Pictures from Dusseldorf

At the train station. 

The Rhine. 

View from the hotel.

Inside the Hotel Mercure.

A nearby park at night, the benches had big florescent bulbs in them. 

Some local art...

This is a shot of the bone marrow extraction site on my lower back a few hours after I left the hospital. As you can see there was a little bleeding where they inserted the needle, but not much. 

Half Way There

This morning I headed over to the Hospital around 9AM for some blood work. I arrived at the XCell Center which was located on the third floor of the local hospital. I was shown to the waiting room where there was plenty of seating, a toy corner for kids, and an espresso machine for patients and visitors to help themselves.

After filling out and signing some more paper work, I went down the hall to the lab for a quick blood test, then it was back to the reception room to await the results. Barring any unforeseen problems with my blood work, I would go ahead and have the bone marrow collection procedure from which the doctors would isolate and harvest as many of my stem cells as they could.

The facility itself was a little stark, but clean. The reception room had windows looking out onto the Rhine.  The receptionist was friendly and spoke a fair amount of English.

Once my tests came back, I was ready for the collection procedure. I met with the doctor who would be performing both the bone marrow collection and the angioraphy and had a chance to ask him any questions I still had. I got the sense that he was genuinely listening to my concerns and trying to give me the best and most honest answers possible.

A nurse accompanied me down stairs to the "sterile" room where my bone marrow would be extracted. I had to put covers over my shoes and hair, but that was it, no hospital gown or anything like that.

I had to lie on my side in the fetal position with my jeans pulled down just a bit in order to expose the spot on my hip where the doctor would insert the needle. I asked about a sedative, but the doctor thought that it was unnecessary.

A small side note about me: I HATE needles. It's not the pain of the needle or anything like that, I guess it's just the knowledge that there is a foreign device inserted under my skin that makes me panic. Getting a shot, having blood drawn, etc, it all makes me very anxious. In retrospect, i should have taken a sedative, but that is only because of my personally phobia of needles.

Anyhow, the doctor first injected the site with a local anesthetic. After that had a minute or two to take effect, the extraction needle was inserted. Now, I am not going to pretend like it felt good at all, because it didn't. That being said, the discomfort was completely manageable. I would say the most noticeable thing is a sensation of pressure. My best suggestion is to try as much as you can to relax, possibly try some deep breathing techniques. I feel like some of the pain was just my imagination because I was a bit worked up not knowing what to expect.

The doctor was nice and talked to me throughout the procedure, probably to help keep my mind off of things, and the nurse was there too, though she barely spoke any english. Actually, it did bother me a little bit that the nurse assigned to me couldn't really understand any of my questions. It would have been nice to be able to ask her things prior to the procedure, but it was not a big deal. I also noticed that, though nice and all, the "bedside manner" in Germany is a little brusque. I think Germans in general are just more straight forward or abrupt in their mannerisms. There does not seem to be the same kind of "hand-holding" that you might find in the states. They are all about getting down to business, not that there is really anything wrong with that.

So, the extraction only took about 15 minutes, though it can take up to 30. I was happy to be off the table and was able to walk around immediately. They put a bandage over the puncture wound and after spending about 20 minutes in the reception room having a coffee, I was free to head back to the hotel. I walked with a slight limp for the rest of the day, but pretty much felt fine and was easily able to grab a cab back to the hotel.

Tomorrow is a "rest day" as they will need that time to isolate the stem cells from the bone marrow. As long as I am feeling alright, I'm, going to take tomorrow to check out the city of Dusseldorf.

Day one seems to have been a success so far. It will be interesting to see how many stem cells they are able to get from the bone marrow they extracted. 15 minutes of discomfort doesn't seem to bad in the general scheme of things, especially when it could result in major quality-of-life improvements...

What do you think? After hearing the details of the bone marrow extraction, would you do it?

Booked!

