Stem Cells

How to treat Chronic Injuries- Regenerative Medicine approach

Posted on October 21, 2020 by Siddharth Tambar MD

How to treat Chronic Injuries- Regenerative Medicine approach
We all have chronic injuries. Even after recovering from an acute injury the involved area is more prone to long term degeneration, instability, and pain. In this video I discuss a healthier approach to managing chronic injuries that includes a regenerative medicine perspective. Key concepts include treating stability and inflammation. I also discuss a patient with chronic knee issues who with regenerative medicine has been able to continue his career as a active duty military professional.

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:

https://chicagoarthritis.com/schedule-a-telemedicine-appointment/

Hello this is Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. It’s October 14th, 2020. Welcome to our weekly live broadcast. So today I want to talk about how to address chronic injuries in a regenerative medicine style. So I’m a big football fan and it’s football season right now and there’s injuries happening left and right as the sport is expected to do. And when you see injuries you start to realize that there’s the acute nature of injuries in terms of what needs to be handled at that moment. But then, these people have chronic issues as well. And how should they be thinking about their issues and how can we better actually treat them. And reality is that for most of us, a lot of our musculoskeletal issues chronically will be from some mild chronic soft tissue injuries when we were younger at some stage of life. And so having an understanding of how to think about chronic injuries and chronic issues is key because it’ll make a big difference in terms of how you actually get a better outcome longterm. So number one, goals from treatment have to be pain relief, functional improvement, and keeping you active and exercising. And I think that’s across the board what goals should be for musculoskeletal issues but definitely for chronic injuries. And it’s important to understand that address this earlier rather than later, if you have chronic instability in an area that’s been previously injured, it’s going to make you more prone to osteoarthritis, tendonitis, longterm as well. And so you’re better off trying to address that at an earlier stage before it gets more advanced. You can still treat something when it’s become more chronic or more advanced but understand that it’s always better to treat it earlier. So if you, there’s a couple of key things that I would recommend. Number one, is stabilizing an area. So if you have an injury that is still relatively early acute or subacute, obviously the ways that you’re going to treat that are going to begin with bracing, physical therapy, if it’s severely traumatic or severely problematic or unstable then even surgery at that time. Obviously the classic example right now is Dak Prescott of the Dallas Cowboys who had a really severe ankle fracture injury or dislocation and obviously they’re going to treat that acutely in the proper way, surgically and bracing and resting and all that, longterm though because he’s got now chronic instability that will develop in that area because of injury to the soft tissue ligaments and all that, that he should be thinking about longterm, meaning five, 10 years down the line how does he prevent that from getting worse. That may not be on his mind right now, but it should be some point. I recommend that people should be thinking about regenerative medicine at an earlier stage of their recovery from a early injury, because there’s a lot of benefit to that. Whether that is taking injury that is not a surgical case and treating it at that stage or taking an injury that is actually a surgical case and when it’s actually been settled down to then actually apply either your own platelets or bone marrow drive stem cells makes a lot of sense at that stage as well. Chronically stability is really important because that what’s driving that chronic arthritic or chronic tendinopathy. And again, maybe some kind of bracing intermittently while you’re physically active can be helpful. I think it’s super important to do the corrective exercises either physical therapy or on your own longterm as well, because you need that kind of stability and strength around that area that’s been injured. In addition I think regenerative medicine utilizing your own platelets or bone marrow stem cells makes so much