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.

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.

Varying Speed and Intensity of treatment for Arthritis/Tendinitis

https://youtu.be/5Qv0f8sf-A0

Varying Speed and Intensity of treatment for Arthritis/Tendinitis

When treating arthritis and tendinitis it’s key knowing when to pause, when to move forward with treatment cautiously, and when to move more aggressively.

Cases:
-Hip arthritis
-Knee/Back degenerative joint disease
-Rotator cuff tendinitis


Hello, everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast. It’s August 12th, 2020. I hope everyone is doing well and is healthy and safe. So on this broadcast I’m focused on discussing professional issues, relevant issues related to medicine, musculoskeletal health. At Chicago Arthritis and Regenerative Medicine we’re focused on evaluation and treatment of arthritis, tendonitis, injuries, back pain, utilizing the most up-to-date current non-surgical treatments that are available and doing so in low-risk, holistic ways to kind of maximize your pain, function, and quality of life.

So something I’ve been thinking about recently is speed, quickness. Speed in terms of life, speed in terms of medicine as well. And I’ll talk about the medical professional aspect in a moment, but first and foremost, speed in terms of life. It seems like life is just moving so fast right now. I was thinking about this recently that, as someone who grew up in the 80s and 90s, there was a relative consistency to life, where you didn’t expect the world to be dramatically changing every single day. And right now we live in a world where things are adapting so fast. Every single day there’s sort of new news and new noise, and that is challenging to sort of keep up with for a lot of people. In fact, even every week on a medical level things are changing. As an example, the states that are considered relative higher risk from an Illinois standpoint where you need to quarantine if you come back from one of those states. It used to be 22 states, overnight it dropped to 19 states. Maybe that’s based on some additional numbers that have come from those states, maybe that’s based on, who knows? Public health or some other issues or some local legislators who have to travel to those states. I’m not really sure, but even on a medical level, we keep on getting input about what is new and what do we understand about COVID happening on a day-to-day basis, sometimes a week-to-week basis, that it’s a lot of change and speed. It’s happening quickly. From my own personal standpoint, the way that I try to look at it is what are the key principles that I truly believe in in terms of life, values that I have in life? And now how do we apply that to every level of my life? Whether that’s personally, relationships, professionally, anything else as well. And then adapting to the situation, but still relying on those principles, because I know those principles and values are, you know, they will last the length of time. They are things like gratitude, integrity, things like that. A few other things as well that I’ll probably discuss in the future, but speed in life.

In medicine it’s interesting, because there’s different ways to think about speed. There’s obviously things like what is acute that needs really dramatic sort of up, immediate real-time sort of changes and care? And then there’s obviously things that are more chronic and subacute, where maybe you can take a little bit more time to think about it. There’s a difference in terms of speed and urgency that you need, but I think there’s even speed and a difference in terms of how quickly and aggressively you wanna treat things based on what are people’s individual goals for treatment, their individual issues when it comes to their medical health as well? And you can be relatively smart with these kind of things. On Monday I talked about how medicine, while 80% of it can be algorithmic, that extra 20% about being personalized goes a long way to making a difference in terms of outcome. And to me, speed plays into that. So you need to know, as a physician, you need to know when to pause, you need to know when to maybe slow down or treat mildly, and then you need to know when to be a bit more aggressive and treat a little bit more quickly or with more strength. And I’ve got some examples for each one of those.
The one for treating mildly or slowly, since I’m using this speed sort of metaphor, an example would be a patient who I saw recently who has knee and back osteoarthritis, moderate level osteoarthritis, and she’s someone where she’s gone through the tradition non-surgical options, meaning physical therapy, activity modification, and some knee bracing, and she’s still having pain and so she’s coming to me sort of has her first line what’s the next step kind of treatment option? And we talked about, well, you know, you could utilize something like platelet-rich plasma, you could utilize something like bone marrow-derived stem cells, why would you choose one over the other? In her case, her real goal was, can you improve my pain? Can you improve my function? And so we talked about as a first line option in her case, as someone who’s really never had any other kind of injection option is why don’t we try platelet-rich plasma for her lower back and both of her knees? And in her case, she did really well, meaning she’s two months out from treatment. Her right knee and lower back are totally pain free. Her left knee, she’s basically 70 to 80% better. She’s enthusiastic and excited about her result and she’s able to go back to work. She works as a machine operator at some kind of bakery. And she’s able to work basically 12 hours at a time now, which is essential for her from a work standpoint, from an income standpoint. And that would be a great result. That is a great result in her case. But the key here was to realize it’s okay to treat in a milder fashion, in a slower fashion, because our goals here are, they kind of meet what her expectations are and she understands that we’re utilizing something milder and if need be, we can escalate to something stronger. And fortunately in her case we don’t have to do that.