I have booked my flights! I will be flying in and out of Amsterdam. The hotel and clinic in Dusseldorf, Germany is only about and hour and a half away by train. I will fly from the States to Amsterdam on Saturday night and arrive Sunday morning. I'm planning to spend most of the day in Amsterdam and hop the train to Dusseldorf in the evening, getting into the hotel around 9pm.
I am planning to take the train back to Amsterdam after recovering from the procedure the following weekend to see some friends who live there and spend a few days checking out the city. I figured since I am making the trip all the way over, I mind as well squeeze in a little fun...

Pre-treatment Instructions/Information

Dear David,

Please see attached copies of the Pre-treatment instructions you will be asked to read and sign at the clinic.

These copies are “FYI” only -  just to give you a better idea of what will happen during the procedure.

There is no need to return these documents to me. 

Kind Regards,

T

Patient Relations Consultant

XCell-Center GmbH

Custodisstrasse 3-17

50679 Cologne, Germany

Tel:  1-951-894-1094
Fax: 1-951-848-9829 

Treatment Contract

Treatment contract:

XCell-Center GmbH Custodisstraße 3 - 17, 50679 Cologne, Germany (hereinafter referred to as “XCell-Center”), 

and _________________________________________________________ (hereinafter referred to as the “Patient”) 

have concluded the following treatment contract: 

1.  

a)Subject of contract 

Within the scope of the contract, XCell-Center will provide the Patient with the following form of treat- 

ment with adult stem cells: 

Lumbar puncture 

Angiography 

Surgery 

Direct Injection 

IV 

b)The medical examination as well as the harvesting and re-implantation of the stem cells are performed by 

medical specialists in a harvesting facility approved by the responsible regulatory authority pursuant to 

Art. 2 No. 11 of the German Ordinance on Good Manufacturing Practices in the Production of Medicinal 

Products and Active Substances and the Application of Good Manufacturing Practice in the Manufacturing 

of Products of Human Origin. 

c)The harvested stem cells are processed in a tissue facility approved by one of the responsible authorities 

pursuant to Art. 2 No. 10. 

d)Both facilities work in compliance with the principles of good Manufacturing practice in the sense of Art. 

3 Para. 1 of the AMWHV. 

2. Remuneration 

a)remuneration for stem cell treatment totals 

EUR 7,545.00 for lumbar puncture. 

EUR 8,925.00 for angiography. 

EUR ________ for ________________ 

b)Remuneration is due for payment upon formation of this treatment contract. 

c)The remuneration is to be paid in full even if the treatment does not take place for reasons in the Patient’s 

sphere of influence. 

3. Clarification 

a)The Patient confirms that, before signing this contract, he/she received comprehensive information from 

XCell-Center through a doctor regarding the course, prospective duration, scope and possible risks and 

side effects of treatment with adult stem cells. 

b)The Patient confirms that, before signing this contract, he/she was informed that successful outcome of the 

treatment cannot be guaranteed. 

c) The Patient confirms that he/she was informed that the above-mentioned therapy is not yet recognized as 

a general treatment method pursuant to Art. 135 SGB V (German Social Code V) by the German Federal 

Joint Committee (G-BA) and that the costs for the treatment will therefore not be reimbursed by the statu- 

tory health insurance funds or private health insurance companies. 

4. Guarantee, liability

a) XCell-Center guarantees proper and professional treatment with adult stem cells from the Patient. 

b) XCell-Center does not guarantee the success of treatment. 

c) Treatment can be expected to take 3 until seven calendar days. The Patient has been informed that this 

figure is merely a non-binding estimate and that the duration of treatment may vary from this estimate 

depending on the conditions in individual cases. XCell-Center assumes no liability for exceeding the treat- 

ment duration if delays in treatment occur for reasons outside of Xcell-Center’s realm of influence. 

