I love the peer reviewed papers that document the science behind iPPS...the real workings under the hood.
But equally I love the front line evidence. The patients whose life was full of pain and loss of function, they try out this compound of ours and all of a sudden the sun shines after years of gloom in the vast majority of cases.
Tonight a true special....an interview with a patient, no not some random somebody plucked off the internet...not some unbeknown individual. A friend of a friend who I have personally met on a couple of prior occasions and now classify as a friend of mine. Its quite a story. The story is enhanced by the sheer detail we have managed to record. I haven't ever had the fortune to hear and ask so many questions to formulate the basis of this detailed account. It was indeed very exciting to hear it all.
Do now enjoy this special Mozz post complete with a couple of bonuses.
Let's go!
BACKGROUND
I have a friend, lets call him M1...in fact I have referred to M1 in the past here at HC. M1 has a friend, lets call him Mr S. The interview is with Mr S. Mr S. played a lot of sport when he was younger, in fact he played volley ball almost at a professional level. As you know Volley Ball involves a lot of jumping...its full impact on the load bearing joints, think knees.
Volleyball - full impact forces, joint loading, can be a tough one!
One paper put it this way: (My emphasis added)
"Thirty-one studies have been included in the analysis. From the results emerged that running, swimming, ballet and handball were not correlated with detrimental structural or molecular cartilage adaptation; instead, soccer, volleyball, basketball, weightlifting, climbing, and rowing showed signs of cartilage alteration and molecular adaptation that could be early predictive degeneration's signs. From the included studies it came to light that the regions more interested in morphological cartilage changes were the knee in athletes from different disciplines. In conclusion, different sports induce different cartilage modifications both at a molecular and structural level". 1
This guy, Mr S, also had a job where he would often have to do an engineering role and would often be kneeling. Mr S is approx 65 years of age. All of a sudden, quite out of the blue last year his knees started playing up and a dull pain began.
There was no warning. After all the years. No small pre-niggling pain...no slight loss of function....no warning.
"Diagnosis is dependent on symptoms that can occur within a year or show up 10 to 20 years late. Regardless of the time span, it’s believed that osteoarthritis develops at the moment of initial trauma to the joint, with changes in cartilage and joint structure that occur immediately". 2
There was no waxing and waning...it just started and it was there. Like many people, Mr S. thought the pain may go away after some time...but it lingered. At a later point he was on a ladder and twisted the wrong way and jarred his right knee.
That was it, such an acute pain developed in the right knee that it was like the left knee didn't hurt as much, the sharp new pain took over, the left knee still hurt the same but it was now relative to the right.
Again S. thought that this new sharp and elevated pain in the right knee may subside after a few days...nope. It was not subsiding.
It was time to see a Doc.
His GP prescribed Panadol Osteo....the Doc actually said take plenty of it for the first week...follow the course but don't miss it...
A solution to OA pain?
So I asked S, did the full course of Panadol Osteo alleviate the pain to a material degree?
His answer was a bit of a surprise to me...
S. commented... "Nope".
I was a bit taken back....really? That much Panadol and it didn't make a difference?!
Mr S. said it may have made a minuscule psychological difference but that was barely noticeable.
Pathetic!
This surprised me and it actually disappointed me even though it could be perversely thought of some sort of competition to us (yeah right!).
I guess the disappointing part was that this poor fellow and so many others get little to no relief...if I was in that much pain I would think something like this would help at least alleviate SOME of that awful pain constant pain? It's no doubt why some patients are forced to go to stronger forms such as corticosteroids and worse still, opioids.
Paradigmers...who here that's reading this remembers the old announcements we have had...take this one for example (see below).3 What that above (Table 4) is telling us is that DESPITE PATIENTS GETTING A DAILY DOSE OF THE NASTY OPIOIDS EVERY DAY UP UNTIL WEEK 12...and iPPS fully HALTING dosing back at Week 6....we still trump them (200mg dose)...6 full weeks after the patient has stopped taking iPPS - We do this safely. We have amazing durability...opioids DO NOT slow the course of OA.
