“we don't see things as they are, we see things as we are.” Evidence-based medicine and the doctrines of standard empiricism offer a structure for analyzing medical decision making but are not sufficient to describe the more tacit processes of expert clinical judgment
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Exosomes 5: Clinical Medicine is Bittersweet

General Disclaimer: This blog is for informational purposes only. It is not an advertisement for exosomes. Use of exosomes has not been FDA-approved for prevention nor treatment of any disease condition.  Anecdotes provided do not constitute scientific proof and all patients were treated in the context of a fully informed consent and patient-physician relationship.


Exosomes 5: Clinical Medicine is Bittersweet

It has been a month since I blogged to this private email list. That is because I have been thinking deeply about the practice of medicine and its ethics. I had two patients come back after improvements yet their benefits were not as dramatic after the second injections.

Yesterday, I was fortunate to attend a full day of presentations from the founder of Kimera Labs as well as Dr.’s Spiel and Sanders, the physicians pioneering exosomes use. To a roomful of 100 clinicians and administrators, they described amazing anecdotes and shared their knowledge and treatment protocols. I was left with several broad conclusions: exosomes are very bioactive and usually beneficial. There is wide variation in clinical practices. Every patient reacts differently and most conditions require multiple treatments. To remind you, I started on this journey because I heard Dr. Sheldon Jordan describe his recovery after a horrific motorcycle accident last December and his reported success in treating neurological disorders made me hopeful. To validate, I and my mother experimented on ourselves and the results were impressive. I opened my practice up to patients two months ago and all seem to have benefitted.

So what is the problem? For the last month, I have been wondering if exosome treatment was like changing a tire or more like cleaning a dirty counter with a sponge. If I pay you to change my tire and I still have leaks, I am mad. But if I clean a dirty counter with one stroke of a wet sponge, I don’t expect the entire counter to be clean, right?

I had a 48-yo patient who experienced 60% improvement in his shoulder after receiving exosomes. As an airline pilot, he was again able to help lift luggage into the overhead compartments. Two weeks ago, he returned for another treatment but reports little to no improvement from the second injection. Do we have to wait, did he receive most of the potential benefit already, or is there another explanation? A second patient had IV and intranasal exosomes and his shoulder also improved along with his libido. But after the second injection he remains about the same and is likely to go through with his shoulder replacement surgery.

On the positive side, some things improve enough to not warrant a second treatment as in the case of our runners getting back on their treadmills in blog 4 below. On the other hand, I can attest that the symptoms I have felt from my three IV and three intranasal treatments have all been different. That doesn’t mean the exosomes didn’t work. It just means that I was in a different condition each time. As the Greek Heraclitis said, “you can’t step into the same river twice.” The first IV injection was followed by bronchitis, and that hasn’t recurred. The second cleared up my eczema flare. The third only gave me increased formed bowel movements (which is a very strange and slightly gross symptom, I know). 

The first intranasal injection gave me voluntary ASMR powers and changed in sleep cycles that persist. The second intranasal injection, I experienced the thirst and polyuria on day two, not day one. As I listened to the way Spiel and Sanders manage patient expectations, I didn’t hear them promising to cure patients in one treatment but instead recommended follow up treatments from every two weeks for skin and hair restoration, to monthly for anti-aging, to every three to six months for chronic degenerative neurological conditions. Apparently, most clinicians and patients understand that unlike changing tires, reversing more established chronic and complex diseases takes multiple attempts. I feel that for many musculoskeletal problems, autoimmune conditions, and perhaps even hypothalamic-pituitary age-related dysfunction, exosomes are a potentially powerful tool. I want to share one strange phenomenon that explains just how confirmation bias, knowledge deficits, and curiosity conspire to make clinical medicine fascinating.

One of my patients is a 65-yo woman who received hip, back, groin, and IV injections of exosomes two weeks ago. She mentioned that she can’t stand the taste of coffee anymore and drinks tea now. As with the many podcasts I did on clinical experiences of telomerase activators, I just filed it away in my memory banks until someone else shared the same results. Yesterday, I was speaking with one of the main people at Kimera Labs who has taken multiple doses intranasal and she also reported the same phenomenon. At the cocktail reception, I spoke with a clinic administrator from a facility that administers over 100 vials monthly and she told me she had heard this coffee aversion side effect multiple times. I submit that this odd reaction was on no one’s radar, would require a lot more knowledge that I have to explain, yet represents an important aspect of clinical medicine. There is something in the brain that determines taste and that was likely altered and is was NOT conditioned because people were not trying to quit coffee and no untoward associations were administered to trigger the aversion.

