TeleMedicine visits available now - Get remote care from the safety of your home. Click to schedule an appointment.
TeleMedicine visits available now - Get remote care from the safety of your home. Click to schedule an appointment.

3 Supplement Alternatives to Chronic Anti Inflammatory Medications

supplement alternatives for pain
img

3 Supplement Alternatives to Chronic Anti Inflammatory Medications

Our weekly Live broadcast 20200902.

Topic:
3 Supplement options instead of anti inflammatory medications for pain.
-Glucosamine chondroitin
-Omega3
-Curcumin/Turmeric

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our Weekly Live Broadcast. It is September 2nd, 2020, I hope everyone’s doing well and I hope everyone’s healthy. So I am talking about three different supplements that you can use in place of chronic anti-inflammatory medications for arthritis and tendonitis. Before I get to that as a reminder, here at Chicago Arthritis Regenerative Medicine, we’re focused on evaluation and treatment of arthritis, tendonitis injuries and back pain, utilizing the most cutting edge treatments and processes available that are non-surgical and orientation that are meant to maximize your functional level and minimize your pain.

It’s interesting, I started playing tennis again yesterday. It’s been about five months since I last played and I’ve stayed relatively in shape and exercising over the summer, despite COVID and getting back into sort of playing tennis competitive shape was a challenge. And part of that was trying to get the muscle memory back, felt like doing more work for the same kind of effect. But part of it also was actually wearing a mask while I was actually playing, which is a rule at the tennis club that I play at. And it’s an appropriate rule, cause there’s a good number of people there, but definitely adds a level of additional cardiovascular challenge that normally is not there, but that is the new normal. Can you do better under more difficult circumstances? And can you do better with less?

So in regards to the topic of today, so there’s an interesting study that came out of Canada recently. That essentially looked at, what happens with osteoarthritis patients when it comes to their cardiovascular risk. So they looked at roughly 7,000 plus osteoarthritis patients in Canada and 20 some thousand age and demographic match patients who did not have osteoarthritis and a few interesting things that they found. Number one, is they found that patients who have osteoarthritis are significantly higher risk for cardiovascular disease as compared to the general population, fascinating. Number one, certainly folks who’ve got osteoarthritis likely have some degree of functional limitations in some cases that could put them at higher risk for progressive cardiovascular issues, including risk factors, such as diabetes and high blood pressure, metabolic syndrome. Number two, there are certain arthritis patients that also have higher rates of inflammation and inflammation on its own can make you more prone to metabolic syndrome, which can then make issues like diabetes and blood pressure more likely, which can then make things like heart disease and cardiovascular disease more likely. So osteoarthritis connected with heart disease outcomes is interesting. On top of that, though, what they found was that, for folks who were taking chronic anti-inflammatory medications, we’re talking about Advil, Ibuprofen, Aleve, Diclofenac, Celebrex, non-steroidal anti-inflammatory medications, that they had a dramatically higher risk of cardiovascular disease compared to the general population. And that risk was up to 40% higher risk that is dramatic. And so while I will generally tell patients, look, we need to find other options for treating your musculoskeletal condition that go beyond just chronic pain medications and chronic anti-inflammatory medications. Here’s a study that really emphasizes that in a more dramatic fashion. And I think that has to be respected because there’s other ways to treat pain and there’s other ways to treat and maximize your musculoskeletal health and wellness. And we all know about the risk of chronic narcotics in terms of pain relief, but maybe we don’t pay quite enough attention to the cardiovascular risk that comes with more routine over the counter pain medications, like the antiinflammatory medications. A lot of people assume, that just because of medication is sold over the counter at their local pharmacy and that, people that they know are using these meds sort of. Almost like it’s candy, just for pain relief that they may feel like those are low risk options. And medically, a lot of physicians, do see it as a lower risk option than other treatment options. But the reality is there’s definitely risks and the cardiovascular disease risk is a realistic one.

So what are other supplements that you can use in place of anti-inflammatory medications that could be beneficial? Well, without a doubt, glucosamine chondroitin makes sense. So glucosamine chondroitin has been around for a long time studies that go back, I think over 15 years ago, that showed that, in the setting of knee osteoarthritis, 50% of people who take glucosamine chondroitin will get pain, relief and benefit. Now, most people when they hear that number 50% in their mind, they’re thinking, is that just a coin flip? What is the point of that? How is that going to make a big difference for me? The reality is when you look at treatments that are available for arthritis and tendonitis, that 50% number, not only is it statistically significant in those studies, that is a real life significant number. And I think if a significant number of people can get relief with something as benign as glucosamine chondroitin, that it’s a no brainer to consider that, especially if you can replace chronic anti-inflammatory meds and other pain medications. So without a doubt, a good first line option.