sense in a chronic injury because that’s what going to actually prevent that from getting worse. I think as much as possible if you have a chronic injury and instability, you want to try to avoid surgery. The issues with surgery are that most of the typical minimally invasive surgeries are about cutting out tissue that’ll actually leave that area more unstable longterm and actually potentially accelerate that degenerative process. And then the other component to that is, regenerative medicine is really made for those kind of cases in terms of helping to improve stability, helping to improve inflammation that’s where it really shines. So number two, kind of key concept is inflammation. So certainly if an area is inflamed, either acutely or chronically, rest, activity modification makes a lot of sense temporarily. I would strongly recommend avoiding using anti-inflammatory medications in large part because while they may be helpful short term, they just have too many side effects longterm. In addition, when you look at some of the supplements like curcumin, turmeric as well omega-3 we know that those kinds of issues can actually help in terms of inflammation and can actually help with wear and tear arthritis as well. And so strongly recommend that as well. You can use ice in a limited fashion. If you’re relying on it too often, I think you really need to make sure you’re seeing a physician expert in musculoskeletal medicine to make sure that you’re actually making that, you’re actually addressing the issue properly and that you’re not just masking the pain. A great example of this, is actually a patient of mine who had a PCL, posterior cruciate ligament injury in his knee several years ago. He’s active military still. He’s more on the training side now. But I essentially see him roughly every six months or so for PRP treatment. At which time we’re treating a number of different ligaments in the knee his PCL, his ACL as well as his medial collateral ligament and some of his patellofemoral ligaments and also treating the patellofemoral joint. What’s helpful in that case is we’ve been able to give him better stability, which has enabled him to continue to function and train at a very high level that he’s required to do as part of his work and in the military. In addition, it’s also helped in terms of just a day to day activities and pain relief as well. Taking a treatment that is relatively very limited in risk and invasiveness, right. And just injecting his own platelets to help keep him going at that kind of level, taking a chronic injury and helping him to stay that physically active is incredibly key. And again, it’s important to understand that most chronic degenerative issues, chronic arthritis or chronic tendinopathy patients are typically they’ve had a milder injury at some point and if you can treat some of those milder injuries at an earlier stage, you give yourself a better chance of preventing this from progressing. Wonderful, so that’s what I want to talk about with chronic injuries today. I see there’s a question that I have regarding chronic pain and also having MS. Is regenerative medicine a treatment option. Yeah, so from a chronic pain standpoint it depends on why you have it right. Is it chronic pain because, let’s say an area has been chronically weakened or unstable and has progressively become degenerative. If it’s at the level of the joint or tendon or ligaments, then that can be treated. If it’s higher up, let’s say at the level of spinal cord, I don’t think there’s enough evidence that’s really a proper treatment for multiple sclerosis at this time. There may be experts in neurology or neurosurgery that have a different opinion but at least from my perspective, I’m still possibly a candidate if the issue is at the level of the joint or the tendon, but probably not a candidate if it’s at the level of the spine. Great. Well, thank you very much for everyone’s time. As a reminder, we do this on Mondays and Wednesdays answering your questions, discussing concepts that are relevant to what we do here at Chicago Arthritis and Regenerative Medicine, focusing on nonsurgical, management and treatment of arthritis, tendonitis, injuries and back pain. In addition, I’m also doing a webinar today four o’clock central standard time. You’ll see a link for that below on whichever platform you’re watching where I’m discussing regenerative medicine treatments for lower back pain. Until next time, until we talk again, have a good day and live well. Bye bye

