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Bone on Bone Knee Arthritis on Xray- What does that mean?

bone on bone knee arthritis
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Bone on Bone Knee Arthritis on Xray- What does that mean?

Bone on bone knee arthritis on xray does not necessarily mean knee pain.
In this video I discuss a study from Korea looking at advanced knee arthritis on xray vs pain.
-Treat the patient, not the image.
-Demystifying “Bone on bone” arthritis.
-Understanding the Regenerative medicine approach to treating the knee.
Treat all pain generators.
There are layers of pathology, treat all layers.
BMC Musculoskelet Disord. 2020 Sep 29;21(1):640.


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
https://www.chicagoarthritis.com/schedule-a-telemedicine-appointment/
 

– Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast is October 7th, 2020. Thank you for everyone’s time and I hope everyone’s doing well. So on this broadcast, I discuss concepts that are important with what we do here at Chicago Arthritis and Regenerative Medicine where we specialize in evaluation and management with nonsurgical options for arthritis, tendonitis injuries and back pain. So interesting study that came out recently that I think really exemplifies a lot of what Regenerative Medicine is about is an article that came out from Korea in the BMC Musculoskeletal Disorders Journal where they essentially looked at what does it mean to really have advanced osteoarthritis of the knee? So they looked at three large national databases in South Korea. They had a total of 20,000 people and roughly 10% of them had advanced knee osteoarthritis on x-ray. That’s probably to be expected in a large enough cohort of people that 10% of them would have KL4 degree osteoarthritis. And what they found that was that up to 30% of them were asymptomatic without any symptoms of pain or loss of function that they were describing due to their knee arthritis. That’s interesting because for physicians we frequently talk about how you should treat the patient and not treat the image. And yet it’s very frequent when it comes to musculoskeletal medicine that people will look at someone’s knee x-ray and will tell them “Well, you actually have bone on bone, knee arthritis, and you should consider knee replacement surgery.” And that’s regardless of how significant our pain is or dysfunction is or if they’ve even failed other treatment options. And so that concept of treat the patient not the image is really exemplified here because just having severe osteoarthritis on the X-Ray did not necessarily mean that you’re going to have really significant pain. And in this article, they have this last line where they say, “Treatment options focusing solely on cartilage engineering should be viewed with caution.” It’s a really great line because there is a developing industry in orthopedics that’s based on actually trying to repair small cartilage lesions. The idea being that a person’s pain is coming from the amount of cartilage damage, as opposed to the stress on the bone or the other soft tissue structures. And this is a great study because you know that even when you have someone that has advanced arthritis of the knee that that’s someone who can still respond very well with regenerative medicine approach to treatment. In fact, the evidence out there shows that the degree of arthritis in the knee does not make a difference when it comes to utilizing your own bone marrow derived STEM cells when it comes to treating that knee arthritis. On the other hand platelet rich plasma sometimes can be worse and not as effective in some of those more advanced arthritis, but your own bone marrow cells definitely can still be helpful. So, and part of that comes from an understanding of how regenerative medicine works. Meaning number one, you want to treat all the pain generators. It’s not just looking at how much cartilage wear there is but it’s also what else is going on in that joint. Is there any degree of chronic inflammation? Is there any sort of chronic stress on soft tissue structures, meniscus, ligaments, tendons? Is there any sort of nerve or muscle related issues? How can you maximize? Not only the cellular health within the joint. How can you produce chronic inflammation. How can you improve stability of the joint by improving the soft tissue structures as well. And really improving the overall joint and what’s driving pain. Understanding that degenerative process in a knee is not just how much wear there is on the cartilage that you see on an X-Ray or an MRI but really it’s the entire structure that’s pathologic. And how do you actually make that whole structure better. And the last part of that is understanding that there’s layers of pathology in someone that’s got degenerative arthritis of the knee, and you need to address all those layers. And so a classic mistake that I see from physicians who dabble in regenerative medicine, is that when it comes to treating an arthritic joint they’ll only inject cells into the joint. They don’t actually treat the whole structure meaning all those other soft tissue structures and those layers and layers of pathology. It can make a big difference from someone who has a average or even mediocre result from treatment to somebody who has a really great result to treatment. That understanding that it’s not just what is an X-Ray look like on a knee, but treating that whole structure and the whole patient as well. And so understanding that you treat the patient and not the image is something that I think for everyone out there it’s important to understand that because even if your physician says that and believes that a lot of times your actions don’t necessarily showcase that. And a proper regenerative medicine expert really understands that and will do a better job of treating the whole structure, the whole joint to give you pain relief and functional improvement. Great, well, I hope that clarifies some understanding of bone on bone arthritis that’s described on x-rays frequently. As a reminder, we do this on Mondays and Wednesdays. In addition, I’m doing a webinar today 5:00 PM central standard time on regenerative medicine treatments for the knee. If you’re interested, just see our link attached to this video. And until next time have a good day and live well, bye bye.