Number two is Omega-3. Omega-3 is interesting. So there are studies that show that if you’re taking a high dose of Omega-3, that can actually help with pain, swelling, stiffness, and overall quality of life in patients with rheumatoid arthritis. It can help with inflammation. We know that inflammation is important, not only in severe rheumatoid arthritis and Psoriatic arthritis and other autoimmune inflammatory conditions. But we also know, that there is a component of inflammation at a milder level in osteoarthritis as well. So again, Omega-3 no brainer to use that as well. So you can get Omega-3 in a few different products with generally you can get it in either flaxseed oil or fish oil or other versions of fish oil, krill oil, things like that. So the studies for Omega-3 in rheumatoid arthritis, we’re utilizing fish oil. So is it apples to apples with flaxseed oil not necessarily? I think flaxseed oil is sometimes easier to tolerate for some people. And so should definitely certainly consider that, on the other hand, Omega-3 from fish oil, some people don’t fully tolerate that very well. I think as a good general rule of thumb, if your fish oil product has a fishy odor to it, it’s not a good quality product, either that or it’s been tainted or spoiled old. And so you should probably get a newer version or a better version than the one that you’re using. The other thing about omega-3 is you have to take a relatively high dose. So in rheumatoid arthritis, the studies were done using 3000 milligrams of Omega-3 3000 milligrams is a pretty high dosage. It’s very unlikely. You would get that, with just eating a normal Western diet of fish. If you happen to live, like they knew it, up in the Arctic and you’re utilizing whale blubber for some of your condiments, you might be getting enough Omega-3 but otherwise it’s hard to get enough Omega-3 without getting mercury poisoning here in America, I would definitely recommend taking Omega-3 supplements.

The last is curcumin or turmeric. So curcumin is the active significant molecule that we’re talking about in turmeric. Turmeric you find that in a lot of South Asian cooking South East Asian cooking as well, and curcumin has been shown when you compare it to something like diclofenac, a fairly hardcore anti-inflammatory medication in knee arthritis to have equivalent results in terms of pain relief. The trick with curcumin is number one, the dosage in that study was up to 1500 milligrams per day, In addition. So you need to make sure you’re getting enough. It’s going to be hard for most Western diets to get enough curcumin. Frankly. I think even if you’re South Asian and you’re eating a heavy South Asian diet, I don’t know if a lot of people are going to get quite that much curcumin. Number two is, you have to also tie that in with black pepper as well. And so in turmeric or curcumin supplements, you want to make sure it also has a product called Bioperine. That’ll help with the absorption and bioavailability of curcumin in the body as well. So again, another really low risk option that I think is very helpful for pain and inflammation.

So those are the three ones, Glucosamine chondroitin, Omega-3, Curcumin. Those are the three, that if you’ve got musculoskeletal issues that you want to focus on, I certainly have patients that are taking other types of supplements as well, but those are really the three big ones that have fairly good evidence and data, and that are routinely available. And that I think are useful if you’re looking for pain relief from arthritis and tendonitis, injuries and back pain, and that in addition can help to replace some of the commonly used over the counter pain medications that people utilize.

Okay, well, thank you for your time. As a reminder, we do… I do a Weekly Live Stream Mondays and Wednesdays every single week and after the Live Stream, we’ll also rebroadcast it after it’s been post edited. Another announcement, I have a Live Webinar, 5:00 PM Central Standard Time today called The Truth about Regenerative Medicine. Really a lot of stuff that you may or may not know that I think is helpful. If you have a musculoskeletal condition that needs additional treatment besides just conservative care. And I will have a link to that in the show notes or underneath wherever this is actually published. Until next time, hope everyone stays healthy, have a good day and live well. Bye bye.


Content- Weekly Live broadcast 20200902

Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:
https://www.chicagoarthritis.com/newsletter/

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast:
https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:
https://www.chicagoarthritis.com/regenexx-candidate-form/

Contact us for more information or to schedule an appointment:
https://www.chicagoarthritis.com/contact-us/


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses 3 Supplement options instead of anti inflammatory medications for pain.

The Truth about Regenerative Medicine

The Truth about Regenerative Medicine

Webinar- 20200902

What you’ll learn from this webinar:
-What are the best available treatments for arthritis/tendinitis that do not require surgery- for example stem cell, blood/platelet treatments.
-What is legit and not legit in the field of Regenerative Medicine.
-How to choose the best physicians/clinics for regenerative medicine. How to avoid the snake oil sellers.

How does Cancer effect how we treat your Arthritis and Tendinitis

How does Cancer effect how we treat your Arthritis and Tendinitis.

