In my searching for the right type of piezoelectric material to be added to the LSJL device, something else I found from the Wikipedia article on piezoelectric material was that piezoelectric materials have been used in surgery.

From the Wikipedia article…

Surgery

A recent application of piezoelectric ultrasound sources is piezoelectric surgery, also known as piezosurgery.^[34] Piezosurgery is a minimally invasive technique that aims to cut a target tissue with little damage to neighboring tissues. For example, Hoigne et al.^[35] reported its use in hand surgery for the cutting of bone, using frequencies in the range 25–29 kHz, causing microvibrations of 60–210 μm. It has the ability to cut mineralized tissue without cutting neurovascular tissue and other soft tissue, thereby maintaining a blood-free operating area, better visibility and greater precision.^[36]

Me: What this seems to suggest is that piezosurgery has been shown to be able to make very precise, small distractions in bones without effecting the muscles or blood vessels around it. At this point the idea is only a thought. However let’s see what other things we can find from google and PubMed…

From the Wikipedia article on Piezosurgery…

Piezoelectric surgery, or piezosurgery in short – is a process that utilizes piezoelectric vibrations in the application of cutting bone tissue. The process was developed by Tomaso Vercellotti ^[1] and has been patented.^[1] It is indicated for use in oral, maxillofacial, cranial and spinal procedures.

By adjusting the ultrasonic frequency of the device, it is possible to cut hard tissue while leaving soft tissue untouched by the process. The ultrasonic frequency is modulated from 10, 30, and 60 cycles/s (Hz) to 29 kHz. The low frequency enables cutting of mineralized structures, not soft tissue. Power can be adjusted from 2.8 to 16 W, with preset power settings for various types of bone density. The tip vibrates within a range of 60–200 µm, which allows clean cutting with precise incisions. A recent article on the topic of piezoelectricity has named Piezoelectric surgery as one of the most important applications of this concept, in addition to the trivial medical ultrasound imaging. ^[2]

Me: What we are seeing is what I speculated was possible after I did the research on the extracorporeal shock wave therapy. We saw that LIPUS (low intensity pulsed ultrasound) could lead to fracture healing, and that the ESWT has a potential to be better since the frequency was higher. This was what made me wonder what would happen to bone if we just increased further either the intensity (magnitude) or frequency in say sound waves or any type of device that can release vibrations at a high level. It seems that Piezosurgery is exactly what happens. The extremely high frequency of the surgery application causes bone material to easily break apart upon contact. The cuts made are very precise.

From one of the cited articles (source)….

Abstract

One of the most useful books I’ve ever had the pleasure of reading was the “The Lean Startup “, by Eric Reiss. In the book, the main idea that Reiss expresses is that success of most startups depend on how well and how fast they can “pivot” in their evolution. Reiss’s book has been one of those business books that has come out in the last decade which has really changed the way many businesses and owners think about how the startup should work.

From the Wikipedia article on “The Lean Startup“…

• The Lean Startup relies on validated learning, scientific experimentation, and iterative product releases to shorten product development cycles, measure progress, and gain valuable customer feedback.^[1][2][4] In this way, companies, especially startups, can design their products or services to meet the demands of their customer base without requiring large amounts of initial funding or expensive product launches

• The lean startup philosophy is based on lean manufacturing, the streamlined production philosophy developed in the 1980s by Japanese auto manufacturers.^[13] The lean manufacturing system considers as waste the expenditure of resources for any goal other than the creation of value for the end customer, and thus a target for elimination

• Ries’ lean startup philosophy seeks to eliminate wasteful practices and increase value producing practices during the product development phase so that startups can have better chances of success without requiring large amounts of outside funding, elaborate business plans, or the perfect product.

• Continuous deployment is a process “whereby all code that is written for an application is immediately deployed into production,” which results in a reduction of cycle times

• A pivot is a “structured course correction designed to test a new fundamental hypothesis about the product, strategy, and engine of growth.

These are the basic ideas behind the philosophy. When I read the book, the main thing I took away from the work was this.

