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Personalized Care in Regenerative Medicine

https://youtu.be/CVtTyvHtWYc

Personalized Care in Regenerative Medicine
A major strength of regenerative medicine care for musculoskeletal conditions is the ability to personalize treatment based on your condition, severity of pathology, and other medical comorbidities. In this video you’ll learn more about how we personalize care using regenerative medicine techniques.


Hello everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast. It’s September 9th, 2020, I hope everyone had a great labor day weekend, and I hope everyone is healthy and doing well. So we’re back at it here in the office and today I want to talk about personalization in regenerative medicine care. So this comes up from time to time and I’ll give a couple of examples of where this is super relevant. But one of the main strengths and benefits of regenerative medicine is its ability to personalize and tailor treatment to the individual that you’re treating. As opposed to medication where you have relative limitation in terms of how personalized you can make treatment. Regenerative medicine really gives you a really wide latitude for personalization and individualization of treatment. So I’ll give you a couple different examples to that.

So number one, one size does not fit all is always a good strategy when it comes to musculoskeletal health. Namely, if you have a knee issue or shoulder issue, you may not be the same sort of problem or the same type of person who respond to treatment as let’s say your neighbor who may also have a knee and a shoulder issue. And as much as you can have a personalized approach to care, that will make a big difference in terms of the outcome, because number one, it requires your physician to really understand what your issues are.

Number two, it really requires a detailed understanding of how to treat a musculoskeletal pathology in a way that will get you a better result. In addition different tissues are not treated the same, they’re treated differently. The way you treat a joint or cartilage injury, the way you treat bone swelling or bone marrow edema, the way you treat tendon injury or tear, or the way you treat a chronically lax ligament, or chronically weak, or atrophic muscle or chronically irritated nerve these are all very different in nuance. And if you utilize the same platelet preparation for each one for example, for platelet rich plasma, then you’re not really treating the tissue appropriately, you’re really treating it too, in too much of a uniform manner. You really should be utilizing subtlety and difference with how you treat these different types of tissues. So as an example, different platelet preparations will give, will help different types of tissue. So when it comes to joints for example, arthritis, you want to use as high a concentration of platelet rich plasma as you want to. You want to use a 14 to 20 times, concentration of platelet rich plasma, that’s very hard to get. There’s no commercial over the counter system or kit based system that physicians use that’ll do that. You can do that in a lab based system by taking more blood and by concentrating it over serial centrifugations, but you re you really require that kind of flexibility and personalization. With tendons while there is some lab based evidence that higher concentrations of platelets get better results. Clinically, we know that a moderate level of platelet rich plasma will do better than a low dose platelet rich plasma. In joints clinically we know a higher dose platelet rich plasma will do better than a low dose platelet rich plasma. When it comes to ligaments, either utilizing a low concentration of platelet rich plasma, or platelet lysate, which are just a growth factors from the platelets is how as a physician, I want to treat that. You don’t need that to be super hyper inflammatory, you just want to have a mild amount of inflammation When it comes to nerves, utilizing platelet lysate, the growth factors from the platelets is healthier and less inflammatory and less irritating to the nerves than normal platelet rich plasma, which tends to be more inflammatory. And lastly, when it comes to using muscles or treating muscles you want to use, what’s called platelet poor plasma, where you don’t have a lot of platelets. That’s actually been shown to be better for muscles and platelet rich plasma. So having both a different set of concentrations, as well as different types of platelet preps is what’s going to make a difference when it comes to deciding what sort of preparation you want to use based on the tissue that you’re treating.

In addition, there are other factors that can make a difference; age can make a difference. If you’re older and you’re treating a joint injury, you want to utilize a higher dose of platelet rich plasma, rather than if you’re somebody very young. Person, who’s 80 plus years old may be very healthy, but you want to to use a higher dose of platelet rich plasma than let’s say someone who is 18 years old and has a milder injury and is just a healthier and has a more robust response to treatment. In addition, if you have other types of medical comorbidities, let’s say chronic diabetes, chronic metabolic syndrome, you likely are someone would require a stronger treatment rather than someone who’s otherwise healthier. So understanding not only musculoskeletal pathology, but understanding how these treatments work, as well as the different types of orthobiologic treatments or platelets or bone marrow stem cells, or other types of treatments that we utilize in this regenerative medicine field makes a big difference and realizing that the individual person’s own variables and factors makes a difference as well, makes a big difference.

