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