1. Focus on getting the product (article or post) out to the readers public as fast as possible and reduce the amount of time in trying to make them perfect. 

1. Get feedback from the readers on how they like the material I produce and adapt the material from their behavior and feedback. 

1. Move as quickly as possible, by changing the business operations, making the neccesary mistakes, correct them quickly, and then moving forward through continuous changes which allow the business or project to morph/ evolve as time moves forward. (ie “PIVOT”)

I’ve been crazy about physics for the longest time and my first choice for a major back in college was to study physics and then become a physicist. After my father rejected that idea because the field was too hard to go into with little financial gain, I eventually switched to Chemical Engineering. Fast forward almost 10 years now and I find that I am not using my Chemical Engineering degree at all in my business or work anymore. Maybe it might have been a better idea going back if I did decide on doing physics. Whatever happened, I always kept on studying as much physics as possible, and for almost all physics enthusiasts, we become inspired by the stories of our predecessors. One of the most brilliant and colorful physicists in the last century was the Caltech teacher Richard Feynman who is famous for his investigation on the Challenger disaster, his work in developing the original Atomic Bomb, and his famous lectures which are today integrated togther into a 3 volume series eloquently entitled “The Feynman Lectures On Physics“,  which was mostly written up and put together by his Caltech colleagues Leighton and Sands. This 3 volume collection is extremely famous among the physics community in how well and clear the ideas of basic physics is expressed and many physics majors and professionals go back to reading just these lectures to help them refresh their minds on some physics ideas. The books themselves are not that mathematically intense but in terms of helping the beginner student to grasp the conceptual understanding of the physics ideas at a deep level, it is definitely some of the best written texts on physics.

One of the happiest moments in my life involved reading his semi-autobiography, “Surely You’re Joking Mr. Feynman (Adventures Of A Curious Character)” where he talks about the events in his life. One of the most interesting for me was the story where he and his advisor at Princeton John Wheeler decided that he should give a presentation on their calculations and work on the idea of “….subject of advanced and retarded potentials in electromagnetism.  Feynman and his advisor John Wheeler had developed a theory of direct interaction (dispensing with classical fields) by using half advanced and half retarded potentials, similar to the theory developed by Dirac in 1938. (source)”. Suffice to say, I am in not position to give any type of judgement on his work since I never came even close to their level of sophistication. This was for Feynman’s first seminar.

Later on, Feynman learned that some incredible intellectuals would be showing up for his lecture including Einstein, Wigner, Pauli, and Von Neumann. These are giants in their field which have literally changed the human race. At the end of the presentation, the story goes, Pauli raised his objections to the proposed idea and Feynman wrote that years later it was found that his ideas for expressing advanced and retarded potentials in electromagnetism was proven wrong.

For me, when I first read that story, it taught me a very important lesson which I have always kept at the back of my mind. The lesson is this. Sometimes in our youthful exuberance we come up with flashes of insight and we develop a a lot of confidence in it’s utility and originally. We think we are so clever and smart in being able to come up with the idea. When we start to talk about the theory and promote it, we don’t realize from our peers and contemporaries, as well as mentors and teachers that what we think is a great idea has some major fundamental flaws which will be proved maybe years later to be wrong or ineffective.

It might turn out like the story of Feynman with his “advanced and retarded potentials” theory which had already been proposed by Einstein maybe 20 years beforehand, someone else before us who is more established with more experience has already thought of that idea, proposed it, and worked out the calculations and experiments, and have shown that it was ineffective. We in turn never hear about their failed attempts and go along with our ambition in trying to recreate this metaphorical wheel. This is part of life and we find out about our mistakes, and correct our behavior to avoid those mistakes for the future.

As I grow older and slightly wiser, I come to realize that most ventures in life end up in failure. Out of 100 business ideas, maybe only 2-3 will be profitable and have a real business model. Given also the elements of inexperience and over-abundance in energy fron youth, we over-estimate our own skills and think that the projects we undertake will take a short time that success will be easy to come by. We start businesses thinking we will change the world and becomes as rich as Bill Gates.