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

Questions and Answers re your Musculoskeletal Health

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Questions and Answers re your Musculoskeletal Health:

-How to diagnose a joint infection.
-How to evaluate and treat bursitis.
-Can you inject stem cells into an infected joint?
-When would you retreat a joint or tendon if it’s already been treated with a regenerative medicine treatment.

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
https://www.chicagoarthritis.com/schedule-a-telemedicine-appointment/


– Hello. This is Siddharth Tambar from Chicago Arthritis and Regenerative medicine. It’s October 5th, 2020, and welcome to our weekly live educational broadcast. So last couple of weeks, I’ve been doing this on my own, but I have a team here today asking me questions, which is the way we’re supposed to be doing it, where I answer questions that they have, or that patients have about what we do here in clinic. As a reminder, we are focused on nonsurgical treatment and management of arthritis, tendinitis injuries, and back pain. So great to be doing this with questions again. Jackie, you have questions go for it.

– [Jackie] Yeah, so the first one would be how to rule out the infection of the joint?

– Okay. So first question was from a patient who was asking, how do you know if you have infection in a joint? So a couple things, number one, if you have an infection, there’s certain classic things you would expect to have. Fevers, for sure, swelling in the joint as well, but the gold standard way to really rule that out would be to take fluid out of the joint and to send that off to the lab, let that incubate and grow for several days and rule out any bacteria, fungus, or any other kind of infectious organisms. So for most people, it should be that simple. There are some cases where someone may have a chronic infection or a chronic reaction if they’ve got hardware in the joint, but for the most part, ruling out infection is generally pretty straightforward in that manner. Next question.

– [Jackie] What can you do for patients that have bursitis?

– Great. So what can we do for patients that have bursitis? So bursitis essentially means over different parts of the body, let’s say the shoulder, the knee, the hip, you have the small little fluid sacks called a bursa, which basically helps to protect the bone and that part of the region from any kind of stress, it’s just another sort of small buffer. And in some patients you can have an irritation of that sack, which then leads to bursitis, pain and swelling. So what’s interesting is that number one, does a person really have bursitis? So something that I frequently see, whether it’s for hip bursitis or shoulder bursitis, is that what gets called clinically bursitis is not actually truly bursitis. When you actually look under ultrasound, which you find is more tendonitis and you don’t actually find fluid in the bursa. So number one is, do you really have that proper diagnosis? And so if somebody truly has tendonitis and it’s not actually bursitis, you’d want to make that diagnosis first. And then the treatment for that would be as we do that, as we do this every single day, which is physical therapy, activity modification, and then if needed using either your own platelets for platelet rich plasma or your own bone marrow derived STEM cells, inject that into the injured tissue, whether that is the tendon, the ligaments that support the support that area as well. And sometimes if there is a chronically irritated bursa, even injecting into that as well. On the other end, if somebody really does have fluid in the bursa, then number one, just draining the fluid out of the bursa, making sure that it’s not infected, making sure that there’s no crystals or other inflammation in it. And then treating not only the bursa with those same cells, but then also treating those other soft tissue components around that as well to help basically protect that area, make it stronger, and then prevent that recurrence of bursitis. What other questions?

– [Jackie] My very last one. Patient wanted to know, how would that procedure work for him, the regenerative procedures, if he does in fact have infection in the joint?

– Okay, great question. So last question that Jackie asked is I guess the question is, can you utilize these kinds of cell based treatments if you have an infection in the joint? And really the simple answer is no. I mean, if you truly have an infection in the joint, you’d want to get that cleared. Firstly with antibiotics, you may need to actually get that surgically cleared as well, drained out more thoroughly. I would not recommend injecting cells or really anything for that matter into an actively inflamed joint. A better option would be to treat the infection first and then treat any sort of residual issues that may be there. For people that have had chronically injured joint after a prior infection, after the infection is cleared and you’re kind of fully away from that, then you can actually inject your own cells, whether it’s bone marrow or platelets into the joint, to actually treat that injured joint to that point. But when it’s actually infected, you definitely want to avoid that.