Weekly Education Meeting- 20200831
Topics:
-History of Cancer and treatment of arthritis and tendinitis.
How it affects stem cell and PRP treatments.
How it affects biologic medication treatments.

-Boosting Stem cell treatment with PRP.


  • Okay. Hello everyone. This is Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly educational broadcast. It’s August 31st, 2020. Welcome, I hope everyone’s doing well and welcome to the broadcast. So I know, we have a couple of questions already and on this weekly broadcast, I’m focused on answering questions that patients ask and that team members ask regarding what we do here at Chicago Arthritis and Regenerative Medicine. I know Jackie’s already got a question, but I was going to first discuss something that on occasion comes up, which is how does a history of cancer effect the treatments that we’re trying to do in the office. So this is a question that I want to discuss for a couple of reasons. Number one is it’s something that does get asked by patients on occasion. And the other one is, I was thinking about cancer this past weekend because Chadwick Boseman, died of colon cancer. He’s the star of Black Panther. And, I think a lot of us are, surprised that he died at the age of 43 from colon cancer. I know more people were affected by that death than maybe they realized, even though I only knew one movie of his, Black Panther, I mean, he certainly had a certain amount of presence and dignity that, I think affected people with his death.

So when patients have a history of cancer, how does that affect how we’re treating their arthritis and tendonitis specifically when it comes to either cell-based treatments, bone marrow stem cells, platelets for arthritis and tendonitis. And also how does it affect how we’re treating inflammatory arthritis with some of the biologic medications that we’re using. And in some ways we have, evidence, data and information to guide us. In some ways there’s still, a great deal of nuance and personalization and just making good principal decisions.
So if somebody does not have a prior history of cancer, how does that affect the cell-based treatments, bone marrow, and PRP for arthritis and tendonitis? So simple answer is it does not. So there is evidence from the Regenexx registry. There’s also evidence from Philip Hernigou, in France of 15-20 years of doing BMAC where there’s no evidence that these treatments increase the risk of cancer. So if you don’t have a history of cancer then no worries, when it comes to cell-based treatments.

If you’re taking a biologic medication for rheumatoid arthritis, psoriatic arthritis, are there any issues with being on these meds? So when TNF blockers that’s meds like Humira, Enbrel, Remicade came out 20 plus years ago, originally there was some concern about the risk of lymphoma and hematologic malignancies in patients that were taking these medications. Over time there’s some nuance thinking to that, which is that just having those kinds of autoimmune issues and chronic inflammation makes you more prone to those kind of cancers. And so our current thinking is that if you don’t have a history of that kind of cancer, then you’re likely okay to take those kind of medications. Obviously, if you have a dramatically increased risk in the family where every single person has had that type of cancer, you probably should be mindful of that and discuss that with your physician. Prevention is the main thing in that case, meaning that age appropriate cancer screening you definitely want to follow through with that as recommended.

So it gets a little bit more complicated if you’ve already had a history of cancer. So if you’ve had a history of cancer, but you’re in remission, however that’s defined, then there’s really not a ton of data when it comes to using stem cells and PRP in arthritis patients. But knowing that those patients at baseline, when they get treated with these kind of regenerative medicine treatments, don’t have higher risk of cancer, you’re likely okay. It’s a little bit more complicated if you have active cancer, if you have active cancer, I would not recommend getting bone marrow aspirate concentrate or platelet rich plasma in part because, you do have a elevation in growth factors, with these treatments that can accentuate certain cancers. And so I think if you have an active cancer, I would not recommend one of those treatments. What I would recommend instead is actually utilizing, Dextrose Prolotherapy, sugar water, which is sort of the original regenerative medicine treatment, not as strong as platelet rich plasma or bone marrow, but certainly effective as well, and can give pain relief and functional improvement. So even if you have that history of cancer, there is certainly, treatments that are available that can still help.

On the other hand, if you have a history of cancer and you’re thinking about taking a biologic medication for rheumatoid arthritis or tendonitis, then it gets a little bit more complicated. Number one, understand that, there’s nuance in this, in that if you’ve had a history of, let’s say skin cancer, certain biologic medications, you need to be careful with things like TNF blockers, there’s other biologic medications that don’t have that kind of cancer risk. And so you can certainly make some decisions there where you can still treat somebody with those medications without putting them at higher risk for recurrence.
Again, there’s nuance here in that cancer treatment itself has changed over time where there’s a lot of people that now have, that are living with chronic cancer, where they may never reach formal remission, but they’re okay for years at a time. And then intermittently they still need to get an occasional chemotherapeutic agent or surgery, but otherwise they’re doing okay. I think the main point that I would emphasize is that if you’ve had a history of cancer and you’re thinking about treatment, whether it’s cell-based treatment or a biologic medication for your arthritis or tendonitis, you need to have that kind of nuance discussion with your physician to make sure you’re on the right path. Questions regarding that guys.