A counter example to that would be a 60-year-old woman, very healthy, very physically active who came to me for hip pain. And in the course of doing her evaluation and imaging examination, all that kind of stuff, came to a diagnosis that she’s got more advanced hip osteoarthritis. And so what we know about hips is that if you have advanced hip arthritis, the chance of getting a good outcome from a regenerative treatment is currently considered challenging. And so my recommendation to her, because she was specifically coming asking about stem cell treatment for her hip, was I don’t think that’s the right option for you. I think you really should consider hip replacement surgery. And you know, she still wants to consider non-surgical options and what I’m guiding her is let’s pause for a second. You need to have a conversation with a hip surgeon, because that is the traditional and likely most appropriate option here. If you end up proceeding with something non-surgical, understand that even our strongest non-surgical option, like utilizing your own bone marrow stem cells, is that your chance of getting a 50% or better pain relief response is about a one in three chance. And we can have that conversation again, but let’s pause for a moment, consider the other surgical options before jumping into anything else I can help you out with. That’s a case where you need to pull the brakes and say, “Well, here’s what the evidence shows. You may be very healthy, you may be very physically active, but here’s realistically how you need to be guided.”
The last option is a younger person who I saw recently, a 25-year-old, he is competitive in Jiu-Jitsu and he basically has a left shoulder injury where he’s got some, a partial thickness tear of his rotator cuff, as well as a labral injury. And we talked about what are the options for treatment, platelets versus stem cells? He’d already failed some physical therapy and talking about what are his goals, and his goals are to get back to a high-level of Jiu-Jitsu where he can still compete and we talked about what are the chances of getting that result with just platelets verus going for bone marrow stem cells, and we ended up advocating for a stem cell treatment mainly because of his goals and expectations. In this case, I’m recommending going a little bit more aggressive, a little bit faster, because I think the speed of treatment here based on the goals that he wants would fit better with that kind of treatment approach. Something a little bit stronger and more aggressive. And the reason why he’ll likely do well is because, number one, we’re utilizing a cell type, his own stem cells that gives him that chance of getting that. Number two, we have sort of a common understanding in terms of aligned understanding of what are expectations for goals of what we can achieve. And then lastly, you know, the way that you wanna treat someone like this is you wanna treat it in a complete and thorough fashion. And that means hitting not only where he has an injury to the rotator cuff and to the labrum, but to understand that the reason why he has that is because he’s had some chronic instability in the shoulder due to some ligamentous strains in the past. Let’s properly treat that as well.

It gets back to the concept of biotensegrity, which is incredibly important in musculoskeletal health, where it’s, the basic understand is that if you take a larger unit, let’s say the shoulder, you have multiple pieces that are part of that. They are not directly attached, but when they’re close together and put under compression, that under that kind of setting, the strength of the whole unit is stronger than the individual pieces. And by treating not only the rotator cuff and the labrum that’s been inured, but by treating the ligaments that provide that support to create that kind of biotensegrity and stability, he’ll get a better response. And so aligning expectations, goals with the right cell type is going to get him the right kind of outcome.

You contrast that to someone where we had treated with just platelets, the knee and her back, where she has done great, and she’s done great because her expectations are a little bit different and she has a condition that can still respond very well to platelets. And understanding the platelets in her case are going to help with not only stability in the knee where she’s got some chronic degenerative issues and ligamentous injuries. She’s got some mild chronic inflammation and we’ll help treat that as well with platelets. And, because we’re also treating the back, we’re also addressing any kind of nerve-related neuromuscular issues that can affect not only the lower back but the knees as well, but it’ll get her to a higher level of physical activity and by doing that additional physical activity long-term, she’ll then be able to help support her knees and her back as well.