– [Jackie] Thank you.

– Devi or Susan, questions?

– [Susan] Nope, none for me.

– Wow, I must be doing a great job answering questions at works then.

– [Jackie] I do have a question. I know I said last one.

– Yes, please.

– [Devi] So we oftentimes have patients who are repeat customers to either treat the same joint a few years later, or the complimentary joint. So, you know, first we did right hip and then coming back to the left. So is it normal for patients to have a few years go by and have the same area treated again and why?

– Okay, great question. So the question is, is it normal to retreat an area after it’s been treated once? Partly it depends on what the problem is, right? So if somebody has, let’s say a recent onset injury, the expectation is if you can treat that early on, you can actually prevent that from progressing in the future. They probably would not need repeat treatments. On the other end, if somebody has, let’s say a chronically arthritic knee or lower back, it’s likely that they will need repeat treatments sometime in the future. The evidence shows that not only do people get long lasting results, but that if they do need a second treatment, they’ll actually get a improvement to a higher level after that second treatment as well. So a couple examples of that. Number one is my own mother-in-law, I’ve treated one or the other knee, basically every six months. So treating, let’s say, her left knee once per year, her right knee once per year. It’s been about a year since we last treated either one of her knees. And she’s someone that has had really significant damage in the knees in the past. Because we’ve repeat treated her over time, she’s actually done well without any treatment for either one of those needs for the last year. So she’s had sort of a persistent longer lasting result because she’s had repeat exposure to cells. Another example would be a patient who I saw in the past that had what I would consider a very challenging hip case. And he actually got treated every six months, three times with his own bone marrow STEM cells. And he’s done phenomenally well, like much better than I would have expected. And so even in cases that would be considered chronic or poor candidates repeating treatment can make a big difference longterm as well. So absolutely for chronic issues, you should expect somewhere down the line, repeat treatment. Note that the best way to maintain effectiveness longterm is to maintain ideal body weight, strength around that joint as well, and alignment, neuromuscular health, metabolic health, all the basics that we talk about nowadays. So yes.

– [Devi] Is that expectation set during the evaluation with you?

– It’s discussed, for sure. Yeah, absolutely. I mean the data and the evidence and the numbers that we generally kind of quote about effectiveness of treatment are based on a one time treatment. What I tell patients is expect somewhere down the line, if you have a chronic issue, you’ll likely need a repeat treatment again at some point. What else? Devi, Jackie.

– [Jackie] I think those were my main ones for this topic.

– Susan, are you inspired with any questions?

– [Susan] No, none. Okay, great. Well, thank you very, very much everyone. This is a relatively short one, but sometimes that’s all the questions that there are. And as a reminder, we do this live two times per week, Monday and Wednesday. As another reminder, I’m doing a webinar this Wednesday 5:00 PM central standard time on regenerative medicine treatments for knee pain. So if you have knee arthritis and are interested in STEM cell treatment, we’ll talk about that. If you’re someone that’s had a recent onset knee injury, we’ll talk about how platelet rich plasma or your own bone marrow cells can help out. If you have an ACL injury, MCL injury, a tendon related injury or tendonitis. Or if you’re just interested in regenerative medicine, learning more about treatment in general and how you can discern and figure out which physician or clinic to see based on best practices, I’ll be discussing that as well. So until next time, have a good day and live well. Bye bye.

– [Woman] Thanks, Dr. T.

– You’re welcome.


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.
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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.

Metabolic Syndrome, Knee Osteoarthritis, Cartilage Degeneration

metabolic syndrome, knee arthritis, cartilage breakdown
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Interesting new study showing that metabolic syndrome increases the rate of cartilage breakdown in knee arthritis.
Indian J Orthop. 2020 Jul 24;54(Suppl 1):20-24.

This particular study is really interesting because we need to start thinking about osteoarthritis progressively more and more as a biochemical process, as a biologic process, and not just as a structural process. Eventually there is structural damage but what drives that are biochemical and biologic processes at the level of the joint and throughout the body. You can actually work on these variables with nutrition, supplements, exercise, and if needed Regenerative Medicine procedures.