  • [Jackie] No questions.
  • Okay. Jackie, I know you had a question for me.
  • [Jackie] Yes.
  • Go ahead please.
  • [Jackie] A patient did ask me why can’t they have the bone marrow, together with the platelet rich plasma on the same day?
  • So, great question. So Jackie’s question is in patients who are getting bone marrow drived stem cell treatment, the protocol that we follow is the Regenexx Stem Cell Protocol it’s a three-step protocol. That’s a protocol that’s been around since 2005. And essentially the initial treatment is with Dextrose Prolotherapy, it creates a mild inflammatory reaction that sort of preps the joint or tendon for treatment few days later. Second treatment is where you aspirate bone marrow aspirate concentrate, and inject that in the same day. In that treatment, we do also prep platelet rich plasma. And then the last treatment few days later is one more platelet rich plasma treatment. So the reason why platelet rich plasma is even utilized in bone marrow stem cell treatment is the growth factors from the platelets help to stimulate the mesenchymal stem cells that you see from the bone marrow. The reason why we do that repeat in platelet rich plasma treatment a few days after the first bone marrow treatment is that it kind of helps to, accentuate the effect of the bone marrow cells. But even during that first treatment, Jackie, we do in fact use platelet rich plasma during that as well. So, patients are getting that sort of repeat exposure to their own platelet growth factors with that stem cell treatment that helps to drive a progressively better response with that initial stem cell treatment.
  • [Jackie] So they’re having platelet rich plasma on the bone marrow day as well.
  • Yes. So in fact, during that bone marrow day, they get not only that treated, but they do get platelet rich plasma on that day. And then also a few days later to sort of keep the effect going and get that longer term better response. And in fact, if we end up doing a booster platelet treatment, few months down the line, the benefit of that is again, the growth factors from that are helping to boost that initial bone marrow treatment that was done few months previous.
  • [Jackie] Okay. Thank you.
  • Any other questions, Jackie?
  • [Jackie] That was my main one, because I really didn’t know how to answer that.
  • Okay. Susan or Devi. Okay. Well this was brief, but, big takeaways, nuances when it comes to cancer and treatment of your arthritis, your physician should have, not only experience with that, but should have a nuanced, personalized approach to that in your case. And until our next live stream, hope everyone is doing well. As a reminder, we do this Mondays and Wednesdays and until next time, have a good day and live well. Thank you. Good bye.

Content- Weekly Education
Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube every monday.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:
https://www.chicagoarthritis.com/newsletter/

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast:
https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:
https://www.chicagoarthritis.com/regenexx-candidate-form/

Contact us for more information or to schedule an appointment:
https://www.chicagoarthritis.com/contact-us/


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses how cancer effects how we treat you arthritis and tendinitis.

Weekly Education Meeting 20200824

Weekly education meeting at Chicago Arthritis and Regenerative Medicine 20200824

Topics discussed:
-The Basics, Inflammation vs Instability.
-Real stem cell treatment vs fake ones.
-Are mouse arthritis studies applicable to humans?

Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain. 
Watch live on FB/IG/Youtube every monday.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis


Hello, this is Siddharth Tambar from Chicago Arthritis And Regenerative Medicine. Welcome to our weekly educational broadcast. It’s August 24th, 2020. Welcome everyone. I hope everyone is feeling well and doing okay. In this weekly broadcast, I am talking to my team at work and we’re discussing topics that are relevant to us here at Chicago Arthritis And Regenerative Medicine. Frequently discussing questions that patients have, or that team members have regarding what we do here in the clinic. And again, here at Chicago Arthritis And Regenerative Medicine, we focus on treatment of arthritis, tendonitis injuries, and back pain, utilizing the most up to date methods of evaluation and treatment to maximize your function and minimize your pain in order to get you to maximize and live your highest quality life possible.

So, we have one new team member today, Susan, who is coming on as a medical assistant, and I thought great opportunity to discuss some of the basics of what we’re doing here at Chicago Arthritis. So, while we’re focused on musculoskeletal conditions, I generally break that up into inflammatory, meaning inflammation causing problems verses degenerative, meaning wear and tear tendonitis, arthritis, and injuries. And so when I really think about these things, I think of them as, does somebody have a primary inflammation problem throughout their body, or do they have a primary instability problem at the joint level? And these are very different because the way that you evaluate, treat, manage is very different from condition to condition. And the reason why it’s important to differentiate those is because number one, you want to understand what’s causing somebody’s problem as you develop a plan to try to maximize and improve their condition. And what drives inflammation is frequently very different than what drives instability. Now there’s definitely some overlap in conditions and sources of problems. And so you do need to be relatively subtle when you make some of these decisions, but they’re definitely very different and they definitely deserve very different approaches to treatment.