5. Other contractual provisions 

a) There are no collateral verbal agreements to this contract. Modifications and additions to this contract 

must be in written form in order to be valid; this is likewise applicable to the rescission of the agreement 

on written form itself. 

b) The place of performance is Cologne / Düsseldorf. 

c) If the Patient’s location of residence is not in the Federal Republic of Germany, the place of jurisdiction for 

disputes arising from this contract is also Cologne. 

d) German law shall apply with the exception of international civil law (Art. 3 to 46 of the German Introduc- 

tory Law to the Civil Code - EGBGB) and UN Sales Law. 

e) Should individual provisions of this contract be legally invalid or become so as a result of changes in legisla- 

tion or alterations in court decisions, this shall not affect the validity of the rest of the contract. The invalid 

provision shall be replaced with a valid provision which fulfills the intentions of the parties upon conclu- 

sion of contract as closely as possible.

Bone Marrow Collection Info

Bone Marrow Collection Info:

Dear patient, 

Through the information presented on this page and a supporting visit with a physician we are informing you 

about the bone marrow collection, its significance and possible complications. 

Extraction method:

A small amount of adult autologous bone marrow stem cells are extracted from the patient’s bone marrow. 

Generally the pelvic bone is punctured for this. This is performed under local anesthesia. Upon request you can 

be given a sedative (injection) prior to the procedure. With a needle a small amount of bone marrow is taken 

from the pelvic bone. In order to prevent infections the procedure takes place under sterile conditions. The 

local anesthetic can hardly be felt. The extraction of the bone marrow with the needle often causes brief pain. 

Generally a longer persisting pain does not occur. 

Possible complications:

Even with very carefully performed procedures there are always certain risks involved. The occurrence of any 

of a number of small unfortunate incidents can lead to severe consequences. The risk of infection is very low. 

Damage to the surrounding organs as a result of the puncture is extremely rare. Secondary bleeding is 

possible, but is usually controlled by applying pressure at the site of the puncture. 

The surgery is a minimally invasive procedure making use of high-tech equipment in the operating room. 

Rules of conduct after the procedure:

In case of normal bleeding the site of the puncture is usually covered with a bandage. Follow-up is only 

needed when there is bleeding from the puncture channel or in case of problems. Normal activities can be 

resumed after the extraction. If you received a sedative before the procedure you should not drive or operate 

machinery for the remainder of that day because your ability to react could be impaired. 

Please ask questions if there is something you did not understand or if you would like to know more about 

the procedure or the possible complications. We will gladly answer all questions during the informational 

visit. 

Angiography Information

Angiography Information:

1. General information 

Dear patient, 

It is important that prior to the treatment you are well informed. Therefore please take your time reading the 

following information. If something is not clear, or if you would like to know more details about the proce- 

dure, possible complications and risks, specifics for your individual case or any other issues, please do not hesi- 

tate to ask. We will gladly answer all your questions! 

You do not have to fast – you can eat a regular breakfast. But do not eat for at least 3 hours before the sche- 

duled procedure. Exception: Patients with allergies have to stop eating the evening before. Drinking water is 

allowed and recommended. 

You can and should take your regular medications – if needed bring the necessary medicines for your stay. 

Exception: Blood thinners or anti-coagulation medicines! 

If you are taking Metformin (Glucofage®, Siofor®, Metformin IR etc.) you must discontinue it three days 

before the angiography takes place. Please ask your general practitioner or diabetologist what other medica- 

tion you can take for that period. Three days after the angiography it is safe to start taking Metformin again. 

If Metformin is not stopped, we cannot perform the angiography. 

For the observation time following the procedure you can bring something to read. For your convenience 

there will be a television in your room. We have our own cafeteria for family members accompanying you and 

a variety of drinks will be provided. 

2. Information about the angiography 

Based on your previous examinations/medical evaluation it is necessary to perform the stem cell transplant via 

an angiography in order to place the stem cells accurately in the target organ. 

An angiography is an X-ray examination to visualize blood vessels by injecting contrast dye. 