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Weekly Educational Broadcast- 20200727- Can regenerative treatments help in bone on bone arthritis?

Posted on July 28, 2020July 30, 2020 by Siddharth Tambar MD

Weekly Educational- 20200727- Replay
Can regenerative treatments help in bone on bone arthritis?
Importance of variables such as age, range of motion, which joint is affected, and patient goals of treatment.
Importance of stability, alignment, inflammation, and optimizing cellular health of the affected joint.
Cases- Hip, Knee, Ankle examples.

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/ChicagoArth…
https://www.Facebook.com/ChicagoArthr…
https://www.youtube.com/c/chicagoarth…

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—

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:
https://chicagoarthritis.com/rege…

Hello, everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, and welcome to our weekly educational broadcast that is live. It’s July 27th, 2020, and thank you for joining me today. So, on this weekly broadcast I focus on questions that my own team and patients are frequently asking, or from the past week, and applying that to cases that I’ve seen in the last week to give some perspective and go over kind of big picture principles in terms of what we’re doing here at Chicago Arthritis and Regenerative Medicine, where our focus is on evaluation and treatment of arthritis, tendonitis, injuries and back pain, with the most cutting edge treatment options available that are low-risk and high in terms of benefit. So, a question that Jackie from my office kind of transferred over to me from a patient, or a potential patient, was can regenerative treatments help in bone on bone arthritis? A really super common question, and the intention is that this is likely someone who is seeing their physician, either orthopedic surgeon or primary care doctor, and has been told that on their x-ray they have significant arthritic issues, and have been told that they have bone on bone arthritis, and that they may not be, that they may only be a candidate for a replacement surgery or some other kind of similar treatment protocol. And really common question that comes up, because the reality is that most people, when it comes to their musculoskeletal health generally are approaching it as something that they’re really only addressing when things have progressed to a severe stature, and obviously it’d always be helpful if you can catch this at an earlier stage. But the reality is there’s nuances to when we say someone has bone on bone arthritis. To begin with, it depends on what joint’s affected, it depends on the range of motion, and it depends on what the goals are of treatment. So, range of motion is a big one in the sense that if range of motion is still intact, or still fairly good, you have to ask, “What exactly do we mean by bone on bone?” If you’re really, truly bone on bone, you really shouldn’t have regular range of motion, and an example of that would be someone who has significant hip arthritis and can’t really move the hip, let’s say inward, or internal rotation. On the other hand, you can have someone that has really advanced or severe arthritis of the knee, and their range of motion is still close to intact or still very good. And so it’s important to understand that sometimes what we see in x-ray does not necessarily translate to what’s actually happening to that individual, and may not necessarily be fully representative of what the problem is. So, a classic example of that is someone who has, let’s say pain in one knee, let’s say their right knee, and their x-ray shows advanced arthritis, and they also happen to have an x-ray of the left knee, and it turns out the x-ray of the left knee actually looks worse than the right knee, and they don’t actually have any pain in the left knee. And it’s a great example of where imaging or x-rays don’t always call out the full, don’t always tell the full story. And it’s important to understand that x-rays and imaging can tell you one thing, but they don’t give you the full story. The other aspect to that is, let’s say somebody’s had an MRI and shows significant findings. Now their pain, someone that has a degenerative process, their pain does not only come from what you see in the cartilage wear, they have pain that’s coming from the bone, from the soft-tissue structures, they have pain that’s coming from various other areas as well, and so these are other areas that can still be treated. And range of motion is a big one because if your range of motion is still intact, it likely indicates that you can still benefit from treatment. The other part of that is also what joint is affected. So, it’s super common that I hear patients who’ve got knee arthritis say that, hey, they have bone on bone knee arthritis, or they’ve been told that, and can these treatments help? And the reality is that the evidence out there for platelet-rich plasma and bone marrow derived stem cells is that wear and tear arthritis in the knee, that even when it’s advanced that people can still get a good degree of pain relief and functional improvement. In fact, there is suggestion that degree of arthritis when it comes to the knee does not make a difference in terms of the ability to have improvement in symptoms. Now, the flip side is if somebody has more advanced hip arthritis where range of motion is gone, then that’s a more challenging category, and that’s someone who likely is a better candidate for let say, hip replacement surgery. So, it does matter which joint is affected, and it does matter, range of motion as well. So, those are really the two big things. Then I think the last thing is what are the goals of treatment that are being pursued. So, in someone that has bone on bone arthritis, we can still help in the following ways, we can help with stability, we can help with chronic inflammation, we can help with alignment, and we can help by improving and optimizing the cellular health of the joint. All of those things can be done non-surgically. They can be done either utilizing just good strengthening exercises, weight loss, over the counter supplements, bracing, and also regenerative medicine treatments, including platelet-rich plasma, bone marrow derived stem cells, adipose micro-fragmented cells, and even dextrose prolotherapy. All of those things can actually be helpful, when your goal is pain relief and functional improvement, and that’s because we can help in those other aspects, we can help with stability by strengthening the soft tissue structures, with strengthening exercises, not to mention with the regenerative medicine treatments, we can help with inflammation with over the counter supplements, dietary changes, and there’s also benefit from the regenerative medicine treatments when it comes to reducing inflammation longer term. Alignment can be improved with physical therapy and bracing, and optimizing the cellular health, meaning you take a joint where the cells are chronically damaged and no longer functioning well, you can get them to function better by