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Weekly Live Replay 2020-07-08

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Weekly Live Replay 2020-07-08
-Fix imaging vs Fix your life.
How we can fix your fix without changing the imaging.

-Incremental progress/Improvement
Covid protocol/plan.
Personal professional development.
Regenerative medicine protocols.

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.
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https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis


Hello everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live live event. So I’ve been doing this for the last couple of months now where basically, talking live about different topics, something new that I also started within the last five weeks or so was starting a weekly educational meeting that I’m taping, where I’m talking to my own team at work, where we’re kind of discussing different topics, different questions that patients have, different questions that the team has about medical issues and what’s nice about is, it’s just a nice way to connect with the rest of the team and sort of answer what their questions are and patient’s questions are and it’s very just kind of very focused on educational topics and we started to do that one live as well, so that’s our weekly educational live event. This one is a little bit different because not so much answering direct questions, more sort of talking about different topics that are relevant to us, here at Chicago Arthritis and Regenerative Medicine and things that are relevant to me professionally as well. So this is our weekly live live event. You need the extra live because we’ve got the live attached to the weekly educational meeting event as well.

So couple of things that I want to talk about. Two topics, number one is fixed versus optimized and the other one is incremental progress and improvement, something that I’m kind of obsessed about. So fixed versus optimized is an interesting topic in that, you know I have patients frequently ask me can you fix this problem? And I understand what they’re asking, which is, can you help me out with my life? As a physician, I’m so reticent to use that word, fix. Because when it comes to musculoskeletal medicine, it’s not like we’re changing a tire at work, right. We’re literally taking someone whose got a chronic musculoskeletal issue and we’re trying to make it as good as it can be.

And so that term, fix, has always kind of thrown me off but I’ve spent some time thinking about it and I kind of realized that it’s important for people to understand that there’s a difference between fixing your imaging, X-Ray, MRI, ultrasound versus fixing your life. So imaging there’s a lot of things that we just cannot correct, if they’re old enough. So as an example, if you’ve had a chronically damaged knee for decades, we’re not gonna be able to get that to look dramatically different on x-ray. But there are certain things that we can actually get to look different on imaging. So if you have a mild to moderate ligament or tendon injury, we can actually get that to look improved on ultrasound and MRI. That’s pretty exciting because with regenerative medicine treatments, you can actually get that. You can’t get that with traditional steroids and other types of treatments. Another imaging find that you can get better if you have swelling in the bone that we can actually reduce that swelling or edema in the bone which correlates with pain relief as well. So there are things on imaging that we can actually get better, but there’s a lot that we can’t. And so a really great minor example that I like to give to people is I was scanning my own knee once, not because I had any pain or dysfunction, but because I was just practicing some hand-eye coordination things. I had some down-time in the office and it’s a good way to sort of stay productive. And everything looked find on my ultrasound. As I got up, I banged my knee, the medial part of my knee against the ultrasound machine. So at that point, I had some temporary pain. I thought, well, what an interesting time to actually see, what does that look like on an ultrasound. And what you could see on the ultrasound was a little bit of swelling around the medial collateral ligament and not much else. So to this day, I don’t have any pain, I don’t have any instability or any dysfunction because of that, but when I look at my ultrasound on my knee, I do have a tiny little bit of calcification in that ligament, something that is chronic that really can’t be totally fixed, and doesn’t really need to be treated or addressed either because it’s not causing any kind of clinical problems. But it’s one of those kind of examples of where certain imaging things you can’t fix, although there are some that can be fixed.

Fixing your life, like we can still do that. So a question that comes up is how can we fix your life without dramatically improving the imaging. So, and there’s a couple different ways that we can do that. So number one, if you do have something like let’s say a arthritic knee or lower back. So what you see in a joint that is chronically arthritic is that the joint itself is no longer pumping out the right sort of proteins, enzymes, or other chemicals that make a healthy joint. You have a pathologic joint, and so biologically, it’s unhealthy, chemically, it’s unhealthy, and the kind of regenerative medicine treatments that we’re using, either your own blood, platelets, stem cells, can actually help to optimize that joint by getting those cells to start pumping out the correct enzymes and proteins that you see in a healthy joint. So you’re optimizing the health of the joint, the biologic health of the joint.

