. "This has nothing to do with embryonic stem cells and those medical and ethical considerations."
The stem cell therapy used at Floyd Valley has been validated as safe and effective for specific procedures, he said.
"They've been shown to be extremely helpful, but have to be done in the right way and with the right application," Saulsbury said.
Patient evaluation
Tillman explained the process he, Saulsbury and Otto use to determine if stem cell therapy is an option.
Individuals first visit with Otto who discusses what stem cells are and the process used to remove them.
She also does some testing as far as what their pain is like and what treatment has been done in the past, Tillman said.
"From there, they come to Dr. Saulsbury and I, and we discuss the process which the patients go through for removal and re-injection of stem cells," he said.
Tillman and Saulsbury review imaging studies available of the problem and further review their treatment history, Tillman said.
Each individual's needs are carefully studied to determine if stem cell therapy is a good option, he said.
There have been "a fair number of people" who have been evaluated, and it was determined that other therapies would be more acceptable, Tillman said.
Mike Donlin, Floyd Valley Hospital administrator, noted the stem cell therapy is individualized.
"This isn't really a scenario where you come knocking on the door and say 'I'm here for stem cells,'" he said.
It's more like someone who has had pain for a long time and tried a lot of other treatments and is looking for help, Donlin said.
"Maybe it's that and maybe it's something else," he said. "This isn't the only thing we can do to help."
Floyd Valley's pain services team offers other therapies and treatments for patients dealing with pain.
Stem cell extraction
There are two area in the body where stem cells are in largest abundance -- bone marrow and fat, Saulsbury said.
"Currently we harvest stem cells from the fat, which is a liposuction-type of procedure," he said.
It is a surgical procedure done under local anesthetic, with the patient awake throughout, Tillman said.
The stem cell harvest takes about an hour, then the cells go through a processing and isolation period, Saulsbury said.
That is followed by re-injection of the stem cells into the area of the pain, Tillman said.
"We do imaging to know precisely where it needs to be," he said, noting other facilities don't always use that technique.
"There is good evidence from places doing this the longest, that you need to put the cells exactly where the injury is," Saulsbury said.
For example, with a cartilage fracture in the knee, cells need to be in that area versus somewhere else in the knee, he said.
"There's only one way to do that. You can't do it by feel," Tillman said. "You need to see it."
Saulsbury said stem cell harvest and re-injection is done in the same facility and is very well tolerated.
"They are laying there talking to us while we are doing it," Tillman added.
He said sedation could be used.
"We've found in the cases we've done so far, no one has wanted it because the harvest procedure is not uncomfortable," Tillman said.
Saulsbury and Tillman said they take only the amount of stem cells needed from the fat.
"We take equal amounts of fat from both sides, in the flank or abdomen," Tillman said.
They estimated about 60 cc's, equal to about one-half cup or a stick of butter, is removed.
Out of that, some 20 million stem cells are harvested, Tillman said.
Patients will need a ride, but will go home in about four hours, the day of the procedure, Saulsbury said.
"The patient will have bandages on, no stitches," he said. "They will go home with basically no restrictions other than light activities."
Saulsbury said recovery time is an advantage over other treatments such as surgery.
Along with stem cells, every patient receives Platelet Rich Plasma, or PRP, said Saulsbury.
That adds nutrition for the stem cells to reproduce and differentiate, he said.
How it works
That is being studied extensively, Saulsbury said.
What is known is there are two main things cells are doing, he added.
They are reproducing and differentiating into the type of cells needed, whether cartilage, ligaments or connective tissue, Saulsbury said.
That regeneration is not something an adult can typically do, he said.
"The cells can repair and regrow significant amounts of new tissue that can be detected with imaging," Saulsbury said. "As important as generation, the cells affect the inflammation in that area."
For example, degeneration in a joint can lead to pain, which causes inflammation, he explained.
"These (stem) cells modulate that inflammation, meaning they decrease it and change that environment," Saulsbury said.
It decreases the pain generators in the body, he said.
"That seems to be relatively long term," Saulsbury said. "These patients have multiple years of improvement."
Tillman said another aspect is that improvement is often very quick initially and then becomes a gradual process over a number of years.
He noted at a recent meeting he attended a pain management specialist, who had done more than 1,000 stem cell therapy treatments, drove that point home.
"His patients are studied out 10 years," Tillman said. "He's had continued steady improvement on those patients."
Therapy benefits
Since beginning stem cell therapy, about a dozen patients have had been treated, Saulsbury said.
Most of them have resided within the hospital's coverage area.
When considering adding stem cell therapy to the hospital's pain treatment options, the pain team did its research.
Tillman added that Saulsbury was the one who introduced the idea of adding stem cell therapy to pain services options.
"We wanted to look at this and we spent a long time evaluating it," Saulsbury said.
There are multiple places around the country where it can be done, and there will be more, Saulsbury said.
He said if he could have the stem cell therapy, he would have it done at Floyd Valley versus going to other states or out of the country.
"I can say with confidence, and Gary can say with confidence, you're not going to have it done at a facility where it is done at a higher level than at this hospital," Saulsbury said.
He has twice attended training at an institute in Florida that specializes in stem cell therapy.
Tillman has also attended a training program for stem cell therapy.
In addition, both men have years of experience in their fields, which complement one another, Saulsbury said.
"So far, we have had excellent results," he said.
Tillman echoed that statement.
"From a pain provider experience of what I've been able to do for patients and not do for patients, this was really exciting," he said.