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Weekly Educational Broadcast Replay- 20200713

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

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

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

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

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

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

Candidate Form

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

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

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

Weekly Live Replay 2020-07-08

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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


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

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

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

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

Candidate Form

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

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

 

Weekly 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 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
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Weekly Education meeting 2020-06-22

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses regenerative medicine treatment options for the hip, and related issues.