When this principle is applied to this project/ endeavor of height increase, I wanted to remind to the readers that we should always try to keep things in perspective and be realistic. People like Sky who worked on his microfracture idea for over 7 years, he was always saying that within 1 year he would find the solution. After multiple times of the same claim, eventually he dropped the project the EasyHeight.com website disappeared (except from the WayBack Machine).

My old collaborator to this project Kazlina expressed her opinion that we can realistically find a solution within 5 years if we really dedicate our energy and focus, I think she was being too optimistic in her guess. I would say that if we find enough breakthroughs and can get the government to loosen its regulation policies over the next 20 years in trying out our proposed ideas on human subjects who are willing, we probably will have a real viable height increase method within 30-40 years. That is my guess.

Working in industry and owning multiple businesses and having to constantly put out fires has taught me that we should NEVER forget Murphy’s Law. This means that anything that could go wrong will eventually go wrong. Life is hard to deal with and as time goes on, it gets harder or at least more complicated. Our carefree life with so much time in childhood gets filled up with adult responsibilities and obligations. And this is usually the real reason why people who were so passionate about growing taller when they were in their 20s give up on that “crazy dream” when they reach their 30s and later. Hell, some of these people even give up on the idea of lossing wight since that idea is also going to become very hard as we grow older.

When I wrote the piece where I said that we could build a LSJL device for around $600, I knew that the real cost was probably more like $1000-2000, if we take into account the possible problems and issues that come up. Very few ventures come out perfectly or right the first time we try it out. In some ways, failure is built into the very fabric of most human actions. If we were to quantify and measure our life and our output for productivity and efficiency we would realize that we fail probably 95% of the time and waste about 95% of the resources we are given. Most of us are very ineffective in our productivity.. This is why I also wanted to extend the time range for the completion of the LSJL device. I had stated before that it would take probably 2-3 weeks to finish building it, but after careful thinking, I would say that the more realistic idea is that it will take around 3-4 months to finish in actuality.

So in conclusion…”Realize that our ventures is probably not original, has already been tried before, will most likely fail, and will take far longer and cost more than we ever thought so in the beginning.” If we go through with building the LSJL device we must also be willing to accept the idea that just maybe it won’t work out and all of the optimism we had will disappear.

One of the most recent posts that I looked through entitled “Combining Growth Factors TGF-Beta1 And IGF-1 With Dynamic Deformational Loading On Chondrocyte Implanted Hydrogels” looked at the idea of combining the effects of a LSJL type device with the most well known growth factors we’ve looked at.

The real reason why I am still reserved about the LSJL method, at least in terms of the theory is because of how the force of the chondrocytes will have to be dispersed and diffused out in all 3 dimensions. The arguement made by Tyler about why the process of continuous MSCs differentiating into chondrocytes in the cavity of the epiphysis is that the chondrocytes in the epiphyseal plates are already strong enough to push apart the upper body of the body from the lower part of the body, assuming we are looking at growth plate cells in the legs. This is a rather good argument and does show that overall, the combined strength of the chondrocytes are strong enough to push against the weight of gravitational force pushing down. However, the cartilage is not completely surrounded by bone which is as strong as steel. It is only covered on the top and bottom by the bones but not on the sides. The sides are sovered by muscles, ligaments, and skin, all of which are far more elastic, stretchable, than the bones.

This is what lead to us looking at whether there are instances where growth plates were able to push past bone bridges which might develop from childhood injusries leading to fractures which lead to bone bridges which cover the gap/thickness of the cartilage/growth plate. So far there is evidence and cases where people’s growth plates did manage to still increase and overcome the resistance.

However, the LSJL is inducing chondrocytes inside a system that completely surrounds it. Every single side is covered in calcium fortified matrix strength material. Even if it was able to push at the bone, most loading forms, although mostly in the axial direction, lead to bone width increases, not lengthening. We saw in past posts like the one with the prepubertal, and post pubertal soccer female players that their cortical bones in terms of thickness increased. This is my real issue with the idea.

