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Episode 10 – Liveyon Pure Cast – Most Popular Questions About Stem Cells – FAQ’s
Dr. Alan Gavick: Welcome back, everybody, to the Liveyon Pure Cast Podcast. I’m Dr. Alan Gavick, director of medical education and clinical
application for Liveyon. And of course, this is John Kosolcharoen, CEO and founder of Liveyon. How are you doing today?
John Kosolcharoen: I’m doing well, as always.
Dr. Alan Gavick: You know, we’re getting a lot of requests for just kinda generalized, frequently asked questions. So, I mean I think we
should, let’s start …
John Kosolcharoen: There’s a bunch of them that come in and I hear them come in from the doctors …
Dr. Alan Gavick: Yep.
John Kosolcharoen: And I hear them coming from the patients. So …
Dr. Alan Gavick: See both of them.
John Kosolcharoen: Yeah. We can go … And some of them kind of overlap.
Dr. Alan Gavick: Right. So, doctors ask questions like, “The patient is a grade 4 osteoarthritis. I mean, they’re really bone on bone. Are
they really a candidate?” Well, studies have shown yes, that they do quite well. Maybe not so much in this complete
reconstruction of the joint. Because realize, they’re probably 60 or 70, possible 80 years old.
John Kosolcharoen: And if that happened, it would take a while.
Dr. Alan Gavick: It would take a while. But the main thing is, subjectively, they have less pain.
John Kosolcharoen: Yep.
Dr. Alan Gavick: Another biggie is, “Will I have an inflammatory response?” Which is also big because while it’s not uncommon to have an
inflammatory response, you don’t necessarily have to have it. And the reason you usually have the inflammatory response, is
people need to remember that these cells are a heterogeneous mix of cells, and part of those are polymorphonuclear sites, and
a component of a polymorphonuclear site is a neutrophil, and a neutrophil can stimulate prostaglandins.
John Kosolcharoen: Well, you need that. You want that to start the healing process, and some of the other ones that I hear in that realm are,
“Well, I’m in a lot of pain. And I want to get a stem cell treatment, but does it hurt?”
Dr. Alan Gavick: The shot doesn’t hurt anymore than anything else.
John Kosolcharoen: Right. People go and get steroid injections. The only difference between a steroid injection and a stem cell injection is
they’re stem cells instead of steroids.
Dr. Alan Gavick: Exactly the same technique.
John Kosolcharoen: I think the biggest problem is what patients’ subjective healing is, and that’s really based on, a lot of it, based on
Dr. Alan Gavick: It is. I tell doctors all the time their toughest job is managing patient expectations because unfortunately, you can go
online, onto Google, and see just about anything you’ve ever seen, and all these miraculous things that are happening and
these patient testimonials.
John Kosolcharoen: The truth is, it’s a biologic, so it takes a while to heal. It’s really stimulating your own bodies to heal.
Dr. Alan Gavick: And some people do have just absolutely unbelievable results, but the reality is most people fit right in that middle
category. I tell doctors all the time, “We understand the physiology of the disease that the patient has, whether it’s RA, or
osteo, whatever it is, and we understand the potential of what the cells can do. I can’t look you in the eye, and tell you
that these cells are gonna do that for you.”
John Kosolcharoen: Well, I think the other big question that I hear is, “How many treatments do I need?” Or, “When am I gonna start feeling
Dr. Alan Gavick: Yeah, and how many treatments I need, we know statistically, approximately 86% of the patients who have joint injection only
need one. However, if you’re in the other 14%, you’re still 100%.
John Kosolcharoen: You’re exactly right.
Dr. Alan Gavick: You’ve still got to have another one. And how long does it take? It can take a while. I usually tell doctors if they talk to
their patients in the terms of weeks and months to look for healing and improvement, they’re gonna have happy patients. If
you talk in the terms of hours and days, no, they’re not gonna be happy.
John Kosolcharoen: Subjectively, when do you think, or what has science shown that you will have your greatest feeling of healing?