So I’m going to give two examples. First is a 57 year old man who I treated recently, who has some mild arthritis in his shoulder AC joint, the joint on top of the shoulder. And he also has a mild to moderate degree of rotator cuff tendonitis, not a really bad tear, but it does have some irritation to the tendon. And the way that we treated his case was I utilized a 14 times concentration platelet rich plasma for the AC joint because it is a joint and will do better with a higher dose platelet rich plasma. And then I utilized seven times concentration, platelet rich plasma for the tendon. I did not want to go overly inflammatory. And I also used platelet lysate for the ligaments around the shoulder as well, understanding that that prolotherapy concept of strengthening ligaments and improving stability will go a long ways to improving both the AC joint arthritis, as well as the rotator cuff tendonitis. But really utilizing in that one patient three different platelet preps is really key.

One way that, you know if you’re dealing with a regenerative medicine expert is do they have that level of dexterity, subtlety and personalization. The way that you know you’re not dealing with an expert is if they are really utilizing a one size fits all platelet rich plasma for your entire condition. That’s not the right way to do it.

Second case would be a individual that has, a patient of mine that I’ve treated for knee and shoulder issues. He was treated by a colleague of mine Dr. Landrum for some arthritic issues in his neck and his thoracic spine. So he ended up having a high dose platelet rich plasma injection into his facet joints. That is 14 times normal concentration he also had platelet lysate, the growth factors from the platelets injected into the epidural space. So again, two different types of platelet preps based on what tissue is being treated. And in addition, in order to draw enough platelets, we had to do a very large volume blood draw, about 450 CCs. That’s a pretty large blood draw, that’s about how much you would actually give during if you’re actually donating blood. So pretty large blood draw we required a blood bag, extra ACD, which is the anticoagulant you put into the blood bag to make sure it doesn’t clot. And then it actually required some additional steps by my own staff to actually properly prep the blood so that you can get the proper product. So it really required multiple steps and really more than just a quick blood draw and five minute preparation, which you do hear some clinics doing, which is not the right way to do this. But in this gentleman’s case because we took the extra effort to properly do this, take the extra blood draw properly, prepare two different types of platelet preps he’ll likely get a much better result than if we’d done this in a you know, really not properly professional manner. So I’m very hopeful that he’ll have a great response like he has for his other areas because we’ve taken the time and the effort to do this properly.

So personalization in regenerative medicine, personalization in terms of tissue that we treat in a comprehensive manner, personalization in terms of choosing the right orthobiologics or cell based treatments based on your condition, and personalization utilizing the right sort of concentrations of your platelet, rich plasma products based on your actual conditions and your underlining medical issues as well. It makes a huge difference, we’ll get you a better result and it’s the right way to do this as opposed to maybe some other ways of doing this.

Thank you for your time. As a reminder we’re doing a live stream talking about topics related to musculoskeletal health and wellness twice per week Monday and Wednesday. This week didn’t do one on Monday just because it was labor day, so I’m glad to get back to this on Wednesday. But we’ll be back at this on Monday as well. In addition, doing a live webinar, which we’ll get more information within the body of this, wherever this is posted on social media, where discussing issues related to regenerative medicine, name of the webinar is the Truth about regenerative medicine. You’ll learn a lot more about details of what is, what is not regenerative medicine, realistic results, what can be treated, what can’t be treated, what are ways to know that you’re going to get a good treatment by a legitimate physician, legitimate clinic and ways to avoid poor quality treatments and clinics as well. Until next time, have a good day and live well. Thank you very much. Bye bye.


