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Weekly Live Replay 2020-07-08

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

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

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


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.


***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 heel pain, plantar fasciitis, achilles tendinis, and prp treatment.

Weekly educational meeting Live! 20200706

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Weekly educational meeting Live! 20200706
We are going live 2x per week. Live on Facebook, Instagram, and Youtube!
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.
#heel #heelpain #heelpainrelief #heelpaintreatment #heelpainsucks #plantarfasciitis #plantarfasciitisrelief #plantarfasciitissucks #achilles #achillestendonitis #achillestendon #achillespain #prp #prptreatment #stemcells #stemcelltherapy #regenerativemedicine #regenexx #chicago #chicagomed

Weekly Education- 20200629

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

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

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

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

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

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

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

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

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

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


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


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

Weekly Live event- 20200624

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


Check us out live on Instagram and Facebook every wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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