Number two, a really key aspect for how we treat patients with regenerative treatments is that if there’s a component of instability, which most degenerative issues have, that we can actually strengthen the ligaments, tendons, soft tissue structures around that joint or area so that it’s a more stable joint, it’s a more functionally stable joint. The ligaments, the soft tissue gets stronger, and so there’s better stability. Lastly, if you have any component of inflammation in the joint, which a lot of joints and tendons do even when they’re osteoarthritic or chronically degenerative, that we can actually help to return that to a healthier, non-inflammatory state as well. All of those things result in less pain, improved activity, and more stability. More stability generally gets expressed as somebody saying, you know what, before, I could only stand for 15 minutes or walk four blocks, and now I can do double that amount of time without my knee or back feeling tired or painful or fatigued. So that’s really fixing somebody’s life, right. And so if trying to fix something is improving pain and function, those are the things that we can fix, but fixing imaging is a much harder thing, but fixing life we can definitely help out with. So, I know that’s how I started to think about when people ask that question, can you fix my problem. It’s, well let’s be clear about what are the objectives and measures that we’re trying to fix.

Second thing that I’ve been thinking a lot about is incremental progress and improvement. I think about this a lot in large part because that’s what we have to do at work. From a business end, but even from a professional end, how are constantly getting a little bit better. And so two things that come to mind right now. The first is our COVID protocol that we use internally. So, you know, when you look at what are the guidance and protocols for how do you handle COVID testing, how do you handle people that are COVID positive or exposed to COVID, the recommendations are not that solid, quite frankly, when you look at what the CDC has to offer. There are some guidelines that make sense, but the CDC’s guidelines come to a point where if someone’s been exposed to COVID that when is the time that they can get back to work? There is ambiguity at that moment where the CDC very clearly says, well, you could do two things. You could either get retested or you could just get quarantined for a specific amount of time, and if you’re asymptomatic, well, then talk to your doctor and then figure out what you should do. That’s not ideal, right. That leaves a lot of ambiguity, and what’s interesting is so, on a week to week basis, I sit down with my own team with Devi and Leah in my office and we kind of talk out what’s the right thing to do. And a lot of times, you kind of settle out as, well, I think this is the right thing to do, and what else have we learned in this last week, what did we learn from talking with colleagues over the last week, what’s the right thing to do now. And we make slight adjustments, incremental adjustments week to week based on what we’re hearing, what we’re learning, the feedback we’re getting from colleagues, feedback that we’re hearing from specialty societies, and it’s just making incremental improvement of progress. That’s the way to do this, especially in a moment in time of ambiguity, just slowly, progressively, and that incremental progress and improvement. And I’m proud of the way that we’ve done that because we’ve had occasions where patients or people that we know turn out to be COVID positive, and because we’ve taken this incremental, dedicated process of trying to figure out what’s the right thing to do, we’ve been able to make smart, healthy decisions for not only our patients, for ourselves as well, and protect all of us here at work, patients, and I think the community at large.

The second way that I think of incremental progress is also, you know, how are we, how am I personally practicing when it comes to certain things. So when I first started practice in 2008 and I was really utilizing what I learned in my training, which was very helpful for certain things, but I quickly realized that there were certain conditions that really were not able to get better with the traditional kind of things that I had learned, and then I had to really sort of kick-start or kinda take my training and education to a higher level on my own. That’s actually how I originally got involved in things like musculoskeletal ultrasound as well as platelet-rich plasma and then eventually things like bone marrow stem cells and prolotherapy. And so along that way, there’s just been a slow and progressive improvement in terms of my understanding for what a lot of this musculoskeletal pathology is, my understanding of how to get a better response from treatment, and how to treat different types of patients and people in a way that’s going to get a better and ideal outcome for their particular issues.

Some examples of that would be when I first started practice or first started utilizing some of these treatments, I didn’t have a full appreciation for the thoroughness that you needed to treat every structure and layer involved in pathology. So an example, if somebody has something like knee pain, it’s very rarely that they have a problem that’s only at the joint level. They have a ligament, tendon, muscle, cartilage, bone, other things that are kind of driving problems, fascial layers, and if you treat each one of those layers, you get a progressively better response to treatment. And what’s interesting about that is in my own incremental progress of my professional career, I came to appreciate each one of those layers in a more and progressive fashion so that as I progressively sort of improved that comprehensive treatment approach, it’d lend to better outcomes.

