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Weekly Education- 20200629

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Weekly Education- 20200629
-Expectations post regenerative procedure for arthritis, tendinitis, injuries, and back pain.
-Can prp or bmac help after a prior surgery?

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. It’s June 29th, 2020, and welcome to our weekly educational meeting. So this meeting is typically me discussing with my team typical issues that come up in the scope of our practice clinically, and discussing how we generally approach those issues, either questions that specific team members have, patients have, or things that I’m seeing, to give a bigger picture perspective in terms of how we handle clinical issues and problems to not only add value to individual patients, but based on how we’re handling them, to also give a sense for how we try to approach medical issues so that the general public gets a sense for what are best practices and how we evaluate things. So today’s going to be a little bit different, namely because I actually have a couple of folks who are on vacation today. So this is going to be more me just discussing directly, questions that have come up in the last week from patients that I think can help to clarify some things and offer some value.

So the first one is from a recently treated patient who had his knee and lower back treated, who had described some discomfort roughly one week after treatment, and discussion I had with him regarding expectations regarding post-treatment care, post-treatment progression and discomfort, and progressive improvement that will occur over time. So in his case, treated about a week ago, and he had sent me a text message over the weekend saying, “Hey, still having some stiffness, what are some expectations?” And so reviewing that with him again to make sure we’re on the same page. So after any sort of regenerative treatment, there is an expectation of inflammation up front. That’s normal. So inflammation for the first two, three days after treatment is expected. That can go out to roughly about a week and that inflammation can get presented as swelling in a joint that’s been treated or a tendon that’s been treated, and more discomfort or even pain for the first few days after treatment. We normally treat that with things that are not going to impair or impact the actual treatment that we’re using. So what I recommend is avoiding anti-inflammatory medications, ice, things of that nature that are meant to reduce inflammation on a more profound level. On the other hand, utilizing things like Tylenol, possibly a short term narcotic, heat, some compression, bracing, manual therapy, all those things are okay, cause they’re not going to limit the effectiveness of what we’re trying to achieve.

So this individual’s gotten over that initial post-treatment discomfort and he’s still having some stiffness and milder discomfort. And what I generally expect is some degree of that sort of stiffness for the first week up to even three weeks. The most I’ve seen is up to four weeks, but normally it’s in that first week to two weeks that people will have that. Again, that’s a normal process of what’s going on here. And that’s because the inflammation component of what we’re trying to trigger with treatment is going to lead to these kind of symptoms. So when you have that initial acute inflammation, that swelling of the structure that’s been treated, you’ll see for that first week or so, there’s still then that lower level inflammatory process that’s bringing in other cells and growth factors that you should expect for the next couple of weeks afterwards. So stiffness immediately afterwards and for the first couple of weeks is normal. If that goes beyond that sort of normal course, then reevaluation may be needed.

So to me, a more significant or concerning aspect would be if someone’s developed fevers. That shouldn’t happen. Some low grade warmth can happen immediately after treating a joint. But it shouldn’t be outright fevers that someone’s having systemically. you would want to make sure that gets checked out to make sure that an individual doesn’t have an infection. In addition, if somebody has something like gout, pseudogout, rheumatoid arthritis, psoriatic arthritis, or any other kind of autoimmune condition, getting a more significant inflammatory component for that first week in a treated joint is certainly common and expected. And I’ve seen that quite often. And that generally comes down after about a week, and then there’s that progressive sort of improvement that will develop. Other things that would have me concerned would be if somebody said after a week, “Hey, knee’s feeling or the joint’s feeling more unstable.” I’d probably want to check that out then at that point. But for the most part, swelling will slowly, progressively improve, and improvement in pain and function I’d want to be hearing at roughly the four to six week mark with a slow, progressive improvement, then going on for the next, roughly three months up to six months. There’s some data showing that with some of these treatments improvement, even up to the first year or so. But my general approach is inflammation, stiffness up front and then slow progressive improvement for the next few months.