Ok back to the story.
S. eventually knew that things weren't improving...the jarred knee was a much more sharper pain, it wasn't subsiding after a few days...indeed it was time to escalate...
THE ESCALATION
Mr S. was already a PAR holder. But S was also dreadfully aware of the next step if he couldn't be admitted on to a trial or some sort of program.
Mr S. knew surgery could be looming. But Mr S also knew that once you have surgery, many patients aren't the same, there are real chances of revision surgery being eventually required. There are some 20% of Post op patients that are still in pain (see Appendix A).
Mr S was well aware of the situation. So he reached out to his Par registered state clinic and luckily, after a few back and forth sessions and a heap of paper work...he was through!
The bad news was that it was a fair bit of travel, a couple of modes of transport and a half kilometre up the hill walk on the way home, each way took a fairly arduous 2.5 hours, that's a good part of one's day in terms of time and effort, specially when you are in pain. This hill hurdle just after the clinic on the way home ended up being a bit of a proving ground.
Lets now take a more detailed look of Mr S's experience.
THE DIARY
Keep a running record - a Big Thanks to you Mr S. Because of this work you did you could more easily recount your full experience. We are all beneficiaries from this effort.
Ok let's do this as a diary snapshot BEFORE and AFTER the course of iPPS.
Mr S has Blood Pressure that was borderline escalatable.... 140/90 Mr S couldn't sleep a full night...we all toss and turn at night...every time he moved, PAIN..and it would duly wake him up Mr S also had to go to pass urine twice a night, a major interruption and effort and of course painful to walk. At this stage there was constant pain. The knee was sore every time he stood up. Every time he would stand up he would actually let out a wincing sound due to the pain. Mr S also stated that he could manage to get around but certainly by 5pm each day he was done, he had to rest, he had to have his leg lifted to attempt to alleviate some of the pain and load.
So let's break this up a touch
Injection 1 - Bloods taken, BP checked; borderline reportable (high).
Injection 2 - Bloods again taken, Blood Pressure still a bit high. Just after the injection he seemed to get some temporary pain relief but then the pain returns again. Mr S. did some manual labour work until 5pm on a typical day, his knee was very sore after 5pm. Pain still affects his sleep during natural tossing and turning at night. (Mozz note: Pain at night was the single best reading in our SAS program).
Paradigm achieved the best results in the "Pain at night category" in our SAS program. The data came in with a very tight range AND no error band overlaps.3
Injection 3 - Bloods again taken, Blood Pressure still a bit high, may need to escalate if this continues. Pain reduction for about an hour after the injection. Knee pain seems to be reducing over all though, no more wincing from that sharp pain while standing from seated position for instance. Some mild benefits being observed here!!
Dull pain still present when he stands up though. Other noticeable difference here is the profile at night, sleeping without too much pain during the natural tossing and turning in bed. This is a good observation quite early in the program.
INCIDENT
While working in the garden after injection 3, Mr S knocked his left knee against a mid sized branch....he was a bit disappointed and wondered if that would cause his treatment to go slightly backwards!! The next day after this incident his knee was a bit sorer.
Injection 4 - On the way back after the injection there is less pain while walking up the hill on the way home...nice observable to receive.
Injection 5 . Bloods all look good. Knee is now definitely improving. Pain reduced when standing. Not waking up at night. Did a bike ride the next day, Less knee pain, feeling good, knee does tend to 'crack' a little. Still some pain while standing.
Injection 6 - Knee still a bit sore next day after injection 6. Certainly the pain is better than before the treatment though. Pain is always most apparent straight after getting up in the morning but as you start moving and the day progresses it gets better. Pain now is about an average of 6 out of 10. Incidentally, while bike riding there is now almost no pain.
That concludes Part 1...
In Part 2 we will continue with Mr S's diary entries and observations. We'll also uncover the not one, but two Mozz Bonuses and we will explore a bit more about an entirely new indication that we may address one day....exciting? You be the judge of that.
ou guys know I'm heavily into the science...
(20min delay)
