This post is long overdue. A fair amount has happened in the last 6 months — more in terms of things I’ve tried than actual results — but I’ve got lots to report on what I’ve learned during this time, and my plan may be more solid now.

First off, I really don’t know how much of an effect the HA (hyaluronic acid) had. As with many things, the feelings are really subjective, and it’s very difficult if not impossible to say for sure one way or the other. At least the scientific evidence is there that it helps with certain pathways involved in OA. I’ve done two rounds of the Orthovisc already, and will be ordering another round soon. The recommendation is to do a treatment course of HA no more than once every 6 months, but I couldn’t find any contraindications for doing it more frequently.

The other thing I tried since my last post was human placenta extract (HPE), specifically, Placentrex made by Albert David, an Indian pharma company. Again, I don’t know if it did anything positive, but at least it was sterile! I still have several vials left, so I’ll continue using it.

My injections have been very on and off, trying a combination of things for 6–8 shots and then leaving things for up to a few months. This was mainly due to pressures and instability at work. Things have settled down somewhat, and I’m back on track with both the hip and knee shots.

One more thing I added to the mix has been GHRP-2, on recommendation from a friend. This is a ghrelin mimetic, and may help:

Attenuated Synovial Fluid Ghrelin Levels Are Linked with Cartilage Damage, Meniscus Injury, and Clinical Symptoms in Patients with Knee Anterior Cruciate Ligament Deficiency

It felt like I’d been on a steady course of decline, that I was getting more and more decrepit as time went on. In fact there was one point I can recall a few years ago that highlights an issue I’ve been having. It was while I was warming up for a ball hockey game at work, I could not stand properly upright, and had no clue why. I didn’t remember feeling that way before, and little did I know that this particular thing would become the main symptom of my hip pain over the coming years.

On October 3, I finally got a stem cell and PRP injection in my left hip — not my worse, right hip, as my doctor felt that this treatment wouldn’t be able to save it. But at least I wanted to prevent my better hip from getting worse. Fat tissue was extracted from my left buttock, and the SVF (stromal vascular fraction) stem cells were prepared from this. Following the injection, my butt was quite sore and the hip joint was stiff for several days. For the next 3 or so weeks, I was going for physical therapy (PT) sessions at the same place twice per week, and I found these just as valuable as the stem cell shot itself.

During the first PT session, I learned some of the most important things — that my pelvis wasn’t in the correct position relative to the rest of my body, and that I had weakness in certain muscles. I was given exercises consisting of foam rolling on my tensor fasciae latae (TFL) following by strengthening the hip abductors and glutes, and a couple of other ones. What I had previously thought for more than a year to be a problem deep in my hip joint turned out to be my TFL! Actually, before I thought it was a joint issue, I had thought for years that it was a tendon issue, so that part wasn’t too far off. But during this new period of enlightenment, I learned that it was a combination of problems that could have led to the OA in the first place. My left hip was too far forward, and right leg was too low, making it appear too long. This caused various other imbalances, both skeletal and muscular. Also during this time I happened to find a video on YouTube by a chiropractor, Dr John Bergman, and that validated all of this. It’s well worth spending the time to watch all of it:

Hip problems and the ignored causes

While I was going for the PT sessions, I had washed my car a couple of times, one wash taking about 3 hours. A day or two afterwards, my physical state had worsened — I had pain in my lower back, and no amount of adjusting my sitting position on the couch or in the car was making it better. Just by chance, my daughter had just started going to a chiropractor due to hurting her back at school, which turned out to be the result of a misalignment in her spine caused by an injury from several years prior. So my wife suggested that I book an appointment, and I did that immediately.

The chiropractor took an x-ray during the initial consultation and showed me what was wrong — my pelvis was totally messed up, which I kind of knew already from the PT sessions. We could see the unnatural curvature in the thoracic (middle) spine that was one of the results of this, as well as the tilt in the pelvis and sacrum. The adjustments he made in the first session alone were enough to correct much of the misalignment. It turns out that my sacrum might have been misaligned for years, and this could have caused the weakening and overexertion of my right TFL that had been declining for all this time. The next several sessions saw my alignment continue to hold position, and improve.