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/ChicagoArthritishttps://www.Facebook.com/ChicagoArthritishttps://www.Youtube.com/c/chicagoarthritis
***For more educational content:Sign up for our email newsletter: https://www.chicagoarthritis.com/newsletter/
See our blog:https://www.chicagoarthritis.com/blog/
Listen to the Regenerative Medicine Report podcast: https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:Determine if you are a Regenerative Medicine treatment candidate: https://www.chicagoarthritis.com/regenexx-candidate-form/
Contact us for more information or to schedule an appointment: https://www.chicagoarthritis.com/contact-us/


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

The Truth about Regenerative Medicine

The Truth about Regenerative Medicine

Webinar- 20200902

What you’ll learn from this webinar:
-What are the best available treatments for arthritis/tendinitis that do not require surgery- for example stem cell, blood/platelet treatments.
-What is legit and not legit in the field of Regenerative Medicine.
-How to choose the best physicians/clinics for regenerative medicine. How to avoid the snake oil sellers.

Options for Pain Besides Anti Inflammatory medications

no anti inflammatory meds
https://youtu.be/BMqRXITaLrM

Options for Pain Besides Anti Inflammatory medications
Topics discussed:Anti inflammatory medications, side effects, why you should minimize.
Other options.Supplement options.Regenerative medicine options.Disease modifying medication options.


Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly educational meeting that is live, it’s August 17th, 2020, welcome everyone. On this broadcast I tried to go over either questions that I’ve gotten from patients in the last week or that my own team has, from either their own sort of questions or things that they’re hearing from patients and sometimes also just frequently asked questions that I get about musculoskeletal health and wellness and so today what I’d like to talk about is anti-inflammatory medications, nonsteroidal anti-inflammatory medication why you want to avoid them other options and I think smart ways about how we can tell if someone’s improving sometimes by how they’re using less anti-inflammatory medications.

So anti-inflammatory medications have been around since roughly the 1960s the more commonly used one since then and they have gone from being prescription based medications to essentially over-the-counter medications and they can include things as routine as Ibuprofen Advil, Aleve to things that are more prescribed like celebrex, diclofenac and even other prior meds that have been taken off the market, including things like Vioxx and they’re used so routinely by people for aches and pains that there’s a relative normalization that people have when it comes to using these medications and because of that, they feel like it’s downright low risk or no risk and the problem is that that is not correct, just because it’s sold over-the-counter, just because it’s utilized super frequently does not mean that it’s actually low risk or no risk and so there are a number of potential side effects that you should be aware of and that includes things such as stomach ulcers, kidney damage, liver damage and even increasing the rates of heart disease. So these are medications that have potential issues in the past when there really weren’t other good treatment options, frankly for various inflammatory arthritis conditions, nonsteroidal anti-inflammatory medications were considered revolutionary. That was however, I mean, 40 to 50 years ago if not longer than that and so in this day and age, when we have a lot of other treatment options, we should be utilizing, maximizing those options in order to really do better because the potential side effects when you sort of weigh risks, benefits and then consider other options you need to realize that these kinds of medications, while they may provide pain relief, they don’t really fix what your underlying problem is and the problem with that is you may be getting some degree of pain relief, but not only are you not correcting longterm issue, but you’re actually increasing the risk of longterm issues as well so considering all that you need to have other options.

The other thing is that the way that I look at it for my patients who are telling me that they’re stuck taking nonsteroidal anti-inflammatory medications long term is that whatever the condition is that we’re treating is obviously not being adequately controlled or treated and it’s a signal to me that we need to be doing more than just having you take that kind of pain medication that kind of anti-inflammatory medication and it’s a signal to me that I need to be digging deeper, looking further into what the problem is in order to make sure that you are being adequately treated.

So what are other potential options? Anytime you have a musculoskeletal issue, arthritis, tendonitis, back pain injuries that’s causing pain, functional limitations, you know, reduction in your normal activities or exercise, you absolutely should be considering physical therapy and some over-the-counter supplements. So physical therapy is that’s a no brainer, quite frankly, if you have an injury or if you have a abnormal motor pattern, exercise pattern, movement pattern, physical therapy is very helpful to help correct that, improve that and optimize that so 100% you should definitely be doing that.