So speed makes a big difference in terms of knowing when to pause, knowing when to treat slowly and mildly and knowing when to treat a little bit quicker and a little bit more aggressively. I think that makes a difference in life. I think that makes a difference in medicine as well. Great, thank you for your time. Until next week, I hope everyone remains safe and healthy and as a reminder, I’m doing the live stream on Mondays and Wednesdays. And until our next broadcast, have a good day and live well.


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 changing treatment intensity for arthritis, tendinitis, back pain, and injuries.

 

Inflammation in Joints and Tendons

img

Inflammation in Joints and Tendons
Weekly Education Replay 20200803
Inflammation
-What is inflammation?
-Inflammation in the musculoskeletal system.
-Cases
Tendinitis
Inflammatory arthritis
Post Covid19 symptoms

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:

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 inflammation in the joints and tendons.

Weekly Education meeting 2020-06-22

img

Weekly Education meeting 2020-06-22
Lots of questions and answers regarding regenerative medicine and hip pain.
-Can regenerative medicine help in hip arthritis?
-SI joint issues.
-How long does it take after treatment to see benefit?
-Treatment candidacy.
-Treating the contralateral side when you have arthritis on one side.
-Medications contraindications to treatment.

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.

Okay Hello this is Siddharth Tambar from Chicago arthritis and Regenerative medicine. This is our weekly educational broadcast discussion that I have with my team. So we have a couple questions today. And these are questions that I get from, team members who are talking to patients in terms of what are they hearing, what are the concerns patients have.

So, a couple questions that came up. Number one is kind of an interesting one which is for the regenerative treatments, How well does it work if you have such bad hip arthritis that you need hip replacement? I think that was the question right Jackie? And it’s a great question because number one, there’s a, it’s worthwhile to understand that different locations, respond differently to treatment. So based on information that we have, from not only the Regenexx network registry but also from the overall literature, what we know is that hip patients will respond differently than knee patients. So someone that has like advanced knee arthritis can still respond quite well, someone who has advanced hip arthritis is less likely to respond well. What that means is that their chance of getting a good degree of pain relief and functional improvement is going to be harder than someone that has knee arthritis.

There’s probably a few reasons for that. Number one, knees are just built to handle a significant amount of damage and pain. So our classic knee patient that shows up will be someone that will come in saying, “I’ve had knee symptoms going on for like 10, 20 years”. Maybe they’ve had surgery, maybe they’ve had other injections and frequently they may not be ideal body weight and they have diabetes. And yet their response to treatment for what we do in terms of the regenerative medicine treatments is they’ll still on average get 60 to 65% improvement in pain or better like just knees can handle it.
Hips on the other hand, are a very different story. Our classic hip patient, is someone who’s actually in shape, is actually exercising, pretty regularly, and comes in saying “wow my hip has been hurting a lot progressively the last nine to 12 months”. And pretty quickly you find that they have very aggressive advanced arthritis. They’ve lost a range of motion. Biologically something else is going on. So an interesting study that came out a couple years ago, actually looked at hip arthritis patients and found that the ones that had more progressive arthritis, and worse outcomes, where folks that actually had significant dysfunction in the mesenchymal stem cells within the bone around the hip joint. So biologically there’s something different about hip patients compared to our knee patients.
So our typical hip patient, if they’re coming in with severe hip arthritis, where they’ve lost range of motion. They are going to be a very hard patient for us to treat. And frequently in that kind of case, I will recommend, if I’m convinced that their pain is coming from the hip joint, I’ll recommend that they actually go for hip replacement surgery. In the cases where patients in that scenario, want to avoid surgery and still want to try one of our regenerative treatments. Number one, I’d recommend bone marrow aspirate concentrate derived stem cells. Number two, they need to understand that their chance of getting a good average or better response let’s say 50% or better response in terms of treatment is going to be harder. That they may have a 30% chance of hitting that or better. They’re just a harder candidate.

