Category Archives: Medicine

The Economy Improves

The Economy: Consumer confidence surged; Everything home-building looking positive. The US continues to post impressive economic numbers. Though nay-sayers shout “Fake News” with every number that’s posted. All news is good news with individual investors finally beginning to pour money into stocks. Brexit, Trump, the rise of populism, the assault on globalism, immigration and the environment are no reason to slow financial markets still feasting on $200 billion a month in central bank stimulus. Repealing and replacing Obamacare was to provide billions in tax savings. Those savings were to be factored into the overhaul of the tax code. The narrative was that passage was a slam dunk. The subsequent fail produced a new narrative that Tax Overhaul would sail through regardless. Markets were thrilled that billions in lost tax savings no longer mattered. True to form, a massive rally followed the fail.

Food for Thought: The Trump phenomenon continues to unfold in stark black and white. Love him or hate him he is a phenomenon. Polarizing in the extreme, he’s brought out the worst in many. The main stream media (MSM), Hollywood, the UN, NATO and foreign governments seem to be the most shocked. Sacred Cows everywhere are in retreat. All concerned are becoming aware that POTUS is a brawler who enjoys taking the fight to the street. As a businessman The Donald understands that the best way to gut a program or department is to decapitate administration and cut or curtail funding. No money, no staffing, no decisions, no activity, no continuation of programs outside the Trump Agenda. Brilliant or Brutal depending on your persuasion. How this ultimately plays out is anyone’s guess. How the financial markets respond is also anyone’s guess. With the stroke of a pen, Trump is undoing decades of U.S. policy and redirecting national priorities and resources. Markets continue to treat these unprecedented events as a win for all sectors of the economy. The prime example is Climate Change. The administration’s position is, “We’re not going to spend any more money on that.” Yet the response of financial markets is that the trillions invested in this sector are going to continue on the same growth trajectory as when they were darlings. Reminds us of PT Barnum’s “There’s a sucker born every minute.”

Music of the Week: Jack Johnson’s “Jack Johnson”

An Expanding Economy and The Future of The Health Care Industry

The Economy: Government statistics continue to show an expanding economy with healthy employment and inflation that will support a near certain interest rate hike next week, when the Fed meets. Fake news? Who knows! Who cares? How do things look from your place in the firmament? Economists and analysts are evenly opposed on the question. David Rosenberg, the economist who coined the phrase the “New Normal” is a case in point. Regardless of glowing reports, Rosenberg remains skeptical that the outlook is so rosy. The noise from both sides of this issue is only exceeded by the screams of the Social Justice Warriors and their nemeses, the Deplorable Populists. For all the racket about how bad things are, I see full restaurants, crowded malls, private schools with waiting lists and growing numbers of happy new car owners who’ve forked over 6 or 7 figures for their piece of the American Dream. If this is a bubble, then the lambs are the happiest campers in history.

Food for Thought: I had hip replacement surgery last week. Was walking around the same day. Was back home 24-hours after surgery and back in the office less than 48-hours after surgery. … I only lasted an hour in the office before my body demanded immediate and total bedrest for the next 4-days. Call it a jock’s hope over experience. Nevertheless, the speed of my recovery has amazed me and I’m now up and about on a full schedule. I’ll have the other hip done as soon as I can get it scheduled. The miracles of modern medicine don’t need my riff. What does is the observation that all aspects of Health Care will be a growth industry as far into the future that we can see. The sector has taken a breather while the new administration brings its plans to fruition, but the space is built on boomer demographics.

Music of the Week: Peter White’s “Smile”

Stem Cell Therapy: A Journey, Part 2

Stem Cell Therapy: A Journey, #2

After watching the stock markets implode on quadruple witching, We left my La Jolla office to drive to The Stem Cell Treatment Center on Directors Place, one block north of Mira Mesa Boulevard. Directors Place is located on the new frontage road on the east side of I805.

“We” is my wife and myself. Though stem cell therapy is considered an outpatient procedure and you are told you can drive yourself to and from the appointment, I wanted to make sure I had a backup driver.

