Weekly Live- 20200520

-Update at Chicago Arthritis and Regenerative Medicine

Our Covid plan updated

-Regenerative Medicine approach to Hip pain. PRP treatment.

-Assurance for autoimmune patients on medications.

-Risk awareness during and post covid19.

Hellow, this is Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. Welcome to our Weekly Live event. This is our essentially regular, Weekly Live event where we discuss, relevant issues for my practice, my clinic, musculoskeletal medicine, my patients, to give you a sense for what’s going on, and you know, the most current updated information that you need to know, regarding your musculoskeletal health. So there’re three kinda broad things I want to cover today. The first is updates with what’s going on with us, because I think we can provide some interesting value, and insight in terms of how we’re handling things during the current COVID environment. Number two, is an interesting case, of how we’re handling hip pain, Regenerative medicine approach, which I think is insightful, will give you an understanding for how I approach hip pain, and how you should think about hip pain as well. And then lastly, you know, a common question a lot of my autoimmune patients, who are on medications have, and how we need to manage their inflammatory issues during this time. Which then also connects to a broader question, of how to think about risk during this moment in time.

So from an update standpoint, you know, at Chicago Arthritis and Regenerative Medicine, we have a lot going on. Even though our sort of clinical patient volume is down, because of COVID-19 right now, I would say we’re probably busier actually, because of all of the administrative-client service issues, that we’re still handling and dealing with, in order to make sure that our patients are being appropriately cared for. Which is interesting because you can still do a great job, even during these kind of difficult times, if you have the right focus. Which is a team, that is really focused on offering high level care, high level service, regardless of what the scenario, and the circumstances are, and regardless of the technical solutions that are available. And I’m really proud of my team for figuring out a lot of the back office stuff, which is very hard. So, some interesting things that we’ve kind of incorporated in this last week. So you know, one thing, a really interesting question is, as we start to get back into some version of normal life, how do we start testing people, to see if they’re safe to come back to the office, to work, all that kind of stuff. And we have some guidelines from the city, from the state rather, and we also have some of our own internal guidelines, that just make good medical sense. So from the state standpoint, you know, there are some obvious medical things, like hey, have the proper protective equipment on, make sure you’re proper distancing between people, still try to maintain some degree of low level traffic within the office as well. We’re doing all those things of course. We’re trying to do most of our patient care, via this kind of method, mainly because I think we can still do a great job of helping patients with their current, or active or chronic issues in just this kind of method. And then the other thing is, just by having less foot traffic in the office, it’s a safer environment for patients that do have to come in. And in that regard, when it comes to procedures, or infusions, that lower level of foot traffic, is keeping those patients safe. In addition, per state guidelines, we, for any sort of procedure patients, for any of our platelet, bone marrow stem cell treatment patients, we do need to check some additional COVID-19 antibody, or COVID-19 testing. So specifically, the recommendation is nasal swab testing, and so we’re complying with that. So the interesting thing is, what tests are appropriate, effective, you know, how reliable are they. And we spent a lot of time thinking this through, going through what’s available, and we have some internal guidelines about how we’re trying to handle things. For example, for my own team, we are checking weekly antibody testing for all of us, and I’ll explain why in a moment. We’re also checking daily temperatures, daily symptom checks, all those kind of basic things. The nature of testing is that there is no test when it comes to medicine, that is 100% foolproof. There’s always some false negative some false positives. And as long as you understand the circumstances where that can happen, and the reason why you’re checking the testing, you can still make some smart, intelligent decisions based on what those results are. So in that regard, with the antibody testing, there are risks of false negatives. By checking everyone in the office, our team weekly, will reduce that risk. There is also a risk of false positives, and we actually have a plan for how to handle that as well. But by checking antibody testing weekly on the team at work, where each one of us is individually considered low risk, because none of us really have any significant medical issues. Our hope is that, if any of us develop anything, we have a plan where we can appropriately take care of that, in a early stage, by that kind of testing. So that we’re not only protecting those of us that work in the clinic, but the rest of you, patients, and everyone else as well. And I think that’s important. We actually have internal guidelines, and I meet with my practice administrator Devi, and I meet with my physician assistant Leah. We’re meeting on a weekly basis to kind of revamp those, so that as more information comes out, as more updated testing comes out, we are at that leading edge, of making sure that we’re we’re protecting everyone. So that’s what we’re doing from a protection standpoint. We’re not rolling out antibody testing. We’re not rolling antibody testing significantly to patients. Because we’re still trying to figure out how best to use that. There’re some reliability issues there. Eventually we’re going to figure that out, and try to take care of things properly. So that’s sort of our biggest updates right now, in terms of how we’re handling things. The other things are we are continuing to help patients, if they need to be in the office, whether that’s infusions or select procedures, we’re still able to do that in a safe compliant way, that’s medically appropriate, safe for all of you as well, and also meets all the guidelines, from a regulatory standpoint as well.