However the most recent post gave me another idea on how it might be possible to increase height. We remember from our elementary anatomy courses that places like the knee are held in structure by cartilage touching cartilage. The articular cartilage of the femoral head is rubbing against the articular cartilage of the tibial head. Just see the picture on the right.

If I was to take a guess from a engineering degrees of freedom/constraints point of view, the epiphysis being subjected to just LSJL will not really be able to increase in the axial longitudinal direction as much as that we wish for. This is from a series of layers covering the bone. The bone itself does want to grow if you give it a chance. The key is to remove the contraints. Let’s assume that the LSJL technique does work in leading to chondrogenesis through progenitor cells differentiating.

We can do the dynamic loading but it seems to make the bones thicker in width and cause it to loss it’s mechanosensitivity and becomes even harder, stronger, and thicker as according to the the consequences of Wolff’s Law.

My new proposed height incease idea is really just the addition of one new step in using all three steps of LSJL< chondrocyte implants, and growth factor injection. Those will all be done, but the step to add is to make a surgical incision into the cartilage through also across the initial bone layer into the inside of the bone.

There is two possibilites I propose.

• We either cut into the femoral head articular cartilage around it until we  make a complete closed pathway for the incision going all the way through to the bone’s inside. The direction will be from a top down approach, made on the transverse plane. We will make a complete loop on that transverse plane so that the cut will be completely encompass the bone’s head.

• We cut also another completely close pathway around the bone. The cut will go completely around  the bone in 360 degree fashion. The distracted opening is then filled with chondrocyte implants. The chondrocytes are doing two jobs. They are used to keep the two separate boen sides from fusing back together while also allowing for cartilage formation. The chondrocytes themselves are kept from ossifying using growth factors that promote only chondrogenesis like BMP-2, IGF-2, and chondromodulin. In the beginning we might just want to keept the open fracture open so we use just chondromodulin.

The other idea is that we combine the directions of incision of the two together so we don’t make a complete axial cut or complete radial cut. We do it as a skewed angle, effectively cut at the corner edges of the bone, right where the articular cartilage end on the tip of the bones. We cut completely past the articular cartilage layer, then cut through he first layer of bone, and reach the inside. The key is to make the cute complete in terms of pathway. It has to be a close pathway, thus allowing for the degree of freedom the original growth plate cartilage have, which is to expand up and down.

If we remember, the long bones are always going through the process of osteoblast bone cell formation and osteoclast bone cell removal. This means that the outerlayer of the bone is being continuously formed by the layer right below the periosteum. I imagine that the layer will act as the new rest zone of the growth plate. That layer has to be very proliferative and be differentiating at a high level to be the cause for the appositional growth of the periosteal layer.

The idea is to first make an incision deep enough into the outer edge of the edges of the long bone, past the layer which is growing, inject the chondrocytes embbeded in the hydrogels to keep the openings open, inject the growth factors so that the chondrocytes can form into cartilage, and then start the process of dynamic mechanical loading/ LSJL. We have already seen in a few past PubMed studies that LSJL on bones with growth plates clearly lead to increased longitudinal growth. In the process the layer that is underneath the periosteum is injected with certain growth factors that keeps it from turning into bone cells but only chondrocytes. Since the layer is already so close to the articular cartilage, they turn into cartilage rather easily. The lateral loading will only help turn more cells of this specific layer into resting zone type progenitor cells. As long as the distracted bone are in a closed loop around the bone, the cartilage that will be formed can be affected easily by the loading.

I think at this point there is a very large amount of evidence that shows that if there is one leading researcher or scientist which can help our cause and give us a lot of assistance and guide to create an alternative way to increase height after growth plate closure, it would be Dr. Carl Brighton from the University of Pennsylvania. Through out my research, I’ve come across this guy at least 4 times now and this latest one shows that he seems to have had an influence on most of the ideas we have looked into (if only superficially so far).