Now with that said, there are different levels to hip arthritis or hip pain. A lot of times when people think of pain in one area, they’ll think of it as a x ray of what’s going on and say your pain is coming from that one arthritic joint, but in reality the human body works a bit differently than that. Meaning when you look at someone that has hip pain, there’s a series of different things that are causing problems that lead to pain and dysfunction, meaning it’s not just a joint. It can be the bone, which I’ll describe in a second, that can lead to hip pain. It can be ligaments, soft tissue structures, labrum. It can be a lot of other structures around the hip that are driving pain. The interesting thing is that it can be more than just hip pain though, it can be coming from the SI joint. The SI joint is essentially the joint between the pelvis and the hip that basically can cause pain in the back of the head in the buttock area, but it can also be pain, even in the lower back, that can then translate into pain in the hip.

So I’ll give a couple examples to that. So my mother, I recall my mother limping, when I was looking, when I was doing college, when I was interviewing for colleges. I remember at Brown University which is located I think in Rhode Island, Providence, Rhode Island. That is very hilly and that she was limping, as we were going from one building to the other is the first time that I noticed that maybe she had something wrong with her gait. I kind of forgotten about for about 20 years. And in my late 30s, I realized she was having more hip pain. On her imaging, you’ll see that she’s got some hip arthritis, but on her examination you realize that her pain is not necessarily coming from the hip joint. It’s actually coming from SI joint. So, when you talk to her, she’ll tell you, “oh yeah, I’ve had that pain in my hip since you were born.” And so what you realize is that the normal kind of experience of pregnancy was that her si joints got loosened up in order to accommodate the womb. And she’s basically had pain from her SI joint those translated into her hip for literally decades. So our approach in her case was we ended up doing PRP treatment into her, into her SI joint, SI ligaments. And the cover our bases, we treated some of those other tissues as well the hip joint in the lower back but it’s is really the SI joint, and she had a really good response to treatment to the point where her hip pain was significantly better, where she’s able to walk significantly more exercise regularly on a daily basis, she can do five K’s. And my mother is about 74, she’s 74 currently or 73 could becoming 74. And essentially, I’ll still treat her basically every two years for the last couple years, and that sort of keeps her tuned up for the next couple of years where she can keep on exercising. So someone that’s got hip pain, could be really coming from SI area. You can tell that based on partly examination, partly on description of pain, and some even imaging.

The thing about imaging is that imaging can sometimes lead you down the wrong path. Have another patient, I’m actually seeing him today for his left hip pain, but I recently saw him several years ago for right hip pain. What’s interesting was his right hip showed a lot of damage on his imaging at that time. And he actually had a hip replacement and he still had hip pain. So at that time before he saw me he actually saw an interventional pain doctor that did a diagnostic injection. where they injected numbing medication into his SI joint, and he had resolution of his hip pain. So again we treated that with PRP, and he did well for a few years. I’ll find out how he’s doing right now, today. But an example of where imaging doesn’t always lead to things, right when imaging can sometimes be tricky.

The last example, I saw a lady recently over telehealth, tele Med. where she was describing hip pain again. She’s in her late 70s. She came to me, because she’s a friend of family in California. So I had a relatively limited examination that I could do for, do you with her, but she’s got an X ray of her hip that shows very mild arthritis, and on her examination from what she could do over zoom, a zoom call you could tell that she can move her hip. She’s still a good range of motion but she would have discomfort in her hip, suggested that there is something going on in the hip joint that could be a problem. So what’s curious is her physicians where she was she lives in Palo Alto had tried an injection to the epidural space. She’s had multiple injections over the last 20 years, steroid injections into the epidural space in her lower back, which have given her pain relief in the lower back. They also then recently tried a injection into her lateral hip, the outside part of her hip because they thought could this be bursitis, and she didn’t get any benefit from that either. So for me I was, I was talking to her saying look your examine is suggesting one thing, your x rays don’t fit that you’ve had some other treatments there’s something that we’re missing here. so we ended up getting a hip MRI. And so her hip MRI ends up showing that she’s got some damage in the actual bone. She’s got some early stage of avascular necrosis. That’s relevant because the bone is what actually feeds the joint. So she’s got pain in her hip, because she’s got avascular, developing avascular necrosis an early stage of that. Realistically, she probably developed that because of all the steroid injections shes had over decades. And so, you know, it’s like she has hip pain that can be treated still non surgically because she doesn’t have bad hip arthritis yet. But if he doesn’t get treated that damage to the bone will eventually lead to bad hip arthritis. And so the right way to treat that is percutaneously, meaning with a needle based method, you kind of put the needle into the hip bone decompress it, and then you inject your own bone marrow derived stem cells that’ll actually help her out. If she does that, she’ll probably get done in California from from a colleague. But it’s another example where there’s layers of this, when somebody says “hey I’ve got hip pain that requires surgery.” Well, you need to look through those different kind of layers. And so you can still come to a smart decision, but realize that there’s sort of what we know about hip arthritis, and there’s really how you approach it to kind of sometimes get at what’s really causing pain. Does that make sense?