Right next. So I had a really interesting hip case, hip pain patient this past week, that I think, has a lot of interesting things, that we can all learn from. And I think for patients to understand, how we handle musculoskeletal issues, when it comes to wear and tear arthritis. There are some subtleties that are important to understand. So when it comes to wear and tear arthritis, it’s so important to understand, that it is very rarely just one structure that’s the problem, it’s a whole unit that’s problematic. Meaning when somebody comes in with hip pain, you can’t just think that, the hip joint that’s a problem. You have to ask, are there any soft tissue issues, ligaments, tendons? Is there any other adjacent joint, like the SI joint, or anything nerve related, from the lower back that could be related. So in this particular case, and I actually made a TikTok video of this, and I put it up on all of our social sites, and I got a lot of interesting kind of feedback from that. It was a woman who has some chronic lower back issues, and has some more recent onset right hip pain. And upon examination, imaging, discussion, we sort of figured out that, her pain was maybe slightly coming from the hip joint, but more predominantly from the soft tissue structures, meaning tendons around the hip, and then also from the lower back and the SI joint. So she had failed multiple other conservative processes, and treatments. So we ended up proceeding with platelet rich plasma, and were able to help her out because we ended up using a very high concentration of platelet rich plasma into the hip joint and the SI joint. We also ended up injecting a lower concentration of platelet rich plasma into the hip tendons and ligaments. And then lastly, also injecting platelet growth factors, into the epidural space, to treat some of the nerve related pain. I’m very confident that’s going to give her a great result, in large part because we properly pinpointed, where her issue was. Which is that it’s not just coming from the hip joint, but from all those other structures. Number two, because we took a comprehensive approach, which means that instead of just treating, that one structure that might be involved, we treated the whole functional unit. Which meant treating not only the joint, adjacent joints, nerves, soft tissue. And because of that, she’ll likely do better longer term as well. And lastly, because using like really high level ultrasound and X ray guidance, able to make sure we’re really directly, and exactly hitting the right things, which will go a long way to getting her to feel better longer term as well. The other aspect in her case, was she actually had a similar kind of pain, couple years ago for the left side, and did dramatically well when we had the same kind of approach to treatment. So I’m very confident she’ll actually do well there as well. But big takeaways are, if you do have some kind of joint issue, it’s never good enough to just say, hey my problem is just this one thing. You really have to think two, three orders deeper, to really get out what’s really driving things, to get a better result.

Lastly, so a question that keeps on coming up, I’ve made some videos on this, but it keeps on coming up and I understand why. For my autoimmune inflammatory arthritis patients, who are on chronic medication, immunosuppressive medication, I have a lot of them asking, “Hey, is it safe and appropriate, for me to be taking treatment?” And the simple answer is, yes, but the more nuanced answer is, you have to think about risk. And you have to understand it, in a more deeper, more meaningful way. So the evidence, and what we’re hearing from physicians all over the world, our international and national specialty, medical specialty organizations, is that if you are an autoimmune patient, that’s on chronic immunosuppression or medications, and you’re well controlled with medication, you should continue that medication. And in fact, what we’re seeing is that, if your only issue is that you have an autoimmune issue and you’re on meds, there does not seem to be significantly higher rates of problems being on these meds, if you were exposed to COVID-19. So you’re okay staying on those meds. Now, the reality is that, you have to think deeper than that. Meaning that, not everyone is a 25 year old that’s on a medication, right? A lot of our folks are people, that are 60 plus that are taking medications, and have other medical issues as well. Whether that’s diabetes, kidney issues, liver problems, heart problems, it’s more nuanced. And it’s important because those other risk factors, are what can put somebody at greater danger. Meaning if you have a history of diabetes, that puts you in a little different category, than someone who doesn’t have that. And you can still make smart, intelligent decisions, if you’re kind of thinking through risks, in a more kind of comprehensive way.

