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Weekly Educational Broadcast- 20200727- Can regenerative treatments help in bone on bone arthritis?

weekly education 20200727
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Weekly Educational- 20200727- Replay
Can regenerative treatments help in bone on bone arthritis?
Importance of variables such as age, range of motion, which joint is affected, and patient goals of treatment.
Importance of stability, alignment, inflammation, and optimizing cellular health of the affected joint.
Cases- Hip, Knee, Ankle examples.

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/ChicagoArth…
https://www.Facebook.com/ChicagoArthr…
https://www.youtube.com/c/chicagoarth…

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

See our blog:

Chicago Arthritis Blog

Listen to the Regenerative Medicine Report podcast:
https://www.chicagoarthritis.com/rege…

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

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


Hello, everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, and welcome to our weekly educational broadcast that is live. It’s July 27th, 2020, and thank you for joining me today. So, on this weekly broadcast I focus on questions that my own team and patients are frequently asking, or from the past week, and applying that to cases that I’ve seen in the last week to give some perspective and go over kind of big picture principles in terms of what we’re doing here at Chicago Arthritis and Regenerative Medicine, where our focus is on evaluation and treatment of arthritis, tendonitis, injuries and back pain, with the most cutting edge treatment options available that are low-risk and high in terms of benefit. So, a question that Jackie from my office kind of transferred over to me from a patient, or a potential patient, was can regenerative treatments help in bone on bone arthritis? A really super common question, and the intention is that this is likely someone who is seeing their physician, either orthopedic surgeon or primary care doctor, and has been told that on their x-ray they have significant arthritic issues, and have been told that they have bone on bone arthritis, and that they may not be, that they may only be a candidate for a replacement surgery or some other kind of similar treatment protocol. And really common question that comes up, because the reality is that most people, when it comes to their musculoskeletal health generally are approaching it as something that they’re really only addressing when things have progressed to a severe stature, and obviously it’d always be helpful if you can catch this at an earlier stage. But the reality is there’s nuances to when we say someone has bone on bone arthritis. To begin with, it depends on what joint’s affected, it depends on the range of motion, and it depends on what the goals are of treatment. So, range of motion is a big one in the sense that if range of motion is still intact, or still fairly good, you have to ask, “What exactly do we mean by bone on bone?” If you’re really, truly bone on bone, you really shouldn’t have regular range of motion, and an example of that would be someone who has significant hip arthritis and can’t really move the hip, let’s say inward, or internal rotation. On the other hand, you can have someone that has really advanced or severe arthritis of the knee, and their range of motion is still close to intact or still very good. And so it’s important to understand that sometimes what we see in x-ray does not necessarily translate to what’s actually happening to that individual, and may not necessarily be fully representative of what the problem is. So, a classic example of that is someone who has, let’s say pain in one knee, let’s say their right knee, and their x-ray shows advanced arthritis, and they also happen to have an x-ray of the left knee, and it turns out the x-ray of the left knee actually looks worse than the right knee, and they don’t actually have any pain in the left knee. And it’s a great example of where imaging or x-rays don’t always call out the full, don’t always tell the full story. And it’s important to understand that x-rays and imaging can tell you one thing, but they don’t give you the full story. The other aspect to that is, let’s say somebody’s had an MRI and shows significant findings. Now their pain, someone that has a degenerative process, their pain does not only come from what you see in the cartilage wear, they have pain that’s coming from the bone, from the soft-tissue structures, they have pain that’s coming from various other areas as well, and so these are other areas that can still be treated. And range of motion is a big one because if your range of motion is still intact, it likely indicates that you can still benefit from treatment. The other part of that is also what joint is affected. So, it’s super common that I hear patients who’ve got knee arthritis say that, hey, they have bone on bone knee arthritis, or they’ve been told that, and can these treatments help? And the reality is that the evidence out there for platelet-rich plasma and bone marrow derived stem cells is that wear and tear arthritis in the knee, that even when it’s advanced that people can still get a good degree of pain relief and functional improvement. In fact, there is suggestion that degree of arthritis when it comes to the knee does not make a difference in terms of the ability to have improvement in symptoms. Now, the flip side is if somebody has more advanced hip arthritis where range of motion is gone, then that’s a more challenging category, and that’s someone who likely is a better candidate for let say, hip replacement surgery. So, it does matter which joint is affected, and it does matter, range of motion as well. So, those are really the two big things. Then I think the last thing is what are the goals of treatment that are being pursued. So, in someone that has bone on bone arthritis, we can still help in the following ways, we can help with stability, we can help with chronic inflammation, we can help with alignment, and we can help by improving and optimizing the cellular health of the joint. All of those things can be done non-surgically. They can be done either utilizing just good strengthening exercises, weight loss, over the counter supplements, bracing, and also regenerative medicine treatments, including platelet-rich plasma, bone marrow derived stem cells, adipose