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Inflammation in Joints and Tendons

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Inflammation in Joints and Tendons
Weekly Education Replay 20200803
Inflammation
-What is inflammation?
-Inflammation in the musculoskeletal system.
-Cases
Tendinitis
Inflammatory arthritis
Post Covid19 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 every monday.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

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

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 inflammation in the joints and tendons.

Episode 11 Regenerative Medicine Report

Podcast episode 11

Episode 11 podcast

Episode 11- Bone Spurs and Regenerative Medicine
-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.
Instability, Calcifications, and When are bone spurs significant.

Episode 11- Bone Spurs and Regenerative Medicine

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 Live event replay- 20200701

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Weekly Live event replay- 20200701
Trying to thrive in a world of heightened uncertainty by focusing on:
-Small wins.
-Falling forward.

Chicago Arthritis and Regenerative Medicine- Weekly Live
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 July 1st, 2020. I hope everyone’s doing well. This feels like the beginning of summer, even though that started a couple of weeks ago. Here in Chicago, we’ve started to enter phase four of the coronavirus response, which generally means that certain retail establishments, including restaurants, I believe bars, are now allowed to allow something like 25% of their normal volume of patrons. That’s a nice small win for us here in Chicago, since we had so really clamped down pretty hard for a couple of months, we’ve been able to start slowly easing into, you know, this new normal. At the same time we have other parts of the country that weren’t quite as… I don’t know if I want to say diligent or aggressive when it came to precautions when they were reopening. And now they’re in a position where they have to start kind of pulling back as well. My sense is that this sort of cautiousness and variability that we’re seeing throughout the country is something we’re going to be dealing with for at least the next several months. Meaning as some places are able to reemerge a little bit, more steady, other places may need to retract, and there’s going to be a bit of give and take, and pull and push as we, you know, as we grow into what this new world is.

And in that kind of world where you have so much uncertainty and volatility, I want to touch base on how can, how can we as individuals, still thrive in a world with heightened concerns? So it goes without saying that for folks that have active medical issues that require treatment or are being delayed because of COVID-19, those are really harsh things that obviously need to be addressed in a hardcore medical way. A lot of the things I’m talking about are more about, you know, how should we be approaching, how should we be approaching things from a mental and emotional standpoint with some of the heightened concerns that we have, and volatility that we have in this world. And so there’s two things that I think of, number one is being able to focus on small wins. And number two is really a concept that I believe in which is falling forward.

So in terms of small wins, I think it’s critical that we really appreciate when we do take those baby steps, when we are, when we are actually moving forward and when we have wins. So as an example, phase four in Chicago, that’s a big deal. I mean, we really were pretty clamped down and shut down from a business standpoint throughout, you know, our, the Metro Chicago economy for the last, for the last few months. And so to see restaurants starting to open up a little bit is a big deal. This past weekend, my family, we were able to go to the Chicago Zoo. And then the next day we were able to go on a picnic with some friends and we maintained appropriate precautions in terms of mask, as well as social distancing. But you know, that, those are small wins, and that’s important to recognize.

So in a professional component, when I think of how do we get small wins for our patients who have arthritis, tendinitis, injuries and back pain, there’s a few things that I think of. The first is, small wins help out in a couple of ways. For example, they help out with maintaining forward momentum or forward progress. In addition, small changes sometimes can equal bigger, bigger wins longterm as well. So as an example, maintaining forward progress, I think physical therapy is a great example of where small wins on a day-by-day basis go a long way. In particular, small gains in strength, small improvements in range of motion, go a long way in terms of improving a person’s function, a person’s pain relief, and a person’s quality of life on a daily basis. So key because small changes in strength, small changes in stability make a huge difference in quality of life. Regenerative medicine sometimes has a similar effect, for example, improving stability, which is a lot of what we’re doing when we’re treating ligaments, soft tissue structures, tendons, muscles, labrum, meniscus, that even just a small amount of improvement in stability and strength in those tissues goes a long way in terms of improving function as well. So that classic sort of example would be a patient who says, “Look Doc, I’m doing okay when it comes to my knee, when it comes to rest, and I can do some basic activities okay. But now when I’m walking about four blocks is when my knee is causing problems. I start to feel fatigue and pain and it starts to feel a bit loose.” Well, improving some of that stability with physical therapy, but also with the regenerative medicine techniques, whether it’s injecting your own platelets, dextrose, bone marrow stem cells, that that goes a long way in terms of taking somebody from walking four blocks to walking eight blocks. Quality life improvement there is pretty big. The original prolotherapy, dextrose prolotherapy, where you’re injecting sugar water, which has been going on for decades as a treatment modality for arthritis and tendinitis, that worked by improving that tissue integrity of ligaments. And by improving that function just a little bit, made a huge difference in terms of functional improvement, and quality of life, and pain relief as well. So small changes, small wins, when it comes to things like physical therapy and regenerative medicine, help to maintain forward progress, and help to push forward a person’s abilities.