I will close with a bittersweet case of an 85-yo woman with severe Alzheimer’s who received IV and intranasal therapy five weeks ago. Before treatment, she was unable to repeat three words back to me in real time and had severe neck kyphosis. Immediately after treatment, she began to repeat words from the TV and interact with her family in small ways like saying goodnight. After a month, her neck kyphosis improved significantly. Now should I feel good or bad about this? I would have loved to cure her Alzheimer’s in one try. She improved a little but would probably benefit from repeat treatment. On the one hand, there is nothing else to help her so relatively speaking, it was a blessing. On the other hand multiple treatments would be expensive and the potential maximum benefit is unknowable. This is the ethical dilemma of clinical medicine in this space.

 

It has been said that “we don’t see things as they are, we see things as we are.” Evidence-based medicine and the doctrines of standard empiricism offer a structure for analyzing medical decision making but are not sufficient to describe the more tacit processes of expert clinical judgment. All data, regardless of their completeness or accuracy, are interpreted by the clinician to make sense of them and apply them to clinical practice. Experts take into account messy details, such as context, cost, convenience, and the values of the patient. “Doctor factors” such as emotions, bias, prejudice, risk-aversion, tolerance of uncertainty, and personal knowledge of the patient also influence clinical judgment. The practice of clinical medicine with its daily judgments is both science and art. It is impossible to make explicit all aspects of professional competence. Evidence-based decision models may be powerful, but they are like computer-generated symphonies in the style of Mozart—correct but lifeless. The art of caring for patients, then, should flourish not merely in the theoretic or abstract gray zones where scientific evidence is incomplete or conflicting but also in the recognition that what is black and white in the abstract often becomes gray in practice, as clinicians seek to meet their patients’ needs. In the practice of clinical medicine, the art is not merely part of the “medical humanities” but is integral to medicine as an applied science. 

(SaundersJ. “The Practice of Clinical Medicine as an art and as a Science”. West Med J 2001 Feb; 174(2): 137–141)


POSTSCRIPT: As I was getting ready to post this, I just received an email from my patient with the new coffee aversions. She writes: 

 1. My hips are feeling better(the right much more than the left) but noticeably improved.
 2. I think it is possible that I got a tiny bit smarter too, not absolutely certain about that.
 3. I still have no interest in coffee
 4. No more stomach cramps or intestinal distress 
 5.My back seems to be ok as long as I don’t try to lift anything.

Feel free to bookmark the following link to have all my exosomes videos at your fingertips!

www.tinyurl.com/exosomesvideos


Archived exosome blogs….Please read them all. 

N.B. On 2/29/2020 I changed my philosophy about keeping these blogs private. The archives up to blog 32 were appended to blogs that had yet to be created when the earlier ones were first written.

https://www.rechargebiomedical.com/exosomes-1-the-journey-begins/

I still have voluntary ASMR. Mom’s arthritis is greatly improved. 

https://www.rechargebiomedical.com/exosomes-2-not-inert/

I explain why I believe exosomes aren’t inert. An amazing case of an overnight in heart rate variability is presented.

https://www.rechargebiomedical.com/exosomes-3-a-case-of-brain-and-neck-trauma/

A case of whiplash and traumatic brain injury improved after exosome use.

https://www.rechargebiomedical.com/exosomes-4-back-on-the-treadmill-again/

After exosome injection, two runners were able to return to running after limitations from tendinosis that plagued them for months (in the case of the 60-yo man, and years (in the case of the 53-yo woman)

https://www.rechargebiomedical.com/exosomes-5-clinical-medicine-is-bittersweet/

In this blog, I discussed how complicated clinical medicine can be. Different treatment protocols, ambiguous results ethical dilemmas and strange phenomena like acquired coffee aversion are part of what make treating with exosomes so challenging.  

https://www.rechargebiomedical.com/exosomes-blog-6-healing-takes-time/

Using my left foot as an example, I attempt to explain that while some exosome effects are immediate, others take time. Remodeling of damaged tissues is a complicated process. My foot is still scarred and probably will be for life.

https://www.rechargebiomedical.com/exosomes-blog-7-nerve-pain-gone/

A patient after dental exosome injection becomes pain free after 4 years of suffering.

http://www.rechargebiomedical.com/exosomes-blog-8-disinformation-or-bad-science/

I explain why lab testing of freshly thawed exosomes is SUPPOSED to come back as normal saline.

https://www.rechargebiomedical.com/exosomes-blog-9-watch-all-my-exosome-videos/

A nine-part comprehensive explanation of exosomes.

