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Weekly Education Broadcast live- 20200720

Weekly Education- 20200720
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Weekly Education Broadcast live- 20200720

-Bone Spurs, when are they significant?
-Instability and Regenerative medicine.
-Cases where bone spurs are not significant and can just be followed.
-Cases where treating can be helpful- calcific tendinitis, tendon impingement.

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 Monday at 9am cst.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

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

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

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

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

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses bone spurs and pain.

Weekly Live Live broadcast replay 20200715

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Weekly Live Live broadcast replay- 2020/07/15
-Covid19
Rising numbers in the country, stabilized numbers here locally.
Staying focused on prevention.
Vaccine.
-Cases
Different sorts of patients, different expectations of regenerative treatments.
Case 1: Young man with shoulder instability.
Case 2: Advanced knee arthritis.
Case 3: Advanced hip arthritis.

Weekly Educational Broadcast Replay- 20200713

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Weekly Educational Broadcast Replay- 20200713
-How do we decide which Regenerative Medicine treatment to use. PRP vs BMAC.
-Why do we recommend PRP for back problems.
-Using treatments that get to the root of the problem, not just masking symptoms.

Content- Weekly Education
Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube Monday at 915a cst.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

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

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

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


– Hello this is Dr. Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. Welcome to our, Monday live broadcast. This is July 13th 2020. I’m still calling this our educational meeting live broadcast, although I may change it to Monday live broadcast, because I’m trying do more and more of these. So, the other thing I’m considering is, do we actually start changing this to more like noon, or 12.15 and do this two, three times per week. We already do a Wednesday one at 12.15, we squeeze this one in the middle of the morning, workday but we may actually change that going forward. Great so, Jackie, you have a couple of questions. Please shoot. What do you have?
 
– [Jackie] So my first one would be, how do you determine your candidate sd the three step protocol to the PRP treatment.
 
– Okay so good question. So Jackie’s question is how far are regenerative medicine treatments. How do we tell if somebody is a proper candidate, for just Platelet Rich Plasma, versus someone say proper candidate, for bone marrow derived stem cells. And I think, the bigger question is like medically how do we evaluate somebody, for any kind of treatment. And the reality is, we look at a couple different things. We look at what is the person’s pathology, like what’s the problem. What’s the severity of their issue, and, what’s the evidence of efficacy of how well it’s going to work, based on their problem. So, this question comes up a lot because, number one people come in with maybe an expectation of one thing and maybe we recommending something else, or somebody thinks their pathology is very bad and why are we not recommending something more aggressive and so this varies because there isn’t a, one set answer for everything. So as in example, if you have, let’s say hip arthritis. We know that, hips tend to be much harder to treat than let’s say, knees or lower backs or shoulders. And so, somebody that has let’s say a moderate level of arthritis in the hip. I would recommend bone marrow derived stem cells as a first line treatment rather than Platelet Rich Plasma because I know that that’s something that can go faster and be more problematic. And the evidence that we have is that they’ll do better with bone marrow cells rather than just platelets. So, that’s a case where you looked at the pathology, you look at the severity, and you can say, listen, I think this makes more sense. Another example would be, let’s say something like knee arthritis. Where the evidence shows that even if you have a significant degree of knee arthritis that platelets can still work. Now the thing is that, my personal experience is that if you have more advanced arthritis, bone marrow derived stem cells will work better in that case. And there’re certain conditions, let’s say, if you have swelling in the bone, that’ll do better if you have injecting bone marrow derived stem cells. But that’s an example of where there’s a little bit more flexibility. And then I’d be looking at other things, meaning, hey, what other medical problems is this person have? Are they on other medications that might make them a challenging candidate? And are they someone who maybe their overall health might benefit better from let’s say, bone marrow versus platelets? Sometimes also you have to look at other factors as well. Namely, does somebody have, let’s say, a history of inflammation, metabolic syndrome and autoimmune condition, in which case bone marrow would likely do better because it has more of an anti-inflammatory effect than just platelets does. So it’s going to to be a few different things, but we definitely rely on what’s a person’s problem, what’s the severity of their problem. And also what is the evidence show will actually work. Make sense?
 
– [Jackie] All right so second question would be, how come for the lower back procedure that we do here, don’t convert to like the three step protocol.
 