Another aspect would be when it comes to how important nerve-related health is, neuromuscular health, is when it comes to joint and tendon problems. It took me a while, but I came to appreciate that what’s happening in let’s say a knee or an ankle or a shoulder can very much be impacted by what’s going on in the neck or the lower back as well. Meaning if somebody has knee pain, they also have a mild pinched nerve in the lower back. If you don’t address that either with strengthening, physical therapy exercises, posture related things, symmetry related things, or even injection-related treatments, you’re not going to get the ideal outcome. So there’s been a slow, incremental improvement in that, and then even seeing the value in other structures. Something big in the world of regenerative medicine now is the value of bone swelling in someone that’s got osteoarthritis. And there are certain findings on MRI that indicate somebody has significant inflamed bone that if you treat that, you’ll actually get a better response to their regenerative medicine treatment. And it’s just an incremental progress in terms of making people better.

From my own personal, professional standpoint, that slow, incremental process is how I personally get better. It’s how I can also do better for patients as well. And I think in a moment during COVID where in real time, we’re literally learning on the fly how to do a better job and what are legitimate treatments and how to deliver better care, there is that incremental process. What works, what doesn’t work, There was something published on LinkedIn by one of my colleagues recently where they were talking about, hey, here’s this brand new study showing that yes, hydroxychloroquine can help in COVID. And they were looking at the headline, and the headline was published in CNN and I went out of my way to then look deeper to look at the actually article to say, look, is there some incremental progress here? Is this actually making things better? And it turned out, that’s not the case. It turned out, what was actually helping was they were using steroids in people who are developing progressive COVID and cardiopulmonary symptoms, and that that’s actually what made them better, and it actually kinda verified another study that came out a couple weeks ago that showed that high doses of steroids in people with pulmonary complications from COVID could actually make a difference. And so in this incremental process, it’s important to understand to take that one depth layer deeper to really understand what’s legit, what works, what doesn’t work, but that slow incremental progress is how we get better so that we can take something that maybe isn’t responding well to treatment and that is challenging, and then we can actually optimize the situation and maybe even fix people that have those kind of problems.

Fixing their life, not just fixing their imaging, not just fixing what is their testing show, but actually getting them to a higher quality of life, and in that regard, I think we can still help to fix people by actually taking that kind of incremental progress of improvement.

Thank you for your time. I appreciate everyone for listening and watching. If you have more things you’d like to hear about or listen about, let me know. Again, we have two weekly live broadcasts, the weekly education broadcast at the beginning of the week, and the weekly live live broadcast midweek, and I’ll keep doing this as long as everyone’s interested in listening and watching. Until next week, be safe, have a good week, and stay healthy, and live well. Bye bye.


***For more educational content:
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Listen to the Regenerative Medicine Report podcast:
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Determine if you are a Regenerative Medicine treatment candidate:

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Contact us for more information or to schedule an appointment:
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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 fixing your life vs fixing your imaging, incremental progress in covid19, musculoskeletal care, regenerative medicine, and professionalism.

 

Weekly Live- 20200610

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Weekly Live- 20200610
-Getting back to normal vs creating a higher standard.
-Covid19 updates.
-Risk awareness.
-Things worth living for.


-Hello everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live event. It’s Wednesday, June 10th. I hope everyone is doing well. Last few months have been something, really pretty intense. Here in Chicago, we entered phase three of our COVID recovery, which generally means that people are starting to be able to do more, some more regular activities. Restaurants are allowed to have patrons eat at the restaurant if they’re sitting outdoors and appropriately spaced. And people are progressively starting to go back to work and we’re seeing a lot more people outside and doing activities.

We’re starting to go back to some version of normal life. And it makes me think of a couple of things; you know, what is normal? Should we be better than normal? Where do we go from here? I’ve heard a lot of people say that we’re moving into a new normal, or we have to think about what is a new normal. It was suggested to me that instead of new normal, why don’t we think of a elevated or higher standard of where we want to be?

So I think COVID-19 has made us all think very differently about; the things that we value, how we’re living, a lot of things. And the recent social protest connected with the George Floyd murder, I think make us think about maybe normal isn’t good enough. Maybe our goal should not be to get back to just regular life, Maybe this is a moment where we start asking, how do we elevate and actually live better in terms of our expectations from our interactions with other people in, terms of what we want out of life? And maybe normal is not good enough. Maybe an elevated standard and a new normal is what we should be aiming for.

