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New Kind of Bunion Surgery: Performed by Dr. Nikravesh of HelloMD
There is plenty of talk in the news and among patient populations about stem cells and the possibilities they hold in treating a variety of conditions. They offer great promise for new and existing medical treatments; falling within the realm of what is known as biological or regenerative therapies.
At HelloMD, we are fortunate to work with the most elite medical specialists in the country who are at the forefront of scientific, technological and medical innovations. Many of our doctors are currently working with stem cells and using them with other biological treatments such as PRP (Platelet Rich Plasma), with incredible success.
HelloMD specialist Dr. Benjamin Nikravesh, a renowned Los Angeles Podiatrist focusing on the foot and ankle, took time after a surgery to talk to me about the extensive use of stem cells within his practice. Dr. “Nik,” who is double board certified, is a huge advocate of stem cell therapy; saying they can be miraculous for the right candidate. Read what he had to say:
Can you take a moment to explain why stem cell therapy is so popular today?
Regenerative therapies include stem cells, I call it stem cell therapy because everyone knows a little about stem cells. It is the wave of the future and a miracle to see working in patients.
Our stem cells are like a fountain of youth. We have them throughout our entire bodies but commonly extract them from the hip bone’s ACIS region. Unfortunately, this method of using a needle to suck the cells out is extremely painful. Patients typically complain about the pain and suffering after a procedure.
I do what no other podiatrist does—get the stem cells from fat. Surprisingly, the fat from liposuction can have far more stem cells present than bone marrow. I don’t know about you but I can also use the method to lose a few pounds! Many people feel it is a win-win. We even found the ability to save the fat for up to a year for additional stem cell use.
So why don’t more doctors get stem cells from fat?
Well, I don’t know. I’m at the forefront of the method and believe we should be heading in that direction.
My practice did therapy on a patient injured from a horrific accident resulting in an arthritic ankle. His previous doctor told him the only option was to fuse his bone. Well, once you fuse your bone, that’s it, you will never move again. This didn’t have to be the end result. The patient received the stem cell therapy and 8 months later had full range of motion.
The important thing to note is that multiple treatments with stem cells and PRP(Platelet Rich Plasma) is necessary in order to achieve the optimum results.
What is the difference between stem cells and Platelet Rich Plasma(PRP)?
The difference is that stem cells come from both bone marrow or fat. Platelet Rich Plasma only comes from fat. When blood is taken out of your vein it is platelet rich plasma. The PRP is your body’s natural cortisone minus all the side effects like crystal development. One influential reason why doctors do not inject cortisone into your Achilles’ tendon is because it weakens your tendons and ligaments. Sure, it rids inflammation, but it will rupture, weaken and snap the Achilles’ tendon.
Although expenses are high and insurance does not cover the method(s), I would do it in a heartbeat. I’ve even done it on myself! You can prevent surgery, use your body’s own healing ability and never get sliced open.
Platelet Rich Plasma is not covered by insurance but it is much more natural than cortisone. I like to say that PRP is your body’s natural cortisone and natural inflammatory. Currently, I am using it for fractures because of the significant difference in the healing rate. My patients are recovering much faster than the typical 8 week period and the results are unbelievable.
Do you always use stem cells in conjunction with Platelet Rich Plasma(PRP)?
No, I do not. In most cases they work very well together. The only problem with PRP is that it may increase swelling. The great thing with both treatments is that there is no down time. The most pain comes from the liposuction, not the stem cell extraction.
What initially motivated you to use stem cells for treatment?
I’m always thinking about how I can be at the forefront and find new ways of treating patients effectively and with less harm. For instance, cortisone helps initially but can harm the patient in the long run. The injection of cortisone into the fat pad of the foot’s heel is found to only work short-term and cause fat pad atrophy over time.
Dr. Newman is an innovator of many of these procedures. I have teamed up with him to work with the foot and ankle. We now work together with stem cells that can be harvested and saved for up to a year through liposuction stem cell harvesting. The therapies may not always work but they do no harm. Surgery is invasive and it can take a while to heal so stem cells are a great start.
That said, there seems to be quite a bit of concern over the safety of stem cells; such as excessive cell growth or growth of tumors. What are your thoughts on this?
The risk of infection is possible. In order to avoid it we follow specific protocols. Patients must be in good health and cannot be on dialysis or have a morbid illness. They are required to take a blood test, physical exam and antibiotics before and 7 days after using stem cell therapy. Unfortunately, if you are too sick, the method will not work. The method is not for everyone and we recognize that.
Do people ever have negative reactions?
It is crucial to pick the right candidate. Successful patients are those that may have a specific problem but are healthy, take care of themselves and have respect for their body. The stem cells tend to work well in athletes with foot and ankle issues or a knee issue. I’ve even injected myself due to hip pains and a torn hamstring and gluteus. After a couple of injections I felt significantly better. I did need multiple injections for the best results, but it works. I have so much faith, my own father has had it done and I practice what I preach.
What are the older techniques that stem cell therapy is replacing? What would you have done 5 years ago?
Stem cell therapy didn’t exist five years ago for what we are talking about. Stem Cell Therapy is brand new. Five years ago I would have injected cortisone. We’ve since learned more about cortisone and why it is not the best method. For instance, cortisone injected under the skin causes discoloration and can permanently turn skin white. After a year the skin pigment may not even come back. Among other non-desirable effects, cortisone also weakens the ligaments and tendons.
Some people say the jury is out on using stem cell therapy over cortisone. Many say that there is not enough evidence to prove that it works, what do you think?
Medically, over the past few years I’ve seen that stem cell therapy has not worked on everyone. My patients are still, however, very thankful and up to 80% end up feeling much better. Again, picking the appropriate candidate is crucial. When the body is actively breaking down, stem cell therapy will not work on very ill people. It is unfortunate that many doctors will promote the use of it in these cases. At my practice we are constantly refining our ways of introducing this method and we just keep getting better and better.
Are there a variety of medical practitioners that you know who advertise the use of stem cell therapy and use it inappropriately?
Yes, I think so. There is actually a science to stem cells that many people do not take the time to really understand. We need to distinguish who are the right candidates and reject those unfit. I also believe that there is this financial upside getting medical practitioners to inappropriately advertise and use stem cell therapy.
Can you give me an example of a procedure where you use stem cells successfully in your practice?
Absolutely, the procedure I perform for bunion removal is extremely successful. No one else is performing the procedure and achieving the same results as I am.
I see plenty of women in my practice who wear beautiful Jimmy Choo shoes or other designer footwear. As a result they end up with an awful bunion/big bone sticking out along side the big toe. The typical bunion surgery involves breaking the bone and sliding it over, causing joints to become much stiffer. This is not the optimal way to perform a bunion procedure. The key to fixing the bunion is to make sure the joint moves well after surgery.
My procedure is called Plantarflexory Metatarsal Osteotomy. First, we take care of the bunion then break the bone. However, rather than moving the bone to the side, we move it down. By moving the bone down it allows the joint to heal and move with fuller motion. My method takes care of the bunion while allowing for better movement and quicker recovery. I’ve also introduced stem cell injections to the Plantarflexory Metatarsal Osteotomy to help with recovery and minimal scarring.
One problem with surgery is scar tissue. If I lay down stem cells underneath the area where surgery is to be performed, the patient will heal better. It is regenerative, so it makes sense. No one else is using stem cells as an adjunct or combining surgical techniques with stem cells to create a winning combination.
My practice is thrilled to use the innovative approaches to procedures and use of stem cells or regenerative therapies available to us. We truly are at the forefront of our field as well as with technology, teaming with other medical practitioners alike. It is a very exciting time for us.