Personalized Care in Regenerative Medicine
A major strength of regenerative medicine care for musculoskeletal conditions is the ability to personalize treatment based on your condition, severity of pathology, and other medical comorbidities. In this video you’ll learn more about how we personalize care using regenerative medicine techniques.
Hello everyone, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast. It’s September 9th, 2020, I hope everyone had a great labor day weekend, and I hope everyone is healthy and doing well. So we’re back at it here in the office and today I want to talk about personalization in regenerative medicine care. So this comes up from time to time and I’ll give a couple of examples of where this is super relevant. But one of the main strengths and benefits of regenerative medicine is its ability to personalize and tailor treatment to the individual that you’re treating. As opposed to medication where you have relative limitation in terms of how personalized you can make treatment. Regenerative medicine really gives you a really wide latitude for personalization and individualization of treatment. So I’ll give you a couple different examples to that.
So number one, one size does not fit all is always a good strategy when it comes to musculoskeletal health. Namely, if you have a knee issue or shoulder issue, you may not be the same sort of problem or the same type of person who respond to treatment as let’s say your neighbor who may also have a knee and a shoulder issue. And as much as you can have a personalized approach to care, that will make a big difference in terms of the outcome, because number one, it requires your physician to really understand what your issues are.
Number two, it really requires a detailed understanding of how to treat a musculoskeletal pathology in a way that will get you a better result. In addition different tissues are not treated the same, they’re treated differently. The way you treat a joint or cartilage injury, the way you treat bone swelling or bone marrow edema, the way you treat tendon injury or tear, or the way you treat a chronically lax ligament, or chronically weak, or atrophic muscle or chronically irritated nerve these are all very different in nuance. And if you utilize the same platelet preparation for each one for example, for platelet rich plasma, then you’re not really treating the tissue appropriately, you’re really treating it too, in too much of a uniform manner. You really should be utilizing subtlety and difference with how you treat these different types of tissues. So as an example, different platelet preparations will give, will help different types of tissue. So when it comes to joints for example, arthritis, you want to use as high a concentration of platelet rich plasma as you want to. You want to use a 14 to 20 times, concentration of platelet rich plasma, that’s very hard to get. There’s no commercial over the counter system or kit based system that physicians use that’ll do that. You can do that in a lab based system by taking more blood and by concentrating it over serial centrifugations, but you re you really require that kind of flexibility and personalization. With tendons while there is some lab based evidence that higher concentrations of platelets get better results. Clinically, we know that a moderate level of platelet rich plasma will do better than a low dose platelet rich plasma. In joints clinically we know a higher dose platelet rich plasma will do better than a low dose platelet rich plasma. When it comes to ligaments, either utilizing a low concentration of platelet rich plasma, or platelet lysate, which are just a growth factors from the platelets is how as a physician, I want to treat that. You don’t need that to be super hyper inflammatory, you just want to have a mild amount of inflammation When it comes to nerves, utilizing platelet lysate, the growth factors from the platelets is healthier and less inflammatory and less irritating to the nerves than normal platelet rich plasma, which tends to be more inflammatory. And lastly, when it comes to using muscles or treating muscles you want to use, what’s called platelet poor plasma, where you don’t have a lot of platelets. That’s actually been shown to be better for muscles and platelet rich plasma. So having both a different set of concentrations, as well as different types of platelet preps is what’s going to make a difference when it comes to deciding what sort of preparation you want to use based on the tissue that you’re treating.
In addition, there are other factors that can make a difference; age can make a difference. If you’re older and you’re treating a joint injury, you want to utilize a higher dose of platelet rich plasma, rather than if you’re somebody very young. Person, who’s 80 plus years old may be very healthy, but you want to to use a higher dose of platelet rich plasma than let’s say someone who is 18 years old and has a milder injury and is just a healthier and has a more robust response to treatment. In addition, if you have other types of medical comorbidities, let’s say chronic diabetes, chronic metabolic syndrome, you likely are someone would require a stronger treatment rather than someone who’s otherwise healthier. So understanding not only musculoskeletal pathology, but understanding how these treatments work, as well as the different types of orthobiologic treatments or platelets or bone marrow stem cells, or other types of treatments that we utilize in this regenerative medicine field makes a big difference and realizing that the individual person’s own variables and factors makes a difference as well, makes a big difference.