– Right. So great questions. So question is, you know, when somebody has a lower back issue, spine issue in general, why is it that platelets are recommended first line rather than bone marrow derived stem cells. And that’s in large part because the evidence from within the Regenexx network shows that Platelet Rich Plasma as a first line option tends to work very well in most of those people. And that’s for a few reasons. Number one, is you have to use the right product for the right problems. So if somebody has, let’s say, an arthritic condition in their lower back, facet joints are arthric. Well we know that utilizing a very high concentration of platelets will for the most part do a very good job of treating that. You can inject bone marrow cells into that as well. But we know that platelets do a really good job of that. Number two, for most people, if they have some chronic instability in the back, meaning some ligaments that have been chronically damaged, which you see in degenerative issues, then platelets are a great first line option for that as well. Every once in a while, if someone’s had just really bad instability, let’s say surgery in the past as well, they may do better with bone marrow cells, but for the most part, most people for back issues seem to do fine, which is platelets, which is why we generally recommend that as a first line treatment.
 
– [Jackie] Thank you. Those were the only ones I had in the main ones.
 
– Only two.
 
– [Jackie] Yes.
 
– Okay. Well another thing that question that that. Well, you know, in that regard, Jackie, you asked about platelets versus bone marrow. So I mean, this comes up so often. So I had somebody asked me about that about her plantar fascia. And so soft tissue injuries are interesting because a lot of soft tissue injuries do fine, which is platelets. So there are certain types of soft tissue injuries, where someone’s, let’s say a tendon tear might respond better to actual bone marrow cells, which is just a stronger cell line. But a lot of times just the evidence shows that if you’re trying to treat pain and dysfunction, that platelets are more than adequate to get that kind of response. So I had somebody last week asking about our plantar fascia and asking why am I recommending platelets rather than bone marrow cells. And it’s because the evidence for platelets, in plantar fasciitis is actually quite good. And so that’s what I’d recommend first line rather than anything stronger than that.
 
– [Jackie] And how much is the evidence for the other is better.
 
– I mean when you look at the some of the initial indications for Platelet Rich Plasma, plantar fasciitis was one of the original indications. Which is why I would still recommend that first line for plantar fasciitis rather than let’s say using amniotic cells using somebody else’s cells or utilizing your own bone marrow cells, because the vast majority of these people will do fine with is platelets, it may take more than one treatment, it may take one or two treatments. But in general, I’d still recommend that first line in large part because that’s where that initial evidence of platelet rich plasma even comes from.
 
– [Jackie] Okay. Thank you.
 
– What else?
 
– [Jackie] Those were the main ones that I kept getting this week.
 
– This week. Okay, good. Another one that that I wanted to mention is, you know, on the inflammatory side where we’re trying to treat people that have chronic autoimmune issues, chronic inflammatory arthritis, inflammation in the joints. A question that comes up frequently if I’m recommending medication is, hey, is this is this just masking a problem, Or is it actually getting to the source or the root of something where you’re really trying to fix something. I went on a little bit of a not rant, but I kind of mentioned last during our last Wednesday broadcast about how I’m always so hesitant to use the word fix, because you know, we’re not changing like a tire here. But there are some things that you legitimately can fix medically. And when it comes to inflammatory arthritis, let’s say where you have somebody that has significant inflammation, there are ways that you can you know, downright try to fix that. Medication is one of them, meaning utilizing medication to actually sort of block the over, over effectiveness or over aggressiveness of the immune system. Something I’m progressively getting more and more into is, are there ways on a non medication basis, whether it’s nutritional supplements, stress reduction, that we can actually help to reduce inflammation as well. I think that’s certainly possible and helpful. Reality is that there’s some conditions that still require medication and when we utilize those medications, you can significantly actually block what’s driving those conditions and you can actually fix that. And I think that’s important because when we think of how you treat chronic musculoskeletal issues, whether that’s osteoarthritis, tendinitis, inflammatory arthritis, a lot of times what’s typically utilized are short term things. Medications, pain medications, chronic anti-inflammatory medications, that are really, that are really short term and are not really fixing the problem. They’re legitimately just masking the problem. And I know an emphasis for me professionally is let’s utilize the products, treatments and approach that are really meant to get to the root of the problem, whether that’s utilizing medication, that is meant to really kind of get to the root of what’s driving a problem, or lifestyle kind of approach that’s meant to kind of reduce inflammation, or exercises that are meant to really improve stability or even injectable options like platelets or your own bone marrow cells that are meant to reduce instability, optimize the joint and really get things to a better level. We’re really trying to get to the root or the essence of what’s driving problems. Trying to optimize, some might say fix the problem. I’m always very cautious about using that. But that’s the general kind of take to it.
 