So, when we’re talking about inflammation, we’re talking about total body inflammation. That includes conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis. Those are conditions where the body’s immune system is miscommunicating, recognizing its own cells as problematic, which then leads to inflammation in the body.

On the other hand instability means that somebody has at some point, a soft tissue injury, let’s say a tendon injury, ligament injury, which then in turn, then leads to slight instability in that joint longterm, which then eventually leads to degeneration of the joint and the tendon.
So, the way that these conditions present they’re very different and the way that we evaluate them is slightly different. And for sure, the way that we treat them is very different. Now, what’s interesting is that there’s definitely cases where somebody may have a primary inflammation problem like rheumatoid arthritis, but that over time they also develop some instability and degenerative conditions as well. And you have to treat that a bit differently than you would treat the inflammation part.

So, some classic examples, let’s say this past week of what I saw. Number one is a gentleman that presented as a new patient who has a history of psoriasis and had a lot of different joints that were painful and problematic. So, naturally when you see someone who presents like that, you wonder, is there some kind of inflammation that’s causing inflammation in the skin, as well as in the joints. That is naturally very suspicious for possible inflammatory arthritis, meaning someone who has psoriatic arthritis. And the reason why is when you see someone that has many joints that are active, you have to ask, is there one common problem that’s driving everything. And so in his case, based on a combination of some examination findings, as well as ultrasound in particular, showing inflammation in his joints, and then labs that help in to confirm the inflammation as well, we’re able to kind of put him down the right road for treatment, which was treating the overall inflammation with medications. And, hopefully on that algorithm, he should do well with treatment.

Second example would be a individual who I saw recently that had pains in multiple joints in the hands and the feet. Again, you would think that could be very suspicious for rheumatoid arthritis. In her case, based on ultrasound and x-rays, I ended up giving her diagnosis of wear and tear arthritis rather than rheumatoid arthritis and her treatment algorithm because she’s already failed some conservative options like occupational therapy and supplements, I’m recommending a regenerative medicine treatment, utilizing her own bone marrow derived STEM cells as well as platelets. So again, based on some objective evidence of what’s driving her pain, able to guide her down the right path.

And the last one would be a individual that has, came to me with shoulder pain, a 77 year old man who had shoulder pain. And so naturally when you first see shoulder pain, you of course, think of some very common things, like, could somebody have a rotator cuff problem? Could they have a wear and tear arthritis problem? In his case, with a reasonable history, we were able to determine that he’s got pain in both shoulders. That’s a little bit unusual. And on ultrasound imaging, he’s got evidence of inflammation in the biceps tendon on both sides. So because he has symptoms on both sides that are very similar with inflammation, we naturally end up kind of looking to see, does he have something else going on, such as inflammation? And in his case, I ended up diagnosing him with a condition called polymyalgia rheumatica, which is an inflammation condition causing inflammation in joints, muscles, and tendons. So again, he falls into the inflammation algorithm and we’re going to treat that appropriately at this time. So, inflammation instability makes a big difference. And, we have the tools at the bedside, including exam and ultrasound to fairly rapidly help to make that diagnosis and put people down the right path for treatment.

Questions off the bat. Susan and Jackie.

  • [Jackie] I do have one, what’s the difference between the treatments they do here in the office and in Umbilical cord procedures.

Great. Great, great, great, great, great question. So, common question that Jackie gets from patients and a common question on the regenerative side is what is the difference between some of the things that we’re doing in clinic versus some of the regenerative treatments like umbilical cord STEM cells? Big difference. So here in the United States, we have some very progressively clear guidance in terms of what we’re allowed to do for patients when it comes to utilizing their own cells, whether it’s using their own blood or using their own STEM cells, there are some very strict rules to this. So, the treatments that we use in the office are utilizing your own live cells, including your own live bone derived STEM cells. In an adult that is where you get the highest concentration of your own mesenchymal STEM cells. What’s become popular over the last several years is utilizing somebody else’s own umbilical cord cells. So, whether it’s umbilical cord or amniotic cells, those come from essentially birth cord tissues. After a baby’s born, there’s a high concentration of cells in amniotic and umbilical cord fluid. And those cells theoretically have the potential to be injected into somebody else without causing a reaction. That sounds very interesting. It sounds exciting. In the United States, however, there’s very clear guidance that you cannot inject somebody else’s live cells into them unless it’s within a research oriented study.

