What are stem cells?

What is Stem Cell Therapy?

Stem cells are special cells that can do two very important things most cells cannot:

  1. Stem cells can multiply.
  2. Stem cells can turn into other types of cells or tissues.

These things are very important because they mean that stem cells have the potential to heal many types of damaged tissue.  In fact, most of the healing that takes place in our bodies is done by stem cells.

When we cut our finger, the damaged cells release special chemicals called GROWTH FACTORS.  Growth factors activate dormant stem cells in the surrounding tissue that then produce new skin cells and heal the wound.

Once it is healed, the stem cells again become dormant.  Enhancing the body’s ability to activate stem cells and deliver them to an injury has a tremendous potential to heal injuries and diseases that have resisted other treatments.

Stem Cell Walkthrough – Video Transcript

For more details, here’s a full transcript of Dr. Johnson’s stem cell walkthrough videos.

AMY VANDEROEF: I’m AMY Vanderoef with Good Morning Texas.

We’re so glad you decided to watch and whether you’ve decided you’re already going to have the procedure or are learning for the first time and want those questions answered, this is the video you want to watch.

Good morning, Dr. Johnson.

DR. BILL JOHNSON: Good morning!

AMY: Good to see you. Let’s talk about the kind of disorders for which you are doing stem cell procedures.

DR. BILL: Well, we’re actually working in there and an IRB which stands for Investigational Review Board and that is an independent group that looks at each disease and how we are treating it that we deal with and they approve a protocol, a procedure that we use.

So, everything that we’re doing is under the oversight of the Investigational Review Board. So, we have procedures for joints which include most of the joints you can think of – hands, wrists, elbows, knees, hips, shoulders, back – almost all of those have a procedure. We’re looking at lot at neurologic disorders – strokes, Alzheimer’s disease, multiple sclerosis, ALS which of course has been big with the challenge. We’re also doing a lot of peripheral neuropathy and so there are a lot of neurologic disorders that have protocols. Lung disorders, especially chronic emphysema or COPD has protocols. We are doing a lot of neurologic disorders like bladder irritation or interstitial cystitis. We’re doing male sexual dysfunction like erectile dysfunction. Also, we’re doing work with Peyronie’s disease. We’re doing work with some muscular disorders. We’re doing work with some cardiovascular disorders so we actually have protocols for folks that have heart failure and others.

So, we have a long list of protocols and there’s a long list of disorders that can be created.

AMY: All right. Dr. J, can you accurately predict anyone’s response to therapy?

DR. BILL: That’s a very good question and one that patients ask frequently. This is investigational (AMY and what that means is exactly we can’t. We don’t have enough information yet to be able to predict with assurance, with certainty, how someone is going to respond. We’ve getting enough data with joints in particular that will give some pretty good ideas but, if someone’s out there thinking about doing this that wants to have assurance it’s going to work, they should stop right now, not even watch the rest of the video because we can’t give them assurance. We can give them hope and we can give them some idea of what procedure you are seeing. But we just don’t have the quality of data to assure anyone’s response.

AMY: Okay. Good to know.

So, how is using stem cells from your own fat different from other types of stem cells like embryonic or cord blood or bone marrow. Let’s break that all down.

DR. BILL: Yeah, that’s a really important point to folks that have heard about stem cell therapy. It’s real
confusing.

Embryonic is the first type of stem cells that were ever used for treatment and what those are are embryos, human embryos typically that have been done by in vitro fertilization and those infants are kept at a few cells – eight to sixteen cells. Those cells are capable of becoming anything. So, embryonic stem cells have the advantage of being truly what’s called “pluripotent” – the ability to become anything. However, you have to take a baby or a fertilized fetus and destroy it essentially and use its cells for others. So, there’s been a lot of ethical concerns that are quite justifiable and really deserve discussion. So, in this country, embryonic stem cells have basically never been used to any extent.

Cord blood is another source and there’s a big movement, a lot of people are having their child’s cord blood.

AMY: It’s a conversation I’ve heard in the hospital when I had my son.

DR. BILL: Very commonly done and, for your son, that cord blood is a great source of future stem cells, but those cells already have his immunologic markers so those are great for him but they aren’t necessarily transferable to another person except the close relative. So, it’s the same thing as transplanting an organ in that setting. That’s cord blood.