I know here at work, we’ve been thinking about that. And for the last year, we’ve made a big commitment in terms of communicating better with patients. And I think the last three months, we’ve taken that even higher to the point where we’re committing more resources, even bringing on an additional employee to help out with client service related issues. Because normal was not good enough, because I think our patients deserve a higher standard and hopefully we can deliver upon that higher standard.

So one of the things that I think is interesting, how do we balance risk and benefit? How do we think about getting back into some of the usual things that we do in life, but take into consideration what are the risks that we have to deal with in this kind of newer COVID world? And you know, what things are worth the risk, what things are not worth the risk?

A couple of examples. During the social protests, these last week and a half, there were a lot of people out and people had concern about; is there risk that you’re going to suddenly spread COVID-19 to a lot of people? And that’s interesting because in large groups of people, where you have less social distancing, that potential risk is there, but are there certain risks that are worthwhile taking?

Now, I wouldn’t be thrilled if a 85 year old individual that has multiple medical problems, was out there without mask. But the flip side is; if you’re a young person, a middle aged person, you’re still healthy, you’re wearing a mask, you’re being sensible, you’re protesting non-violently. Maybe that risk is worth it because the benefit is you’re trying to create a better society. It’s an example of where I think thinking about risk and benefit is not a static thing, it’s a much more dynamic thing.

On that same level, the World Health Organization this past week or last couple of days, came out saying that they’re not exactly sure about the risk of asymptomatic spreaders of COVID-19. That’s a little bit disappointing. It’s good news that if the risk is not as bad of asymptomatic spreaders, but the flip side is; we literally just stopped the whole world because of concern about asymptomatic spreaders. I think this is one of those things that’s still up in the air and we still don’t fully understand. And so, I think still maintaining the usual precautions is important, but I think it emphasizes that if you’re in a position of authority, like the World Health Organization, that you need to be careful with your words and how you’re guiding people. Because, if you say one thing one week, and then you say another thing a couple of weeks or couple of months later, that’s a little bit of a problem. Like, we literally stopped all of the world’s economic activity almost to account for asymptomatic spreaders.

But the flip side is; I think for those folks who are considered low risk, getting back into some version of their usual life, maybe they can slowly start creeping back into that. Which is what people are doing and I think that’s smart. I still think it would be sensible that if you do have any medical issues, that you still talk to your trusted physician to get guidance in that regard, that what are your own personal risks? What are things that are worthwhile getting into? And kind of balancing that,
An example of that is; I was speaking with a patient of mine, an 85 year old woman. She’s 85, she’s got things like diabetes, blood pressure but she’s relatively healthy. She’s got a lot of osteoarthritic issues that I help care for. In her words; she hasn’t been this stressed as COVID-19 has put her under stress. And the last time she was under this amount of stress was when she was a little kid living in Northern Italy during World War II bombings. That’s pretty profound to hear somebody say that and it’s affected her life in a lot of ways. For example, it’s because she’s had less social interaction with friends and family, because she’s had less physical activity that she would normally do with those social outings her back has started to ache. She’s a little bit less strong, a little bit weaker and that’s causing her back to be a problem. We’ve been able to maintain her back issue for the last three, four years with some treatment but really just a lot of physical activity. And trying to figure that out for her and realizing that that is a significant issue for her because it’s not only that she has back pain but in turn, that means that it’s hard for her to cook, it’s hard for her to do other things that she enjoys, gardening. And so, trying to figure out a sensible solution for her that’s still is cautious and risk conscious, has taken some effort. And a lot of it has been some small things, things like, well, what about if we try to get you some regular physical activity every hour or two? What if you work with a physical trainer remotely? Little things to try to get her back into that.
But the reality is that this is one of those costs of COVID-19 that I think, that really won’t register in terms of problems officially but it’s one of those things that is really meaningful because it affects her life, it affects her children’s life, it affects her quality of life, it also affects her husband as well. And so, it’s a big deal. So the other thing there is, she’s thinking about; what are the other things that she can get back into? I think it’s her and her husband’s like 60th wedding anniversary, something remarkable like that. And so, they’ve made some plans with their family where they’re going to cautiously try to have some kind of get together in that regard. Where they’re still maintaining some safety measures, social distancing and all that, but realizing that maybe the risk of that is low enough but the benefit is so high that she should absolutely do something like that. And so, I think the next several months are really going to be a lot of balancing benefit and risk and trying to figure that out.

