FREQUENTLY ASKED QUESTIONS
The following are common questions that people ask us.
If, after reading, you have any additional questions that we did not cover here, please feel to contact us at any time!
About The Procedure
IN THE SIMPLEST TERMS, HOW DOES STEM CELL THERAPY WORK?
Every joint in the body and most tissues contain stem cells that are responsible for maintaining health in that location. Degeneration of tissues or joints occur when the stem cell population becomes depleted and that structure losses its ability to heal itself. Stem cell therapy is an attempt to repopulate tissues or joints with stem cells, thereby restoring the body’s ability to heal itself.
WHAT ARE THE RISKS OF THE PROCEDURES?
There are very few risks involved. You are certain to be sore for a few days after the procedure, but that is a side effect, not a risk. Infection is within the realm of possibility but is almost unheard of in the Regenerative Pain Medicine community. Regenerative injection therapy and adult stem cell therapy are conservative approaches to treating pain unlike surgery that might help, but it might make it worse. You can always have surgery, but you can’t “un-have” it. The biggest risk of these therapies is that it won’t help your condition, however, performed properly, they will not make your condition worse.
DOES INSURANCE COVER THESE PROCEDURES?
Short answer: no. Long answer: stem cell therapy and PRP are considered experimental procedures. While some insurance companies will pay for platelet rich plasma or bone marrow aspirate concentrate when used by a surgeon in conjunction with certain orthopedic surgeries, they generally do not pay when used as an injection. For this reason, Docere Clinics has a ‘payment at the time of service’ policy. Some clinics that offer regenerative injection and cellular therapies list on their websites the insurance plans they accept, but usually these clinics will only submit for the consultation and anesthetic/steroid injections.
DO THE STEM CELLS COME FROM MY BONE MARROW, FROM MY FAT, OR FROM BOTH?
Upon establishing that you are indeed a candidate for treatment, we will decide whether to harvest stem cells from your bone marrow (BMAC), from your fat (ADSC), or from both. Most patients who undergo treatment at Docere Clinics opt to receive both BMAC and ADSC in a single treatment. Based on close follow-up with our patients, this appears to provide the most consistent and powerful results.
Please click here to read a scientific article written by Dr. Adelson published in The Pain Practitioner describing his experience comparing bone marrow stem cells, adipose stem cells, and the combination of the two for the treatment of low back and knee pain.
Clearly, if you have too little subcutaneous fat to consider lipoaspiration, then ADSC is not an optionand we will opt instead for BMAC alone. If you have a history of bone or blood cancer, we opt for ADSC suspended in platelet rich plasma.
I’M DECIDING BETWEEN USING MY OWN STEM CELLS OR USING “AMNIOTIC MEMBRANE STEM CELLS”. WHICH IS BETTER?
They don’t compare, they’re totally different. The first thing to understand is that stem cells from these amniotic membrane compounds do not survive the freeze-drying process. Therefore, these “stem cells” being advertised are not living stem cells, they’ve been destroyed. The amniotic membrane preparations do however contain growth factors found in stem cells. So if you get an injection of amniotic membrane compound, you are getting a burst of growth factors that can be helpful in the short term, but you are not getting living stem cells that will help in the short and long term. Based on this, it seems to us that amniotic membrane compounds might be helpful in cases where you still have a healthy stem cell population in the target location (a case where we would use PRP anyway, not stem cells), but if you have completely depleted your stem cell population such as in advanced osteoarthritis, amniotic membrane compounds will not repopulate the area with stem cells like you will if you have your own living stem cells transplanted from your bone marrow or fat. The second thing to consider (or maybe the first) is that clearly, the amniotic membrane compounds come from a person that is not you, and further, from a person neither related nor even known to you. We would rather use our own stuff from our own bodies. It’s our personal preference, and the preference of those that choose us to provide them with stem cell therapy.
HOW MANY TREATMENTS WILL I WANT TO DO AND HOW OFTEN WILL I RECEIVE THEM?
Our overall experience has been that at the one year mark after an ADSC/BMAC treatment, about half of our patients are still going strong with 75% or better improvement, and half have had improvement in the 50%-75% range and request a second treatment. Once we get people where they want to be, most people require tune-up treatments every two to six years. Approximately 10% of our patients are “non-responders” and have no improvement at all. Factors include patient health/habits, adherence to post-treatment guidelines, and severity of the condition.
HOW SOON MIGHT I NOTICE IMPROVEMENT?
These therapies are intended to stimulate the growth and repair connective tissues. Unlike a steroid injection, there is rarely immediate pain relief. Typically, patients notice improvement after two to eight weeks and continue to notice continual improvement months after the treatment (unlike a steroid injection that typically wears off after a period of weeks or months).
HOW WILL I FEEL IMMEDIATELY AFTER THE TREATMENT?