The kind of over-the-ounter supplements that I recommend and, you know, I hear a lot of things that patients are taking, a lot of them without really very good evidence of whether they work or not, but a lot of them do seem to provide patients pain relief, the three big ones that I generally recommend however, which do have decent evidence of efficacy in arthritis and tendonitis patients would include glucosamine, curcumin as well as omega-3. So glucosamine which has been around for many years has decent evidence that it can help with wear and tear arthritis, wear and tear arthritis is in particular for knees, there’s evidence that glucosamine can help in 50% of people that take it. Number two, omega-3, omega-3 is a anti-inflammatory that you can get from fish oil, flaxseed oil those are the two big sources and there’s decent evidence that it can help with pain and even functional limitations in inflammatory arthritis conditions such as Rheumatoid arthritis. So I think it’s a good low risk anti-inflammatory medication and lastly is curcumin, which you get in turmeric, turmeric’s been around for, I mean, centuries, if not thousands of years utilize medicinally for all that time as well. There’s actually been some evidence that curcumin can actually provide similar degree of pain relief as anti-inflammatory medications for wear and tear arthritis. So again, a great low risk option that I think can provide pain relief and certainly preferable over anti-inflammatory medications may not be as strong, but it’s low risk, gives benefit and is definitely preferable on a longterm basis glucosamine, omega-3 and curcumin.

So those really conservative options, physical therapy, exercises, altering some of your activities, over-the-counter supplements is not enough then if you’re still kind of hooked onto anti- inflammatory medications, then I would recommend escalating to the next level of treatment and what that treatment is depends on what is really the cause of your problem. The issue with anti-inflammatory meds is that they don’t treat the cause of your problems if you have, let’s say a wear and tear arthritis or tendonitis issue, then the next step would be an injection option, again, I don’t recommend steroid injections cause it’s not the right longterm option, but rather a regenerative medicine treatment options such as platelet-rich plasma, bone marrow aspirate stem cells is really the next appropriate treatment option to consider treating your arthritis, tendinitis and pain. Number one, it will actually do a better job in terms of longer term management or for that isse compared to anti-inflammatory med. Number two, it’ll actually be safer for the joint, the tendon, the ligament, it’ll strengthen those tissues as well, which is another reason why it helps with pain relief and functional improvement also.
On the other end, if your issue is more of an inflammatory arthritis conditions, such as Rheumatoid arthritis, Psoriatic arthritis or Ankylosing spondylitis, I would strongly recommend if you have significant active inflammation throughout your body, to then utilize a medication such as, a disease modifying treatment, a biologic treatment that will actually treat the condition at its source and what’s really causing the inflammation and problem rather than just taking more and more anti-inflammatory meds. Now, there are some people where medication may be an issue because they have other medical problems and number one, understand that your physician should be nuanced enough to be able to choose a treatment that’s going to be low risk in your case. In some settings, if someone cannot tolerate those kinds of medications, rather than being stuck on those kinds of anti-inflammatory meds, like Ibuprofen, Advil, Meloxicam, you can then consider some of the regenerative medicine treatment options that have more of an anti-inflammatory angle to them and so in all cases, these are the options that you should be considering for chronic musculoskeletal pain rather than chronic anti-inflammatory medications and really the reason is because you should always be thinking longterm, longterm in terms of benefit and longterm in terms of potential risks and when you weigh all those together, you realize that chronic, Ibuprofen, Advil, Diclofenac anti-inflammatory meds is not right way to go.
Another interesting thing is that for patients who are on those kinds of medications long term, anytime we’re trying to figure out how well is somebody doing from treatment for their musculoskeletal condition. You’re always looking for objective evidence, whether that’s objective evidence that inflammation is down in a joint or a patient telling you, hey, my pain level is down or hey, my functional improvement is better or my range of motion is better I’m able to do activity X, which I was not able to do six months ago those are somewhat objective options. Things like pain scores can be subjective of course, but there are definitely disease activity scores and ways to get more objective measurements from that. But another, I think interesting objective way is, has a person reduced their pain medication? Have they reduced their ingestion of anti-inflammatory medications? That’s another, I think clever and nuanced way to tell if someone is actually improving, because the goal is to get you off those kinds of medications.