My appointment was for 1PM. $8,000 cash. $4000 per hip. As of the date of my treatment, Stem Cell Therapy was not approved by the FDA. So it is called “experimental medicine” and is not covered by medical insurance. A hip replacement, which is approved by the FDA costs a minimum of $35,000 per hip. It is massively invasive and results in cutting the largest bone in your body and replacing it with a manufactured ball and socket. Welcome to life as a Borg.

We drove up the hill from the beach on Camino Del Oro and got on La Jolla Village Drive East. It was a judgment call to go La Jolla Village Drive or to get on I5 north and go east on Sorrento Valley Road. To my chagrin, I chose the former.

It took us 30 minutes to drive the 4 miles from my office in La Jolla to the doctor’s office. We hit every single stoplight during Christmas lunchtime rush hour. Count ‘em 17 stoplights.

The German logic embedded in the BMW navigation system proved to be maddening as we approached the stem cell center. The Prussian My-Way-Or-The-Highway algos didn’t allow me to input the exact address so I had to rely on memory to guide me in to the doctor’s office.

We parked the car, entered the lobby of the surgical building; then went up to the third floor Suite 360. Nobody was in the office except for the nurse receptionist Kathy who I had swapped emails with but had never met.

Medicine is like the Navy; Hurry up and wait. I throttled my impatience and chatted with Kathy. At 10 minutes after 1PM the entire plastics and orthopedic crews showed up. They had been shopping at Costco. They were good naturedly honest about it. They apologized for the traffic; the only legitimate late excuse in Southern California, and all was forgiven. “Andale!”

The stem cell treatment was to be performed in three parts. First was harvesting adipose tissue (fat cells) through liposuction of love handles on the upper butt area. Part two was to centrifuge the extracted 50 mL of fat to get the stem cells. Step three was to inject three vials of 1) stem cells, 2) growth factor and 3) Hyaluronic Acid. Think of the three as, the cells, their food and the molecular lattice structure for the cells to grow on.

Still waiting, I decided to take a coffee break; maybe it would counteract some of my growing impatience. It seemed to work because I was in better spirits when I got back to the waiting room. Bob the Physician’s Assistant introduced himself and told me to saddle-up for lipo.

At this point, I was the only patient in the 3000 square-foot surgical suite. Later my wife told me that after I disappeared behind Oz’s curtain for the liposuction, there was a steady stream of Baby Boomer cash buyers who came through the complex.

I followed Bob back to the treatment room where the liposuction would be performed. I left my Kindle, IPhone, wallet and car keys with My wife in the waiting room.

It turned out that Bob had been a Navy Corpsman. As an Asian American he’d spent his Navy time in Iraq and Afghanistan.

“Glad I missed Vietnam,” he said. “It was easier to be around the camel jockeys than it would have to be around the gooks.” After getting out of the Navy a few years ago, he tried pharmaceutical sales before coming back to the surgical suite.

Bob began to place me on the lipo gurney when the Plastic Surgeon, Craig, came into the treatment room. Craig explained that he was the Plastics Guy and was only going to do the lipo. When I asked where his medical offices were, he told me that he was an active duty Navy Captain stationed at the Navy Regional Medical Center in Balboa Park.

He said that in a war zone he did wound reconstruction but that most of what he did now was breast cancer reconstruction of the kind done on Angelina Jolie. I mentioned the Boat School and Craig laughed saying, “I was born and raised in Annapolis. My grandfather and uncle were Ring Knockers. I’m 47. It’s taken me 19 years to make Captain. Time to transition.”

“Amen Brother,” I replied. “I did 4-Westpacs when Hong Kong, Olongapo and Singapore were full of the wildest women on the planet.” “I love you, no shit. Buy me a drink!” Bob chimed in. The three of us erupted in laughter

With the testosterone at the appropriate level, I took off my old topsiders and laid face-down in my navy blue sweats on the gurney. Bob asked me to pull the top of my sweats to mid chest and pull down the bottom of my sweats to the bottom of my butt cheeks.