The one that’s used the very most in the United States is bone marrow blood and that’s what, when people talk about bone marrow transplants, really, what’s happened is we’ve gotten the stem cells out of the blood and bone marrow, and that’s what’s being transplanted to stem cells. The issue with bone marrow is it takes multiple harvests – you have to go into the bone many times to get enough cells and then, even still, even with that, you often have to put them on a plate and grow them for several days to get enough cells to make a difference therapeutically. So, while that is used in a lot of cancer patients, it’s a much more tedious and difficult prospect to get adequate cell numbers than fat stem cells that come from fat where we can do in about two hours get anywhere from 20 to 100 million stem cells very quickly, very easily, and without having to grow them in the lab.

AMY: Okay. That really helps kind of break it down for the viewer. Here’s the word stem cell in many different varieties. This kind of really explains what we’re discussing here.

Okay. So, now we have some sort of idea the kind of disorders that we address which you said. Where do the viewers start?

DR. BILL: Well, anyone that’s really interested and at this point they still think they should finish watching this video because we’re going to step through point by point exactly what things they can expect, okay? Most patients start with a phone call. So, if you’re watching this and you come to us through the video, most come to a phone call and talk with us so that we can take in enough information to find out if they’re a good candidate. Do they have a disorder that would allow them to expect a reasonable response? And we have a protocol so that we can safely do their procedure.

AMY: Okay. So, it’s information gathering on their end but it’s also information gathering on your end.

DR. BILL: On our end. And we may often, at that point, request some of their medical records and some of their films so that we can make sure that we’re certain of the diagnosis and that we have the information that we need to know that we can do these harvests and use the stem cells safely.

AMY: Okay. So, while you’re collecting information about their case, they’re watching this video at home getting all of their preliminary questions answered before they find out if they’re a good fit.

DR. BILL: That’s right.

AMY: Okay. So, once you’ve reviewed the chart, what happens next?

DR. BILL: Well, once we’ve reviewed the chart and we know they’re a good candidate, then we can either go ahead if they’re confident and have had a chance to look at the video, look over the website, and they said yeah, they’re ready to go, then we can go ahead and schedule them for a time. Many patients may want to come in and meet with us at the office and so what we’ll do is schedule a consultation time for them to come in. We do charge for that, but the charge is added to their cost on the procedure if they decide to go ahead and have the procedure.

AMY: Okay. Consultation fee applied to the procedure in the event that they do do it.

DR. BILL: That’s correct. So, at that point, we can come in, discuss their diagnosis, go over any questions that they have, and then they can make certain if they want to schedule. Oftentimes, when the patient comes in for consultation and meets with us, and they decide to go ahead, we may go ahead at that point and do our pre-op exam which involves me making sure that they’re safe to have the fat harvested and we get a little bit of lab work as well to make certain that their blood tests and everything look good.

AMY: Okay. So, that’s part of that consultation process.

Okay. Now, the patient has decided to proceed with stem cell therapy. We get them on the schedule and they come in the day of the procedure. What should they expect?

DR. BILL: If they do their procedure at the same day as we do the pre-op, then there’s a large amount of paperwork, and it’s important to understand that, if you’re going to the doctor in the 21st century and you’ve not been there before, there’s a lot of paperwork. They have to show you their privacy rules, they have to show you your rights, they have to show you your payment requirements, and, in this case, there’s a lot of consent forms – not only the consent forms that we use for doing a liposuction but also consent forms that are related to the investigational nature of doing stem cells.

Now, if they’ve come in for a consult before and we’ve pre-opped them, they may have had an opportunity to do some of this paperwork beforehand and that’s right when they can because it could easily take an hour to go through all the paperwork and do it properly.

AMY: Okay, and that’s for the safety of the patient and for you as well as the physician so you collect all information on both sides. So, this is a common question I’m sure you get with any of the procedures that you perform here, what are the risks?

DR. BILL: The risks are really minimal. We’re part of a network of about 40 to 50 physicians nationwide that have worked under the same investigational review board and do these the same way. We’re now well over 1,000 patients and, within that group, there’s been one patient that was on a blood thinner that developed a blood clot where the fat was harvested, and that’s the extent of the complications that have been recorded within the network. It’s a very safe procedure done under local anesthetic. It takes only five to ten minutes to perform and it typically results in minimal to no complications.

So, AMY, patients may be here for three to five hours, but the actual harvest probably takes about half as long as we’ve been actually talking on the video.

AMY: I see. You said bruising, maybe swelling or soreness, but everything is very low.

DR. BILL: Yeah, we see some bruising and swelling where we take the fat. You may occasionally get a little bruise is we inject the knee or if we put in an IV, you may get a bruise where the IV was, but that’s really the extent of the problems from this. It’s very safe.