So, in order for amniotic and umbilical cord cells to be utilized, they need to be processed in the following way. Number one, they’re collected, they’re then freeze dried, they’re then gamma irradiated, essentially all the cells in that product have been killed off, they’re there then pulverized into a powder and then shipped over to a physician’s office where they can then be stored for 18 to 24 months. And when they need to be used they’re then hydrated, meaning you put some fluid into the vial and then they’re re-injected. Multiple organizations have looked at this. There are no live cells in those products. That’s important to understand because if you think you’re getting a STEM cell treatment, you want to have live cells, your own cells, you don’t want to have dead cells. They’re likely some growth factors in those products, but there are no live cells. Also keep in mind that the vast majority of research that’s available in the world when it comes to orthopedic use for these kinds of treatments are from utilizing your own live, bone marrow derived STEM cells. So very different. Unfortunately, they’re marketed as something different, the umbilical cord treatments, but very, very different concept.

So question on IG asking, can I discuss the recent Stanford study discussed in the New York times. So, a recent article came out where this was mouse study, where essentially they took, they did what was called a microfracture, where they poke little holes into the arthritic joints of a mouse to get some blood flow into the joint. They then utilize a medication called Avastin to effect a growth factor called VEGF. And they found that utilizing this combination seemed to help rebuild cartilage in a mouse. It’s kind of interesting study. The challenges to note with this are number one that was in a mouse, not in a human. There’s a big difference between a mouse model study and human beings. A lot of things that work in mice don’t work quite as well in humans. And the reason why is because we don’t present like mice, we’re not lab mice. And most mice studies are very specific and controlled. They take mice that have very specific genetic backgrounds, mice that have very specific problems. And it’s in a very controlled atmosphere. In humans, that doesn’t work as well. So, what’s interesting is that microfracture surgery in humans has been done for probably 20 years, if not longer than that. And the evidence of its effectiveness is relatively mixed. It’s not necessarily so great.

On the other hand, there’s other ways to utilize your own cells besides poking holes into the actual bone and that’s by injecting those same cells into the cartilage layer, into the bone that’s been damaged, into the soft tissue components as well. There’s much better evidence of that than there is in microfracture surgery. So what’s interesting is that that recent paper actually got reported in the New York times. That is a far, far away from actually reaching clinical utility in human beings. And part of that is because mice are not humans. And keep in mind that in that study, it’s not just that they’re utilizing someone’s own cells, it’s that they’re actually utilizing a medication as well. And there may be something to that in the future in terms of harnessing a person’s own cells and combining it with possibly medication to get a very specific kind of effect. But this is a long ways off from what we’re doing right now. But what we have to offer right now, has good effectiveness in human beings, regular human beings who have regular human conditions like arthritis and tendonitis and back issues and injuries. And that’s what I would stick with right now.

But it is interesting that in the lay press, you’re starting to progressively see more positive recognition. And I think part of that is because there is more and more scientific data. Part of that is also because we live in a world now where people have a more heightened perception of risk. And they’re starting to realize that there may be lower risk ways to get good results when treating people that don’t require more invasive procedures and surgeries. I hope that answered that question.

  • [Jackie] Yes. It did.
  • Jackie other questions for me.
  • [Jackie] There was actually, my main one and I didn’t know how to answer the difference in regards to the umbilical cord cells.
  • Yeah. I mean, it’s tricky because a lot of patients are told that, “Well, you don’t have enough cells in your own body after a certain age, and that’s why you should utilize someone else’s cells.” That in theory kind of makes sense. But the reality is when you look at the evidence, when it comes to effectiveness of treatment, as long as your cell count meets a certain minimum threshold, regardless of age, you can still get a very good result with your own cells. The flip side is, when you’re utilizing somebody else’s cells, in order to be done safely, they’re being done with dead cells. When you’re utilizing live cells, there may be some effectiveness to this, but there’s a lot less evidence of its effectiveness and safety compared to utilizing your own cells. So, good general rule when you’re thinking about risk, utilize your own cells because you avoid any of the issues with possible rejection. Utilize treatments that have a lot more evidence. It’s important to find things that work, things that are low risk and things that you can do in a legally compliant way in the country that you live in.
  • [Jackie] Thank you.
  • Anything else? Susan.
  • Okay. Very good. Great. Well, thank you for joining us on our weekly educational broadcast. As a reminder, we’re doing a streaming broadcast every Monday and Wednesday. Mondays are more about answering patient and team questions and Wednesdays are a little bit more, I think, big picture thoughts that I have on medical issues and related issues. Until our next broadcast, thank you for your time. Have a good day and live well. Bye bye.