micro-fragmented cells, and even dextrose prolotherapy. All of those things can actually be helpful, when your goal is pain relief and functional improvement, and that’s because we can help in those other aspects, we can help with stability by strengthening the soft tissue structures, with strengthening exercises, not to mention with the regenerative medicine treatments, we can help with inflammation with over the counter supplements, dietary changes, and there’s also benefit from the regenerative medicine treatments when it comes to reducing inflammation longer term. Alignment can be improved with physical therapy and bracing, and optimizing the cellular health, meaning you take a joint where the cells are chronically damaged and no longer functioning well, you can get them to function better by injecting the right kind of cells in there. Bone marrow aspirate concentrate has mesenchymal stem cells, and the growth factors within that as well can help to stimulate the local cells in the joint that had been damaged. Optimizing the cellular health along with those other factors can help with pain relief and functional improvement. So, if the goal is improving pain and function, then even if you have bone on bone arthritis, in the right occurrences and in the right patients, you can still get those kind of outcomes. So, a couple of patient examples from this past week where I think that’s all very relevant. So, the first is a woman who is in her early 70s, she is still an active nurse, she actually works in a hospital where she’s actively kind of running things, and she’s very active, walking, almost running around just because it’s so busy, and she’s developed pain in her left hip. So, her range of motion is still intact, the issues in her case are, number one, what’s her degree of arthritis, because we know in someone, when it comes to hip arthritis in particular, as they get older they become a harder and harder candidate with these kind of treatments. And so it’s going to be important to get the right kind of imaging, meaning an MRI to figure out, along with her symptoms, which is pain in the groin in front of the hip, that is she a proper a candidate. And if her MRI shows that she’s got mild to moderate arthritis, and her range of motion is still intact, then despite her age, she’s someone who could still benefit from treatment. On the other hand, if her hip MRI shows more advanced arthritis and she’s really at the tip of really kind of progressively getting dramatically worse, then anything from the regenerative medicine treatment standpoint might be more short term oriented, might be able to help with some of the soft tissue kind of strains and pains that can occur in the degenerative arthritis, but she may be someone who’s headed towards hip replacement faster. So, in that case, telling whether somebody is quote-unquote, “bone on bone,” will make a big difference. Another example would be a woman who I’ve seen kind of for the last, I think seven years, and she intermittently, we’re treating, you know, maybe a hip, a knee, an ankle, a lower back over the last seven years, probably three or four times we’ve treated something or another. And in her case, she really does have pretty significant knee arthritis. What’s been described on x-rays as bone on bone. And she’s someone where her range of motion is still intact, she’s still very highly physically active, still in good general health, and she’s someone who with just platelet-rich plasma has done great. Even though her x-ray shows, you know, bone on bone, she’s someone who, because we’ve been able to help with stability, chronic inflammation, alignment, and optimizing the health of the joint, we’ve been able to give her, really, a great degree of pain relief and functional improvement over the last several years. And a contrast to, let’s say a hip patient, where someone who can still do really, really well. The last one is a patient of mine who I treated four years ago, he has a pretty bad ankle. And he’s someone who has a baseline pseudo-gout, and so he’s had chronic inflammation that caused bad damage in his ankle, and by the time he came to me, he had, you know, what’s been called bone on bone arthritis in the ankle, and that’s very legitimate. He had limited range of motion in the ankle, and he’s someone who I would say is a very challenging candidate for treatment. He had originally bone marrow aspirate concentrate, utilizing his own stem cells from the bone. As well as platelet rich plasma to treat the ankle joint, and he’s done quite well actually in terms of pain relief and functional improvement. He’s had a 70% improvement in terms of pain. He’s been able to reduce his chronic anti-inflammatory medications. And he’s generally done very well. He’s someone who I would say was a very hard candidate for treatment, very challenging candidate, but because we’ve been able to help with all those other variables, improving stability, inflammation, alignment, and really optimizing the health of the joint, he’s had a good result. Someone where traditional treatment or traditional approach would say this is a challenging candidate because it’s bone on bone, but someone who because we’ve taken a comprehensive approach to treating it, and that means treating not only the joint that is damaged, treating the bone that is chronically swollen, treating the ligaments that are chronically lax and unstable, and treating even some of the nerves around the leg, and the ankle, and the lower back has given him better pain relief than he had expected, or that his imaging would really predict. And that’s really the key. Make sure you’ve got the right diagnosis, make sure you’ve got the right understanding of the severity. Make sure you’ve got the right comprehensive treatment approach, and make sure your goals of treatment are aligned with what the patient’s goals are. And if so, you can take somebody who still has bone on bone arthritis, and still give them a good result in the right cases. Great! Well, thank you for your time. Until next week, I hope everyone does well. As a reminder, we do this live event on Mondays and Wednesdays. This Wednesday is my live-live event, I may have a guest on with me, and we’ll have some conversations about some exercise and physical therapy related issues when it comes to arthritis, and issues related to the aging athlete. And I look forward to that conversation. Until then, have a good day and live well. Bye-bye!