So anti-inflammatory medications, not the way you want to go longterm for treating arthritis, tendinitis, injuries and back pain definitely plenty of other better options. If you’re stuck on those kinds of meds, make sure you’re maximizing things like over-the-counter supplements and physical therapy. If that’s not enough then make sure you’ve looked into regenerative medicine treatment options or medications for inflammatory arthritis conditions and lastly, if you’re not getting that kind of opinion, make sure you find a trusted physician who will keep you on track to make sure you’re being optimized in terms of your musculoskeletal health. Thank you for your time until we reconnect and again, I do a live session Mondays and Wednesdays until the next time have a good day and live well, bye bye.


Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain. 
Watch live on FB/IG/Youtube every monday.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

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

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast: 
https://www.chicagoarthritis.com/regenerative-medicine-report/


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

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


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

About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses Options for Pain Besides Anti Inflammatory medications.

Restarting Sports and Exercise during Covid

Weekly Live- 20200819- Pic YT

Returning to sports and exercise during Covid19.

Restarting your normal exercise routine is important for your health. While many people are focused on the covid risk aspects, this video/blog focuses on your musculoskeletal issues that may arise when restarting exercise, and optimizing your health and wellness.


Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. It’s August 19th, 2020. Welcome to our weekly live broadcast. I’m excited to have everyone here. I hope everyone is having a great day, great week. It’s really, we’re kinda, we’re still in the middle of summer, but we’re starting to wind down and it’s August 19th. Before I start, I would be remiss if I did not say happy birthday to my mother. I won’t mention how old she is. She is still incredibly youthful and young looking, and happy birthday to her.

So around this time of year, there is so much going on from a sports standpoint, whether that is the US Open Tennis, football season is starting. And right now, obviously with COVID, you even have baseball and the NBA sort of in full swing and hockey as well. In particular, I am a huge football fan. I grew up in Western New York. And so I am a Buffalo Bills fan, and very excited about their season this year. The NFL has a number of interesting things that they’re trying to do in terms of dealing with COVID, stuff I’m not going to really talk about today, but just a whole enterprise of trying to manage their whole COVID protection prevention kind of program is mind boggling, quite frankly, and given all the circumstances, it’s probably the best that they can do if they’re trying to play. They even have some interesting ways that they’re trying to protect players while they’re actually playing with a special type of mask that they’re going to wear now. It’s a lot of interesting stuff that kind of connects public health and sports together. But it kinda makes me think about how for the rest of us as we start to reincorporate physical activity, things that you should be thinking about.

In my case, I happen to play tennis. I also swim. All stuff that I have not been really able to do in any significant degree in the last few months during COVID, but it’s stuff that I’m starting to look forward to reincorporating relatively soon in hopefully a safe and low risk manner. And over the summer, I mean, the things I’ve been doing to stay physically active have included a lot of body weight related exercises, spinning as well at home. And so things that are keeping me physically active, but as I try to reincorporate certain activities that are a bit more sports specific in particular for me overhead activity, including tennis and swimming, there are a number of things that you should be thinking about when it comes back to reincorporating physical activity.

So first and foremost, you need have a really clear on a sense for where your own physical vulnerabilities, weakness, injuries are. If you already know that, fantastic. You’re ahead of the game. If you don’t know that in any significant degree, probably worthwhile assessing yourself. For that kind of assessment, physical therapy tends to be really good. Most physicians don’t typically do a really dedicated exam to properly kinda figure that aspect out, but you really want to be kinda checked out head to toe to get a sense for where you have asymmetry, weakness, imbalances, instability, maybe some chronic inflammation signs. Those are the kinda things you want to be aware of because it’ll affect how you start to reincorporate physical activity. And what’s interesting is if you have, let’s say a shoulder issue, you need to know if you also may have some issues in the neck, whether it’s arthritic issue, instability issue, posture related issue, maybe some weaknesses from one set of muscles to another set of muscles. You want to be aware of that because that’s how you’re going to protect yourself and actually get better as well. So first and foremost, assessing yourself.