So an interesting thing that came up recently for me, on my LinkedIn feed a colleague of mine, Mark Testa, put up something saying, hey, now that maybe we’re slowly starting to come out of this COVID-19 thing, he wanted to know what are people thinking when it comes to getting their kids back into activities, and just normal life. I mean, for a lot of us, our kids are just locked up doing, you know, they’re totally isolated from their normal life, and it has been very hard. And his daughter is the same age as mine, which is six. And my take was, you know, when I think about risk from my family’s standpoint, meaning me, my wife and my kid, we’re generally low risk. We don’t have a lot of other chronic medical issues where, you know, if we were exposed to COVID, we’d probably be okay, we’re probably someone who would do fine, that’s as the odds and the numbers say. And so from a risk standpoint, I can think about this, and think, okay, what are the things that we can do, to reduce our risk of having problems, and that means using all the appropriate social distancing, protective equipment, mask, gloves, all that kind of stuff. But take it to the next level, which is, how do I start thinking about, how this affects other parts of my life as well? So I’ve started to have conversations of risk, not only between me and my wife, about what do we think from a family standpoint, but also with my parents, also with my team at work. And each level, the risk kind of conversations will be different, it’s a little bit nuanced. When I talk with patients, again, that risk conversation is nuanced, based on what’s going on with them as well. And it’s, it’s interesting, I actually have a great grand uncle, my grandfather’s brother in Delhi, I think he’s in Delhi. I met him for the first time, he’s 92-93 years old. I met him for the first time that I recall, last year when my family was visiting India, and I was told today, by my mother, that he actually is in the hospital, the ICU there with COVID. And so, you know, it makes you realize that, there are different levels of risk conversation and I think it’s worthwhile for all of us, that at a moment where, we’re now more hyper-interested, and concerned about risk, that you need to start thinking about your own risk. Meaning what are the risks for you and your family? What are the risks that you have as you start to reintegrate into normal life, and society and work? How do you sort of start to think about that. And you don’t want to be reactive, you know, either too aggressive or too conservative. You want to be able to think about risk, in a way that makes sense to you. I think if you do have chronic medical issues, it would be very important and helpful, to actually have those conversations with your own trusted physician, because realistically, those conversations are going to be nuanced, and it’s going to vary from person to person. The conversations I’m going to have about risk with my wife, are going to be different than the conversations I have with my parents. I’m more concerned about the risks that my 70 plus year old parents have, who are very physically active. I’m more concerned about, if my dad wants to run six marathons this year, which he normally does, because his risks are different, than let’s say the risk I have. And that nuance is important because what we’re seeing across the country, is that different communities, states, have different sense of risk tolerance. And the risk that we can take here in Chicago, where it’s dramatically more populated, compared to the risk that somebody might feel comfortable taking in rural, Southern Illinois is going to be very different. And while you can take some basic guidelines, individually, you need to think about this in a more nuanced and appropriate way. And realize that that conversation continues to change, and what you may think now, next week, based on what’s happening in the world, what’s happening in terms of testing, vaccinations, stuff like that, that that’ll change as well. And constantly having that sort of, intermittent risk analysis in your own head is helpful. You don’t want to make this an anxiety provoking issue. You want to be thoughtful and intellectual about how does it help to to make some thoughtful decisions. Utilize resources you have, meaning, don’t rely on necessarily your national news sources, that are just giving you sort of the extreme version, but utilize your trusted physician sources, and other trusted resources to help make that decision. And, you know, I think it’s helpful to think about it, that how do you in a practical, intermittent fashion, keep thinking about that? So at work, we do that by weekly having that meeting, where we’re talking about what is our plan for COVID testing and protection, for all of us and for staff and for patients. And I think having that same kind of process, in my own personal life, and in your own lives, I think would be helpful as well, so that you can guide yourself through this kind of tricky moment. Because a lot of our understanding, of how we’re going to get back into regular life, is a day by day, week by week kind of process, where we learn from each other, and what other people are doing. And I think the key is, to keep your head on straight, don’t get too far to one extreme, and make some decisions that make sense, and utilize the people that can help guide you.

Hope that’s helpful. I am extremely grateful, that everyone who had a chance to log in is able to do so. If you have questions, if you have things you want to hear more about, message me, call me, email me, whatever, and to keep this kind of conversation going on a weekly basis. And until next week, hope everyone is doing well. Hope you stay healthy. Have a good day and live well. Bye bye.

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