Second question that I got was from someone who was interested in learning more about our treatments, who is asking that, she had had surgery for her joint, could this treatment still be helpful? So there’s layers to this question. The first question is obviously what kind of surgery did they have, and then in addition, what’s actually their pain? So I gave an example, I believe last week, on this same broadcast, about how someone who’d had hip replacement surgery had persistent hip pain, and it turned out that his hip pain was actually coming from his SI joint. So in that kind of case where someone’s had surgery, if they still have pain, the exact same pain, perhaps their pain is coming from a different structure. In which case, yes, they can still benefit from treatment because the area that’s already been treated was not actually their pain generating structure.

Number two, let’s say someone’s actually had treatment. Let’s say arthroscopic surgery for the knee or some kind of surgery for the back, and they’re still having pain. Why would they still be having pain, or is the pain different than what they’ve had before, and can they benefit from treatment? So, number one, let’s say someone who’s had arthroscopic surgery, they’ve had some benefit from treatment initially, but they’re still having some discomfort or progressive pain. So that can happen for a number of reasons. Number one, again, their pain is not coming from just that one area that’s been treated. They may have pain that’s coming from chronic instability in the joint. And in which case that’s not something that’s going to get naturally better with routine arthroscopic washout kind of surgery, but can still get better from the regenerative treatments that we offer, whether that’s platelets or bone marrow or even prolotherapy, where if you can improve some of the instability in a soft tissue structure, that that person’s pain and functional impairment may actually get better.

Number two is if you’ve treated an area with surgery, let’s say a lumbar fusion, they can still get what’s called adjacent segment disease, where the areas above and below what’s been treated can still get stressed. And that’s expected in the sense that if you have a surgical procedure that fuses a segment, you still will have the same normal forces and weight that’s going through that area. And instead of now being taken up by that area that’s been fused, it’s now offloaded to the area above or below. And so people can then develop that same degenerative process in that area above and below. Or in some of the soft tissue components over that same segment that had already been fused. And so in that kind of person, now they can still benefit from treatment because now you’re treating those other segments that are now being stressed. Not to mention those same ligaments that were previously in that segment that’s already been fused, those ligaments may be taking on more stress. Just because you’ve taken it off one structure, the other structures around it are now still having to take on the load. So in someone that’s had surgery, if they’re still having pain, yes they can still respond to treatment if their pain is coming from a different structure or if their pain is coming because now the stress has been offloaded to other structures.

So the short answer is yes it’s possible to get benefit from treatment, but the more nuanced answer is, why do you still have pain, what structures are involved, and what else can be helped? Now, without a doubt, if you have, let’s say, something like a knee replacement, and if you still have pain, not only consider is the pain coming from another structure, but you would also want to make sure with your surgeon that there isn’t anything wrong with the hardware that’s in place. That should always be step one. But then also consider whether other structures are problematic. So the more nuanced answer is, get to more of the details and the why, but the short answer is yes you may be able to still benefit from treatment.

Well, this was a shortened version of this week’s educational meeting. I hope those two issues are ones that, if people have been thinking about them or having questions, I hope that gives some additional explanation and answers. And until next week I hope everyone is doing well. Be safe, be healthy, have a good day and live well. Bye bye.


Content- Weekly Education
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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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses expectations post regenerative procedure for arthritis, tendinitis, injuries, and back pain. And also whether prp or bmac treatment can help after a prior surgery?


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

Weekly Live event- 20200624

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Chicago Arthritis and Regenerative Medicine- Weekly Live Event 2020/06/24
-Comparing our Weekly Live event and our Weekly Education meeting.
-Weekly Live with the Arthritis Foundation.
-Covid19 Phase 4. Sports league examples, Tennis vs NBA.
-Regenerative medicine treatments in Inflammatory Arthritis.
Case examples-
1. Severely active Psoriatic Arthritis.
2. One joint inflammatory arthritis.
3. Rheumatoid arthritis case where regenerative medicine treatment would not help.


Check us out live on Instagram and Facebook 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


Hello everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live event. It’s June 24th 2020. I hope everyone is doing well. Hope everyone is healthy, and hope everyone is not only just getting through and surviving everything in life currently. but is trying to grow and improve and thrive as well if possible.