https://www.rechargebiomedical.com/interviews-with-exosome-experts-posted/

I interviewed the principal scientists of Kimera Labs and other experienced clinicians using exosomes

https://www.rechargebiomedical.com/exosomes-blog-11-deb-bs-knees-are-improving

66-yo Deb B went from not being able to do one squat to 100 per day after exosome injection.

https://www.rechargebiomedical.com/80-yo-doug-ran-121-miles-in-6-days/

80-yo Doug describes in his video how much his knees have improved since getting exosome injections. He is reaching new athletic peaks with no signs of stopping.

https://www.rechargebiomedical.com/exosome-blog-13-microneedling-my-mom-with-exosomes/

My 82-yo mom underwent microneedling with exosomes with fantastic results. Most impressive was the absence of “downtime” from redness or bruising.

https://www.rechargebiomedical.com/exosome-blog-14-the-shoulder/

54-yo weightlifter with chronic pain from a rotator cuff tear shows remarkable improvement in just four days! He re-injured it at the gym so had to undergo a repeat shoulder injection

https://www.rechargebiomedical.com/exosomes-blog-15-face-blindness/

48-yo woman with severe face blindness experiences some improvement after nasal injections of exosomes. Her ability to remember new faces has improved permanently

https://www.rechargebiomedical.com/exosomes-blog-16-lecture-in-hawaii/

I delivered two lectures in Hawaii. The first was about exosomes generally and the second is a password-protected video about clinical applications. 

https://www.rechargebiomedical.com/exosomes-blog-17-reading-is-fundamental

Three cases of middle-aged women reporting enhanced enjoyment and renewed capacity to read after nasal exosome therapy

https://www.rechargebiomedical.com/exosomes-blog-18-dental-health-improved

Two cases of improved dental health presented. We discuss the hazards of EMF and the promising future of dental regenerative therapy

https://www.rechargebiomedical.com/exosomes-19-chakra-balancing-with-exosomes/

We discuss the notion of energy centers known as chakras and the fact that we are electrical beings

https://www.rechargebiomedical.com/exosomes-blog-20-seborrheoic-dermatitis/

A case of improvement in Seborrheoic Dermatitis after microneedling with MSC exosomes is presented.

https://www.rechargebiomedical.com/exosomes-blog-21-bias-is-unavoidable/

I explain how poor we are at assessing change and how attribution and recall bias play important roles

https://www.rechargebiomedical.com/exosomes-22-badpress/

In the past year, there has been a lot of shifting loyalties in the exosome space resulting in a lot of rumor, innuendo, and bad press. With various parties trying to get each other in trouble with federal regulators, it is a treacherous business to be in.

https://www.rechargebiomedical.com/exosomes-blog-23-stasis-dermatitis

I describe a case of an 86-yo woman whose chronic leg rash disappeared after improvement in her leg circulation

https://www.rechargebiomedical.com/exosomes-blog-24-how-long-do-exosomes-last

I use a car wash analogy to answer the question “how long do exosomes last?” The answer is it depends on how dirty and damaged the car is, how well you clean it, and how dirty you get it after washing.

https://www.rechargebiomedical.com/exosomes-blog-25-knee-treatments/

I describe four cases of improvement of osteoartritic knees from my trip to Hawaii.

https://www.rechargebiomedical.com/exosomes-blog-26-the-placebo-effect/

I explain the three definitions of placebo and why I believe most of the effects of exosomes cannot be attributed to the so-called placebo effect.

https://www.rechargebiomedical.com/exosomes-27-soft-signs-of-exosome-actions/

Some remarkable “soft signs” of exosome effects include itching (new nerves), twitching (new muscles), and heaviness (a healing FORCE).

https://www.rechargebiomedical.com/exosomes-28-varicose-veins/

Three amigos came to see me and all enjoyed benefits. The best was the 48-yo gentleman who had a dramatic improvements to his irritable bowel syndrome, varicose veins, and appearance.

https://www.rechargebiomedical.com/exosomes-29-are-exosomes-smart/

I address the common observation from patients that exosomes seem “smart” or that they know where to go. In fact, I doubt this is true and that they are no smarter than player piano scrolls are good musicians.

https://www.rechargebiomedical.com/exosomes-30-real-exosomes-patients/

I gave a lecture at the University of Hawaii with about 80 attendees. Around 10 of them were actual patients. Hear in their own words how exosomes helped them.

https://www.rechargebiomedical.com/exosomes-blog-31-leg-swelling/

I describe two cases of improved leg swelling and explain what causes this common condition and how exosomes may be improving it.

https://www.rechargebiomedical.com/exosomes-32-nerve-regeneration

We present an amazing case of overnight nerve regeneration after ultrasound-targeted exosome injections.

 

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