Number two is technique. I think having had some time off from physical activity, like formal sports related physical activity, that’s a great chance to kinda reevaluate technique related issues so that you are optimizing and putting yourself in the best position to not only function at a high level in that physical activity, but that you’re also doing things at their most optimal sort of technique so that you’re putting yourself at lower risk as well. So this is really relevant for me for a couple of reasons. Number one, as a tennis player, I do have some very mild rotator cuff tendinopathy in my shoulder. That’s something I’ve had probably since I was a teenager because it’s something that I first recognized about 12 years ago when I started using musculoskeletal ultrasound to look at joints and tendons. And that’s important because, well, why do I have a little bit of rotator cuff tendinopathy? Understanding sort of how I may have a little bit of asymmetry right to left, how my posture might be a little bit off, how my technique might be throwing things off as well. That’s stuff that I need to work on. And in my case, I made a really pretty strong effort a few years ago to really correct some technique related issues when it comes to serving and that’s kind of an ongoing process and something that I should always be thinking about. Another example of that for me was when I reincorporated swimming, I went out of my way to take some time to improve my technique, partly because it’s much harder to reincorporate an activity like that compared to when you’re a teenager. But number two, I know that having a mild shoulder issue, that can be something that can be at risk as I start to incorporate other types of overhead activity. So improving technique, a huge part of getting back into physical activity even if you are an amateur athlete. You don’t need to be a professional level athlete to be working on your technique. If you’re someone that does an activity once, twice per week, or even a couple of times per month, you should be thinking about technique obsessively. That’s how you protect yourself.

Then as you start to reincorporate physical activity, if you ever have any sort of an injury, pain, anything that seems off, I would recommend instead of just grinning and bearing it, which is what most people do, which is what we all do realistically, that you should be looking in terms of getting evaluated sooner rather than later. And the reason why is because if you have something at an early stage that can be improved upon, improve it. Do what you can so it doesn’t become something worse. It always strikes me as incredible that when it comes to things like diabetes and blood pressure in the past, nobody did anything about it until they actually had a heart disease or a stroke. But now it’s common medical wisdom that you need to do something about it. Diet, exercise, maybe medication, to treat that in an early stage so that you don’t have those kinds of bad consequences, like heart attacks and kidney failure. Well, it’s the same thing when it comes to your joints. If you have a little bit of knee pain, rather than sitting on it and just grinning and bearing it, icing it after playing or taking some anti-inflammatory meds, you really should be evaluating what’s going on here. Do I have a problem here? Is there something I can fix? Is there something with my back, my knee, my ankle? Like what’s going on here that needs to be corrected so I can actually fix this? My own brother who has started playing tennis pretty aggressively in his early 40s routinely tells me that he’s got pain in his elbow, or his shoulders, or his back, and he’s icing himself down after playing. And routinely I tell him “You really need to get that checked out because that’s probably not a good thing if you’re just icing yourself down and taking anti-inflammatory meds. That’s really not the right way to be treating this. Figure out what’s going on and fix it, or at least put yourself in the most optimal position so that you don’t need to deal with this chronically or that it gets worse.

So evaluation early makes sense. You want to get evaluated by somebody who knows what they’re doing here. Realistically, the vast majority of physicians don’t know how to evaluate musculoskeletal issues properly or competently. That’s a problem because they may be focused on other problems like diabetes, blood pressure, when you really should be focused on how to handle this in a more competent way. One issue if you’re seeing a surgeon for these kind of issues rather than someone who’s got expertise on a nonsurgical end, is that they’re looking at it from the lens of how bad is this? Does it need surgery now? It’s very likely if you have something early, you may have something that can be treated non-surgically early on so that you don’t need to be thinking about surgery. So you need someone who knows what they’re doing. They need to be able to do a proper examination.