I think one of the other challenges that a lot of us are going to have is how do we get back into our normal physical activity routine? I know the last few months I’ve had to change a lot of things, in terms of maintaining my shoulder health, my back health. Things that I was normally doing, I’ve had to sort of adopt other ideas with home related exercise rather than going to the gym. And I think it’s going to be interesting that as some of these facilities reopen, how do we get back into that? And I think, again, it’s a matter of being smart and targeted and risk aware that likely I’ll probably go back to playing tennis once where I play tennis opens up, because you’ve maintained kind of a natural amount of distance. I’d probably be a little bit more cautious upfront for those first few weeks or even month when they reopen the actual sort of gym facilities. But I think it’s one of those on a case-by-case basis where you recognize the benefit of doing certain activities and you have to balance that with other things.

I know in that same respect, one thing that we’re trying to do at work we’ve had, I mean, my office team has been incredibly busy and really hustling to try to make sure that patients and client service has been maintained the last few months, even when we’ve had COVID-19 going on. And so, we’re trying to set up some sort of outing where we can kind of meet outside of work in a safe space that sort of is able to let the rest of the team kind of cool off, enjoy themselves and sort of recognize some of their hard work. And I think, it’s a low-risk activity that we’ll figure out how to do but the benefit is; it’s a matter of connecting with the people who are working so hard and doing the right thing, that there’s some benefit to that.
I think there’s a version of that, that we have for everyone. Some sort of regular recommendations I would have for folks who are older, that are dealing with some of the challenges of being confined in social distancing is; keep in mind that there are certain things that are still worthwhile doing. You can still take a walk outside. I think when it comes to important life events, birthdays, do we totally avoid them now? I don’t necessarily think so, I think you can do some of these things in a risk-conscious, low-risk way. I think if you’re asymptomatic and you know that the number of people that are going to be at the event is going to be relatively small and limited, you can still partake in some of those activities.

Part of getting out of COVID-19 is recognizing what things are still important and are worth living for. And I think if we take nothing else from the last three and a half months, it’s resetting what is worthwhile for life. I think in the normal groove of life, there’s a lot of just distractions and things that don’t really have a lot of importance that we all get stuck in. And I’d like to think that in this new normal, this elevated standard, that hopefully we start to think about that. Maybe we really allocate our time and efforts on things that are more meaningful to us, because realizing that some things are still worth the risk and there’s a lot of things that really aren’t.

Lastly, the last recommendation for some of my autoimmune patients who are taking medications, good news is; we’re still on track. Meaning that if you’re on meds, understand that the evidence and data out there is that it’s still okay to stay on those medications. I still think you utilize the same precautions that we’ve all been taking in terms of social distancing, as well as wearing masks but understand that there’s no evidence that folks who are on these medications are at higher risk for complications. And as long as you’re asymptomatic and you’re doing well, you’re staying in touch with your physician, you’re making risk-conscious decisions, it’s okay.

I think this, it’s such an interesting time right now that we’re all so risk-conscious and thinking about things in ways that are different. Whether it’s, how do we want to live in a more equitable and just society? Or whether we’re thinking about what things are really worth the risk of living? I think we can come to some decisions individually and hopefully as a society to make smarter, better decisions that make life worthwhile living and make it better. So that we’re not just getting back to the usual normal but that we’re actually trying to live and get to a higher standard.

I appreciate your time. I hope everyone is doing well. Leave me your thoughts, and until next week, have a good day and live well! Thank you, 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 doing better than normal.

 

Weekly Live- 20200603

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Weekly Live- 20200603
Topics discussed:
-George Floyd
-Peaceful protests
-Riots
-Doing better
-Health disparities
-Covid19

-Okay, hello everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. This is our Weekly Live event. It’s June 3rd 2020. My mother just sent me a message saying you’re drinking water while live. Yes, I know. It’s okay. These are some fairly extreme times whether you’re talking COVID whether you’re talking about protests, whether you’re talking about rioting, an extra sip of water on a live stream I think is okay right now. I think we all get some leeway.