A couple things I want to announce before I get started. The first is that I have started a weekly educational broadcast as well, that’s different than the weekly live broadcast. So the weekly live broadcast is me basically talking about different relevant topics that are occurring at work. Not to mention things that are related to not only COVID, but rheumatology, regenerative medicine, things that we see at Chicago Arthritis and Regenerative Medicine, and my thoughts as well. The weekly educational events will be different. On Mondays, I meet with a few of my team members and I answer their questions. Whether it’s questions that they directly have, or whether it’s questions that they’re hearing from patients. And we’re kind of riffing back and forth about those kind of things. It’s been really interesting and helpful for me, because I’ve learned a lot. Not to mention I’ve also had some interesting discussions as well. And so I’m looking forward to doing more of those as well.

We started to do some of the weekly live events along with the Arthritis Foundation now. I think that’s absolutely fantastic. The Arthritis Foundation has been around for a long time, they do such good work in terms of patient outreach. Research related funding as well for arthritis patients, as well as arthritis physicians and practitioners as well. So such a worthy and honorable organization, and I’m really proud to be connected with them in any way.

There are a couple things that I want to talk about today. First is COVID, getting back into some version of normal life. And here in Chicago, in Illinois, we’ve gone from phase three, and we’re about to enter phase four, I believe beginning of next week. So essentially what that means is we’ve been allowed to do things like eating at restaurants, and small numbers of people outside. They’re going to progressively start letting people start doing some of those kind of activities, and limited numbers of people indoors. It also means that certain types of gyms are going to start opening up at limited capacity as well. Exciting, because it means that we’re slowly making progress. It seems like just yesterday or rather a few months ago, when we couldn’t do anything. And so really pretty positive that we’re starting to move forward. With that said, let’s still be sensible. Let’s still use the right precautions, masks, social distancing, we still need to do that.

There are a couple interesting things. I’m not going to get into any sort of political rallies or stuff like that, but in the sports world, that are very, very educational. The first is I’m a big tennis fan, and Novak Djokovic had a tennis series that he had started in Eastern Europe recently. And unfortunately, they were taking none of the appropriate precautions, in terms of mask and social distancing. Amongst not only players but their entourage and fans, and they had 4,000 fans at an event. And four top level players came back COVID positive. So they had to cancel that whole mini tour. And it really speaks to that, even if things are improving, don’t be reckless, still be sensible, still do the right thing to protect yourself, your family, your community and others as well. Because realistically, the people who are most at risk for problems, are the elderly people that have multiple other issues as well. Which is a challenge.

I’m getting a message that someone’s having difficulty hearing on Facebook. If anyone else is having difficulty hearing me on Facebook, please let me know. And please let me know if on Instagram, anyone is having difficulty hearing. Because we should be up and running.

The counter to what’s happening in the tennis world is what’s happening in some of the sports leagues here in the US. So the NBA has a really interesting approach that they’re trying to do to complete their playoffs. They’ve actually invited their playoff teams to Orlando. To, essentially they’re renting out Disney World for a couple months. And they’re going to do everything right there, in a very controlled fashion. And it’s interesting because, Number one, their guidelines are over 100 pages long. But there are a couple things that I found interesting. Number one is how they’re restricting people that can come and go. Number two is how often they’re really checking players to make sure that they’re safe. And then lastly, another interesting aspect is, if people turn out to be COVID positive, not only are they trying to protect those players and the people around them, but before they let the players get back into a competitive atmosphere, they’ll actually do cardiopulmonary testing, heart and lungs. That’s really smart. And I haven’t seen anybody else talking about that. But from like a health standpoint for people who are trying to stay physically active, that’s a really smart idea. Because we know with COVID, that not only for lung involvement, because it’s a respiratory illness, but also from a vascular standpoint with the heart, that it’s potentially causing problems. And so I think that’s a really smart thing that the NBA is doing to help protect their players, and provide value to fans as well. So getting back to some version of normal life, but you still need to make the right smart decisions, to protect yourself and your family and community.
On a clinical level, I had a couple patients where got me thinking about regenerative medicine treatment options for inflammatory arthritis. So in my own practice, we have how we treat our inflammatory arthritis patients, meaning folks that have autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, conditions like that. Inflammation conditions where the immune system is attacking the joints and tendons. We generally treat that in a systemic fashion. Meaning talking about medications, sometimes diet, exercise, supplements as well. Then we’ve got our osteoarthritis and tendinitis patients where we’re using regenerative medicine treatments. Where we’re utilizing things like your own blood, bone marrow cells, stem cells, platelet rich plasma, to treat those kind of conditions. The reality is that there is some overlap here. And so what are the indications and ways that we’re using regenerative medicine treatments for inflammatory arthritis patients. It comes up in a few different ways. And I’ll give you sort of three different examples that I saw in the last week. To give you a sense of that.