injecting the right kind of cells in there. Bone marrow aspirate concentrate has mesenchymal stem cells, and the growth factors within that as well can help to stimulate the local cells in the joint that had been damaged. Optimizing the cellular health along with those other factors can help with pain relief and functional improvement. So, if the goal is improving pain and function, then even if you have bone on bone arthritis, in the right occurrences and in the right patients, you can still get those kind of outcomes. So, a couple of patient examples from this past week where I think that’s all very relevant. So, the first is a woman who is in her early 70s, she is still an active nurse, she actually works in a hospital where she’s actively kind of running things, and she’s very active, walking, almost running around just because it’s so busy, and she’s developed pain in her left hip. So, her range of motion is still intact, the issues in her case are, number one, what’s her degree of arthritis, because we know in someone, when it comes to hip arthritis in particular, as they get older they become a harder and harder candidate with these kind of treatments. And so it’s going to be important to get the right kind of imaging, meaning an MRI to figure out, along with her symptoms, which is pain in the groin in front of the hip, that is she a proper a candidate. And if her MRI shows that she’s got mild to moderate arthritis, and her range of motion is still intact, then despite her age, she’s someone who could still benefit from treatment. On the other hand, if her hip MRI shows more advanced arthritis and she’s really at the tip of really kind of progressively getting dramatically worse, then anything from the regenerative medicine treatment standpoint might be more short term oriented, might be able to help with some of the soft tissue kind of strains and pains that can occur in the degenerative arthritis, but she may be someone who’s headed towards hip replacement faster. So, in that case, telling whether somebody is quote-unquote, “bone on bone,” will make a big difference. Another example would be a woman who I’ve seen kind of for the last, I think seven years, and she intermittently, we’re treating, you know, maybe a hip, a knee, an ankle, a lower back over the last seven years, probably three or four times we’ve treated something or another. And in her case, she really does have pretty significant knee arthritis. What’s been described on x-rays as bone on bone. And she’s someone where her range of motion is still intact, she’s still very highly physically active, still in good general health, and she’s someone who with just platelet-rich plasma has done great. Even though her x-ray shows, you know, bone on bone, she’s someone who, because we’ve been able to help with stability, chronic inflammation, alignment, and optimizing the health of the joint, we’ve been able to give her, really, a great degree of pain relief and functional improvement over the last several years. And a contrast to, let’s say a hip patient, where someone who can still do really, really well. The last one is a patient of mine who I treated four years ago, he has a pretty bad ankle. And he’s someone who has a baseline pseudo-gout, and so he’s had chronic inflammation that caused bad damage in his ankle, and by the time he came to me, he had, you know, what’s been called bone on bone arthritis in the ankle, and that’s very legitimate. He had limited range of motion in the ankle, and he’s someone who I would say is a very challenging candidate for treatment. He had originally bone marrow aspirate concentrate, utilizing his own stem cells from the bone. As well as platelet rich plasma to treat the ankle joint, and he’s done quite well actually in terms of pain relief and functional improvement. He’s had a 70% improvement in terms of pain. He’s been able to reduce his chronic anti-inflammatory medications. And he’s generally done very well. He’s someone who I would say was a very hard candidate for treatment, very challenging candidate, but because we’ve been able to help with all those other variables, improving stability, inflammation, alignment, and really optimizing the health of the joint, he’s had a good result. Someone where traditional treatment or traditional approach would say this is a challenging candidate because it’s bone on bone, but someone who because we’ve taken a comprehensive approach to treating it, and that means treating not only the joint that is damaged, treating the bone that is chronically swollen, treating the ligaments that are chronically lax and unstable, and treating even some of the nerves around the leg, and the ankle, and the lower back has given him better pain relief than he had expected, or that his imaging would really predict. And that’s really the key. Make sure you’ve got the right diagnosis, make sure you’ve got the right understanding of the severity. Make sure you’ve got the right comprehensive treatment approach, and make sure your goals of treatment are aligned with what the patient’s goals are. And if so, you can take somebody who still has bone on bone arthritis, and still give them a good result in the right cases. Great! Well, thank you for your time. Until next week, I hope everyone does well. As a reminder, we do this live event on Mondays and Wednesdays. This Wednesday is my live-live event, I may have a guest on with me, and we’ll have some conversations about some exercise and physical therapy related issues when it comes to arthritis, and issues related to the aging athlete. And I look forward to that conversation. Until then, have a good day and live well. Bye-bye!

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses whether regenerative treatments can help in bone on bone arthritis.

Weekly Live Live broadcast replay 20200715

Posted on July 19, 2020July 19, 2020 by Siddharth Tambar MD

Weekly Live Live broadcast replay- 2020/07/15

-Covid19

Rising numbers in the country, stabilized numbers here locally.

Staying focused on prevention.

Vaccine.

-Cases

Different sorts of patients, different expectations of regenerative treatments.

Case 1: Young man with shoulder instability.

Case 2: Advanced knee arthritis.

Case 3: Advanced hip arthritis.

Weekly Educational Broadcast Replay- 20200713

Posted on July 14, 2020July 30, 2020 by Siddharth Tambar MD

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:

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See our blog:

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—

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

Candidate Form

– 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.

***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

Posted on July 10, 2020July 10, 2020 by Siddharth Tambar MD

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
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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.

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***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.

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