I had met Craig last week at the pre-op conference. As we chatted while Bob prepped me for the liposuction, Craig told me that in order to comply with all regulations, he would take a leave day to perform the lipo on a specific patient group. This was why the stem cell treatments were scheduled for all patients only twice a month on Fridays. The scheduling allowed Craig to take a leave day, perform a couple of dozen liposuctions, make more money in a day then he made in a year as a Navy captain and then go back to his work at Navy regional medical center Balboa Park.

As a Bob draped my butt, Dr. Craig explained what was going to be happening during the liposuction.

He said the most painful part of the procedure was going to be the process where numbing solution was injected into the fat to be removed. He then proceeded to numb the skin in a dozen different places on both sides of my upper butt just below my belt-line.

Next was injecting the numbing solution into the fat … and he was right. The injection of the numbing solution was painful. My body jerked involuntarily in spite of my trying to remain relaxed. I was aware that the jocular talk had tapered off as I focused on the task at hand; trying to play the Terminator without flinching..

My mother was a Registered Nurse. Early on I realized that medical personal never use the word “pain.” Instead, the euphemism “discomfort” is substituted.

I can imagine the field hospital scene at the Battle of Gettysburg. A young soldier whose leg has been shattered by gunfire, is brought into the surgical tent. The drunken butcher who is going to amputate the leg, asks 9-men to hold the patient down because there are no anesthetics. Even the whiskey has run out. As the doctor picks up the bloody saw and positions himself to hack off the offending limb, the terrified patient looks up and whimpers, “Doc, is it gonna hurt?” … and the doctor says, “Son, you’ll just have some discomfort.” …. as piercing screams fill the air … fade to black.

So there was some discomfort; uncomfortable but not unbearable as the area was numbed. Then two small vertical incisions, about ¼ inch in length, were made on each side at the top of my butt cgurney and the lipo began.

Liposuction consists of ramming a hollow tube, called a cannula, back and forth through your fat. The dislodged fat residue is then sucked out of the area. There is nothing delicate about this process of having a foreign object jammed in and out of your body. The motion is the same as that you would use when shooting pool. But unlike shooting pool, the doctor is putting his back into this effort. This “rammin’ and jammin’” was done in silence as the banter gave way to the very physical task at hand.

There is discomfort. But anesthetics do a remarkable job. The occasional pain spike caused my body to jump but Craig was responsive saying, “We won’t go there again” as he rammed and jammed in another direction. He worked a fan shaped area on both sides of my upper butt. When he was done with the left side, he immediately went to work on the right side. In a few short minutes he was done.

He then asked if I was interested in seeing the 50 ml cylinder of extracted fat cells. I was interested. It looked like a cigar size syringe full of pink Smoothie from 7/11..

After 20 minutes of which included prep, the lipo and post lipo wrapping, I was back on my feet and in the waiting room.

Kathy, the reception area nurse, told me that it would take an hour for them to centrifuge the fat cells and extract the stem cells. She recommended that I leave the office and kill an hour with a cup of coffee. She gave me a $20 Starbucks Gift Card and recommended that I drive down the hill to the Scranton Road Shopping Center on the North East corner of I 805 and Mira Mesa Boulevard. Kathy recommended that we be back in the office at 3:30. So at 2:30 PM we left, drove down the hill and got some Christmas cookies and hot chocolate at Starbucks.

The shopping center is adjacent to the infamous red “Dog Dick’ sculpture that is in front of the San Diego Tech Center building. The sculpture was erected in the mid 1980’s. It used to be easily seen from I805. Now you have to be on Scranton Road to see it. But there it is. “Dog Dick” reigns supreme in its turgid 100 feet of .fire-engine-red glory; pointing at the sky awaiting the Mother of all Bitches.

After sitting out in front of Starbucks enjoying the 70 degree weather, we drove back to the surgical center.

We arrived back in the surgical office at 3:30PM. I was met in the waiting room by the orthopedic surgeon, Dr. Pete, who was going to perform the stem cell injections. My wife again sat in the waiting room while I was ushered into the treatment room which was located across from the nurses station. After a quick introduction, Pete disappeared after turning me over to Bob for prep.

