Keep in mind, it is Dr. Otten’s responsibility and goal to make the total procedure as pain free as possible.
The complete stem cell procedure takes about 2 hours. It is not painful, but rather patients describe the overall process as a moderately uncomfortable. Dr. Otten will attempt to make the procedure as pain free as possible and will ask your comfort levels throughout the procedure.
Medications will be prescribed prior to the procedure to be take before and after to reduce discomfort and anxiety.
The procedure begins with the harvesting of the adipose tissue. This is best summarized as a minimally invasive mini-liposuction. The adipose tissue is anethisized with a mixture called tumescent which is injected and allowed to settle for 20 minutes to fully numb the harvest area. Tumescent is a commonly used sterile fluid used in plastic surgery. It expands, numbs and separates adipose tissue, enabling a higher volume, more productive harvest.
Adipose from the abdomen is the most stem cell rich area, this will most likely be your site for harvesting. The required amount of tissue is then harvested with a small blunt cannula. Adequate amount of small adipocytes for each individual patient. The complete process of stem cell harvesting takes about 45 minutes. These stem cells will then be processed, isolated and purified. They will be activated with PRP just prior transplantation.
Your blood will be drawn in a normal fashion like routine labs. This will typically be performed while waiting for the tumescent to take full effect. This blood will be centrifuged for 2-3 separate times in order to isolate your platelets. Platelets help activate and instruct stem cells to begin regenerating damaged tissue. This process is commonly known as PRP. Dr. Otten in his years of experience and research firmly believes in the addition of PRP to stem cells.
Both your stem cells and PRP have now been prepared. They are ready to be combined, activated and injected.
This will take about an hour. Your stem cells are now ready to be injected.
The stem cell and PRP mixture will be injected like a normal injection which most patients have experienced. However, unlike most injections image guidance is always used.
Your injections will always be performed under Ultrasound needle guidance or X-Ray guidance (fluoroscopy). It is not uncommon to have both X-Ray and Ultrasound used for your procedure. There are typically multiple injections for one area. For example, stem cell procedures for one knee often require 4-5 separate injections. The area will be anesthetized (or “numbed”) with superficial lidocaine prior to reduce pain.
Specialty needles and syringes are used for injecting stem cells.
Abstain or minimize NSAIDs 10 days prior to the procedure.
Minimize NSAIDs for 14 days after the procedure.
Tylenol can be taken as needed.
Pain management medications will be prescribed and a prescription will be placed in your post of kit
Turmeric is not well studied at this time. However, this has NSAID properties through Cox-2 inhibition and is recommended that you refrain from turmeric like NSAIDs.
No reliable data is present with medical marijuana currently to report.
Aspirin, Plavix and other blood thinners please consult directly with Dr. Otten; pros and cons need to be considered.
Normal vitamins and supplements can be taken.
Often, this is the major complaint after the procedure. This can be rather uncomfortable for 2-7 days. It is more of a “discomfort” as described by most patients. An abdominal binder is included in your post op care kit, specially formulated for each patient. This binder should be worn for 5-7 almost to reduce unwanted cosmetic outcomes.
Two small incisions will be made for the adipose harvesting. These are small, about 0.5-1cm in length. However, this is the major possible source of infection, so make sure to take proper care of the incision until they heal. Healing should be complete in 3-5 days. These sites will drain both tumescent fluid and small amounts of blood for about 24 hours after the procedure. Change the bandages as need. The vast majority of fluid is the tumescent. These will need to be changed a couple times the first 24 hours. After about 24 hours the draining should reduce substantially or totally. Keep the bandage on for 3-5 days or until the incisions are totally healed. No need to change the bandage if they appear clean and dry.
Bandages are given to you to take home in your personalized post op kit.
Yes. The bandages that are used are a special material called tagaderm. This is basically a Gortex material creating a water barrier. Do not immerse in water, such as, swimming, hot tub, bath, etc. until the incision have closed completely.
This goes one of two ways:
30% of patients describe and report moderate discomfort and moderate pain for less than a week, which dissapates each day.
The remaining 70% of patients report moderate discomfort and pain for about 2 weeks. Most patients state the evening of the procedure and the following day are the most painful days. Patients are able to walk and function normally immediately after the procedure, albeit with some discomfort. Typically, it is recommended to take about 5-7days off of work if you are concerned to error on caution.
Hips are the major exception to be noted. Hip procedures often are quite painful for 1 week and pain will persist about 2-4 weeks. Dr. Otten will discuss this further with you for your individual case.
Yes, but minimize. There is emerging data that icing may reduce an initial cytokine response needed to get the maximal effects and benefits of your stem cell procedure.
This is common to occur in the adipose harvesting site, typically the abdomen. Don’t be alarmed, this is harmless and does not have consequences. Arnica gels an oral supplements have been clinically shown to reduce the time of bruising and this can be taken if you wish.
There are no major restrictions with the exception of pain. If something is painful, obviously don’t do it. That being said, once the initial discomfort from the procedure subsides is it crucial to treat your new stem cells properly. The new stem cells are very similar to an octopus. They form sticky “legs” that attach to sites of injury to regenerate new tissue. These can be forcefully sheered off and will not reattach in most cases. With that analogy, here are some of the most common take home points to maximize your benefits:
Keep your body moving; a body in motion wants to stay in motion.
Do not pound or load the joint/tendon/muscle aggressively for 6-8 weeks. For example, if you are a runner, do not run for 6-8 weeks, instead, cross-train in the water, use the elliptical/rowing machine, bike, etc.
Light to moderate activity is need to mobilize and activity the stem cells for the first 6-8 weeks.
Pool activities are always encouraged and recommended. Water is a resistant exercise building muscle, flexibility and strength without major trauma.
Light eccentric or isotonic strengthening is encouraged. Always take your muscles to fatigue, this builds lean, high metabolic muscle.
Yoga, Pilates and other body weight work outs are highly encouraged.
In most reported literature and my clinical experience:
3-10 years in arthritic or chronic conditions, depending upon the severity
Virtually permanent improvements in ligament/tendon and muscle injuries
Acute injuries can be potentially reversed if the procedure is performed with 6 months of the injury
Stem cells have been radio-tagged in clinical studies and have been found to be active and viable for 12 months. That is, the stem cells are alive and regenerating new tissue for about one year.
The first 3-4 months will be the most dramatic improvements with a more gradual improvement experienced the remaining 8-9 months.
The major possible complication is infection at the incision site. Our office has never had an infection or complication.
In over 100,000 procedures documented world wide, no major complications have occurred.