So I’m going to give two examples. First is a 57 year old man who I treated recently, who has some mild arthritis in his shoulder AC joint, the joint on top of the shoulder. And he also has a mild to moderate degree of rotator cuff tendonitis, not a really bad tear, but it does have some irritation to the tendon. And the way that we treated his case was I utilized a 14 times concentration platelet rich plasma for the AC joint because it is a joint and will do better with a higher dose platelet rich plasma. And then I utilized seven times concentration, platelet rich plasma for the tendon. I did not want to go overly inflammatory. And I also used platelet lysate for the ligaments around the shoulder as well, understanding that that prolotherapy concept of strengthening ligaments and improving stability will go a long ways to improving both the AC joint arthritis, as well as the rotator cuff tendonitis. But really utilizing in that one patient three different platelet preps is really key.
One way that, you know if you’re dealing with a regenerative medicine expert is do they have that level of dexterity, subtlety and personalization. The way that you know you’re not dealing with an expert is if they are really utilizing a one size fits all platelet rich plasma for your entire condition. That’s not the right way to do it.
Second case would be a individual that has, a patient of mine that I’ve treated for knee and shoulder issues. He was treated by a colleague of mine Dr. Landrum for some arthritic issues in his neck and his thoracic spine. So he ended up having a high dose platelet rich plasma injection into his facet joints. That is 14 times normal concentration he also had platelet lysate, the growth factors from the platelets injected into the epidural space. So again, two different types of platelet preps based on what tissue is being treated. And in addition, in order to draw enough platelets, we had to do a very large volume blood draw, about 450 CCs. That’s a pretty large blood draw, that’s about how much you would actually give during if you’re actually donating blood. So pretty large blood draw we required a blood bag, extra ACD, which is the anticoagulant you put into the blood bag to make sure it doesn’t clot. And then it actually required some additional steps by my own staff to actually properly prep the blood so that you can get the proper product. So it really required multiple steps and really more than just a quick blood draw and five minute preparation, which you do hear some clinics doing, which is not the right way to do this. But in this gentleman’s case because we took the extra effort to properly do this, take the extra blood draw properly, prepare two different types of platelet preps he’ll likely get a much better result than if we’d done this in a you know, really not properly professional manner. So I’m very hopeful that he’ll have a great response like he has for his other areas because we’ve taken the time and the effort to do this properly.
So personalization in regenerative medicine, personalization in terms of tissue that we treat in a comprehensive manner, personalization in terms of choosing the right orthobiologics or cell based treatments based on your condition, and personalization utilizing the right sort of concentrations of your platelet, rich plasma products based on your actual conditions and your underlining medical issues as well. It makes a huge difference, we’ll get you a better result and it’s the right way to do this as opposed to maybe some other ways of doing this.
Thank you for your time. As a reminder we’re doing a live stream talking about topics related to musculoskeletal health and wellness twice per week Monday and Wednesday. This week didn’t do one on Monday just because it was labor day, so I’m glad to get back to this on Wednesday. But we’ll be back at this on Monday as well. In addition, doing a live webinar, which we’ll get more information within the body of this, wherever this is posted on social media, where discussing issues related to regenerative medicine, name of the webinar is the Truth about regenerative medicine. You’ll learn a lot more about details of what is, what is not regenerative medicine, realistic results, what can be treated, what can’t be treated, what are ways to know that you’re going to get a good treatment by a legitimate physician, legitimate clinic and ways to avoid poor quality treatments and clinics as well. Until next time, have a good day and live well. Thank you very much. Bye bye.
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