Dr. Alan Gavick: A study was done, a synovial fluid analysis was done on, I believe it was 500 patients, and they analyzed the synovial fluid
before the injection, and then after the injection, and then at one month, three months, six months, and twelve months. It
did not show significant decrease in the inflammatory components for up to three months. It can take a while because that
joint is damaged, which means that all these inflammatory components, tumor necrosis factor alpha, interferon gamma, and
those harmful inflammatory components are in there and these cells have to tamper them down. Your best subjective response is
probably at about three months.
John Kosolcharoen: So someone comes in, they have knee pain, they want a stem cell injection. They get an injection, and a week later they say,
“I don’t feel any better.” What do you say?
Dr. Alan Gavick: Too soon, way too soon. Also we tell them if they’re gonna have the injection, this is what we talk to the doctors about,
don’t significantly increase your activity level just because you start feeling better, and also, give this time. It could be
two, three weeks before you notice much is going on, also, do not significantly increase your activity level above what you
were doing when you came in here. Sometimes we say up to three months don’t significantly increase it because remember, it’s
the trauma that caused the inflammatory components inside that joint. If you continue to create the trauma, how do these
cells ever overcome the inflammatory component that’s in there? The runner that comes in and says, “I gotta run five miles a
day or you have to put me back on Prozac,” well then understand you’re probably not going to get the absolute ultimate
John Kosolcharoen: Yeah, expectations, definitely expectations.
Dr. Alan Gavick: Managing expectations is a big thing.
John Kosolcharoen: Even treating or setting the body up for the best reception of the stem cells. You probably don’t want to go out and have a
bottle of wine the night before and just come and get a stem cell injection. To get a better effect, maybe going through a
fasting diet of a few days prior to your stem cell injection … there’s actually a lot of protocols that a lot of doctors
Dr. Alan Gavick: A lot of good protocols too.
John Kosolcharoen: A lot of very good protocols. Everybody’s kind of different, but I’ve seen some pre-stem cell injection protocols that really
put the body in the best state for healing.
Dr. Alan Gavick: I think it makes sense because we’re dealing with principally … until those inflammatory components have been neutralized,
that joint is not optimized, and those growth factors are not gonna have a great effect, so that has to get knocked down.
Anything that you can do to balance and lower that inflammatory load in your body is just going to pay dividends-
John Kosolcharoen: Pre-load, basically pre-pay ahead, pay yourself ahead for the stem cell injection.
Dr. Alan Gavick: Exactly. I think that that’s important. You know the clinics that do that have fantastic results.
John Kosolcharoen: Most of the clinics that have the best results, they actually have a one year program where you’re coming in, you’re doing
all the right things to get your body in the best position. You actually do the stem cell injection, and then you have that
continue follow up to make sure that you’re either doing physical therapy or not working out too much, overworking the joint,
and still being on supplements or whatever it takes to put your body in the best state of healing.
Dr. Alan Gavick: There’s a lot of stuff out there. You know the big one, “Can I take my anti-inflammatory medication?” Right?
John Kosolcharoen: Yep.
Dr. Alan Gavick: Non-steroidal anti-inflammatory drugs, the recommendation is none three days before, up to three weeks after. They don’t have
a really long half life so you don’t really have to worry about them in the body. The reason we don’t really like the non-
steroidal anti-inflammatory drugs is because they directly suppress the formation of prostaglandins. Right? Prostaglandins
cause an inflammatory response. That’s what wakes up your body to what’s going on, so what confuses some people is the other
guideline is you can use a corticosteroid.
John Kosolcharoen: That and on the physician side of it, “Can I use something to numb the patient where I give the injection?”
Dr. Alan Gavick: Oh yeah, and anesthetic.
John Kosolcharoen: An anesthetic.
Dr. Alan Gavick: Interesting because you’re either looking into sodium channel block anesthetic, which is Lidocaine, Carbocaine, that sort of
thing, or you’re looking at an amide, Marcaine, Bupivacaine, [Bropivacaine]. You read one article that says Lidocaine’s bad,
Marcaine’s good. You read another article that says Marcaine’s bad, Lidocaine’s good. I don’t know, and they actually don’t
even know why the cells get damaged in that presence, but what probably makes as much sense is it only has a pH of about 5.5,
so ideally, if you need to numb them, numb the skin track, don’t necessarily fill up the joint with the local anesthetic.