I frequently talk about how metabolic syndrome is a problem for joints. So metabolic syndrome is a cluster of conditions that when they occur together, increase your risk of heart disease, stroke and type two diabetes. So these cluster conditions include elevated blood pressure high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride or fatty content in the blood. Significant because if you have metabolic syndrome, I frequently talk about how that makes you more prone to inflammation, which then makes you more prone to joint and tendon related problems.

So how does that really translate in a practical manner? And do we have evidence that that can really affect arthritis? It turns out, yes we do. A recent study published in the Indian Journal of Orthopaedics took a look at people that have knee osteoarthritis, and took a look at this specific question about how on a biochemical level does metabolic syndrome affect knee osteoarthritis. They essentially analyzed two different biochemical markers that you see in cartilage health. One is a biochemical marker of cartilage degeneration and another is a biochemical marker of cartilage regeneration. They found that between these two groups one with metabolic syndrome, one without metabolic syndrome, both with knee osteoarthritis, that there was no difference in the level of cartilage regeneration biomarker. However, the degeneration biomarker was higher in the metabolic syndrome patients. That is interesting and significant.

This shows on a biochemical level how metabolic syndrome may be impacting cartilage health and joint health. Also, frequently we think when it comes to treating your joints/tendons, your arthritis/tendonitis, we think of it as very much just a structural issue. We think of it as how do you improve the strength of the muscles. We also think of bones as very static tissue. That’s not really accurate. These are dynamic processes, and they can get better and worse over time. And rather than think of arthritis and tendonitis in a static manner, and as a linear two dimensional physical process only, we should be thinking of it as an inflammatory process, as a biochemical process as well, and realize that there’s other ways to treat these kinds of issues.

This particular study is really interesting because we need to start thinking about osteoarthritis progressively more and more as a biochemical process, as a biologic process, and not just as a structural process. Eventually there is structural damage but what drives that are biochemical and biologic processes at the level of the joint and throughout the body. You can actually work on these variables with nutrition, supplements, exercise, and if needed Regenerative Medicine procedures.

So really interesting study. And to me, it gives another angle about how we need to think about osteoarthritis and joint issues. And it also helps to explain why metabolic syndrome is a problem for people that have osteoarthritis, in particular of the knee, but really osteoarthritis in general. That kind of insight lets us help people in more ways. It allows us to think about how can we be preventative when it comes to knee osteoarthritis. Well, it’s by working on some of those metabolic syndrome and biochemical issues.

***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/


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.

Uncertainty in Life and Medicine

dealing with uncertainty
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Weekly Live broadcast replay 20200805

Uncertainty in life and medicine.

Strategies and examples
-Focus on what you can control.
-Accepting uncertainty.
-Focus on your big principles.
-Trusted sources

Also covered a new study showing treatment with canakinumab a il1 blocking medication can possibly help prevent progression of osteoarthritis.
Discussion on how IRAP, PRP, and Bone marrow derived cells can do so as well without medication risks.

