Weekly Education- 20200615
-Why regenerative medicine.
-Improving upon the standard of musculoskeletal care.

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.

Okay, all right, so welcome to our first weekly educational meeting. This is Siddarth Tambar from Chicago Arthritis and Regenerative Medicine. In this weekly format, I’m here to talk about a lot of the basics of what we’re doing in clinic to help treat arthritis, tendonitis injuries, and back pain. This is really situated for my team, all of you guys, in terms of getting us on the same page. And whether that is discussing concepts related to the rheumatology side with inflammation or the regenerative side regarding procedures and sort of philosophical bend with how we approach things, the idea is that we’re all sort of on the same page, understanding, messaging, all that kinda stuff.

And this works best if it’s kinda back and forth. Meaning if it’s not just me talking, I can do that if needed, but I think it works best if you guys have questions as well. In particular, Jackie, you’re talking to patients more and more. They’re probably asking you a lot of questions. I think as you have questions, kinda asking me, that’s how we learn. Right? Lilia, you’ll learn just kind of the basics of what we’re doing as you start conversing with patients more, it’ll be the same kinda thing. This is really meant to help fill in the details regarding the frequently asked questions sheet that we’re building out for what we do around here. And of course, Devi, this is good for you to at least get the basics. Then also to help coach me. Am I messaging things appropriately on a non-medical level? And then also kinda integrating and synthesizing everything that we’re doing.

We are definitely going to be videotaping this. It is videotaping. Good. Mainly because if there’s anything that is work-related, content-related, information-related, that is HIPAA compliant, we want to videotape, tape, and sorta distribute. I just think that going to be smart going forward.

So I thought a good topic to start our first one is why we even are involved in regenerative medicine? Like what’s the reason, what’s the purpose, what’s the why. And it’s really a couple-fold. The big picture to me is we can do better. Right? Something I’ve been talking about more and more is, as we come out of corona, we’re starting to realize there’re people talking about going to back to normal. And I would say, forget about normal. Why don’t we do better? Why don’t we take this is an opportunity to say, why don’t we do better? So regenerative medicine is one of those things. How do we do better?

So, as an example, when you take individuals who are at the level where their musculoskeletal condition is so severe, where surgery’s being discussed, the British Medical Journal has documented that only 20% of orthopedic surgeries meet Level I evidence for evidence and purpose of treatment. And what that means is, Level I evidence means that you have double blind, placebo-control. It’s like your highest level of evidence in medicine. So that means 80% of those surgeries do not meet that criteria. What that really means is that there’s opportunity to do better. Whether that’s on the non-surgical side. Whether it’s on the minimally invasive side. Things that we do. Or whether that’s even on the surgical side. You know, how can medicine do better knowing that only 20% of them meet that highest level of evidence? So first and foremost is how do we do better? And regenerative medicine, while it’s a relatively new field, the concepts, which we’ll talk progressively over the next few weeks, are built on sound medical concepts and in a low-risk fashion.

We’re thinking about risk so much more aggressively now. In large part because we’re all obsessively thinking about corona. But the reality is that when it comes to medicine, we should be thinking about risk in everything. We should be thinking about the risk involved in a blood draw. We should be thinking about the risk of actually coming to the clinic rather than doing this in a telehealth setting. Let alone we should be thinking about risk when it comes to medications, when it comes to surgeries, when it comes to procedures. The general public doesn’t always think about this proactively. They sometimes rely on us, on the physician end. And I think where we can add a lot of value to people is that when it comes to their musculoskeletal health, how do we help them re-understand or begin to understand risk and reward when it comes to their musculoskeletal health.