– [Jackie] At least they repair.
 
– Judy says, I’m sorry, Jackie says, repair the problem. In some cases, yes. And yes. I still like to work to optimize because I think that’s realistically what it is. Which is some things cannot be fully reversed or repaired, but you can optimize it, get it to its best state possible.
 
– [Jackie] Thank you.
 
– What else Jackie?
 
– [Jackie] Those were the main things that I keep forgetting in regards to. Okay thank you so much first…
 
– Great. Great, great. Well, that’s it for today. And until our Wednesday broadcast. I hope everyone is well and stays healthy. And until then, have a good day and live well. Bye bye.

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

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses how we choose between regenerative medicine treatments including PRP and Bone marrow aspirate concentrate stem cell options.

Weekly Live Replay 2020-07-08

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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


***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

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

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

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

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses fixing your life vs fixing your imaging, incremental progress in covid19, musculoskeletal care, regenerative medicine, and professionalism.

 

Weekly Education meeting 20200706- Replay

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Weekly Education meeting 20200706- Replay
Topics discussed during this broadcast:
Heel pain:
Plantar fasciitis and Achilles tendinitis
Case 1
Case 2
Avoid steroids!
Nerve related pain.
PRP vs Amniotic fluid.

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 Monday at 915a cst.
https://www.Instagram.com/ChicagoArthritis
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Welcome everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly education meeting. So we’re doing this live, this week. So as an update, we’ve started to do this educational meeting where I’m talking to team members, about what we do in the office in terms of evaluation, treatment, key principles when it comes to arthritis, tendinitis, injuries and back pain. And it’s been interesting and helpful because it gives me a chance to talk and it gives a chance for team members to kind of learn and ask questions, and I think it’s relevant for not only us, but also relevant for general public or existing patients as well. And my natural course of doing this is videotape. And then just put it out there, maybe get some captions on it, but really nothing else post editing. So, I just decided let’s do this live. And I think that makes sense. It’ll get out there faster and maybe connect with more people, which is interesting.

I am using a software platform called StreamYard to connect on Facebook and LinkedIn and shout out to Orlando Landrum for giving me that idea. He is dramatically more technically savvy than I am. I was just saying to Devi and Jackie, that I think I’ve maximized my technical abilities at this point. I have the streaming on Facebook, YouTube, and now IG. And I think that’s as high level as I can possibly get. I think after this, it’s just like, do we have a rocket ship to Mars? That’s as far as I’m going.
Alright, so something interesting I thought would be interesting to talk about is heel pain or plantar fasciitis. So, we have two cases where that’s relevant from this past week, one where we actually treated, one where existing patient was emailing some questions. And so it kind of brings up some interesting topics, which I think are worthwhile learning about and talking about. So the first case is a man in his late 40s, who was presenting with heel pain, and what he has an exam is tenderness along the bottom of his foot, as well as tenderness along the Achilles tendon. So, the bottom of the foot where he has tenderness over the heel. He has plantar fasciitis, that’s a length of tissue along the bottom of the foot that basically helps to provide support and structure over the bottom of the foot. It can get chronically aggravated, which is what plantar fasciitis is. He also has tenderness over the Achilles tendon, the Achilles tendon is basically, the tendon from all the calf muscles that basically insert at the heel, so it’s an area of very high pressure, high tension and if it gets irritated, it can be very painful as well. So, we came to his diagnosis based on not only examination, but also ultrasound and X-ray, really ultrasound more than anything else because it shows chronic changes in the plantar fascia as well as chronic changes in the Achilles tendon. In both cases, there’s chronic kind of wear and tear changes, degenerative changes. There’s not any active inflammation, there’s no severe tear either.