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 whether regenerative treatments can help in bone on bone arthritis.

Weekly Education Broadcast- Replay 20200720

img

Weekly Education Broadcast- Replay 20200720
-Bone Spurs, when are they significant?
-Instability and Regenerative medicine.
-Cases where bone spurs are not significant and can just be followed.
-Cases where treating can be helpful- calcific tendinitis, tendon impingement.
Instability, Calcifications, and When are bone spurs significant.

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 Monday at 915a cst.
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:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis 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:

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 bone spurs, when they are significant and when not, and when to treat.

#chicago
#chicagoarthritis
#chicagoarthritisregenerativemedicine
#westloop
#westloopisthebestloop
#regenerativemedicine
#prp
#stemcells
#arthritis
#osteoarthritis
#tendinitis
#knee pain
#hip pain
#back pain
#ankle pain
#feet pain
#shoulder pain
#elbow pain
#wrist pain
#hand pain
#neck pain
#rheumatology
#rheumatologist
#rheumatoidarthritis
#psoriaticarthritis
#anklyosingspondylitis
#autoimmune
#covid19
#bonespur
#achillestendinitis
#achillestendonitis
#anklesprain
#kneesprain
#telemedicine

Weekly Education Broadcast live- 20200720

Weekly Education- 20200720
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Weekly Education Broadcast live- 20200720

-Bone Spurs, when are they significant?
-Instability and Regenerative medicine.
-Cases where bone spurs are not significant and can just be followed.
-Cases where treating can be helpful- calcific tendinitis, tendon impingement.

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 Monday at 9am cst.
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:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis 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:

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 bone spurs and pain.

Weekly Education meeting 20200706- Replay

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Weekly Education meeting 20200706- Replay
Topics discussed during this broadcast:
Heel pain:
Plantar fasciitis and Achilles tendinitis
Case 1
Case 2
Avoid steroids!
Nerve related pain.
PRP vs Amniotic fluid.