***For more educational content:
Sign up for our email newsletter: 
https://www.chicagoarthritis.com/newsletter/

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast: 
https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate: 
https://www.chicagoarthritis.com/regenexx-candidate-form/

Contact us for more information or to schedule an appointment: 
https://www.chicagoarthritis.com/contact-us/


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses evaluation and treatment of arthritis, tendinitis, injuries, and back pain without surgery or medication.

Timing of Treatment if you have Pain

Timing of Treatment if you have Pain.

Topics
-If you have pain, what are the first steps you should take?
-If those steps fail, what should you do next?

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast, it’s August 26, 2020. I hope everyone’s doing well and welcome. So today I want to talk about timing. People say timing is everything in life, it may not be 100% but it’s obviously a significant part of it. When it comes to your own musculoskeletal treatment and health, I think timing is really critical here.

In large part because you can do a lot more and a lot better if the timing is correct. And in part, because it’s important for people to know when is the time to actually get evaluated and treated. So there are a number of things that I think of when it comes to timing of treatment, when it comes to your joint, tendon, back sort of health and wellness.

First and foremost is do you have any kind of pain or limitation? That may sound obvious but the reality is that most people typically wait until things have gotten significantly worse and debilitating before they actually decide to address something. Well, that’s very normal for how humans act and kind of proceed with their life. The reality is that that’s not very healthy for optimizing your life. And an example of that in a different field of medicine would be diabetes or blood pressure. You would never wait until somebody’s diabetes or blood pressure is so bad that they’ve had multiple heart attacks and strokes. You would want to address that at a earlier stage before they actually have those kinds of complications. In the same way, if you have a joint or a tendon problem, you don’t want to wait till it’s so disabling and problematic that you’re no longer able to do your activities that you enjoy, you’d rather take these on at an earlier stage.

So initially, if you have pain or functional limitations, that should be your trigger to do something about it, to take some kind of initial action. And whether that’s correcting biomechanics, posture, some adjustments to your physical activities, you want to be thinking about that right off the bat. So some things that come to mind right off the bat for me would be if you happen to be, I mean, the whole world right now is sort of working at their computers at their desks. And if you’re someone who’s starting to develop some neck pain, some shoulder pains, if there’s issues with your biomechanics at your workstation, with your posture, those are things that you can address fairly straightforward and easily. And you want to make a conscious effort to do that. Easy way to kind of jump in and make a difference for your symptoms right off the bat. On the other hand, if you have pain, that’s really related to specific activity, let’s say sporting activity, you want to address that as well.

So, as an example, I’m using my brother as an example a lot nowadays, but he’s someone who plays a lot of tennis these days and he’s in his 40s now. And he’s got some various pains, elbow, shoulder. Well, he needs to make some changes, figure out some of the biomechanics, some of the strokes that he’s doing while he’s playing tennis, overhead activity and figure out how to improve some of those so that he has less stress on his shoulder and his elbow. If he’s not already doing that, that’s your first step.

Other good first-line steps would include over the counter supplements. The ones that I recommend are glucosamine chondroitin, Omega-3 and turmeric. Glucosamine chondroitin has been shown to help in 50% of folks who’ve got near arthritis. That’s actually pretty good in the world of musculoskeletal medicine if you’re wondering 50% may not sound overwhelming, but that is actually a good number. Omega-3 can help if you’ve got inflammation in the joints and turmeric or curcumin has been shown to help equally as well as anti-inflammatory medications, if you have arthritic pain as well.

So good first line options with your goal of being able to get back to your baseline activity or continuing your baseline activity without significant pain. Good first-line way of kind of jumping in and doing something. The timing there is, hey, you’ve got pain, you’ve got some functional limitations, there’s something abnormal. Recognize pain as what it is, which is a signal from your body that there’s something wrong here and address it, treat it properly, do something about it. Next steps, if you’ve done all that, and you’re still having pain, I wouldn’t wait.

I wouldn’t just ice it down, putting on anti-inflammatory meds, that’s the traditional way of treating it. It’s a traditional way of treating something like pain is let me just take something for pain in terms of pain medication, let me suppress it, let me take an anti-inflammatory medication to suppress that pain, rather than trying to actually get to the root cause and try to make a more longterm decision to actually improve things. Icing and anti-inflammatory meds, they have a role short term, longterm, not ideal, not the only approach that you want to take.