When I was doing research to find the type of piezoelectric material we could put on the loading device to be built, I decided to review my material science knowledge on piezoelectric materials.

As for my educational background, I have a degree in Chemical Engineering with a focus on Material Science And Physics. I took one class where a considerable amount of homework problem sets were focused on doing piezoelectric calculations. Unfortunately I threw away the textbook after the class was over. I had taken the advanced undergraduate class in E & M (Electricity and Magnetism) using the Maxwell Equations with the classic textbook written by Griffiths (3rd ed.) and also glanced through the Berkeley textbook by Purcell and have looked through Feynman’s lecture books as well. I have seen this stuff before.

When I was looking through the Wikipedia article on Piezoelectric Materials there was a subsection dedicated to just Bones, specifically dry bones. I’ll post it below…

Bone

Dry bone exhibits some piezoelectric properties. Studies of Fukada et al. showed that these are not due to the apatite crystals, which are centrosymmetric, thus non-piezoelectric, but due to collagen. Collagen exhibits the polar uniaxial orientation of molecular dipoles in its structure and can be considered as bioelectret, a sort of dielectric material exhibiting quasipermanent space charge and dipolar charge. Potentials are thought to occur when a number of collagen molecules are stressed in the same way displacing significant numbers of the charge carriers from the inside to the surface of the specimen. Piezoelectricity of single individual collagen fibrils was measured using piezoresponse force microscopy, and it was shown that collagen fibrils behave predominantly as shear piezoelectric materials.^[15]

The piezoelectric effect is generally thought to act as a biological force sensor.^[16][17] This effect was exploited by research conducted at the University of Pennsylvania in the late 1970s and early 1980s, which established that sustained application of electrical potential could stimulate both resorption and growth (depending on the polarity) of bone in-vivo.^[18] Further studies in the 1990s provided the mathematical equation to confirm long bone wave propagation as to that of hexagonal (Class 6) crystals.^[19]

Me: There was one key phrase that really got me interested in seeing what researchers have found and it was the highlighted one above. This citation, #18, reveals that it was written by Brighton…. What we may need to do right now like detectives is try to track down these papers, get them, and see what is inside them. Tyler’s idea behind the potential inducing from fluid flow idea for LSJL comes directly from these findings from more than 30 years ago.

^ Pollack, S.R, Korostoff, E., Starkebaum, W. y Lannicone, W (1979). “Micro-electrical studies of stress-generated potentials in bone“. In Brighton, C.T., Black, J. and Pollack, S.R.. Electrical Properties of Bone

So I tracked down this paper from PubMed records. This is the link I found. (SOURCE). It seems that the name of the paper is DIFFERENT. It might not even be the same paper since it is missing one of the authors, someone named Lannicone.

J Biomed Mater Res. 1979 Sep;13(5):729-51.

Microelectrode studies of stress-generated potentials in four-point bending of bone.

Me: From a reader of the website Sugata Negi (thanks man) he provided me with a link to a proposed experiment Zhang did in 2009 looking at the specific nature of the possibility of lengthening bone entitled “LOAD-DRIVEN BONE LENGTHENING” . We see that the project finished in May 2011 and there was no results published on what happened on the results section. This suggest that Zhang already knows the results and haven’t published his findings yet to PubMed. If the results are positive with this research project, then I will definitely go back to the US to get the device built for humans. There is so much potential for this biomedical device to change the lives of children throughout the world. Even if this thing can’t work for adults, we can still use it for young kids and make a huge difference while possibly make some good profit too. What is really the most interesting part is the section under the “Similar Projects” tab.

Implications: What we see is that many of the ideas and topic we have looked at before are already in this database. We can see who are the top researchers in this field and which professors in the world who are doing the type of research we really need help with. There is a select few that will be critical to help us or guide us if we can get their assistance. We find People like Robert Ballock, Clifford Tabin, and as always Dr. Carl Brighton. His name and association is HUGE in this field. If I can get an interview with him for the podcast it will definitely be the greatest coupe and push in real breakthrough for this website ever.