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 Monday at 915a cst.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis


Welcome everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly education meeting. So we’re doing this live, this week. So as an update, we’ve started to do this educational meeting where I’m talking to team members, about what we do in the office in terms of evaluation, treatment, key principles when it comes to arthritis, tendinitis, injuries and back pain. And it’s been interesting and helpful because it gives me a chance to talk and it gives a chance for team members to kind of learn and ask questions, and I think it’s relevant for not only us, but also relevant for general public or existing patients as well. And my natural course of doing this is videotape. And then just put it out there, maybe get some captions on it, but really nothing else post editing. So, I just decided let’s do this live. And I think that makes sense. It’ll get out there faster and maybe connect with more people, which is interesting.

I am using a software platform called StreamYard to connect on Facebook and LinkedIn and shout out to Orlando Landrum for giving me that idea. He is dramatically more technically savvy than I am. I was just saying to Devi and Jackie, that I think I’ve maximized my technical abilities at this point. I have the streaming on Facebook, YouTube, and now IG. And I think that’s as high level as I can possibly get. I think after this, it’s just like, do we have a rocket ship to Mars? That’s as far as I’m going.
Alright, so something interesting I thought would be interesting to talk about is heel pain or plantar fasciitis. So, we have two cases where that’s relevant from this past week, one where we actually treated, one where existing patient was emailing some questions. And so it kind of brings up some interesting topics, which I think are worthwhile learning about and talking about. So the first case is a man in his late 40s, who was presenting with heel pain, and what he has an exam is tenderness along the bottom of his foot, as well as tenderness along the Achilles tendon. So, the bottom of the foot where he has tenderness over the heel. He has plantar fasciitis, that’s a length of tissue along the bottom of the foot that basically helps to provide support and structure over the bottom of the foot. It can get chronically aggravated, which is what plantar fasciitis is. He also has tenderness over the Achilles tendon, the Achilles tendon is basically, the tendon from all the calf muscles that basically insert at the heel, so it’s an area of very high pressure, high tension and if it gets irritated, it can be very painful as well. So, we came to his diagnosis based on not only examination, but also ultrasound and X-ray, really ultrasound more than anything else because it shows chronic changes in the plantar fascia as well as chronic changes in the Achilles tendon. In both cases, there’s chronic kind of wear and tear changes, degenerative changes. There’s not any active inflammation, there’s no severe tear either.

So this is something that is still amenable to non surgical treatment. And in his case, he’d failed physical therapy, and his existing podiatrist had recommended a steroid injection. And so that brings up a couple different topics. Number one is what’s the right treatment if you fail conservative options for something like plantar fasciitis and Achilles tendonitis. So, traditionally a steroid injection could be considered. The problem with steroid injection is as follows number one, it can weaken tissue, and while it’s rare, but it can actually cause a tear or even rupture of a tendon. Something that was taught to me when I was in training was you need to be careful about injecting steroids into a weight-bearing tendon. And the reason why is because if it ruptures, even if that’s rare, that can be disastrous to that human being, meaning they can no longer ambulate. So, the idea of utilizing a steroid injection in this man’s case, I think, is a really bad idea.

My suggestion to him is, why do something that’s going to increase your risk that may give you short term pain relief, let’s consider something that makes a little bit more sense, which in his case was Platelet-Rich Plasma. Which is utilizing your own blood, platelets, growth factors from the blood and platelets, to inject that into the chronically damaged tissue and do what’s called Percutaneous Needle Tenotomy. Which is where under ultrasound guidance, you stick a needle into the chronically damaged tissue, and sort of needle that to create more blood flow. And there’s good evidence to suggest that this is helpful for plantar fasciitis. And there’s also evidence that this is helpful for Achilles tendinopathy as well.