Okay, good. So that’s kind of one big picture. The other big picture is when it comes to musculoskeletal health, most people take the following approach. They wait until something is so severely bad that they cannot do anything before they actually pursue treatment. That’s crazy. Meaning if somebody’s got back pain, they don’t address that when they’ve got back pain initially. They wait until it’s so severe that they can’t work, till they can’t lift up their kids, till they can’t do anything. And they’re missing a chance to do something at an earlier stage to make things better. So whether that is addressing an injury at an early stage with something like physical therapy or exercises. Whether that’s emphasizing things like weight loss, more of an anti-inflammatory approach, the diet supplements functional medicine. Or, if somebody has something that is early on not responding to treatment, rather than just doing things like ice, rest and anti-inflammatory medications, can we help to improve stability at that functional unit that’s been damaged so that we can prevent this from getting worse. That is really where regenerative medicine can shine at that early stage. Because traditional medicine, the way that it’s approached, is if someone’s got persistent pain, you’re basically masking that with pain medication, steroid injections, ice. And you’re just waiting until it gets worse. The reality is if you’re 16, 18, 20 years old you’re probably going to get better on your own. For the rest of us, that’s just not how life works. Right? That progression and accumulation of injuries and mild soft tissue problems eventually leads to instability, which then leads to arthritis, tendonitis, and more problems. If we can catch some of those issues earlier on, regenerative medicine can help to improve stability and actually put somebody on a better trajectory course.

So why regenerative medicine? Because we need a higher standard. Because we need to be thinking about risk more proactively. Because there’s a huge scope of area that we can do better for people that have more advanced conditions. And because, can we treat people at an early stage to prevent this from getting worse? So, you’re starting to hear about more and more formal organizations starting to recognize these kind of treatment modalities. Whether it’s platelet-rich plasma from knees or other conditions, but this only going to be growing. And, you know, I’m pretty excited to be in this at a ground level. Questions? Jackie.

– [Jackie] I have to think of some. I will have some. Trust me.

– Okay, good. Yeah, I think going forward as much back and forth is helpful because number one, it, I think the best way to learn is if you’re asking questions. Right? And we’re going back and forth with that. Number two, I think as you start to talk to patients and hear their questions, like the way you respond to them, is how you’re actively learning at the same time. And then the reality is that helps me learn as well. That helps me to refine thoughts and philosophical approach to treatment as well. Good.

– [Student] At what point do you decide they are no longer benefiting from weight loss or PT and it’s time to intervene?

– Such a great question. Right. So when do we decide someone is failing conservative treatment like weight loss or strengthening? You know, the nice thing about medicine is that you can really just ask are you making progress? Right? So if you take somebody that has, let’s say, back pain, right? Well, start some physical therapy, some weight loss. If at the two month mark, six week mark, they’re telling you, hey look, I’m like 40% better, great. Give it more time. Right? But if at some point they say, look I’m doing my part appropriately, I’m still not making progress, that’s the time to jump in and intervene. So, medicine offers us this great concept that we can get feedback from a patient immediately. And we can figure out when they’re kind of plateauing, and that’s the best time to intervene. Reality is, a lot of our patients don’t quite do that. They kind of wait for us to initiate. But it works better if they’re initiating on their own, pushing proactively, and then we’re getting feedback from them in terms of when we realize we need to push harder. What else? Yes?

– [Lilia] When….

– You don’t need to raise your hand, Lilia. Yeah.

– [Lily] When do you know when there isn’t…. Is there a time where you cannot help these….

– Yeah. Great question. So when do we know when we can’t help them?

– [Lily] Yes.

– The reality is that there is data on some of these things. Right, so we know someone that has advanced knee arthritis can still benefit from treatment. But someone that has advanced hip arthritis, less likely to benefit from this treatment. So it’s going to vary from area to area. A lot of that is still relatively early understanding. But we know that different areas will respond differently. We know that certain types of tendon tears, right, if someone has a partial tendon tear or even if it’s a full tendon tear but it’s still pretty closely approximated, that can still respond well. But we know one that’s more pulled apart really just needs surgery. Now the thing, the interesting thing is that even in those kind of cases, the kind of treatment that we offer can actually help to augment a surgical process long-term as well.

A lot of it is defintely understanding certain things really would be better off with surgery. But in the same way that, let’s say, cardiac surgery went from being the dominant way of treating advanced coronary artery disease to now it’s a very small subset of that. Where the vast majority is handled with minimally invasive procedures. That’ll be the same thing with what we’re doing.

What else? Jackie? No questions from you. Putting you on the spot.
– I can’t think.
– Okay. All right, good. I know. I know.
– [Jackie] No, but I am doing a spreadsheet of what the main….
– The FAQ. Good. Good, good, good. Okay good. If there’s nothing else, thank you, guys. This is a good start. The back and forth is helpful for me. Thank you very much. Yeah, bye.

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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses why regenerative medicine is a necessary step in musculoskeletal care.