Here’s the “before” x-ray. We won’t have an “after” one for several months, as the chiropractor doesn’t want to take another one too soon due to the radiation exposure.

This was all fantastic and almost unbelievable — everything had come together, converged into a possible cause and long term solution. The decision to get the stem cell procedure done, the hurt back my daughter had endured and the resulting suggestion to get me to get chiropractic care, and my shear luck that the professionals I saw were just the right people I needed. What amazing luck.

This is when I knew that the book I had all but discredited in my mind — Susan Westlake’s Hip Osteoarthritis CAN be cured — is full of useful and vital information that I need. This book itself is validation of what I had gleaned from the PT and chiropractic sessions. The book, the YouTube video in the link above, everything makes perfect sense now. Attempting to regenerate cartilage in any joint without addressing everything together would not be a viable solution. Also, you may have heard that some people that have undergone THR (total hip replacement) surgery do not get much of an improvement in their symptoms. Almost certainly for some of them at least, they have not corrected the imbalances that possibly led to their OA in the first place.

Now with the proper framework is in place, I began injecting both knees and my right hip again in earnest.

But before I go into that, I want you to know that something else important happened — irentat contacted me a couple of months ago to say that he found what works in hips, and that it’s different from what works for knees and ankles. Hip OA got to him too unfortunately, but never conceding defeat, he’s been using dextrose and collagen (plus the odd other compound such as MGF and IGF-1 LR3) and is saying how these are getting his hips healed. Mind you, this is without x-ray evidence so far, but he has a lot of credibility with me so I really value his opinions. He also told me that plain testosterone suspension works to cure knee and ankle OA (but not hip). Hips are just plain harder to fix. I’ll have the test suspension in my hands 8 days from now, and can’t wait to start using that in my knees. I helped him refine his technique for sterilizing the collagen, though I’m still a little dubious on using it myself for the time being, as well as whether it can be sterilized by heat without it denaturing to gelatin. He certainly thinks that it can survive the heat for a certain amount of time. For now I’ll just stick with compounds that are already sterile, and bring collagen and other extracellular matrix (ECM) ingredients into the mix later if necessary.

Here’s a couple of studies with evidence that injecting components of the ECM might help with OA:

Effectiveness of intra-articular injections of sodium hyaluronate-chondroitin sulfate in knee osteoarthritis: a multicenter prospective study

Double-blind clinical evaluation of intra-articular glucosamine in outpatients with gonarthrosis

Also after the PT sessions and with my spine having been realigned, I re-introduced cardio sessions into my weekly routine. This had been on-and-off since March, where sometimes I would feel OK in the days following the session on the elliptical machine, and other times it felt like things were getting worse. It’s probably the latter that was occurring while my skeletal system was out of alignment, since my TFL was more sore (although I thought it was the joint, at the time) and it’s possible that my cartilage was also wearing thinner. Right now I’ve just built back up to three cardio sessions per week, and I’m feeling just fine. Perhaps I can continue this way and the cartilage won’t wear down any further, and I can say that my hip OA is “cured”! Just kidding there, I wouldn’t consider it cured unless cartilage regrowth occurs. One thing we do know, is that inactivity is bad for joints, and activity is good — we need the compressive forces to keep the cartilage in there healthy, and perhaps to help stimulate regrowth also.