The other aspect of his case is that he also has burning sensation in the bottom of his foot. My original suggestion was let’s do also work up for the lower back to see if you also have evidence of a pinched nerve in the L5 or S1 level, they could also be causing pain and burning sensation in the foot. He had actually declined treatment for the lower back, but when we ended up treating him we ended up taking the consideration of possible nerve condition as well. And I’ll describe that. So, the way that we end up proceeding with treatment in his case, was to utilize a high concentration of Platelet-Rich Plasma under ultrasound guidance, to inject that into the plantar fascia on the bottom of the heel. And then to also inject that into the Achilles tendon on the other side of the heel. And because he also had some of the burning sensation to also inject a concentration of growth factors in the platelets called platelet lysate, which is healthy for nerve tissue and inject that around the posterior tibial nerve, which is a nerve that supplies the bottom of the heel in terms of sensation, and, can also cause pain as well if it’s irritated. So the goal in his case, is to utilize a product that’s going to be healthy, his own cells that doesn’t have the risk of causing disruption or tearing of the tendon or plantar fascia. And that has evidence of giving longer term pain relief and functional improvement. And I think he’ll actually do pretty well.

The second case is a woman in her late 50s, who sent me an email over the weekend, someone who I’ve treated for various other things in the past knees, lower back, I think maybe an ankle issue in the past as well. And she was basically emailing saying that she’s been seeing a podiatrist and for again, heel pain and was diagnosed with plantar fasciitis. She had failed conservative treatment, again, physical therapy, some orthotics, and her podiatrist had recommended amniotic stem cell treatment, and she was asking, is that the way to go, or should she do something else? And so, my recommendation to her is, okay, you failed conservative options, what injection options are right. So, okay, good she hasn’t been recommended a steroid injection. She had been recommended amniotic stem cell injection. Does it make sense to use that versus platelets versus some other kind of cell based treatment from herself.

So, number one, you need to understand what are amniotic stem cell treatments, there are no live cells in that product. So the way amniotic stem cell treatments get packaged to be sold as an over the counter product to physicians, is that they take it from birth cord tissue after a baby’s been born, then it has to be processed. And by process, I mean that it first gets freeze dried, gamma irradiated and then pulverized into a powder tissue. So it’s no longer tissue actually, it’s just a powder. That powder is then re-hydrated with saline in the physician’s office and then re-injected back into the area that needs to be treated. So number one important to understand that there are no live cells in that like, no human or live tissue can actually survive that kind of process. And there’s a reason for that. Meaning from the FDA standpoint, they want to reduce the risk of transmissible diseases. And they do that by requiring that kind of process. The other part to that is in order to be sold as an oft over the counter shelf product that needs to have a certain shelf life, months. And so you can’t just have live cells sitting around for months, it’s really created into this kind of powder package product. So there are no live cells in that, that’s been looked at multiple organizations to see are there any live cells or no live cells. So it’s not really a stem cell treatment, what it is a growth factor treatment.

So there’s a couple aspects to that. Number one is, if you have the option of utilizing your own cells versus foreign cells, you should always use your own cells if you can get the same kind of effect. Number two is if you have the option of utilizing a product with your own live cells versus a product that has maybe growth factors, which is what amniotic products do. You might as well use your own live cells, there’s benefit to that. Lastly, there is a good deal of evidence in using your own live cells for this kind of condition, plantar fasciitis. And there’s less on the amniotic fluid product standpoint. You can still get a good response from utilizing amniotic product. But, why not use your own cells, less risk, non foreign material with live cells that has good evidence. And so my recommendation to her is, if you have a moderate level condition, let’s utilize just your own platelets to begin with. Now, I personally do have experience combining amniotic cell products with someone’s own platelets, or even with someone’s own bone marrow derived stem cells. That’s a pretty, rare indication where I would do that. In her case, I would say stick with your own platelets as first line treatment before doing anything else a bit more creative, because of all those reasons that I’ve mentioned.

So, in both both of these cases, there’s important understanding in terms of why we’re selecting certain products, there’s an important understanding of what products not to use and what products to use preferentially. And then even how to proceed with treatment, which is to be more expansive in treatment for treating not only let’s say plantar fasciitis, but the other side of the heel, such as the Achilles tendon if there’s pathology and a nerve issue, if that’s involved as well.