The first would be a psoriatic arthritis patient that has widespread disease. Meaning really severely active skin involvement from psoriasis, and a lot of very inflamed joints as well. And in that kind of case where someone has like 10,20 joints involved, systemically very active condition. If they’re asking me can we use a treatment like their own bone marrow derived stem cells, that’s not the right candidate at that moment. They’re in a situation where the best way to treat them, is to first control the overall big picture condition. Whether that’s with medications, dietary intervention, other kind of interventions like that, but get the systemic overall condition under control, and then decide what to do. Meaning if there are overall systemic inflammation is under control, they might be 80% better, 90% better, and they may not need any additional treatment from a joint standpoint. Alternatively, if they’ve been treated, and they still have one or two joints that are involved, then it’s sensible to then treat some of those other areas. But taking a big picture approach in that kind of condition is the right way to take it on.

The second version of that would be someone that’s already been treated, and has maybe one joint that’s still problematic. Or alternatively, if somebody comes in, and says look, I’ve got inflammation in this one joint, and how do I treat this? So that’s interesting. So I saw a patient recently, who’s had this progressive inflammation in their knee. Pain and swelling in that knee. And they don’t have a lot of structural problems, they’ve got little bit of instability. But when you take the fluid out of the knee, it’s definitely inflamed. The traditional way to treat that would be to use anti inflammatory injections and medications to try to suppress that. That may work temporarily, but from like a bigger picture standpoint, that might be a little bit too aggressive. And that’s someone who we could actually utilize a regenerative medicine approach to actually possibly get a better treatment result. So in my own practice, what I’ve noticed is when you take someone that has an overall inflammatory condition, that if you’re treating that one joint that’s still active or problematic, whether that is one inflamed joint or one osteoarthritic joint, that joint can do not only very well from a treatment standpoint, but that’s a joint that will actually stay protected longer term.

So a great example that I have is a psoriatic arthritis patient, who had originally come to see me for pain and swelling in one knee. He definitely had active psoriasis. But he only had that one joint that was problematic. That joint was definitely inflamed. We ended up utilizing his own bone marrow derived stem cells, and he’s done really well with treatment for that one knee. But since that time, over the next couple years, he’s developed pain and inflammation in other joints. That knee remains protected and still doing well, because that’s the knee that we treated, but his systemic condition has affected other areas.