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


– Hello, everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. This is our weekly live, live broadcast. Welcome, it is August 5th, 2020. On this broadcast, essentially I’m discussing topics and professional aspects that are relevant and interesting to me. Here at Chicago Arthritis and Regenerative Medicine, we are focused on evaluation and treatment of arthritis, tendonitis, injuries, and back pain with a real focus on utilizing nonsurgical treatments and the most up-to-date and interesting treatments that are currently available to treat not only pain and improve function, but to really treat the root cause of what’s driving these conditions. So there’s two topics I’m talking about today. The bigger one is uncertainty because I think that is just huge right now. But before that, I wanted to briefly go over a recent article that was published in the articles, on the Annals of Internal Medicine yesterday. It’s sort of a hot-off-the-press sort of topic that I think is interesting that I want to give a very brief but relevant commentary on. So essentially the title of the article is Effects of Interleukin-1B Inhibition on Incident Hip and Knee Replacement. It’s a ridiculous name, but it’s being sort of presented as, hey, finally, a medication that will prevent the progression of osteoarthritis and relevant because we have other treatments for things like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, where medication will actually prevent the progression of those conditions. And we don’t really have a medication for osteoarthritis that can do the same thing. So in this study, they looked at a medication called canakinumab, which specifically blocks a molecule called interleukin-1B, and it’s currently approved for rheumatoid arthritis. Canakinumab is approved for systemic juvenile rheumatoid arthritis or juvenile idiopathic arthritis. And it’s also approved for a very small subset of some other inflammatory conditions called caps CAPS, C-A-P-S. And in this study, they actually looked at patients that in a bigger study, they looked at the patients who have had a history of heart disease and have mildly elevated inflammation levels. And they wanted to know if utilizing this medication would prevent other heart disease. So this followup sort of subset of this study was to look at 1,000 of those patients. And they wanted to see if the patients who are on this medication would actually, it would actually do anything else from a osteoarthritis standpoint. And they found that for patients who are on this medication, as compared to patients who were just taking placebo, they had a much lower rate of progressing to knee replacement surgery or total hip replacement surgery. And so it’s presented as, wow, look at this, finally a medication that is disease-modifying for osteoarthritis. And it’s interesting. It’s very early. There still needs to be much larger studies and more dedicated studies from the osteoarthritis standpoint. And the whole point is that it’s blocking this molecule called interleukin-1. And that’s interesting because here is possibly a biologic way to actually prevent the progression of osteoarthritis. Super interesting. And it’s curious that the medication can do it, but it’s worthwhile understanding that this sort of medication has potential risks, and there may be other treatment options, and I’ll discuss that, that can do the same thing. So the potential risks of this kind of medication are, the main one is infection risk, that it increased the risk of infection. And that’s significant because you need to balance the risk of infection with the possible benefit of what this treatment is trying to do. And you’d have to be careful about suddenly utilizing this in a wide spectrum and like millions of people who’ve had osteoarthritis, especially if there’s some other treatment options that are lower risk. So the options that are lower risk are to utilize your own blood platelets and bone marrow graft stem cells to actually treat osteoarthritis. And the reason why is because those same treatments from your own blood and body and bone marrow do actually block interleukin-1 receptor antagonist protein. So it does the same effect, but because you’re utilizing your own cells, you don’t have that same risk of infection, that same risk of allergic reaction. And anytime you’re measuring risks and benefits, you need to say, what are the potential risks? And can I get the same benefit in a lower-risk fashion? And in this case, you possibly can. Now there’s no head-to-head trials of saying, utilizing your own cells versus this medication. That’s still very early. But it’s worthwhile understanding that while there may be some benefit here to this medication, you can get a similar, if not same effect, in a much lower-risk fashion utilizing your own cells right now. And so my sort of hot-take or initial take is very interesting that there there’s maybe some progress on looking for disease-modifying medications for osteoarthritis. It’s always good to have additional options, but understand that there’s existing options that already work in that same kind of mechanism where we know it’s definitely safer. Okay, so the bigger topic for the day I wanted to discuss is the concept of uncertainty, obviously with a focus on the medical side and a focus on musculoskeletal health and stuff like that. But uncertainty is the topic of the day. It’s just too big of a topic to ignore. I mean, I can’t just talk about joint and tendon issues and not sort of address what are the things everyone’s thinking about, uncertainty, meaning uncertainty with COVID, uncertainty with what are people doing if they want to go back to the gym, uncertainty when it comes to sending your own kid back to school. Obviously, my wife and I are thinking about that a lot in terms of what’s right for our own family and our own child in terms of going back to school, knowing that most schools really don’t, don’t know how to address this. I mean, this is a once-in-every-couple-100-years kind of event. And obviously the modern school system is not exactly made for that once-in-a-several-lifetime event. And there are a number of things that I think about when it comes to uncertainty and obviously seeing patients, and they’re all going through those same issues and thinking about those same concerns. Here’s kind of how I think about it. There’s sort of four different things that I’m going to give examples of of how to address kind of