So, I’m going to keep it relatively focused and straightforward today. I normally am focused on obviously talking about medical related issues because am a physician obviously will have something to talk about. But you know the last couple months everything has been so focused on COVID. COVID, COVID COVID! And that’s like everything is affected by that you know, are we talking about you know condition x, what’s going on with COVID. People are on treatment, why? But has COVID affected that, COVID COVID COVID. And at some point, you start to get kind of drained from just talking about everything connected with COVID. But that’s obviously what’s on people’s minds.

And so as you try to stretch out to talk about other things, I think there’s always value in that kind of diversity of thought and thinking and what else is going on. This last week however, you know we have to be honest and the only thing that’s on the mind for a lot of us in the United States is really what’s been going on socially in the world or rather in our country. And it’s relevant from not only the standpoint of that’s what on my mind and that’s what’s on the mind of everyone that works in my office, my colleagues, in the town I live in, my family, but I’m sure all of you as well. But also you know, how do we grow, adapt and how do we get better with what we’re doing? because some of the themes and topics of what’s going on right now affects us in healthcare as well for sure.

Obviously the big picture right now is all about George Floyd and protests related to that and now some of the violent activities related or surrounding that as well. And first and foremost you know, it’s made me think about some things very differently. And you know the video of George Floyd getting killed. I’ve never seen anything quite so dramatic and so vicious to see someone literally get choked out and killed on a video, that’s something. You know, with that said, I mean, we’re constantly nowadays seeing videos of Black Americans black people being shot by either security forces or civilians. And that’s some heavy stuff and so relevant because it affects not only our neighbors, our colleagues, co-workers, employees, team members, all that kind of stuff. But you know some of this even affects, you know my daughter who’s six years old. I’m obviously very disturbed to see some of these kind of things on TV because it is extreme and so dehumanizing. But, you know, on top of that, I’m obviously not thrilled that, you know my six year old daughter is seeing some of these things. And while she hasn’t necessarily seen a video of that of George Floyd being killed, you know, she knows what’s happened. She knows that this happened to somebody by a police officer who is supposed to be there to help. And fortunately, my wife has a level of sophistication and emotional intelligence to have that kind of conversation with her to give some perspective and thought and understanding to it. But you know, what a world that we live in that our kids that young have to be thinking and aware of this. Obviously, incredible. Not a good thing.

On the other hand, you know also just seeing the video of George Floyd being killed, knowing some of the things that he said, not just that he can’t breathe, but even calling out to his mother knowing that his life is ending. I mean, just heartbreaking. Really just amazing. And in my office today, you know we have our weekly meeting. And you know we spent some time talking about this because it affects all of us and it weighs on us and I think talking about it, discussing it is vital to really not to make sense of it, but just sort of deal with it. And so that’s really what’s going on in my mind.
You know, it’s been impressive the nonviolent protests that have happened after that. It’s very encouraging to see the diverse group of people that are involved in that, whether it’s ages, whether it’s racial ethnic groups, all over the country that’s incredibly positive and productive and something that I’m proud of as an American for sure. On the flip side, you know the violence, the riots, the looting that have happened afterward, is devastating and very disappointing and so hurtful to people. And to see what’s happened certainly in the city I live in here in Chicago is shocking. And first and foremost, understand that here at work you know we’re very fortunate that even though we’re located downtown, we’re in an area that is still relatively protected and okay and safe. And so, in our office I mean, we’ve been fine. In fact, we’re starting this week we’ve been working in the office three days per week and starting next week we’re here five days per week. We’ve been fortunate that things have not been more extreme or problematic and so I’m very grateful for that.

But, you know this goes much beyond just you know what we’re doing at work. The reality is that here at work we’ll be okay, we’ll get through this security is fine. But, you know it’s made me think about other things as well. You know, at baseline there are security issues that a lot of our friends, colleagues have to deal with that maybe we don’t always think about. And I think decent people think about, you know what they’ve seen in the last week and say this is unacceptable and having that kind of animosity or dehumanization of another person is unacceptable, especially when it’s based on things like race, ethnicity and gender.