AMY: A big question you are asked when it comes to risks, the risks of mixing up, if you will, stem cells – deploying the wrong one to the wrong person. How do you prevent that?

DR. BILL: Well, we don’t ever have two stem cell patients going on at once and the cells that are harvested for stem cells, we use special syringes, special techniques. We have a designated person that follows those cells from the moment they’re harvested and to the moment they’re deployed so there’s really zero risk of mixing stem cells because, one, they’re followed and in the custody of someone from start to finish and, two, we don’t have two stem cell patients going on at the same time. Therefore, there’s no chance of getting confused at which person these cells belong to versus those cells.

AMY: Okay. So, let’s go on to the good news – potential benefits.

DR. BILL: Well, the potential benefits are really exciting because, for instance, we are treating a lot of knees and that’s probably the area we’ve got the very most information and one of the doctors in the network has been doing knees for about five years – he’s an orthopedic surgeon – he’s chosen carefully who he has allowed that all of the patients that he has treated, he thought would have to have knee replacement. In the five years, he’s done 140 patients and none of them have required knee replacement.

AMY: Wow!

DR. BILL: So, it’s really starting to become an impressive body of evidence. There are some disorders like COPD or chronic emphysema that we’re keeping patients out of hospitals, seeing really remarkable improvement in their ability to breathe. We’ve seen really impressive improvement in erectile dysfunction and Peyronie’s disease. We’ve seen a lot of impressive improvement with neuropathies. Some of the central nervous system disorders have been a little less consistent and some people will have really dramatic responses and some people have less dramatic responses. So, on those, we’re looking at new and exciting ways to try and use the cells so that we can enhance the improvement. So, we’re getting more and more evidence that we’re on the right track. It’s really exciting.

AMY: And when you come in for your specific disorder, and you’ve already been making that appointment and finding that your a candidate, you’ll get more specific.

DR. BILL: More specific based on exactly what their disorder is.

AMY: Okay. So, after the paperwork, information has been collected, where do we go?

DR. BILL: Well, after the paperwork, we will bring you into a room like this and, if we’ve not done your pre-op, we’ll do a little pre-op exam and make sure that we’ve decided where we’re going to take the fat. We take it from the abdomen is where we take it most commonly but we can also take it from the love handles, we can take it from the thighs, we can even take it from your arms if we need to. So, we’ll decide where we’re going to take the fat and mark that area. Then, we get a quick picture of the area and we take you into the surgical suite and sterilize the area, put some drapes around it, and get ready to actually harvest the fat.

AMY: Okay. So, that part takes about thirty minutes or less. And now, we are ready to harvest the fat, is that right?

DR. BILL: That’s right. So, harvesting the fat is really just a simple case of doing a small amount of liposuction. We’re doing about 50 ccs which is roughly three tablespoons. It’s the size of a shot glass, okay? If we do it through an incision – that’s about a quarter inch or slightly smaller than a quarter inch – and we then use a local anesthetic to numb the area where we’re going to take the fat. So, most of the time, we don’t even sedate the patient. The patient’s wide awake, able to move and function normally. So, we numb the area and then, using a syringe that I just pull back to provide the suction, we get the fat out by suctioning out that 50 ccs. So, that take anywhere from five to ten minutes. And, once that’s done, we put a dressing on and give you some ice to kind of cool it down and then we can get to the process of getting the stem cells.

AMY: Okay. So, when you say five to ten minutes, that seems so fast.

DR. BILL: That’s all it takes.

AMY: The paperwork is even longer.

DR. BILL: The paperwork takes much longer than doing the procedure.

AMY: That’s fantastic. Okay. So, the patients come back in there but your work has just begun because now you process the cells.

DR. BILL: Now, we have to process the cells and processing the cells, we do it in a sterile environment, we have a room that we isolate that does it, and it’s really quite simple what we do. We first set the centrifuge to separate it out so we can have the cells without any fluids. Then, we take that and we mix it with an enzyme called collagenase. What the collagenase does is simple. Right now, those cells are all in clumps of thousands and thousands of cells and the stem cells are trapped in those clumps. When we add the collagenase, it breaks down the clumps and makes it all individual cells. That’s all it does. Then, when we put you back in the centrifuge, the stem cells are larger and denser and they fall to the bottom. It’s really that simple.

AMY: Okay. So, that takes about how long?

DR. BILL: It takes about two hours to do the collagenase, wash it away, and get the stem cells, and get to our final product which is called Stromal vascular fraction or SVF.

AMY: We’ll call it SVF because it’s easier to say. So, tell us about SVF.