When I got the stem cell with PRP injection in early October, and a follow-up PRP “booster” shot just 3 days ago, the doctor used an injection site more medial (towards the centre of the body) than what I had been using. I was determined to replicate it. That evening I performed an ultrasound (US) examination of the area on both hips to try to locate the site, and after over an hour, I had found it. Two days ago I got ready for the second in a series of injections into my right hip, this time combining 5 mL of 50% dextrose, 10 IU of hGH, some BPC-157, and about 2 mL of 0.9% sodium chloride solution (saline). This idea was from an article in the Journal of Prolotherapy:

Hip Arthritis Prolotherapy Injection Technique

I didn’t use lidocaine in the IA injection, as I fail to see why it’s necessary — it doesn’t do anything to promote regrowth as far as I know. My dextrose solution has a pH of 4-point-something and I was a little worried that the whole injection would be too acidic and cause problems (synovial fluid has a neutral pH), but fortunately I didn’t encounter any negative consequences.

Getting the dextrose solution divided and dosed appropriately was a whole problem unto itself. Here is the product I used:

https://medimart.com/product/dextrose-injection-abboject-lifeshield-pre-filled-syringe-dextrose-50/

The problem with this is that it’s meant as an IV drip. One can’t just take out a portion of it using a syringe like one can from a vial. Here’s what I figured out, after examining the instructions and thinking about it for a while:

Got some sterile empty vials (5 mL size), each one to hold 5 mL of the dextrose solution. Since the dextrose is single-use only, rather expensive, and not bacteriostatic, I would apportion the dextrose into the vials and freeze them. Emptied a few vials of bacteriostatic and sterile water, which I would inject the dextrose solution into. After emptying them, I try to create as much a vacuum in them as possible by using a syringe. The dextrose syringe had a couple of ways of getting the solution out — one with the built-in 18 G needle, and the other with a Luer lock attachment. First I tried using the needle, but it turned out that it wouldn’t extend past a certain point, and the needle wouldn’t reach the vial. So I attached a 25 G needle using the Luer lock. I was then able to inject all of the dextrose into two of the emptied water vials. Next, I withdrew 5 mL of the dextrose solution from those vials, and filled each sterile empty vial with it, then equalized the pressure in them by just sticking the needle without a plunger through the rubber stopper. The 5 mL-apportioned vials could then be frozen for use at a later point, without worrying about bacterial growth.

Now that I had the injection mixed and ready to go, the timing was pretty bad as my wife had gone on the phone and wasn’t going to get off it any time soon. I’d always wanted to try doing the entire injection alone, and this was going to be it. I always do the initial skin anesthetic shot myself, but nothing afterwards as I’m always holding the US scanner and ensuring that I can find the needle as it goes into the joint.

This time, I put in the deep anesthetic using the layer-by-layer technique that I explained to my wife. No problem there. I waited 5 minutes for it to kick in fully, then went for the spinal needle. No pain with that going in, though I had to push it in pretty hard and wasn’t expecting that. I started the needle without the US transducer in place, following the line from the points I had marked as I always do, a little away from the top and the bottom of the US probe. Then I put the probe in place, and watched the path of the needle — I had no trouble locating it. I was a little worried at one point thinking that I was looking at the femoral NVB (neurovascular bundle) and that the needle might hit the nerve, but once it got there and went through that part of the image, it was all fine. I got the target site, which was closer to the main problem area of the hip, so to get the injection done there was probably better. My wife came along to do the actual injection while I took a video of it as I often do, to make sure I can see the effusion develop as the solution is plunged in gradually. That validates the intra-articular placement.

Finally, I need to mention some evidence that dietary habits can influence the progression of OA:

Sulforaphane represses matrix-degrading proteases and protects cartilage from destruction in vitro and in vivo

One of the best sources of sulforaphane is broccoli, so make sure you eat sufficient quantities of it regularly! Brussels sprouts and cabbage (and other cruciferous vegetables) are also good sources.

Besides taking the usual supplements (glucosamine, chondroitin, fish and cod liver oil), I’ve also been consuming more of the “fermented K super foods” — kefir, kombucha, sauerKraut, and kimchi — it helps for the last one that my wife is from a Korean background. As a developed society, fermented foods are rarely consumed, and adding these to ones diet is crucial to maintaining good gut health, which leads to a host of other health benefits.

That concludes the long awaited update. Now it’s time for my foam rolling and hip and posterior chain exercises before I retire for the night.