Portfolio Items Archive | Chicago Arthritis and Regenerative Medicine

Weekly Live- 20200520 -Update at Chicago Arthritis and Regenerative Medicine Our Covid plan updated -Regenerative Medicine approach to Hip pain. PRP treatment. -Assurance for autoimmune patients on medications. -Risk awareness during and post covid19. Hellow, this is Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. Welcome to our Weekly Live event. This is our essentially regular, Weekly Live event where we discuss, relevant issues for my practice, my clinic, musculoskeletal medicine, my patients, to give you a sense for what's going on, and you know, the most current updated information that you need to know, regarding your musculoskeletal health. So there're three kinda broad things I want to cover today. The first is updates with what's going on with us, because I think we can provide some interesting value, and insight in terms of how we're handling things during the current COVID environment. Number two, is an interesting case, of how we're handling hip pain, Regenerative medicine approach, which I think is insightful, will give you an understanding for how I approach hip pain, and how you should think about hip pain as well. And then lastly, you know, a common question a lot of my autoimmune patients, who are on medications have, and how we need to manage their inflammatory issues during this time. Which then also connects to a broader question, of how to think about risk during this moment in time. So from an update standpoint, you know, at Chicago Arthritis and Regenerative Medicine, we have a lot going on. Even though our sort of clinical patient volume is down, because of COVID-19 right now, I would say we're probably busier actually, because of all of the administrative-client service issues, that we're still handling and dealing with, in order to make sure that our patients are being appropriately cared for. Which is interesting because you can still do a great job, even during these kind of difficult times, if you have the right focus. Which is a team, that is really focused on offering high level care, high level service, regardless of what the scenario, and the circumstances are, and regardless of the technical solutions that are available. And I'm really proud of my team for figuring out a lot of the back office stuff, which is very hard. So, some interesting things that we've kind of incorporated in this last week. So you know, one thing, a really interesting question is, as we start to get back into some version of normal life, how do we start testing people, to see if they're safe to come back to the office, to work, all that kind of stuff. And we have some guidelines from the city, from the state rather, and we also have some of our own internal guidelines, that just make good medical sense. So from the state standpoint, you know, there are some obvious medical things, like hey, have the proper protective equipment on, make sure you're proper distancing between people, still try to maintain some degree of low level traffic within the office as well. We're doing all those things of course. We're trying to do most of our patient care, via this kind of method, mainly because I think we can still do a great job of helping patients with their current, or active or chronic issues in just this kind of method. And then the other thing is, just by having less foot traffic in the office, it's a safer environment for patients that do have to come in. And in that regard, when it comes to procedures, or infusions, that lower level of foot traffic, is keeping those patients safe. In addition, per state guidelines, we, for any sort of procedure patients, for any of our platelet, bone marrow stem cell treatment patients, we do need to check some additional COVID-19 antibody, or COVID-19 testing. So specifically, the recommendation is nasal swab testing, and so we're complying with that. So the interesting thing is, what tests are appropriate, effective, you know, how reliable are they. And we spent a lot of time thinking this through, going through what's available, and we have some internal guidelines about how we're trying to handle things. For example, for my own team, we are checking weekly antibody testing for all of us, and I'll explain why in a moment. We're also checking daily temperatures, daily symptom checks, all those kind of basic things. The nature of testing is that there is no test when it comes to medicine, that is 100% foolproof. There's always some false negative some false positives. And as long as you understand the circumstances where that can happen, and the reason why you're checking the testing, you can still make some smart, intelligent decisions based on what those results are. So in that regard, with the antibody testing, there are risks of false negatives. By checking everyone in the office, our team weekly, will reduce that risk. There is also a risk of false positives, and we actually have a plan for how to handle that as well. But by checking antibody testing weekly on the team at work, where each one of us is individually considered low risk, because none of us really have any significant medical issues. Our hope is that, if any of us develop anything, we have a plan where we can appropriately take care of that, in a early stage, by that kind of testing. So that we're not only protecting those of us that work in the clinic, but the rest of you, patients, and everyone else as well. And I think that's important. We actually have internal guidelines, and I meet with my practice administrator Devi, and I meet with my physician assistant Leah. We're meeting on a weekly basis to kind of revamp those, so that as more information comes out, as more updated testing comes out, we are at that leading edge, of making sure that we're we're protecting everyone. So that's what we're doing from a protection standpoint. We're not rolling out antibody testing. We're not rolling antibody testing significantly to patients. Because we're still trying to figure out how best to use that. There're some reliability issues there. Eventually we're going to figure that out, and try to take care of things properly. So that's sort of our biggest updates right now, in terms of how we're handling things. The other things are we are continuing to help patients, if they need to be in the office, whether that's infusions or select procedures, we're still able to do that in a safe compliant way, that's medically appropriate, safe for all of you as well, and also meets all the guidelines, from a regulatory standpoint as well. Right next. So I had a really interesting hip case, hip pain patient this past week, that I think, has a lot of interesting things, that we can all learn from. And I think for patients to understand, how we handle musculoskeletal issues, when it comes to wear and tear arthritis. There are some subtleties that are important to understand. So when it comes to wear and tear arthritis, it's so important to understand, that it is very rarely just one structure that's the problem, it's a whole unit that's problematic. Meaning when somebody comes in with hip pain, you can't just think that, the hip joint that's a problem. You have to ask, are there any soft tissue issues, ligaments, tendons? Is there any other adjacent joint, like the SI joint, or anything nerve related, from the lower back that could be related. So in this particular case, and I actually made a TikTok video of this, and I put it up on all of our social sites, and I got a lot of interesting kind of feedback from that. It was a woman who has some chronic lower back issues, and has some more recent onset right hip pain. And upon examination, imaging, discussion, we sort of figured out that, her pain was maybe slightly coming from the hip joint, but more predominantly from the soft tissue structures, meaning tendons around the hip, and then also from the lower back and the SI joint. So she had failed multiple other conservative processes, and treatments. So we ended up proceeding with platelet rich plasma, and were able to help her out because we ended up using a very high concentration of platelet rich plasma into the hip joint and the SI joint. We also ended up injecting a lower concentration of platelet rich plasma into the hip tendons and ligaments. And then lastly, also injecting platelet growth factors, into the epidural space, to treat some of the nerve related pain. I'm very confident that's going to give her a great result, in large part because we properly pinpointed, where her issue was. Which is that it's not just coming from the hip joint, but from all those other structures. Number two, because we took a comprehensive approach, which means that instead of just treating, that one structure that might be involved, we treated the whole functional unit. Which meant treating not only the joint, adjacent joints, nerves, soft tissue. And because of that, she'll likely do better longer term as well. And lastly, because using like really high level ultrasound and X ray guidance, able to make sure we're really directly, and exactly hitting the right things, which will go a long way to getting her to feel better longer term as well. The other aspect in her case, was she actually had a similar kind of pain, couple years ago for the left side, and did dramatically well when we had the same kind of approach to treatment. So I'm very confident she'll actually do well there as well. But big takeaways are, if you do have some kind of joint issue, it's never good enough to just say, hey my problem is just this one thing. You really have to think two, three orders deeper, to really get out what's really driving things, to get a better result. Lastly, so a question that keeps on coming up, I've made some videos on this, but it keeps on coming up and I understand why. For my autoimmune inflammatory arthritis patients, who are on chronic medication, immunosuppressive medication, I have a lot of them asking, "Hey, is...

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