So this is something that is still amenable to non surgical treatment. And in his case, he’d failed physical therapy, and his existing podiatrist had recommended a steroid injection. And so that brings up a couple different topics. Number one is what’s the right treatment if you fail conservative options for something like plantar fasciitis and Achilles tendonitis. So, traditionally a steroid injection could be considered. The problem with steroid injection is as follows number one, it can weaken tissue, and while it’s rare, but it can actually cause a tear or even rupture of a tendon. Something that was taught to me when I was in training was you need to be careful about injecting steroids into a weight-bearing tendon. And the reason why is because if it ruptures, even if that’s rare, that can be disastrous to that human being, meaning they can no longer ambulate. So, the idea of utilizing a steroid injection in this man’s case, I think, is a really bad idea.

My suggestion to him is, why do something that’s going to increase your risk that may give you short term pain relief, let’s consider something that makes a little bit more sense, which in his case was Platelet-Rich Plasma. Which is utilizing your own blood, platelets, growth factors from the blood and platelets, to inject that into the chronically damaged tissue and do what’s called Percutaneous Needle Tenotomy. Which is where under ultrasound guidance, you stick a needle into the chronically damaged tissue, and sort of needle that to create more blood flow. And there’s good evidence to suggest that this is helpful for plantar fasciitis. And there’s also evidence that this is helpful for Achilles tendinopathy as well.

The other aspect of his case is that he also has burning sensation in the bottom of his foot. My original suggestion was let’s do also work up for the lower back to see if you also have evidence of a pinched nerve in the L5 or S1 level, they could also be causing pain and burning sensation in the foot. He had actually declined treatment for the lower back, but when we ended up treating him we ended up taking the consideration of possible nerve condition as well. And I’ll describe that. So, the way that we end up proceeding with treatment in his case, was to utilize a high concentration of Platelet-Rich Plasma under ultrasound guidance, to inject that into the plantar fascia on the bottom of the heel. And then to also inject that into the Achilles tendon on the other side of the heel. And because he also had some of the burning sensation to also inject a concentration of growth factors in the platelets called platelet lysate, which is healthy for nerve tissue and inject that around the posterior tibial nerve, which is a nerve that supplies the bottom of the heel in terms of sensation, and, can also cause pain as well if it’s irritated. So the goal in his case, is to utilize a product that’s going to be healthy, his own cells that doesn’t have the risk of causing disruption or tearing of the tendon or plantar fascia. And that has evidence of giving longer term pain relief and functional improvement. And I think he’ll actually do pretty well.

The second case is a woman in her late 50s, who sent me an email over the weekend, someone who I’ve treated for various other things in the past knees, lower back, I think maybe an ankle issue in the past as well. And she was basically emailing saying that she’s been seeing a podiatrist and for again, heel pain and was diagnosed with plantar fasciitis. She had failed conservative treatment, again, physical therapy, some orthotics, and her podiatrist had recommended amniotic stem cell treatment, and she was asking, is that the way to go, or should she do something else? And so, my recommendation to her is, okay, you failed conservative options, what injection options are right. So, okay, good she hasn’t been recommended a steroid injection. She had been recommended amniotic stem cell injection. Does it make sense to use that versus platelets versus some other kind of cell based treatment from herself.

So, number one, you need to understand what are amniotic stem cell treatments, there are no live cells in that product. So the way amniotic stem cell treatments get packaged to be sold as an over the counter product to physicians, is that they take it from birth cord tissue after a baby’s been born, then it has to be processed. And by process, I mean that it first gets freeze dried, gamma irradiated and then pulverized into a powder tissue. So it’s no longer tissue actually, it’s just a powder. That powder is then re-hydrated with saline in the physician’s office and then re-injected back into the area that needs to be treated. So number one important to understand that there are no live cells in that like, no human or live tissue can actually survive that kind of process. And there’s a reason for that. Meaning from the FDA standpoint, they want to reduce the risk of transmissible diseases. And they do that by requiring that kind of process. The other part to that is in order to be sold as an oft over the counter shelf product that needs to have a certain shelf life, months. And so you can’t just have live cells sitting around for months, it’s really created into this kind of powder package product. So there are no live cells in that, that’s been looked at multiple organizations to see are there any live cells or no live cells. So it’s not really a stem cell treatment, what it is a growth factor treatment.