DR. BILL: SVF is really neat stuff. It is a combination of stem cells and a large amount of growth factors which are mostly anti-inflammatory.

Now AMY, you and I have talked about growth factors many times, but for folks that don’t know, growth factors are the chemical messengers that our cells use to talk to each other. So, if I cut my finger, the cells that are damaged release growth factors to call in cells to clean up the mess, to call in cells to stop the bleeding, and to call in cells to grow new cells to fix the cut. That’s all mediated, all the messages are sent via growth factors. We’ve got a large amount of growth factors in SVF and they’re very anti-inflammatory so they’re very, very good at turning off inflammation in joints and nerves and other tissues as part of the treatment.

AMY: Very sophisticated. So, how do you deploy the SVF?

DR. BILL: SVF is deployed differently depending upon the disorder we’re doing. So, for disorders like joints, say you have a bad knee, we’ll put some of it in the knee – actually inject it into the knee as you would a steroid – and we’ll put some in the vein because we’ve found, when we put some in the vein, we get more consistent responses. We will often do it in shoulders, do it in hips. So, if it’s a joint, we do it in that joint as well as in the vein. Sometimes, like with lung disorders, we will have some in the vein and have you inhale some with a nebulizer like you would your asthma treatment, okay? So, sometimes, we do it that way. We also sometimes, like with neuropathy, we’ll put some in the vein, but we’ll also inject some around the nerve that’s involved with the neuropathy, to inject it directly around the nerve. So, there are a number of different deployments depending upon what we’re trying to address.

AMY: Okay. So, once the appointment is done, remove the IV, band-aids where needed, and you are ready to go.

DR. BILL: Ready to go.

AMY: Three to five hours about the time you’ll be in the office total?

DR. BILL: Three to five hours on the high side. If you’ve done your paperwork beforehand, it’s probably going to take about three hours. If you need to do the paperwork here, then yeah, it’s going to add an hour or more because there is, as we’ve talked about, a lot of necessary paperwork that has to be done before we can do any investigational work.

AMY: Okay. So, we talked a little bit about the assurance question off the top but let’s talk about what patients expect from their deployment.

DR. BILL: Well, we’ve got really good information on joints and we know, for example, that about 85 percent of folks with knee problems are going to see improvement and about 85 percent to 90 percent of shoulders, and about 75 to 80 percent of hips. That usually comes as some fairly quick improvement within just a few days and we really think that that improvement is because of the growth factors. Then, most patients will improve for two to three weeks and then they plateau and they’ll go several weeks with no change. And then, beginning about three months, you start to see a gradual improvement out to six to twelve months. What we believe has happened is, during that first three months, the stem cells look around, find out what they need to do, multiply and become the kinds of cells we need. It takes them about three months before there’s enough of the proper cell in place for it to start making a difference in what we feel. And then, they continue to work for several months after that.

AMY: Okay. The human body is pretty amazing when you break it down like that.

DR. BILL: Well, what we’re trying to do is capture and utilize your body’s own healing power and just multiply it and direct it where we need it and help it in areas that the body just doesn’t have enough healing power in that place.

AMY: Dr. J, let’s talk cost for the procedure, not covered by insurance.

DR. BILL: This is not covered by insurance. This is investigational and there is not an insurance company out there that covers it and there’s no plans in the near future for it being covered. So, we get asked all the time because they’re wanting to treat their joint disease, they’re wanting to treat their emphysema if they can get insurance to cover it, and the answer is no. This is just investigational. It’s research. And, because of that, there’s no reimbursement so the cost is cash out of your pocket and it will cost between $5,000 and $8,000 to $9,000 and the variance depends upon what we’re treating. Some areas require additional physicians to be involved and we have to pay them. Sometimes, it varies by we can get specials from our suppliers that allow us to do it less expensively and we can pass those savings on to others. But you’re talking about somewhere between $5,000 and $9,000 – depending upon what what you need to be treated and what the environment of your treatment is.

AMY: So, is financing available?

DR. BILL: We do have financing through a company called Care Credit where patients can get up to twelve months interest-free and be able to pay it out to that separate company who actually does the financing over a twelve-month period – or longer, if necessary – and not have to be out all the money upfront.

AMY: Okay. Dr. J, you answered a lot of these preliminary questions today and we hope we helped make your journey to stem cell therapy a little easier. You may want to go back and watch this video again, write some notes, maybe watch it with a loved one so you can get an extra set of eyes and ears on it, and we look forward to seeing you in the office soon.

We hope we have answered the majority of your questions. If you have others or wish to schedule a consultation please call: 214-420-7970.