Another example would be a patient who’s had chronic RA, and that’s actually under control, but he has one joint that’s still problematic. Still a bit inflamed, very osteoarthritic. And again, he’s done really well, because we’re treating that one joint. Another great example of where you can utilize regenerative medicine techniques in an autoimmune patient with rheumatoid arthritis or psoriatic arthritis. So a nice way to sort of combine those two clinical interests of mine, but two different ways of approaching somebody that has inflammatory arthritis, or rheumatoid arthritis or autoimmune related arthritis, and they can still do well.
The last one that I think is interesting is I saw a patient this past week, he sees somebody else who has rheumatoid arthritis. He’s on medications, he’s generally doing quite well, but he has one knee that still kind of persistently swollen. So he came to ask, asking well, if we utilize his own bone marrow derived stem cells, can that get better? So it’s interesting because when I examined him, his knee was definitely swollen but not hyper-inflamed. And when we actually do an ultrasound of his knee, what’s curious is that he doesn’t have a large amount of fluid, and he doesn’t have active inflammation. What he has is called synovial hypertrophy. Which means that the joint’s been inflamed in the past. So it has a distended look. It has a swollen look. So if you only look at this as someone that has a swollen knee, would this be a candidate for treatment, maybe. But when you realize why he has swelling, which is that it’s not actively inflamed, and he doesn’t really have pain. What he has is a chronic joint finding imaging that’s causing that swelling. But that’s not going to get better, just with the kind of injectable treatment that we can give. And so in this case my recommendation was, I wouldn’t rush to jump to an additional treatment in your case, because I think your overall inflammation is controlled. And because injecting your own stem cells into the knee, is not going to reverse that chronic damage that you already have, that I would just watch this at this stage. You don’t have active inflammation, you don’t have pain, you don’t have an active osteoarthritic joint. You have a chronically thickened synovial hypertrophy, thickened lining of the joint, and that’s not going to get better with any additional treatment. And so it’s a case where on initial surface, you would say maybe he could benefit from one of our treatments. But when you kind of dig deeper, which is to kind of look at what are his actual symptoms, what are his actual concerns. Not pain, more just that chronic swelling, and what does he have on ultrasound. You can actually give them better guidance, which is don’t proceed with the regenerative medicine treatment, stick with just what you’re doing on the rheumatology side, and you’ll be fine. And so that guidance was helpful for him, because we didn’t push them into more treatment. We kept them on the right path in that case.

When it comes to medical decision making, you can take things that can be a little bit nuanced and complicated, but a combination of an understanding of the pathology and condition of what’s going on, and understanding of what you’re seeing on examination. Some bedside imaging that you can do right off the bat such as ultrasound, you can then come to a pretty good decision to actually help protect somebody and guide them the right way. And I think a interesting thing that I’m finding, is some of the conversations I’m having with folks right now, is it’s beyond just, hey, what hurts and what’s swollen. It’s more along the lines of what’s your goal? How do we get you onto the right track? And how do we get a better result long term, based on what your goals are. Whether that is less pain, whether it’s better function, or sometimes it’s maybe goals that we can’t quite achieve, with what we actually have, and maybe additional treatment isn’t the right way.

So even though we’re in a different world, meaning we’re not back to normal, right. You can still utilize good human communication, good medical communication and still convey value to people, when they have needs and challenges. And I think utilizing good common sense, and good connection with patients based on what’s important to them, you can still come to some smart decisions. And I think as we all start to reintegrate into life, continue to use good common sense, continue to use your trusted physician sources, to come to some sensible decisions about your own risk tolerance, about your own treatments, and about how to proceed forward in all those ways.

A personal challenge that I know we’re going to have at my own house is, we’re trying to reintegrate our own lives, back into some of our usual kind of situation. Whether it’s some of my activities for my daughter, because she’s a regular six year old kid, and needs to get back into some semblance of normal life. Or whether that’s how do I get back to playing tennis or going to the gym. How do we do some of these things in a safe way? Because it’s not just making decisions, based on our own personal health. It’s taken into consideration things like. Well, Who are we working with at the office. Whether it’s patients, my other team members. Even things like I’ve got my in-laws coming next next month as well. Those are things we need to proactively think about to protect people.

I keep on coming back to this understanding that risk assessment does not mean you need to be panicked or concerned. It means you live your life with your eyes wide open, with an understanding of what a reasonable risk, and reasonable things to take chances on, because they’re worthwhile living for. And I think if you do that appropriately, you can get through the next several months, which are going to be challenging. In a way that is healthy, productive and still growth oriented.

Thank you for your time. And until next week, I hope everyone is safe and healthy. Again, if you want to learn about more educational stuff that we’re doing, check out our weekly educational video that we put out every Monday as well. It’s sort of contrasts a little bit with what we’re doing in a live video as well, and I think it gives a different flavor in terms of, some of the things that we’re doing at work, and ways that we can help. But until next week, have a good day. Be healthy and live well. Bye bye.