John Kosolcharoen: Right.
Dr. Alan Gavick: Absolutely do not mix it with the local anesthetic.
John Kosolcharoen: Any type of pre-loading that a patient should do that puts them in the best state of … it is an allogenic product so they
are gonna get some type of … or they have the possibility with the DMSO, some people have a reaction to DMSO or sulfa, so
is there any way to prevent that?
Dr. Alan Gavick: There are. There’s certainly things you can take if you read in prepping patients for it that’s basically an H1 antagonist
and H2 antagonist and some Dexamethasone sodium phosphate, so typically they’ll take, if they do it orally, like 40 mg of
Ranitidine, which is pepcid, 25 mg Diphenhydramine, which is Benadryl, and then like 10 mg Dexamethasone sodium phosphate,
Solumedrol. Those things taken orally can really help, you know, can really knock it down, and actually if you’re gonna take
them orally, you don’t need to take the Dexamethasone sodium phosphate, that’s an injectable, but you can if the patient is
concerned about it. They can always take a Medrol dose pack home with them, but a lot of people have a sensitivity to sulfa,
and since the crowd preservant is DMSO Dimethyl sulfoxide, some people do have that response. Don’t have to worry about it,
it’s usually very easily taken care of by just a little bit of Benadryl and some pepcid, and they’re usually in pretty good
John Kosolcharoen: I’m sure that this whole podcast today will spark some interest and we’ll get a bunch of emails in, so maybe at some point
we’ll have part two where we can answer other questions.
Dr. Alan Gavick: Part two would be good, but I also want to go back and cover one point, that while we don’t NSAIDs, the corticosteroid
injectable is okay because a corticosteroid, and doctors ask me all the time, “Well you say you don’t want to use NSAIDs, why
do you say a corticosteroid is okay?” Because a corticosteroid does not directly suppress prostaglandin formation. It does it
to the COX-2 inhibitors in the central nervous system.
John Kosolcharoen: Yeah, totally different.
Dr. Alan Gavick: So it secondarily suppresses them and that’s okay because it’s at the site that we really don’t want them suppressed.
John Kosolcharoen: What do you think the number one question that you get asked? You’re on the phone 12 hours a day with doctors. What’s the
number one question you get?
Dr. Alan Gavick: Wow.
John Kosolcharoen: Because I see FAQ sheet that you did.
Dr. Alan Gavick: Fourteen pages.
John Kosolcharoen: Fourteen pages.
Dr. Alan Gavick: Probably number how, “How soon can I tell my patients they’re gonna start feeling better?”
John Kosolcharoen: Yeah.
Dr. Alan Gavick: And that’s probably the toughest one of them all because there’s no straight answer.
John Kosolcharoen: There isn’t, right.
Dr. Alan Gavick: You know as well I do patients that get an injection and say within five minutes, “Amen, I have absolutely no pain whatsoever
in my body.” Not typical, but it can happen, and that’s fine. More than likely it takes a few weeks, takes at least a couple
weeks because you’re trying to overcome that inflammatory process, and in that time, we just want you to take it easy, maybe
do a little passive motion, physical therapy, and all that sort of thing. That’s all good stuff, but mainly just follow the
advice of your doctor and give these cells the absolute best opportunity possible.
John Kosolcharoen: Well, I think if you have any questions that you want to ask either Dr. Gavick or myself, or any questions, email in and find
out. Support at Liveyon.com and we will try to get back to you with a response, or if there’s enough people asking about the
same thing, we’ll do another podcast specifically to answer more FAQs.
Dr. Alan Gavick: Then we’ll have FAQ part deux.
John Kosolcharoen: Dos.
Dr. Alan Gavick: Alright man.
John Kosolcharoen: Alright, appreciate it.
Dr. Alan Gavick: Thank you.