When I entered the treatment room, I noticed that there was an intravenous drip (IV drip) set up next to the treatment gurney. Bob commented that my stem cell count was about 85 million cells which was the upper end of the norm. Bob asked me to lay on my back on the gurney. The IV drip contained saline solution. Bob told me that treatment now included a systemic injection of a portion of the stem cells through an IV drip back into the patient’s body. He said that this had reduced or eliminated a variety of aches and pains in patients that had received it. This was good news. Self-medication continues to recede. “Fire when ready Gridley!”

As Bob searched for an appropriate vein in my left arm, I told him that my veins rolled. As a blood donor I’d gotten in the habit of telling the help because my rolling veins had been problematic. On more than one occasion I’d had to stop some dullard who confused vivisection with medical care, as they continuously tried to harpoon my rolling veins. Eventually I began to address all medical technicians as Doctor Moreau whenever I sat down and began to roll up my sleeve to give blood. Many times the technician would disdainfully tell me, “I’m not a Doctor.”

Duh!

But Bob was the real McCoy. His aim was true and in no time my own stem cells were coursing back into my body on the IV drip. When the injection was done, Bob removed the needle from my left arm, and put a bandage on the spot. Then the door opened and Pete came in.

While Bob prepared the sonogram transducer with KY and positioned the screen, Pete explained the injection procedure. He showed me the three vials and explained that the largest containing the stem cells would be injected first, followed by a smaller volume of growth factor and a third volume of hyaluronic acid aka “rooster comb.”

The procedure was similar to the cortisone injections that I’d previously had. With me lying on my side, the Doc selected a spot directly above my hip joint. Then an aerosol can of numbing solution was sprayed on the point of entry for the 4-inch hollow needle. The Doc drove the needle straight down into the hip joint while Bob sprayed the impact zone with the local anesthesia. Once the needle had been guided into the joint using the sonogram, the stem cells were injected with Dr. Pete looking at the sonogram display and injecting the cells into specific areas of the hip joint. On my left hip this was a slow and painful process as he moved the needle around within the joint. I could feel the stem cell solution going into my joint and the resulting pressure of having the area around the hip joint expanded by fluid. The stem cells were followed by the growth factor and then the hyaluronic acid.

The process for my right hip went much faster. Pete again drove the needle straight down into my hip joint. He then injected the entire stem cell solution quickly without having to work the needle. Next, as he injected the growth factor and hyaluronic acid, he explained that my left hip had been “dry.” Injecting the left hip had been more painful and had gone more slowly because there was little natural lubricant in the left hip joint.

My right hip, however, was full of fluid because it was more inflamed. This is consistent with what I had experienced since my last Cortisone shot 90 days ago. I went into that Cortisone shot with my left hip more painful than my right. I came out with my right hip more painful. It has subsequently remained more painful. Uh …. I mean there had been more discomfort!

The stem cell injection procedure from beginning to end took half an hour from the moment that I walked in and lay down on the gurney until I got back up and was escorted out of the room by Bob.

When I left the treatment room, Pete, Craig and Bob were all standing at the nurses station. I stopped for a moment to thank them. They asked what I did for a living. When I said that I owned a wealth management firm, they began talking about the venture-capital opportunities available in the stem cell space in San Diego.

My wife and I left the Stem Cell Center at 4:15PM with a Vicodin script. We drove straight to Ralphs Pharmacy to get it filled. Sorry Charlie, Pete had mis-dated the script 12/19 instead of 12/18 so the pharmacy wouldn’t fill the script. The pharmacist wouldn’t give the script back to us so we were stuck with having to come back after midnight to pick it up.

I just laughed. Thank you God for all my blessings!

Stem Cell Therapy: A Journey, Part 1

Stem Cell Therapy: A Journey, #1

Stem Cell Therapy is also called Regenerative Medicine. It’s a branch of molecular biology which deals with the “process of replacing, engineering or regenerating human cells to restore or establish normal function.” The objective is to engineer damaged tissues and organs by stimulating the body’s own repair mechanisms to heal previously irreparable tissues or organs.

The mechanism of regeneration is not yet fully understood. Most doctors will tell you, “We really don’t fully understand what is happening here …” But like early vaccinations, which weren’t fully understood either, the positive results are encouraging. Some of the long-term results are evident in the rarefied world of horse racing where stem cell therapy has been used for years.