So next steps would be if you’re still having pain, despite making the right smart decisions in terms of altering your biomechanics, over the counter supplements, will then be to actually see a musculoskeletal trained physician. If your physician is not nuanced in terms of treating your musculoskeletal health, you really should see someone who is. If you’re not, it would be like seeing someone for heart problem who isn’t really an expert at heart disease, that’s not ideal. So the next steps really are diagnostics. Based on your examination and imaging, what’s really causing a problem. I think a great first-line imaging test for a lot of musculoskeletal conditions is an ultrasound. You can take a look at a lot of subtle things in terms of ligaments, tendons, joints, inflammation. You can make some decisions right off the bat with that. Sometimes x-rays can be helpful. Sometimes even an MRI can be helpful. The key is you don’t want to get the imaging just for the sake of getting the imaging, you want to make sure it makes sense based on your symptoms, your exam, and working with a trained appropriate physician.

At that point, as you come to a decision as to what’s causing your problem, the next steps are then to properly treat it. Treatment on a nonsurgical level, hopefully first-line. There’s some things that do need surgery kind of upfront, but most things, 75% of musculoskeletal issues, 80% can be treated non-surgically. And at that point, you should be figuring out, look, is your problem coming from a joint or tendon problem? Is there possibly a pinched nerve that’s kind of driving issues? Do you have an inflammatory issue? Do you have an instability issue? Figure out what’s going on with your physician and then come to a treatment algorithm. So at that point, if you’ve already failed physical therapy, over the counter supplements, some activity modification, then you want to consider actually doing a regenerative medicine treatment.

I think a good first-line option for a lot of things that are mild to moderate is platelet rich plasma for things that are more significant then you want to consider something like bone marrow derived stem cells, but that’s generally the algorithm. Have you sort of failed some things that are relatively mild and then what are the next steps? In terms of timing to know when you should take some of those next steps, certainly if you failed the conservative options, but in addition, you may be able to get back to your normal activity level or exercise, but there’s some sort of things that might indicate you still have something low level or underneath the surface that’s still driving problems. That may be an issue as you get further down the line. And so, as an example, if you notice with exercise that the area that been affected, let’s say your knee or your back, there’s just a little bit more weakness or fatigue in that area, compared to the rest of your body, more so than what you normally have at baseline, that could be a sign that you have an ongoing problem that really would benefit from treatment. Or really sort of finding of instability, meaning where a ligament or tendon has been damaged and is not really providing a lot of protection, is that kind of easy fatigue in that area. So, one way that I’ve heard that explained to me is someone who’s got knee pain, they feel okay, but when they walk more than let’s say a mile or two, they start to notice that the leg starts to feel a little bit more tired or weak or cramping. It’s a sign that there’s some instability there that probably needs to be evaluated and treated. Subtle ways, I think some other subtle ways to figure out are you kind of having an ongoing issue that might be under the surface would be, let’s say you have a knee issue, and then you start to find, hey, I’m starting to compensate and now my back and my hip is starting to cause a problem. You found a way around it. The body’s an incredible machine in terms of finding ways to get around the problem, but now you’ve kind of offloaded and now put that into another area, that’s a problem. And is something that be addressed by addressing the root cause, which is that initial area that was injured or painful.

To me, timing is key in the sense that, recognize pain for what it is, which is a signal from your body that something needs to be evaluated. Recognize that the timing when you have that kind of problem should be relatively soon and immediate, make decisions that are correct longterm, improving your biomechanics, posture, taking the right kind of over the counter supplements, not relying on anti-inflammatory or pain medications, trying to maintain that overall baseline physical activity. If you’re not able to, then transitioning to actually seeing someone who knows how to properly evaluate that, using the right diagnostics, ultrasound, x-ray, occasionally MRI to properly make a diagnosis based on what’s going on, not just relying on the imaging, but correlating it with what other symptoms and examination findings you have and then kind of progressing if needed to a regenerative medicine treatment.

Timing is everything in life or at least a large part of it. And I hope this gives some better clarity on how timing is important when it comes to your musculoskeletal health and wellness. Thank you for your time. As a reminder, I do a live streaming event every Monday and Wednesday, and until next time, have a good day and live well, bye-bye.


Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.https://www.Instagram.com/ChicagoArthritishttps://www.Facebook.com/ChicagoArthritishttps://www.Youtube.com/c/chicagoarthritis
***For more educational content:Sign up for our email newsletter: https://www.chicagoarthritis.com/newsletter/
See our blog:https://www.chicagoarthritis.com/blog/
Listen to the Regenerative Medicine Report podcast: https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:Determine if you are a Regenerative Medicine treatment candidate: https://www.chicagoarthritis.com/regenexx-candidate-form/
Contact us for more information or to schedule an appointment: https://www.chicagoarthritis.com/contact-us/


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.
***About this video***In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses timing of treatment if you have pain.