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.

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.