Stem Cell Therapy uses three biological factors to work. 1) Your own stem cells. 2) Nutrients to encourage cell growth and 3) A molecular lattice or scaffold that the Stem Cells can attach to and grow.

Let’s look at each of these three biological factors:

1) Stem Cells or Mesenchymal Stem Cells are now also known as Multipotent Stromal Cells (MSCs). They can morph, into a variety of cell types, including bone cells, cartilage cells and muscle. Stem cells are divided into “adult” and “embryonic.” Adult stem cells are used in stem cell therapy. Embryonic stem cells are still the focus of ethical issues and are not part of this discussion. The two most common areas where stem cells are taken from your body are from bone marrow or body fat. Early stem cell therapy emphasized bone marrow over body fat as a source for bone and cartilage treatment. Most therapies have moved away from this distinction and now use body fat, also known as “Adipose-Tissue-Derived Stem Cells” or (ADSCs). ADSCs are usually taken from the back or “love handles” in a minor liposuction procedure at the beginning of your same-day treatment. Body fat one of the richest sources of stem cells. There are more than 500 times more stem cells in 1 gram of fat than in 1 gram of bone marrow. Body fat stem cells are actively being researched in clinical trials for treatment of a variety of diseases.

2) Nutrients to Encourage Cell Growth is a platelet-rich plasma (PRP). PRP contains multiple growth factors including transforming growth factor (TGF), insulin-like growth factor (IGF), fibroblast growth factor (FGF), and platelet-derived growth factor (PDGF). Data shows that PRP has a positive effect on the stimulation of bones, blood vessel and cartilage formation. Think of it as nutrient bath that encourages stem cell growth and development in the affected areas of your body. Stem Cells need to food to grow as they develop in the body. Chow Time!

3) A molecular frame, lattice or scaffold that the Stem Cells can attach to and grow. Think Chia Pet. Those seeds need to have something to hang onto while they grow. Same with Stem Cells; they’ve got to have a structure to grow on. Hyaluronic Acid (HA) is a molecule with functions found in many tissues, including cartilage. HA is currently used as the molecular scaffold system. The scoffold typically serves for at least one of the following purposes: To allow cell attachment and migration; To deliver and retain cells and biochemical factors; To enable diffusion of vital cell nutrients and expressed products; To exert certain mechanical and biological influences to modify the behaviour of the cell phase. Using injected HA-binding provides the ability to interact with your body’s local HA which should foster new 3-dimensional cell tissue production. Calcium chloride is used as a PRP-activating agent.

My Stem Cell Treatment on December 18, 2015,consisted of 3 injections, one right after the other in the same spot, during my 2-hour procedure: 1) Stem cells. 2) Platelet-rich plasma (PRP) RPR Growth Factor. 3) Hyaluronic Acid (HA) as a Scaffold.

Cognitive Biases by Mark Dow

1. We overestimate our abilities, our uniqueness, and our objectivity, even more so when under emotional strain. We have all seen the studies: 90% of people say they are above average drivers. Rarely do people think those around them work harder or better than they do. And so on…

2. We systematically understate the role of ‘random’. We crave order, and we are willing to torture the facts to get there. But sometime things just happen, and sometimes problems don’t have solutions. No fundamental cause, no guilty party, no concrete answers. Moreover, on the up side, when random does break our way it’s appropriated as skill. The investment world is shockingly bad at separating outcome and process—yes, even those who drone on and on to prospects about their processes.

3. People will find a way to believe what they are incented to believe. As the saying goes, “The most dangerous place to stand is in between someone and what they want to believe”. In my experience, it’s hard to overestimate the power of this statement. Starting with the conclusion and reverse-engineering the supporting arguments is central to the human condition and, surprisingly, serves and important role in our evolution.

4. When presented with points 1, 2, and 3, almost everyone recognizes their validity, but believes at some level that he/she is exempt. The typical reaction is “Yeah, for sure, of course that’s how [other] people act”. It is always easier to see others’ mistakes than one’s own. And this is one of the reasons we have a very hard time changing our cognitive biases. All of us.