In my own clinic, diagnostic musculoskeletal ultrasound for a lot of those types of injuries, whether it’s arthritis, tendonitis, or injuries is very helpful in terms of figuring out why do you have pain? Is there instability? Is something that’s developing? A really great way at very quickly making a diagnosis. If you have a overuse injury, the reality is that X-rays, they’ll show you some arthritic issues, but they’re not going to necessarily, they’re not going to show any of the soft tissue issues. And frequently you don’t need an actual MRI, but an ultrasound can help make that diagnosis. So your physician should be able to do that if they’ve got that expertise to help make that kind of diagnosis for you quickly.

And then making some changes early on so that you can improve things, whether it’s getting back into the right kinda strengthening exercises, correcting technique as well. Something that I’m very well aware of is that for my own shoulder, if I’m not doing the right kind of upper back kind of exercises, scapula stabilizing exercises, I’m putting my shoulder at risk longterm as well. So that’s stuff I need to be focused on chronically. And certainly if you have an injury or developing problem as you reincorporate your athletic activities, make sure that you’re doing the right kind of rehab or exercises to strengthen the muscles and put yourself in the best position to be protected. And then if you’re not getting better with that basic kind of approach, then consider a regenerative medicine treatment sooner rather than later.

So this is relevant and sort of nuanced in a couple of ways. Number one is if you have a mild to moderate injury, you may be fine with just using your own platelets or prolotherapy. If you have something that’s a little bit more than that, then using your own bone marrow derived stem cells would be helpful. But on top of that, you have to also think about timing. If you’re someone who’s playing at a more competitive level where you have sort of a dedicated season, then understand that some of these treatments will actually sort of prevent you from doing that kind of physical level of activity for the first couple of weeks or so. So if you have something like platelet rich plasma, or your own bone marrow derived stem cells in the middle of season, you would have to expect that you’re really kinda shutting it down for the first two weeks in terms of that sort of sporting activity. And as you reincorporate that activity, you’d be starting at maybe 25-30% of your normal level of the next few weeks after that, and then slowly ramping up. So that may be something that’s better off if you’re willing to kinda take some time off, let’s say a month or so after treatment or something that’s outside of your normal competitive season. The other way to look at it is if you have a milder injury, that’s more of a soft tissue strain, you’re doing the right kind of physical therapy, you’re still having discomfort, you have something that doesn’t necessarily require platelet rich plasma or your own stem cells, then utilizing a treatment like neuro prolotherapy to reduce the pain, to reduce some of the neural agitation that’s causing the pain, myofascial related pain, is a great option to help shut down some of that pain quickly, keep you at a high level of function, as well as keep you physically active and keep you active during your actual sporting league season as well, during your competitive season as well. So there’s different sort of levels to how to approach that and treat that and with the right kind of approach, you can not only stay at a high level, you can recover from an injury. You can also kinda keep going at a high level even in the middle of your competitive season as well.

So exciting times for those of us who are trying to get back into physical activity, more sporting related activity, be smart about it in terms of assessing yourself before you get back into it, improving technique, making sure you get evaluated if you’re starting to develop pain or dysfunction as you kinda reincorporate things, and understanding how to incorporate some of the more modern regenerate medicine treatment options if needed when required.

Well, thank you very much. I hope everyone’s doing well. As a reminder, I’m doing this live every Monday and Wednesday. You can catch the replay as it’s been sort of edited and captioned after the next couple of days. And until our next broadcast, have a good day, and live well. Bye bye.


Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter: https://www.chicagoarthritis.com/newsletter/
See our blog:https://www.chicagoarthritis.com/blog/
Listen to the Regenerative Medicine Report podcast: https://www.chicagoarthritis.com/regenerative-medicine-report/


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:Determine if you are a Regenerative Medicine treatment candidate: https://www.chicagoarthritis.com/regenexx-candidate-form/
Contact us for more information or to schedule an appointment: https://www.chicagoarthritis.com/contact-us/


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

Varying Speed and Intensity of treatment for Arthritis/Tendinitis

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

Varying Speed and Intensity of treatment for Arthritis/Tendinitis

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

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


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

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

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

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

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

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

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


Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis

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

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast: 
https://www.chicagoarthritis.com/regenerative-medicine-report/


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

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


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

About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses changing treatment intensity for arthritis, tendinitis, back pain, and injuries.