[Team] yes What’s the next question Jackie?
– [Jackie] How Long Does it take,
– Recovery after the procedure to see differences?

Right, so great question. So, when you look at, so the question was how long does it take after a regenerative treatment process to see a response. So, this is very different than let’s say a steroid injection or a numbing injection. Steroid injection you’ll get relief after like one or two days, it’ll last for weeks to a couple of months, and then it progressively wears off. It’s different than let’s say a platelet or bone marrow stem cell injection, where you’ll have more inflammation for the first few days and even stiffness for the first couple of weeks, and then progressively improvement that starting at that four to six week mark. That’ll then kind of progressively improve for the next three to six months. In PRP there’s data that shows you’ll get that improvement up to six months in some cases even up to 12 months. What I generally tell people as expect improvement at the four to six week mark let we reconnect at the at the eight week mark see where you are. And if at some point over the next several months you’re starting to plateau and you’re not at your goal, then let’s repeat treatment. However, if you’re still improving expect there to be a continued slow improvement. And the nice thing is, as that improvement occurs, you’re able to then start to do more physical activity, which then provides more support for the joint that’s been treated. And then, that adds on to treatment improvement as well.

Jackie you had one more question?
– [Jackie] Yes, can they still proceed with the procedure if they are anemic?
– Right, so the question is about anemia. So, if you’re anemic it depends on how anemic they are, realistically so if you are, the guidelines that we have are if you are mildly to moderately anemic we reduce the amount of bone marrow that we’ll draw out or the amount of blood that will draw out from a safety standpoint. So part of it depends on, you know why are they anemic? Meaning if somebody is anemic because they have let’s say, leukemia or lymphoma, well that’s not really the kind of person that you necessarily want to treat with these kind of treatments, you’d prefer that they actually get their underlying condition treated first, before they proceed with treatment. On the other hand if they’re anemic because let’s say, they’re B12 deficient. Okay, well you just reduce the amount of blood or marrow that you take out, you should obviously be trying to treat the anemia as well. Mainly because from an overall health standpoint you want to improve that also. If they’re anemic because they’re on meds. Maybe it would make sense for them to actually do something to manage your meds first before they actually proceed with treatment. But at the time, obviously you kind of adjust the amount of blood or marrow that you take out. Does that make sense?
– [Jackie] Yes

To me the big thing is, why, right, like are they anemic because there’s something actively going on. That should be addressed before they actually proceed with treatment. You know reality is if somebody is anemic because they’re severely B12 deficient, if you corrected that they may just feel better on their own, right, they may not actually need to proceed with treatment. So sometimes understanding the Why goes a long way to, you know before you make a decision. Other questions.

– [Member 1] When someone comes to you with hip arthritis in the right hip, how often do you notice the other hip have damage, and do you ever recommend treatment, what kind of treatment?