It’s occurred to me that, you know at baseline, obviously, black people have a level of stress and bias that they have to deal with that most of us don’t have to think about. And even if we have our own issues and our own biases that we have to confront on a regular basis you know our black brothers, sisters, colleagues, friends, neighbors, they deal with a level of stress on a daily level that is crazy. And it’s unacceptable.
Since I’ve had my daughter who’s six years old, you know I’ve thought about issues that women deal with in a much different way as well. And, you know at baseline it’s disturbing for me to think that at baseline women have concerns about security every single day. And that the greatest threat to women kind is mankind. That’s terrible. And so even if we don’t have explicit biases, and if we don’t have explicit badness in our heart or in our actions, the implicit biases that so many of us carry and walk around with are making the lives for a lot of our citizens worse, whether it’s for black folks or their ethnic or racial groups and certainly for women as well. That’s unacceptable and I think that’s something that you know as individuals we have to work on.

You know, locally, you know I didn’t grow up in Chicago, I grew up in Western New York, but I’ve been in Chicago for almost 20 years now. And I’ve been in practice since 2008. So for 12 years now. And the vast majority of people that have worked for me have generally grown up and have very deep roots in Metro Chicago, whether that’s North side, South side, West side or the suburbs. And to see their city and their area being burned down is very rough. And it made me realize that for a lot of the people that have spent the time and the effort to help me at work, to help patients and to help my professional career that a lot of them at baseline have security issues based on a neighborhood that they live in, or social issues that they have to deal with, if based on their racial or ethnic background, or security concerns just because they’re women. And the majority of people that work in my office are women. And it strikes me that for them to still be able to deal with that on a daily basis and to come to work, and to show such a high level of professionalism. I mean that takes a lot. And I’m impressed by that. And I’m extremely grateful for that. Because a lot of those things I don’t necessarily have to think about on a daily basis. And I’m impressed that those folks who support me and help me out, are able to push through those things in a way that goes above and beyond what is frequently required or expected. And so I’m extremely grateful for that.

So, you know it’s interesting here in Chicago, we are actually in the next phase of opening up like we’ve had this crazy week where protests are still ongoing, but on a nonviolent basis. Incredible amounts of violence though and yet we are actually opening up to the next phase to account for COVID and I think for businesses that have the wherewithal, the guts to kind of persevere and try to open up now, hats off to them. because that’s not easy. I can tell you here at Chicago Arthritis and Regenerative Medicine, we’ve been very fortunate that we’ve been able to continue at a significant level because my team’s been able to figure out telemedicine at such a high level. And we’re pretty much getting back to full capacity and doing what we need to do.
But this is, you know the new normal. It’s gotta be better than the old normal, because the old normal wasn’t that good. The old normal was a world that made it a lot harder for black folks, for women, and was kind of lousy to begin with. And I think this is an opportunity for us where we have such extreme challenges but we can do extremely well. And how we react to create a better world is how we are defined going forward. So you know, hopefully the new normal is dramatically better than what we’ve been dealing with. Anyway, I know this has been sort off my normal flow and sort of ideas. But this is important.

Reality is we need to do better for each other, but this affects not just things outside the office. The reality is that when you look at health outcomes for black folks, Latinos, even women when it comes to heart disease like their outcomes are worse than other populations. And is that because that there are intrinsic problems, metabolic problems, maybe. But are there differences in terms of how people are treated and dealt with how their health concerns are addressed long-term. If black folks have higher rates of have high blood pressure long-term because they’re not getting the same level of care that the rest of us do. Or if their rates of asthma are worse than other asthmatics then they do worse with coping. And that’s what we see, we see that COVID patients that are having much harder times tend to be blacks and Latinos. And I can’t fix, none of us can fix the macro the global problems, but on an individual basis on a micro basis, we can do better. And I think we all deserve that to live in a world that is better.
So thank you for your time. Have a good day and live well and look forward to talking again next week. Bye bye.


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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses doing better.