each one of these. But, you need to focus on what you can actually do something about. You need to be able to accept uncertainty, focusing on big principles, and you need to know what are trusted sources. And the examples I’m going to discuss are going to involve COVID-19, in addition, uncertainty in everyday decision-making, as a physician how I look at some of the uncertainty associated with musculoskeletal conditions, whether it’s things like inflammatory arthritis or even routine things like lower-back or knee issues, and how you think about imaging findings as well. Because uncertainty is present in all of these things. So first and foremost, I think it’s so essential to focus on what you can actually control. As an example, so we’re starting to realize that post COVID infection, there’s likely some chronic inflammatory issues that may be present a few months later, and obviously a lot of people are still symptomatic. We’re starting to see some of those patients. And there was a small study that came out of Germany a couple of weeks ago where they found that even two to three months after the initial infection, that a significant number of people in this small study still had evidence of inflammation around the heart, objective inflammation, either lab tests, MRI evidence. And that was regardless of how severe their COVID infection was, whether it was mild, moderate, or severe. So relevant because that same inflammation can be present in other parts of the body as well. And so I’ve had certainly one patient in particular recently who came in with all sorts of pain symptoms and fatigue symptoms after she’d had a COVID infection diagnosed a couple months ago. And it’s challenging because you’re looking for objective evidence of active inflammation that needs to be treated. And in her case, while she has slightly elevated labs, her imaging and exam don’t really show that. And so you’re in that sort of gray zone about, you want to treat this appropriately because this is likely related to her prior COVID infection, meaning the immune system is still revved up. She’s not any longer infected, but her immune system is still revved up and still causing inflammation. And yet how aggressively do you treat this is not clear. In addition, we’re not even sure what the full scope of post-COVID will be, how long does that last, and what’s the right way to handle that. There’s a lot of uncertainty to that. And for that individual that’s dealing with that, that’s super difficult and obviously very challenging when you’re being told that, listen, you have likely something, but we need to be realistic with how we’re going to treat this. And we need to be realistic to understand that there’s a lot of uncertainty here and that there isn’t really definitive guidance as to how to treat this. So let’s focus on what you can control, meaning here’s someone who’s had to pull back in a lot of exercise activity because of symptoms. Well, that will not only perpetuate her pain. It’s obviously affecting her sort of overall emotional and mental wellness as well if she went from doing significant physical activity five days out of the week and now doing none. Well, let’s get back into some physical therapy. Let’s let them start to kind of promote some of that kind of muscle firing, load bearing, get you back into doing some low-impact exercise. They can use some modalities like electrical stimulation, massage, maybe dry needling, just to help with pain as well. Let’s get back into something like that. There’s something that you can do something about. Let’s make sure you’re doing the right stuff from a nutrition standpoint, from a supplement standpoint. Optimize what you can control. It may not be 100% in terms of controlling your symptoms, but let’s at least maximize what we can control on your own without having to resort to medication, stronger treatment options as well. Focus on what you can control. Number two is focusing on big principles. So every single day, right, when I see patients, there’s uncertainty in terms of diagnosis, in terms of treatment options, in terms of what’s the next right step. And a lot of times, you just have to rely on what are your big principle understanding for the overall condition, the way the body works, in order to help make some decisions. So, as an example, inflammatory arthritis, early rheumatoid arthritis, is it really meet the criteria, does it not meet the criteria? You sometimes don’t get exact definitive diagnoses in medicine. And a lot of times, you need to use your best clinical judgment based on what you understand and have seen in the past, based on subtle findings that you might see on exam. For me, utilizing musculoskeletal ultrasound to find some subtle findings to help really push somebody into the right diagnostic criteria, it goes a long way. But a lot of times it is, in times of uncertainty, you still need to find and utilize those big principles, that if somebody has inflammation, their ultrasound findings will tend to look like this as opposed to degenerative arthritis and may look like that. That’s a big principle that helps to guide me in terms of my decision making. And that goes a long way to helping to make a right decision. Another example would be, I mean, knee and lower back degenerative arthritis is endemic. Like 70% of the population will have one of those issues or, if not higher, in their lifetime. And a lot of times people come in with pain symptoms, and their imaging may show a lot of findings. Their X-ray may show advanced arthritis in their knee, or their MRI may show tons of different things. And clinically you realize that not all of that correlates with their pain or their symptoms. And you have to utilize good principles of exam, understanding of the pathology, to really help guide people. As an example, the example I love to give for hips where it can be a little bit confusing is for my own mother. She’d had chronic hip pain for decades, and she’s had some imaging of the hip that actually showed some degree of wear-and-tear arthritis. But after a proper examination and figuring it out, it turned out her pain was really coming more from her SI joint, and her SI joint doesn’t have a ton of imaging findings. But clinically, based on my clinical experience, exam, and even treatment, we figured out that her pain was really coming from the SI joint. And focusing treatment on that has got a humongous way to treating her hip pain. And so even though her imaging may have said one thing, clinical understanding