While the treatment itself is not terribly painful, after the procedure, you will have localized soreness and discomfort, especially after hand, foot, and shoulder injections, and after lipoaspiration. Most patients find over-the-counter medications and rest sufficient to help with the pain. Some other clinics scrape the surface of the joint with the needle while injecting stem cells in order to cause a localized irritation. This causes a great deal of post procedure pain that can last weeks or months. We have not found this necessary to do, subsequently our treatments produce very little soreness after.
ARE THE RESULTS PERMANENT?
Unless you are a vampire, nothing in this life is permanent. Total joint replacement surgery is not permanent; even the latest prosthetic devices must eventually be replaced. The treatments we offer are intended to reverse tissue damage and degenerative changes and turn back the hands of time, but they do not stop the hands of time. Our overall experience has been that one year after an ADSC/BMAC treatment, about half of our patients are still going strong, and half have a second treatment. Most people require tune-up treatments every two to six years.
DOCERE CLINICS’ FEES ARE MUCH LOWER THAN MOST OTHER CLINICS. WHY IS THAT?
Because adult stem cell therapy for chronic pain is considered experimental, insurance does not pay for it; it is a ‘cash procedure’. Since Docere Clinics opened in 2002, we have been a ‘cash-based practice’ and have never billed insurance. The reason for this is that our philosophy is that we want to work for YOU, not for an insurance company. This means we have always offered and performed the treatments that we deem best and agree upon, rather than only what insurance companies deem they will pay for. Most other clinics that offer adult stem cell therapies for chronic pain transitioned to a ‘cash-based practice’ from ‘insurance-based practice’. Because these clinics were originally designed and structured based on a traditional high-volume, insurance-based model, they have large facilities and large support staff. Some of our colleagues additionally run very expensive marketing campaigns, whereas we grow almost entirely by ‘word-of-mouth’ referrals by satisfied patients. Subsequently, their cash prices are frequently very high in order to pay for their large overhead, while our low overhead allows us to charge far less without compromising quality.
WHERE DID DR. ADELSON LEARN TO INJECT?
In 1995 and while in naturopathic school, Dr. Adelson was cured of an injury with RIT/Prolotherapy by the since deceased and very much missed Rick Marinelli, N.D.. He decided from that experience that he would devote himself to Regenerative Pain Medicine. He underwent training in RIT/prolotherapy from the American Association of Orthopeadic Medicine, the American Academy of Musculoskeletal Medicine, the American Academy of Osteopathy, and from his mentors, Rick Marinelli, N.D. and Richard Bachrach, D.O.. During his years in Connecticut in 2000 – 2002, he volunteered after working hours in a large homeless shelter in Bridgeport offering RIT/Prolotherapy to its residents. In addition to providing Regenerative Pain Medicine to those living in pain that could otherwise not afford these services, this allowed him to perform several hundred RIT/Prolotherapy procedures before he opened the doors of Docere Clinics in 2002. Since that time he has treated thousands of patients and performed over ten thousand procedures.
WHERE DID DR. ADELSON LEARN TO HARVEST AND PREPARE STEM CELLS?
In February of 2010, Dr. Adelson visited the clinic of orthopedic surgeon and leader in the field of clinical stem cell medicine, Joseph Purita, M.D. in Boca Raton, Florida to learn regenerative cell therapy for musculoskeletal pain conditions. Upon return to Docere Clinics, Dr. Adelson began utilizing these therapies right away and has enjoyed years of successfully helping people with these elegant and safe modalities. Dr. Adelson has also visited the clinic of cosmetic surgeon and pioneer in adipose-derived regenerative cell medicine, Robert Alexander, MD to have his lipoaspiration technique critiqued and improved.
WHY CHOOSE DOCERE CLINICS?
When Dr Adelson opened Docere Clinics in 2002, from day one his practice has been 100% regenerative injection therapy procedures for the treatment of musculoskeletal pain conditions. In 2006 he began injecting PRP with ultrasound guidance. He began performing bone marrow and fat stem cell procedures in February, 2010, making him one of the very early doctors providing this therapy. Since that time, his practice has been over 90% adult stem cell procedures for chronic pain conditions (the remaining 10% being PRP procedures). It’s all he does; he doesn’t do anything else. He has performed nearly three thousand adult stem cell procedures with X-ray or ultrasound guidance that have produced zero serious adverse outcomes and many satisfied patients. This places him among the most experienced in the world with adult stem cell procedures for the treatment of pain.
WHAT GUARANTEE DO I HAVE THAT I WILL BE SATISFIED WITH THE RESULTS?
None. We are happy to report that our overall patient satisfaction rate is very high. We grow almost entirely by word-of-mouth referrals from satisfied patients. We help more people than we don’t help, but we don’t help everyone. We have found that the severity of the condition is much less of a predictor of the clinical outcome than is the overall health of the person being treated. If you’re unhealthy, it is entirely possible that your stem cells don’t function properly. We have observed that we tend to have inferior outcomes in people who are smokers, heavy drinkers, diabetics, have uncontrolled hypertension, sleep apnea, lousy diets, and who have a negative outlook on life.
WHAT RECOMMENDATIONS DO YOU MAKE TO OPTIMIZE THE OUTCOME OF STEM CELL THERAPY?