The entire procedure lasts about 30 to 60 minutes. Normally the procedure is not painful and is done under 

local anesthesia. If you want to we can give you a sedative prior to the procedure. 

3. Course of the procedure: 

1. You will lie down on the examination table in the angiography room. 

2. After the skin is disinfected and covered with a sterile cloth a local anesthetic will be given either in the 

groin or the inside of the elbow by means of an injection of about 10 ml lidocain 1 % (Xyloneural). Subse- 

quently a puncture of an artery of the leg or arm is performed and a sheath will be put in place. Then a 

thin catheter is introduced via the sheath. The diameter of the catheter is about 1.2 to 1.8 mm (4-6F). The 

catheter is advanced into the main artery on the basis of an X-ray image and then guided into the intended vessel; normally this takes only a few minutes. For placing stem cells e.g. in the pancreas the leg artery is 

commonly punctured. 

3. Next a contrast material is injected via the catheter in order to show the individual blood vessels and to 

visualize the distribution. For a short time the contrast material causes a feeling of heat/warmth through- 

out the body, with the femoral access this is mainly in the lower part of the body and can sometimes 

involve a feeling like the start of a cramp in the calf. This feeling of heat/warmth lasts less than 10 seconds 

and is completely harmless. During the procedure you may be asked to briefly hold your breath. 

4. Additionally it may sometimes be necessary – in order to assess the image of the vessels on the screen 

better – to administer a medication that temporarily blocks the movement of your intestines during the 

procedure. This medicine briefly causes a dry, bitter taste in the mouth and possibly also dizziness for a 

short time. This medicine must not be administered to a patient with increased intraocular pressure 

(glaucoma/ cataract). So please let us know if you suffer from glaucoma. 

5. After confirming by angiography that the catheter has reached the target area the stem cells will be 

injected. After the application the catheter and sheath will be removed. 

6. After the removal of the devices from the groin a special closure tool (AngioSeal®) will be put in place. 

This allows you to stand up immediately and move, albeit very carefully. Following another four hours rest 

you can be discharged. After the removal of the devices from the arm the site of the injection must be com- 

pressed manually until the bleeding has stopped (normally after 10 minutes), after which a pressure ban- 

dage is applied; otherwise due to the puncture of an artery and to the pressure of the blood, the puncture 

would not close. Therefore the pressure bandage has to stay in place for 4 – 6 hours and you will need strict 

bed rest during that time so no bleeding occurs or a hematoma (accumulation of blood in the tissue) is 

formed in the area of the injection. 

7. A written report (protocol) is prepared of the procedure. 

8. After the period of rest and bedside monitoring at the clinic, and provided that there were no complica- 

tions, you can be transported by car or taxi to your home or hotel. 

Possible side effects and complications: 

1. Allergies for iodine containing contrast medium are rare and in most cases can be treated with medicines 

immediately. However, in very rare cases major allergic reactions may occur with an acute reduction of the 

blood pressure and respiratory and cardiac arrest. 

As a rule this concerns patients who experienced severe allergic reactions previously. If you suffer from 

allergies you must inform us. For details see below. 

2. Sometimes circulatory hypersensitivity reactions occur. These can usually be relieved quickly by using 

medicines to increase the blood pressure. 

3. At the site of the injection bruising or vessel wall injury can occur. Major bleeding can result in consider- 

able blood loss; it may then be necessary to operate immediately to remove the hematoma and to suture 

the blood vessel at the site of the injection. 

4. Iodine contrast medium may rarely lead to a deterioration of renal function, or even to a renal failure. 

Therefore we might give you a special medication - saline in combination with ACC (Acetylcysteine) - to 

protect your renal function if your renal-parameters are slightly elevated (Creatinine and BUN). If there is 

already a severe renal insufficiency we most likely will not be able to perform an angiography. In most 

cases these complications can usually be treated successfully.