of how pathology works and how a condition presents, those big principles, helped to guide me in terms of making the right kind of medical decision and treatment decision in her case and in other cases as well. I think that same kind of concept applies to big principles in life as well. So, as an example, deciding, you know, what sort of activities do you put your kid back into, you don’t need to make reactive, scared decisions. You do need to make sensible, commonsense ones, things that are based on your own prior experience and principles that you live by. Apply those to the challenges and uncertainty of the day. It’s not going to be 100%, but it’ll at least help guide you to make the right kind of decisions that are going to respect your own beliefs and do the best that you can for your own family. Focus on big principles I think is a huge one in times of uncertainty because that’s how you stay on the right path. The third one is really accepting that uncertainty is, that is what life is. And it’s hard because right now, we went from a world that we were used to. And now there’s a humongous amount of uncertainty about what is happening in the fall for kids’ schooling, uncertainty in terms of what can you do for the normal kind of events in your life, going to weddings, going to the gym, going to restaurants, meeting friends, all that kind of stuff. And yet I think it’s important to understand that as human beings, we’re literally built for this kind of uncertainty. If you go far enough back in anyone’s family lineage, you’ll find people who went through a high degree of chaos, uncertainty, and troubled times. And the reality is that, as hard as right now is, there’ve been times in human history where people, our own family members, have had to go through things that are dramatically worse. We are built for this physically, mentally, emotionally. It’s hard, but we are really built for this, to be hardy and adaptable, to take these kind of things on. And I think that that understanding of uncertainty that that’s what life is, is helpful for not only on an individual level, but understand that even on a macro level, in terms of how science works, how medicine works, that uncertainty is part of the process. And so it’s frustrating for a lot of people to hear the CDC give guidance, one thing, or doctors saying one thing about maybe this medication works, maybe do this, maybe wear masks, don’t wear masks. And then later on, they change it up. But the reality is that’s how science and that’s how medicine works. It works based on understanding to the best of your ability what is going on now, and as more information comes in, to then adapt and change to what the new information is. That’s literally how science works. And while it may be unsettling for people to hear that, the reality is that uncertainty is part of the strength of the system, that it adapts to what the new information is. It considers what it already understands, but then adds on and layers on that new information. And the better people understand that that’s how science works, that’s how medicine works, it’s not static, it’s dynamic, it’s learning, it’s growing and understanding, I think people will feel a little bit better in terms of the advice and guidance that they’re hearing from authorities and their physicians. The last thing is you need to have trusted sources. You need to be really clear what people, organizations, news sources can you trust and that you should rely on. We live in a world where it’s great to have so much information, but there’s just so much noise. It’s overwhelming to hear the discordance in terms of what people are thinking and talking about. You need to be able to judge who you trust so well. That’s no different than how it was pre-COVID. It’s just now there’s so much noise. You really need to be very clear what physician do you trust. What higher authority organizations on a medical level do you trust? What policy organizations and other sources do you trust? Understand that they may not always be right. I think one way that you know you’re dealing with a legitimate organization or person is, are they willing to admit when they’re wrong, and when they’ve made a mistake. When can they admit that my prior belief and understanding was this way, and as information has adapted and changed, now I’m thinking this. That sort of humility is very important. And understand that when it comes to things like science and medicine, you really should trust science, scientists and doctors who are actually experts in their field of study rather than trusting necessarily political sources, other news sources, but actually trusting people who are experts at what they’re doing. So, expertise is helpful, but a sense of being humble and humility when they’re expressing that, and a dynamic process of adjusting that information as things go along because the reality is circumstances change in life. Understanding changes as well, and you know a trusted source is on it when their opinions slowly adjust over time, not someone who’s changing every week or every day what they’re recommending, but somebody who, as they gather more information, can give you more updated, sensible understanding of what you should be thinking and doing. So to me, those are the big things. Uncertainty is difficult at this time, but the same rules apply pre-COVID as they do right now. Understand that there are things that you can focus on, and that’s what you should really be focused on, the things that you can control. Number two, having a big picture understanding of how you approach life and relying on those when times are more difficult. Number three, accepting that uncertainty is part of how life is. And then lastly, making sure you have good trusted sources that can guide you during this process as well. Until next week, I appreciate your time. As a reminder, we do this twice per week, Mondays and Wednesdays. Until the next time, have a good day, be well, live well, bye bye.


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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 dealing with uncertainty in life and medicine.

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

weekly education 20200727

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

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


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

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses whether regenerative treatments can help in bone on bone arthritis.