Questions and Answers re your Musculoskeletal Health:

-How to diagnose a joint infection.
-How to evaluate and treat bursitis.
-Can you inject stem cells into an infected joint?
-When would you retreat a joint or tendon if it’s already been treated with a regenerative medicine treatment.

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

– Hello. This is Siddharth Tambar from Chicago Arthritis and Regenerative medicine. It’s October 5th, 2020, and welcome to our weekly live educational broadcast. So last couple of weeks, I’ve been doing this on my own, but I have a team here today asking me questions, which is the way we’re supposed to be doing it, where I answer questions that they have, or that patients have about what we do here in clinic. As a reminder, we are focused on nonsurgical treatment and management of arthritis, tendinitis injuries, and back pain. So great to be doing this with questions again. Jackie, you have questions go for it.

– [Jackie] Yeah, so the first one would be how to rule out the infection of the joint?

– Okay. So first question was from a patient who was asking, how do you know if you have infection in a joint? So a couple things, number one, if you have an infection, there’s certain classic things you would expect to have. Fevers, for sure, swelling in the joint as well, but the gold standard way to really rule that out would be to take fluid out of the joint and to send that off to the lab, let that incubate and grow for several days and rule out any bacteria, fungus, or any other kind of infectious organisms. So for most people, it should be that simple. There are some cases where someone may have a chronic infection or a chronic reaction if they’ve got hardware in the joint, but for the most part, ruling out infection is generally pretty straightforward in that manner. Next question.

– [Jackie] What can you do for patients that have bursitis?

– Great. So what can we do for patients that have bursitis? So bursitis essentially means over different parts of the body, let’s say the shoulder, the knee, the hip, you have the small little fluid sacks called a bursa, which basically helps to protect the bone and that part of the region from any kind of stress, it’s just another sort of small buffer. And in some patients you can have an irritation of that sack, which then leads to bursitis, pain and swelling. So what’s interesting is that number one, does a person really have bursitis? So something that I frequently see, whether it’s for hip bursitis or shoulder bursitis, is that what gets called clinically bursitis is not actually truly bursitis. When you actually look under ultrasound, which you find is more tendonitis and you don’t actually find fluid in the bursa. So number one is, do you really have that proper diagnosis? And so if somebody truly has tendonitis and it’s not actually bursitis, you’d want to make that diagnosis first. And then the treatment for that would be as we do that, as we do this every single day, which is physical therapy, activity modification, and then if needed using either your own platelets for platelet rich plasma or your own bone marrow derived STEM cells, inject that into the injured tissue, whether that is the tendon, the ligaments that support the support that area as well. And sometimes if there is a chronically irritated bursa, even injecting into that as well. On the other end, if somebody really does have fluid in the bursa, then number one, just draining the fluid out of the bursa, making sure that it’s not infected, making sure that there’s no crystals or other inflammation in it. And then treating not only the bursa with those same cells, but then also treating those other soft tissue components around that as well to help basically protect that area, make it stronger, and then prevent that recurrence of bursitis. What other questions?

– [Jackie] My very last one. Patient wanted to know, how would that procedure work for him, the regenerative procedures, if he does in fact have infection in the joint?

– Okay, great question. So last question that Jackie asked is I guess the question is, can you utilize these kinds of cell based treatments if you have an infection in the joint? And really the simple answer is no. I mean, if you truly have an infection in the joint, you’d want to get that cleared. Firstly with antibiotics, you may need to actually get that surgically cleared as well, drained out more thoroughly. I would not recommend injecting cells or really anything for that matter into an actively inflamed joint. A better option would be to treat the infection first and then treat any sort of residual issues that may be there. For people that have had chronically injured joint after a prior infection, after the infection is cleared and you’re kind of fully away from that, then you can actually inject your own cells, whether it’s bone marrow or platelets into the joint, to actually treat that injured joint to that point. But when it’s actually infected, you definitely want to avoid that.

– [Jackie] Thank you.

– Devi or Susan, questions?

– [Susan] Nope, none for me.

– Wow, I must be doing a great job answering questions at works then.

– [Jackie] I do have a question. I know I said last one.

– Yes, please.

– [Devi] So we oftentimes have patients who are repeat customers to either treat the same joint a few years later, or the complimentary joint. So, you know, first we did right hip and then coming back to the left. So is it normal for patients to have a few years go by and have the same area treated again and why?

– Okay, great question. So the question is, is it normal to retreat an area after it’s been treated once? Partly it depends on what the problem is, right? So if somebody has, let’s say a recent onset injury, the expectation is if you can treat that early on, you can actually prevent that from progressing in the future. They probably would not need repeat treatments. On the other end, if somebody has, let’s say a chronically arthritic knee or lower back, it’s likely that they will need repeat treatments sometime in the future. The evidence shows that not only do people get long lasting results, but that if they do need a second treatment, they’ll actually get a improvement to a higher level after that second treatment as well. So a couple examples of that. Number one is my own mother-in-law, I’ve treated one or the other knee, basically every six months. So treating, let’s say, her left knee once per year, her right knee once per year. It’s been about a year since we last treated either one of her knees. And she’s someone that has had really significant damage in the knees in the past. Because we’ve repeat treated her over time, she’s actually done well without any treatment for either one of those needs for the last year. So she’s had sort of a persistent longer lasting result because she’s had repeat exposure to cells. Another example would be a patient who I saw in the past that had what I would consider a very challenging hip case. And he actually got treated every six months, three times with his own bone marrow STEM cells. And he’s done phenomenally well, like much better than I would have expected. And so even in cases that would be considered chronic or poor candidates repeating treatment can make a big difference longterm as well. So absolutely for chronic issues, you should expect somewhere down the line, repeat treatment. Note that the best way to maintain effectiveness longterm is to maintain ideal body weight, strength around that joint as well, and alignment, neuromuscular health, metabolic health, all the basics that we talk about nowadays. So yes.

– [Devi] Is that expectation set during the evaluation with you?

– It’s discussed, for sure. Yeah, absolutely. I mean the data and the evidence and the numbers that we generally kind of quote about effectiveness of treatment are based on a one time treatment. What I tell patients is expect somewhere down the line, if you have a chronic issue, you’ll likely need a repeat treatment again at some point. What else? Devi, Jackie.

– [Jackie] I think those were my main ones for this topic.

– Susan, are you inspired with any questions?

– [Susan] No, none. Okay, great. Well, thank you very, very much everyone. This is a relatively short one, but sometimes that’s all the questions that there are. And as a reminder, we do this live two times per week, Monday and Wednesday. As another reminder, I’m doing a webinar this Wednesday 5:00 PM central standard time on regenerative medicine treatments for knee pain. So if you have knee arthritis and are interested in STEM cell treatment, we’ll talk about that. If you’re someone that’s had a recent onset knee injury, we’ll talk about how platelet rich plasma or your own bone marrow cells can help out. If you have an ACL injury, MCL injury, a tendon related injury or tendonitis. Or if you’re just interested in regenerative medicine, learning more about treatment in general and how you can discern and figure out which physician or clinic to see based on best practices, I’ll be discussing that as well. So until next time, have a good day and live well. Bye bye.

– [Woman] Thanks, Dr. T.

– You’re welcome.

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.
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