Fundamentals- Why Regenerative Medicine for Musculoskeletal care

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Regenerative medicine in Musculoskeletal care
In this video we discuss why regenerative medicine is being used for arthritis, tendinitis, injuries, and back pain.
Hello, this is Siddharth Tambar from Chicago arthritis and regenerative medicine. In this video I’ll be talking about a fundamental issue which is “why regenerative medicine in musculoskeletal care”.
So regenerative medicine is the utilization of cell based treatments like your own blood, platelets, other chemicals, bone marrow derived stem cells to treat orthopedic and musculoskeletal conditions including arthritis, tendinitis, injuries, and back pain. So why Regenerative medicine. Why is that even an option that we should be considering and discussing.
First and foremost it’s because our current options can be better. As an example in 2015 the British medical journal came out with a article that showed that only 20% of current Orthopedic surgeries meet level 1 evidence. That’s the highest level of evidence that scientific and medical studies can go through and only 20% of the surgeries that are done really meet that criteria. That means 80% may have some utility but are not really hitting the highest mark. It’s an opportunity for can we do better? Not just only on the surgical end, but are there ways that we can treat some of those conditions non-surgically to get an equivalent or better response.
Number two, we need to look for lower risk options that can give similar or better results. So for an example a number of studies over the last 10 to 15 years have shown that if somebody already has knee osteoarthritis a routine meniscectomy surgery where you shave down the meniscus or routine arthroscopy to shave down some of the cartilage is no better than just physical therapy. We need more lower risk options. Those are opportunities where regenerative medicine can actually help.
Lastly traditional medicine for Orthopedic conditions is generally to take a very conservative approach until a condition reaches a very end stage level where now only a surgical solution may be beneficial. And in the meantime, utilizing conservative measures such as physical therapy, manual therapy, acupuncture, and Chiropractic which are all good low-risk options. But to also use other options that have a bit more risks, including anti-inflammatory medications, narcotic medications, and even steroid injections which all have potential risks if utilized in a long-term fashion. So again areas where we can do better and regenerative medicine has the potential to fill in that gap.
So how can we do better? Well, we can help with regenerative medicine to improve instability to improve certain degenerative conditions, including osteoarthritis and tendinitis. To reduce chronic inflammation in a joint or tendon. If a joint has been acutely traumatized we may be able to help in that kind of case as well. If someone has an acute soft tissue injury of a ligament a lot of time that can partially repair but you may be able to get a better response in terms of repair and functional Improvement if you can utilize a regenerative medicine treatment. And there’s also some evidence that you can augment some surgeries of the knee and the shoulder with cell based treatments as well. These are all places where regenerative medicine has a role.
So why regenerative medicine, it’s because we can do better in a lot of traditional cases. It’s because we don’t have a lot of great options in some cases. And it’s because some of the options that we’re using already can be augmented with some cell-base regenerative medicine treatments as well. Hope that gives some perspective on where and why regenerative medicine It is something that has a role in Orthopedic care and musculoskeletal care. Thank you for your time. Have a good day and live well, bye bye.

Continue reading “Fundamentals- Why Regenerative Medicine for Musculoskeletal care”

A Tale of 2 Different Patients

A Tale of 2 Different Patients

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One of the joys of clinical practice is the diversity of patients that you see. Diversity in who they are, in their demographics, but also diversity of pathology and presentation as well. I have two cases today that really are a good example of that.

The first is a 84-year-old woman, high functioning, who recently became a great grandmother, seeing me for her knee osteoarthritis. And number two is a 41-year-old man, who is active military and in the last couple years transitioned to more of a training role, and he has a number of chronic injuries affecting his left shoulder, left elbow and right knee.

Very different, very different level of function, but goals are in some interesting ways similar. Namely, can you reduce pain, keep them at a very high baseline function level, and can you do this in a low-risk, high-reward sort of way?

In the case of the 84-year old who has chronic knee osteoarthritis, it’s been essentially treating her roughly every 18 months for the last seven to eight years, with a high concentration for her knee osteoarthritis joints, and also treating her ligaments around the knee with what’s called Platelet Lysate as well as Dextrose Prolotherapy to add more stability as well, and she’s done really well with that.

In the case of the younger man who’s still a very high level of physical activity, it’s a matter of treating some of his soft tissue injuries, but also some of the early arthritic component that he has as well. So a combination of different sorts of PRP, different concentrations, as well as Platelet Lysate to treat some of the ligamentous injuries as well. And again, in his case, treating him roughly every year or so for one or another sort of injury that he’s developed over time. In both cases, fortunately, these are folks that have done well for the last few years with treatment, they’ve been able to avoid surgery, they’ve been able to maintain their activity level, at a very high level. In the case of the man, being able to maintain a active military duty lifestyle. And in the case of the great-grandmother, being able to spend her time with her family, and doing all the activities that she wants to do. Those are great outcomes in both cases, and hopefully they both continue those kind of great outcomes.