The other thing is sometimes small changes can actually be equivalent to humongous gains. So two examples of that. Number one is a patient I saw recently who was having a lot of hand and wrist pains, who I think has probably early rheumatoid arthritis. You know, the next step in her evaluation is actually to check a diagnostic ultrasound of her hands and her wrists. And the reason why is I’m expecting to see some subtle changes of fluid. But really what I want to see is does this person have what’s called power Doppler uptake or active inflammation in those small joints, because if they do, that makes a big difference in terms of what our next steps would be. In particular, because if they have that small vascular change on ultrasound, it’s a sign of very significant inflammation, and it’s a very significant sign of progression or risk for progression of their condition, including actual damage in the joint as well. So identifying that small change is huge because we can actually make a difference with treatment there. If you start a person on the right kind of medication treatment who has that condition, you can reverse or actually get that inflammation signal to resolve, and that will then predict a reduction in chance of progression of their condition, and a reduction in chance of actual damage from their condition as well. So that’s humongous, making small changes, small win for that one small change can go a long way to improving that person’s condition, pain, inflammation, and longterm outcomes as well.

The second concept that I think that’s important is something that I think a lot about is this idea of falling forward. So, you know, I got this idea originally, I am a big football fan, and every once in a while, you’ll find a running back who’s in the league who is not the fastest, not the quickest, not very elusive in his movements, but he’s someone who based on his size, his agility and the way he plays, that anytime you hit him, he still falls forward. He still somehow gains yardage. So if you hit him after a three-yard gain, he gets five yards total. If you hit them behind the line of scrimmage, instead of a one-yard loss, he still somehow ekes out two yards. Falling forward. I think that’s important mainly because, in my own personal and professional life, I find that when you have to make tons of decisions, it’s hard to make all those decisions perfectly and correctly. And sometimes you just have to make a good decision that makes sense on paper. And hopefully if it’s enough of an improvement, that even if the result is not ideal, you still fall forward, meaning you’re still getting some forward momentum. You’re still inching forward, so that you’re not as concerned about, “Did I make the exact perfect decision?” You’re more thinking about, “Did I at least move things forward? Did I at least move my life forward, my business forward, the effect on this individual forward?” So that we’re still moving forward in a positive way. I think that’s key because it’s important that when you make decisions that you are learning, you’re adapting, and you’re moving forward.

This is, this is important, not only from a life standpoint, a business standpoint, I think it’s so key from a musculoskeletal standpoint as well, namely for the following two reasons, two examples. I had a patient ask me recently about what to expect after his regenerative medicine treatments. And the key for him to understand is that, that first couple of weeks are going to be a little bit up and down, that he may feel like he is, his progress is a little bit up, a little bit down, but the key is to understand that as long as you’re inching forward, falling forward, you’re making progress. And that long term, that sort of slow progress of falling forward will eventually equal big gains longterm. I think physical therapy and exercise is the same thing. There’ll be moments where you feel like you’re doing well. And there may be the moments where you feel like you have a little bit of retraction. That little bit of retraction, that can occur. And that’s okay because that’s part of the process of healing and improving, meaning that it’s not a linear straight line. A lot of times it is actually just getting small improvements and there may be a small setback, which you learn from that, you adapt from that, and then you kind of get back on that upward trajectory. Falling forward is key because I think in a world of uncertainty, we’re not going to have full visibility of what’s coming next. We’re not going to have full visibility of, are we making always good progress? But as long as we’re making micro progress falling forward, I think that’s, that’s a way to gauge that. Are we actually in the right direction?

So in this world of heightened uncertainty and concern, I think whether it comes to your own personal life, whether it comes to your own professional life, and certainly when it comes to your own musculoskeletal health, those are the key things. Are you making small wins again and again. And are you falling forward. I think if you are, then you’re heading in the right direction. You’re still growth-oriented. You’re still moving positively. I think that goes a long way.

Thank you for your time. Until we connect again next week, I hope everyone stays healthy and is safe. As a reminder again, I’m publishing two things right now. The first is obviously this Weekly Live kind of interaction. The other one is a Weekly Educational meeting that I have with my own team every week. We’re publishing that as well. Good way to kind of learn from both of them in a slightly different way, but until next week, I hope everyone stays 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 how to thrive in a volatile world- 1) Small wins. 2) Falling forward.

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

 

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?


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