So there’s a couple aspects to that. Number one is, if you have the option of utilizing your own cells versus foreign cells, you should always use your own cells if you can get the same kind of effect. Number two is if you have the option of utilizing a product with your own live cells versus a product that has maybe growth factors, which is what amniotic products do. You might as well use your own live cells, there’s benefit to that. Lastly, there is a good deal of evidence in using your own live cells for this kind of condition, plantar fasciitis. And there’s less on the amniotic fluid product standpoint. You can still get a good response from utilizing amniotic product. But, why not use your own cells, less risk, non foreign material with live cells that has good evidence. And so my recommendation to her is, if you have a moderate level condition, let’s utilize just your own platelets to begin with. Now, I personally do have experience combining amniotic cell products with someone’s own platelets, or even with someone’s own bone marrow derived stem cells. That’s a pretty, rare indication where I would do that. In her case, I would say stick with your own platelets as first line treatment before doing anything else a bit more creative, because of all those reasons that I’ve mentioned.

So, in both both of these cases, there’s important understanding in terms of why we’re selecting certain products, there’s an important understanding of what products not to use and what products to use preferentially. And then even how to proceed with treatment, which is to be more expansive in treatment for treating not only let’s say plantar fasciitis, but the other side of the heel, such as the Achilles tendon if there’s pathology and a nerve issue, if that’s involved as well.

Questions?
– [Devi] What’s an example where amniotic cells would be better than your own cells?
– [Devi] Or is it amniotic cells versus-
– They’re described as amniotic stem cells, right? but there’s no live cells. So it’s not really a accurate way to describe it right?
-Yeah I think the the indication to utilize amniotic cells is that you can get a very aggressive pro-inflammatory response. That’s, considered one of its benefits. The thing is that you can just concentrate platelets to a much higher degree and get that similar kind of response. So one of the advantages that we have for doing this in an open lab format in being in the Regenexx Network is that we can, sort of determine what concentration of platelets that we want to use, whether we want to use just platelets or growth factor some platelets like platelet lysate, we have more flexibility in that regard. So if you’re taking a very low concentration of platelets, comparing that to let’s say, amniotic cells is not a fair comparison. On the other hand, if you can increase the concentration of platelets, you can initiate a higher inflammatory response, which means you can get a similar or better effect. So, I wouldn’t say that there’s a indication to use amniotic cells in preference to some of our other cell products, I would say, are there indications where you can combine that. And I think there are depending on the degree of pathology.

– [Jackie] What would be the pain scale for patients after the procedure-
– Okay, so great question. So, Jackie is always asking about what’s the discomfort associated after treatment. But that’s cause what patients ask. And so the nature of injecting into a plantar fascia or Achilles tendon is that, like you’re walking on that so it’s sore, it’s already inflamed. If you’re gonna be putting pressure on it, it’s gonna be more inflamed. So what I generally recommend is utilize a CAM Walker boot, basically, it takes all the pressure off the foot, and you’re able to put pressure on it as you’re walking. So you’re basically offloading it. You could use crutches or a cane as well. But I personally find that using the boot, is easier for that first week. And normally it’s that first week where people are most uncomfortable. I’ve done this without that. And I think it’s just harder for people to kind of get around. But if they can use the boot for that first week, they’re generally okay with that. And then after that they can transition off and then as they start to work with physical therapy, they can then start to progressively put more and more load and strain on that heel and foot and then keep on pushing it. Does that makes sense?

– [Jackie] Mhm! And when will they see a difference four to six weeks?
– I always recommend that four to six weeks mark I can tell you that if like in that initial case that I mentioned where we’re treating the nerve part of it as well, if he does have a component of like nerve irritation that’s driving his heel pain as well, which he probably does, cause he does have that burning sensation symptom, that even just treating that he’ll get some relief up front. That’ll slowly wear off and then it’ll start to get effect from treating the actual tissue as well over the next few weeks.

– [Jackie] Thank you. I got nothing else
– Yeah, nothing else. Jackie?
– Okay, good plantar fascia. There’s more nuances to it in terms of how we treat it, how we evaluate it. I hope this has been helpful.

And until next week, I hope everyone is well. Again, as a reminder, we do two live broadcasts per week now, I’m trying to do that. There’s the weekly educational meeting that I’m doing live now. We have a set weekly live meeting every Wednesday we’re gonna have to kind of rethink about how we define that just as weekly live live. Is there some other name to it? I’m not sure. But we’re trying to do two of these per week. And until next time, I hope everyone is well. Have a good day and live well. Bye bye.


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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses heel pain, plantar fasciitis, achilles tendinis, and prp treatment.