#chicago
#chicagoarthritis
#chicagoarthritisregenerativemedicine
#westloop
#westloopisthebestloop
#regenerativemedicine
#prp
#stemcells
#arthritis
#osteoarthritis
#tendinitis
#rheumatology
#rheumatologist
#rheumatoidarthritis
#psoriaticarthritis
#anklyosingspondylitis
#autoimmune
#covid19

 

Weekly Education meeting 2020-06-22

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

Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Inflammation, Pain, and Musculoskeletal Health

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Inflammation, Pain, and Musculoskeletal Health
Inflammation is complicated. But it definitely has a role in musculoskeletal health, pathology, and pain.
Hello, this is Siddharth Tambar from Chicago arthritis and regenerative medicine. On this video today I am talking about a fundamental issue when it comes to your musculoskeletal health and that is inflammation. First and foremost it’s important to understand the difference between acute and chronic inflammation. Acute inflammation would be when you’ve sprained an ankle, acutely injured your shoulder or knee, and it feels very inflamed, hot, warm, maybe a little bit swollen as well. That is generally the body’s normal way of trying to recover from an injury. Meaning you have an acute injury, trauma, your body brings in platelets, red blood cells, growth factors to help try to heal that kind of injury. In most circumstances that’s a good process. Occasionally too much acute inflammation can be problematic, but normally that is the normal process of trying to recover from an acute trauma. On the other hand, there’s chronic inflammation.
Chronic inflammation is a problem. And the reason why is because it’s your body’s way of trying to function and recover but is not doing so appropriately, and will actually prevent a normal healing process and normal function. So when it comes to chronic inflammation, it’s important to understand the difference between systemic or total body inflammation, versus local chronic inflammation. So systemic inflammation or total body inflammation is a problem because it can cause a number of issues including inflammation in the joints, damage in the joints, and sort of permanent damage and persistent functional problems. It can also make you more prone to metabolic syndrome as well as cardiovascular disease. Chronic inflammation is on a systemic level is a big problem and leads to a lot of pathology and pain and dysfunction long term. There’s then chronic inflammation at a local level meaning at a one joint, one tendon level. You could see that as persistent inflammation within a knee that is chronically swollen, or a tendon that is chronically strained or inflamed as well. That leads to not only persistent pain, instability, dysfunction, but also damaged in some cases as well. You can have that chronic inflammation if you have a joint or tendon that is chronically unstable or if you have some other process systemically that is causing that inflammation in that joint.
So chronic inflammation is a problem. Ways that you can control that include trying to be as clean and healthy when it comes to an anti-inflammatory diet. That can mean different things to different people, but as a general rule it, to me, at least it means more of a plant-based diet, reduced refined sugars. Each person probably has some degree of susceptibility to inflammation based on their diet and that can vary from person to person. Working with an expert, proper nutritionist can help you in that regard.
There are certain supplements that can also help with chronic inflammation- omega-3 and turmeric have benefit as well that’s been shown to help not only osteoarthritis, and rheumatoid arthritis in some cases. And can be as useful as chronic Anti-inflammatory medications as well. In some cases if there’s significant chronic inflammation, medications are necessary to help control those kind of conditions. Those medications work by modulating your immune system to prevent that chronic inflammation. And then lastly in some cases regenerative medicine treatments, orthobiologic treatments, can be helpful as well either because the actual treatment itself has an anti-inflammatory effect or because if you have an instability issue by improving instability, you can reduce the chronic inflammation with that joint as well.
Inflammation has some good parts if it’s acute but is a problem if it’s chronic. It’s something that can be treated and evaluated. It’s important to recognize, it’s important to treat it. And if it’s a component of your pain and inflammation and dysfunction, it’s something that should be checked out. Have a good day. Be well, and 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 inflammation, pain, arthritis, tendinitis, and injuries.

Joint Stability- Your Musculoskeletal Health

Continue reading “Joint Stability- Your Musculoskeletal Health”