There’s so many layers to that. So the question is when someone comes with hip arthritis on one side, how often do you see problems on the other side. And would you prophylactically treat that. That’s an interesting question because if you’re getting if you if you have someone that has severe arthritis in one hip, That may just need to be treated separately surgically anyway, Right? But then you sort of put attention to the other side where you’re saying well look something’s developing over there, maybe it would still make sense to treat that after the other hip has been treated. I think that’s one way to think of it. The other way to think of it is if somebody has let’s say mild to moderate hip arthritis that can still succeed from our treatments. Should you also be thinking about the other hip, you should certainly be thinking about it from a physical therapy, posture related standpoint, weight reduction standpoint. I think if you’re treating one hip with let’s say bone marrow derived cells, if they’re other hip is milder, they may benefit from just platelets. Alternatively, understand that they may have pain on the other side, not because of the hip joint but maybe from the lower back. So, if their lower back or SI areas is problematic, perhaps treating that at the same time would actually help the other side as well. So again it depends on why the other side is problematic, what stage is it, and is there something else going on the lower back that needs to be addressed.
– Thank you

-Lilia.
-[Lilia] what make a candidate not a good candidate for treatment?
Yeah. So what makes somebody a bad candidate for treatment. I think of a few different things. Number one is obviously what’s the severity of the pathology, but again, understand, an advanced arthritic knee can still respond well to pain relief. Advanced hip arthritis, not as much so part of it depends on which area, what degree of pathology. Number two is what about their otherwise overall health. You take someone that’s like a bad diabetic, who is poorly controlled that’s got bad metabolic syndrome, that kind of person is a challenging candidate for any treatment that humans can do, right, just because they are overall, just not a healthy person. On the other hand if you take someone that’s a diabetic, but they’ve actually put in the work the effort. Maybe they’re on meds, but really good diet, they’re exercising they’re doing everything they can. That’s kind of someone who’s put in a lot of effort, where maybe they’re controlling things where maybe they’re actually an okay candidate still that despite that other diagnosis they’ve done so much to help themselves out where they can still benefit. Then I think the other thing that I think of is what other meds they on. Are they on meds that can actually be challenging in terms of response to treatment. Because there are some meds that can actually do that. And then, to me, the the other kind of thing is what is also their expectations for treatment. When I talk to patients, if they’re fixated on let’s say, improving an imaging finding and not as much pain relief and functional improvement, You know, like maybe they’ve got the wrong expectations for treatment. That they may be a good candidate based on some of the other objective medical factors. Maybe they’ve got the wrong expectations and so having that conversation is important. So it’s going vary from person to person based on pathology, or their medical issues, maybe medications, and then also their expectations like from a professional standpoint, it’s sort of sussing out all those details to align our expectations and what we can achieve.

– [Member 2] Can you me an example of medications?
Yeah it’s an interesting one because the Regenexx lab in Colorado has really looked at what medications are harmful for mesenchymal stem cells in the lab setting. there’s so many different meds, like it’s it’s most meds, realistically. Your body’s not used to being exposed to that, it’s not evolutionary been developed for that. So, it’s tricky because if you can get people to limit certain non essential meds, then they should try to limit that. Let’s say anti inflammatory meds for pain. Okay, let’s try to limit that. Some blood pressure meds, maybe they can do stuff like that but it’s a little bit hard, right. The one that’s most relevant to me that I see are patients that have autoimmune issues, who may be on steroids, some other immunosuppressants. And what I try to guide them is, can you minimize the steroids as much as possible. But if you need that other medication to maintain your overall immune health, then I think you stay on that. It’s tricky. In my own experience, even when patients are on those meds, in theory you can tell them that maybe that’s not ideal for your treatment, but in my experience, they still do fine, in terms of treatment, but in theory that might be something that could be a limiting factor to treatment. But in reality, if they stopped those meds, if their overall condition is then active, that makes them a much harder medical candidate at that point. So, my personal take is, if someone’s got an overall medical issue that’s still active, optimize that in whatever way you can, ideally if you could do that non medication wise, which is diet and exercise or supplements. but in those people that still need meds, if that keeps them optimized and the best at their health, then that’s the best they can be in terms of a candidate. And just stopping those meds is not a smart thing you need to just take that into consideration that that may limit the effectiveness, but at least those meds have optimized your ability to live. What else.

So good questions you guys came prepared. Thank you.
-[Member] Thank you.
Yeah. Okay, good. Well, thank you very much everyone, and until next week, look forward to talking then. Be well and live well. Bye bye.


***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 regenerative medicine treatment options for the hip, and related issues.