Mostly common sense: wholesome diet, regular exercise, quality sleep, fulfilling interpersonal relationships, avoidance of smoking and heavy alcohol consumption. Click here to read an article co-written by Dr. Adelson on the topic of naturopathic approaches to optimizing stem cell therapy.
WHAT IS AN N.D.?
Dr. Adelson is a Naturopathic Physician. After a receiving a bachelor’s degree at McGill University in Montreal, Quebec, he underwent a four-year N.D. program at the National College of Naturopathic Medicine in Portland, Oregon. This was followed by a one year residency in Integrative Medicine at the Yale/Griffin Hospital in Derby, Connecticut under the direction of David L. Katz, M.D., M.P.H. and then an additional year as clinical faculty at University of Bridgeport College of Naturopathic Medicine, before opening Docere Clinics. He holds licenses to practice Naturopathic Medicine in Utah and Arizona and he is licensed with the US Drug Enforcement Agency. Utah and Arizona grant NDs broad scopes of practice and Dr. Adelson is authorized to perform the therapies described on these pages.
HAVE YOU PUBLISHED ANY DATA ON THIS COMBO ADIPOSE/BONE MARROW STEM CELL METHOD?
Click here to read a manuscript written by Dr. Adelson published in The Pain Practitioner describing his experience treating low back and lumbar disc pain with the combination of ADSC with BMAC.
HOW DO YOU KNOW THE NEEDLE IS IN THE RIGHT PLACE?
Dr Adelson uses imaging for 100% of the procedures he performs; fluoroscopy (X-ray) for bone marrow aspiration and injection of joints and spine and ultrasound for soft tissues (i.e. rotator cuff, Achilles, plantar fascia, etc).
WHAT DOES A TOP UTAH ORTHOPEDIC SURGEON THINK OF DR ADELSON’S WORK?
Click here to read what Paul Winterton, M.D., orthopedic surgeon and Utah representative to the Board of Councilors of the American Academy of Orthopaedic Surgeons, thinks of Dr. Adelson’s work.
WHAT DOES ROSS HAUSER, M.D. THINK OF DR. ADELSON’S WORK?
“Dr. Adelson is one of the most talented and innovative teachers I have come across. His knowledge of anatomy and the use of regenerative cell therapy is extraordinary. I have worked and studied with him on several occasions and been grateful for his sharing his knowledge with me. He is one of the true experts on regenerative cell therapies and is at the forefront of this technology. Every time I am with him I learn something new! I believe we will all benefit from the innovative approach Dr. Adelson has toward healing the human body! I consider him one of the most gifted doctors in the United States!”
Ross A. Hauser, M.D. Medical Director, Caring Medical & Rehabilitation Services Editor-in-Chief, Journal of Prolotherapy
WILL I SEE IMPROVEMENTS IN MY X-RAY OR MRI?
We apologize in advance to the engineers, we know you’re going to hate this answer. While the goal of stem cell therapy is to reduce your pain and increase your activities of daily living and quality of life, it most likely will not lead to improvements in your X-ray or MRI… and we’re OK with that. To us, success is being able to normally walk down a flight of stairs, keep up with the grandkids, or go surfing. We really don’t care about the before and after pictures.
How can stem cell therapy reduce your pain without improving your pictures? In the evaluation of pain, we consider “the subjective” and “the objective”. The subjective is the pain the person reports and the objective are “the pictures”; the diagnostic imaging such as X-ray and MRI. You would think that the two would be directly correlated; the worse the pictures, the worse the pain. But it turns out, it has been proven they are not directly correlated. What this means is how bad the pictures look, does not predict how much pain the person reports. There have been conducted large, scientific studies looking at people with no back pain, and they frequently have abnormal spine MRI’s. We see it all the time in the clinic when we X-ray knees; frequently, the one that looks like “the bad one” doesn’t hurt much, and the one that looks like “the good one” is excruciating. Just because it looks bad, doesn’t mean it’s painful and just because it looks normal, doesn’t mean there’s no pain. How is this? We can think of our bodies in terms of macro-environments and micro-environments. Macro-environment is anatomy that shows up in X-ray or MRI (bones, joints, ligaments, tendons). Micro-environment is the microscopic anatomy that cannot be seen on X-ray or MRI, such as tiny nerves, tiny blood vessels, and collagen fibers. Macro-environments are not the pain generators. Micro-environments are the pain generators. When we inject stem cells into an area, we are treating the micro-environment by growing robust collagen and healthy blood vessels, but most often, we are not altering the gross anatomy.
DO YOU OFFER COSMETIC PROCEDURES USING MY STEM CELLS?
Yes. More specifically, Dr. Adelson wishes to make a modest contribution to the field of regenerative pain medicine, and for that reason he himself does not offer cosmetic treatments as it might dilute his efforts. However, in response to demand from our patients and their families, we have invited Amy Killen, M.D. to offer stem cell and PRP treatments for rejuvenation of the skin, hair restoration, and sexual optimization. Please visit www.doceremedical.com for more information.