Questions?
– [Devi] What’s an example where amniotic cells would be better than your own cells?
– [Devi] Or is it amniotic cells versus-
– They’re described as amniotic stem cells, right? but there’s no live cells. So it’s not really a accurate way to describe it right?
-Yeah I think the the indication to utilize amniotic cells is that you can get a very aggressive pro-inflammatory response. That’s, considered one of its benefits. The thing is that you can just concentrate platelets to a much higher degree and get that similar kind of response. So one of the advantages that we have for doing this in an open lab format in being in the Regenexx Network is that we can, sort of determine what concentration of platelets that we want to use, whether we want to use just platelets or growth factor some platelets like platelet lysate, we have more flexibility in that regard. So if you’re taking a very low concentration of platelets, comparing that to let’s say, amniotic cells is not a fair comparison. On the other hand, if you can increase the concentration of platelets, you can initiate a higher inflammatory response, which means you can get a similar or better effect. So, I wouldn’t say that there’s a indication to use amniotic cells in preference to some of our other cell products, I would say, are there indications where you can combine that. And I think there are depending on the degree of pathology.

– [Jackie] What would be the pain scale for patients after the procedure-
– Okay, so great question. So, Jackie is always asking about what’s the discomfort associated after treatment. But that’s cause what patients ask. And so the nature of injecting into a plantar fascia or Achilles tendon is that, like you’re walking on that so it’s sore, it’s already inflamed. If you’re gonna be putting pressure on it, it’s gonna be more inflamed. So what I generally recommend is utilize a CAM Walker boot, basically, it takes all the pressure off the foot, and you’re able to put pressure on it as you’re walking. So you’re basically offloading it. You could use crutches or a cane as well. But I personally find that using the boot, is easier for that first week. And normally it’s that first week where people are most uncomfortable. I’ve done this without that. And I think it’s just harder for people to kind of get around. But if they can use the boot for that first week, they’re generally okay with that. And then after that they can transition off and then as they start to work with physical therapy, they can then start to progressively put more and more load and strain on that heel and foot and then keep on pushing it. Does that makes sense?

– [Jackie] Mhm! And when will they see a difference four to six weeks?
– I always recommend that four to six weeks mark I can tell you that if like in that initial case that I mentioned where we’re treating the nerve part of it as well, if he does have a component of like nerve irritation that’s driving his heel pain as well, which he probably does, cause he does have that burning sensation symptom, that even just treating that he’ll get some relief up front. That’ll slowly wear off and then it’ll start to get effect from treating the actual tissue as well over the next few weeks.

– [Jackie] Thank you. I got nothing else
– Yeah, nothing else. Jackie?
– Okay, good plantar fascia. There’s more nuances to it in terms of how we treat it, how we evaluate it. I hope this has been helpful.

And until next week, I hope everyone is well. Again, as a reminder, we do two live broadcasts per week now, I’m trying to do that. There’s the weekly educational meeting that I’m doing live now. We have a set weekly live meeting every Wednesday we’re gonna have to kind of rethink about how we define that just as weekly live live. Is there some other name to it? I’m not sure. But we’re trying to do two of these per week. And until next time, I hope everyone is well. Have a good day and live well. Bye bye.


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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses heel pain, plantar fasciitis, achilles tendinis, and prp treatment.

Weekly educational meeting Live! 20200706

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Weekly educational meeting Live! 20200706
We are going live 2x per week. Live on Facebook, Instagram, and Youtube!
Topics discussed during this broadcast:
Heel pain:
Plantar fasciitis and Achilles tendinitis
Case 1
Case 2
Avoid steroids!
Nerve related pain.
PRP vs Amniotic fluid.
#heel #heelpain #heelpainrelief #heelpaintreatment #heelpainsucks #plantarfasciitis #plantarfasciitisrelief #plantarfasciitissucks #achilles #achillestendonitis #achillestendon #achillespain #prp #prptreatment #stemcells #stemcelltherapy #regenerativemedicine #regenexx #chicago #chicagomed