by Dr. Tan Boon Cheong

MBBS (MU),. MS Ortho (MU)

Many issues ago I did very briefly mentioned about stem cell treatment in orthopaedics, but only in a few sentences. Stem Cell Therapy has gained increasing popularity in orthopaedic treatment especially in knee osteoarthritis in the last few years. Stem cells are not only used for articular cartilage regeneration, but also used for osteonecrosis, fracture healing, osteochondral defects and tendinopathies.

The two most common sources of adult stem cells for clinical application in orthopaedics are the bone marrow and adipose tissue. Bone marrow aspirate is first harvested and centrifuged, Bone Marrow Aspirate Concentrate (BMAC) which contains Mesenchymal Stem Cells (MSCs) will then be produced. When lipoaspirate has been treated by enzymes and has undergone differential centrifugation, a layer of Stromal Vascular Fraction (SVF) which contains MSCs will be obtained. With the advancement of technology today, industry players have managed to obtain better stem cell count with each centrifugation; Thus, making the cultivation of stem cells easier and faster. 

Although stem cells have been widely used in orthopaedic treatment, stem cell usage in knee osteoarthritis has interested patients more than others. With recent advancement, more research articles have been able to show the regeneration of articular cartilage in knee osteoarthritis with stem cell treatment. Even though most of these studies were small-scaled, but they have shown promising results.

Stem cell application in knee osteoarthritis can be in two ways. The first will involve a minor operation through arthroscopy of the knee. During the arthroscopy procedure, the cartilage defect on the joint surface will be identified and prepared. The stem cells will then be used to fill up the defect (implantation). The second method which is much simpler is direct intra-articular injection into the knee joint. This usually goes together with hyaluronic acid (gel).

Having said about the use of stem cells in the treatment of knee osteoarthritis, not every patient with knee osteoarthritis is suitable to be treated with stem cell as the patient must be well selected. Knees with severe osteoarthritis should not have Stem Cell Therapy performed on them as this will result in poor outcomes, for them knee replacement surgery is their only option. Do bear in mind, Stem Cell Therapy in knee osteoarthritis is not permanent. Several studies have shown that the effects only last a range of 2 to 5 years. 

One major drawback of stem cells  being widely used in knee osteoarthritis is the cost. The cost of stem cell treatment can range from RM12000 to RM 20000 (USD 3000 to 5000) per knee per treatment. Moreover, this cost will not be covered by medical insurance.

I believe that the usage of stem cells in knee osteoarthritis treatment in the years to come as more studies are conducted will be able to provide us with better evidence on the outcomes of Stem Cell Therapy. Therefore, before one decides to have this treatment, it would be great to first have a consultation with an orthopaedic surgeon as every patient differs. 

Image(s) courtesy of Freepik.com

by Dr. Mecherl Lim 

MD (MA) Naturopath (ND), Holistic Kinesiology

There’s a new acronym in the dieting world: FODMAP. It’s  an acronym that makes life easier for anyone discussing this particular diet, because the words represented by the acronym are so difficult to remember, let alone pronounce.  FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

IBS RELIEF

One of the reasons this new diet is getting so much attention is that it seems to help those who experience the symptoms of irritable bowel syndrome (IBS). Millions of people suffer from digestive disorders, and up to 20 per cent suffers at some time with IBS

WHAT IS IBS?

While the word “bowel” is built into the name, IBS involves pain and discomfort anywhere in the abdomen, and includes such varied symptoms as diarrhoea, constipation, painful wind, belching, flatulence and bloating. If left untreated, over time it can lead to dehydration, nutrient deficiencies, social discomfort and could contribute to some forms of cancer.

WHAT CAUSE IBS?

Experts believe that IBS is the result of dysfunction in the muscles or nerves controlling the  organs of the gastrointestinal tract, which is  a lot more complex than it might first appear. A system of nerves runs the length of the digestive tract starting at the oesophagus and ending at the anus.  In fact, the number of nerves in the gastrointestinal  tract is exceeded only by the number  present in the spinal cord and brain!

WHAT ROLE DOES DIET PLAY?

While some experts ponder the source of the dysfunction, others are focusing on the role of diet in producing the symptoms associated with IBS. Poor digestion, malabsorption of dietary sugars (lactose from dairy and fructose from fruits) and food chemicals have often been considered triggers for IBS symptoms. 

Similarly, while dietary fat helps food and wind to move slowly through the stomach and small intestine of healthy individuals, it seems to really slow down food and wind transit in those with IBS. New research also suggests non coeliac gluten intolerance may play a role in those who suffer with irritable bowels.

One of the major complaints associated with IBS involves wind production. For example, IBS sufferers report more  wind, as well as wind that takes longer to dissipate from the small intestine that those without IBS.

As a result of the wind build up, bloating causes an increased abdominal size throughout the day, leading to discomfort and possible embarrasment- not to mention a wardrobe full of unattractive clothing with elasticized waistbands! 

Image(s) courtesy of Freepik.com

by Dr. Tan Boon Cheong

MBBS (MU),. MS Ortho (MU)

The shoulder is a region that commonly gives rise to pain and immobility. A common shoulder problem in orthopaedic practice is frozen shoulder or adhesive capsulitis. Frozen here does not mean cold temperature but it carries the meaning of the inability to move the shoulder joint in almost all directions as the disease progresses. Frozen shoulder is debilitating and will affect the daily activities of the patient. Frozen shoulder tends to heal over time, but full recovery may take up to three years.  

It generally affects people between the age of 40 to 60 and more in females. The causes of frozen shoulder are not fully understood but there are a few factors which may present higher risks.  Prolonged immobilisation after shoulder injury or surgery is one of them. Thus, early mobilisation is important. Diabetic patients (10% to 20%) are more prone to the ailment.  They tend to have greater degree of stiffness and longer duration of the problem. Other medical conditions such as heart disease, thyroidal imbalance or Parkinson’s are linked to this malady as well. 

The main symptoms are pain and stiffness. The pain is usually dull or achy in nature, typically in the outer part of the shoulder. Some patients may feel this pain at the upper arm. It gets worse at night, making sleep difficult. Symptoms of frozen shoulder can be categorised in three phases namely freezing, frozen and the thawing phase. Basically, the pain intensity slowly builds up to a stiffness that will lead to a debilitating phase before a slow recovery over time.  

Diagnosis of frozen shoulder is based on clinical history and physical examination. Some imaging may be ordered to rule out other diagnosis if the history and examination are inconclusive.  

Treatment of frozen shoulder is usually conservative with medication and physiotherapy. Shoulder joint injection with corticosteroid and joint distension with the injection of sterile water may sometimes be applied to reduce the symptoms. Shoulder joint manipulation under general anaesthesia can help in loosening the joint but is rarely needed or practiced. Surgery for frozen shoulder is seldom necessary. 

Image(s) courtesy of Freepik.com