Ep. 12: New treatment options for orthopedic pain

Regenerative medicine and orthobiologics uses our own bodies in treating orthopedic injury pain while promoting healing

Episode Transcript

Alan Helgeson (Host): Hello and welcome. You’re listening to the Health and Wellness podcast brought to you by Sanford Health. I’m your host, Alan Helgeson with Sanford Health News. This series begins new conversations and continues the important ones, all designed to keep you well, physically and mentally. Today we’re talking about Dr. Donella Herman, an orthopedic physician with Sanford Orthopedics & Sports Medicine in Sioux falls.

Dr. Donella Herman: Thanks for having me. I really appreciate it.

Host: Well, we’re going to talk about something today we hear a lot about these days and we know we’re all more active than we’ve ever been before and not just young people, but old people and everybody in the middle. What we’re hearing a lot about is regenerative medicine and orthobiologics. Hopefully you can describe what they are and why they should mean something to us.

Dr. Donella Herman: Absolutely. It’s an exciting field that Sanford is approaching right now, where we’re looking at how we can use resources within our own body to promote healing and promote a good environment where we’ve had an injury.

Host: When we’re talking about regenerative medicine and orthobiologics, are they the same thing when we hear those terms or do they mean different things?

Dr. Donella Herman: Regenerative medicine is kind of the larger umbrella. There are a lot of things that fall under regenerative medicine, including things in cardiology and oncology and ortho biologics. So orthobiologics is kind of the orthopedic side of regenerative medicine.

Host: Is this something that’s fairly new in the science that we were hearing so much about it these days, Dr. Herman?

Dr. Donella Herman: You know, it’s something that’s been in the works for a long time. There’ve been some studies in Europe. It’s something in the U.S. that people have been dabbling in. I think that if you go to the coasts, you can find kind of pop-up shops where people have been doing this for awhile. At Sanford, we’ve been doing platelet-rich plasma, which falls under this umbrella. We’ve been doing that for some time, but it’s something that it’s pretty widely found, but not widely studied. And so that’s where we kind of get into trouble is that people are using it, but we don’t really know what it does or if it works. And so it kind of, it can have some negative connotations to it, but at Sanford, we’re trying to kind of change that conversation. We’re hoping to kind of study what we’re doing and, and gather information. So we know what people are getting injected with, and really what the outcomes are in the end.

Host: As an orthopedic physician and working in the clinic and seeing patients every day, how does orthobiologics then compliment what you’ve done or what you’ve seen or traditionally done in an orthopedic clinic?

Dr. Donella Herman: Yeah, great question. In orthopedics, we have kind of some limitations in what we do in that there’s people usually think there’s non-surgical things and surgical things and the non-surgical things, things like physical therapy, therapeutic exercise, corticosteroid injections, something we call Viscosupplementation for joints, these are things that we use quite a bit, but we kind of have a, we have a couple of options and then the next option is surgery. And so orthobiologics we’re hoping is going to compliment that and that it’s going to give us some additional non-surgical options moving forward. Obviously there’s some things that, that have to be surgically intervened on but for, for the person who’s just trying to stay active and maybe isn’t quite ready for the surgery and we can provide them some relief with other options, we’re hoping this will help fill in the gaps.

Host: Right now as the current state is, you may have a menu with several items on it, but with this, this is a much bigger menu of things that you can use depending on whatever the injury is or what your recommendation is and all the things that go into how to decide to use it right?

Dr. Donella Herman: Absolutely.

Host: Let’s talk a little bit about Sanford Health and the role in orthobiologics.

Dr. Donella Herman: Yeah. We really have dedicated ourselves to making sure that if we’re doing it, we’re doing it right. One of the things that we know is that you can go to a lot of different places and get a lot of different promises. You know, we make sure that people know what our expectations are and try to have realistic expectations of what, what the orthobiologics products can do. But we’re also making sure that we’re following patients and we’re learning about if you have one, one kind of injection, like a regenerative cell versus a PRP, like when is that going to be more appropriate? Because that’s what we really don’t know and that’s one of the reasons insurance companies don’t like to cover these is because we don’t have that information about which one really is better than the other. And so at Sanford Health, we’re really dedicated to that. To making sure that we’re looking and following and seeing what, what patterns we can find so, you know, in, in a few years, we’ll be able to say, you know, this is what your knee looks like, or your hamstring looks like, or your Achilles looks like, and this is going to be the best product for you because we’ve looked at it, we’ve studied it and we’ve seen results and this is going to be the best option for you moving forward.

Host: Is it safe to say that really looking at, I don’t know if this is even a term, I’m making this up, but like a conservative pioneering in, in doing it the right way through research combined with the treatment options?

Dr. Donella Herman: Yeah, absolutely. We’ve got a very unique opportunity. The FDA has approved us for a clinical registry and we’re the only clinical registry in the nation and we were using that to study what we call stromal vascular or fat cells and stem cells that we can get from fat or regenerative cells from fat and what we’re doing is we’re, we’re, we have this registry and we’re the only one in the nation that has permission to do this and so we follow very strict guidelines in terms of who can, and can’t get the product, what the product has to look like. We have a lot of safety measures in place and so we make sure that we know how many cells that we’re injecting. We know how many of those cells are alive when we inject. We need to make sure that there aren’t any toxins involved and that there’s no infections involved and so we have that for the registry, but we’re treating all of our products that way, whether it be bone marrow aspirate, or PRP, we’re testing all of our products to make sure that that safety is in place and you’re getting what we say you’re getting. I think that that’s one of the shortfalls of a lot of places is that you can go in and get the injection, but they’re not taking those extra measures to ensure safety and also to make sure that you’re getting what we say, you’re getting.

Host: This is so much good stuff. Dr. Herman., let’s get into now, someone listening to this program and they have joint pain or an issue, who is a candidate for this?

Dr. Donella Herman: It’s kind of a complicated algorithm and honestly, it’s a very individualized conversation. If you have pain, whether it be a chronic tendon pain or an acute muscle injury, or if you have chronic joint pain, those are kind of all areas that, that we’re looking into and we basically have people just come in to talk about their pain and talk about how it’s limiting them and through that conversation, we discuss, you know, what expectations they have, what their overall goals are. And then we think of, okay, what options do we have that are going to be able to allow you to meet your goals, but also be either cost effective, or if you have kind of a manual job, we take that into account. We don’t want lay you up too much from your job or limit how much you can do at work. So it’s kind of a, it’s a very much individualized conversation we have with people in terms of, okay, what are you a candidate for? What would be the most promising thing for you? And I, I often tell patients, you know, ask me in five years exactly what that best product is because in five years, I’ll probably know, but right now we’re just, we’re, we’re studying it and we’re gathering more information. And so we base it on a lot of individualized kind of characteristics of, of not only what your pain is, how long you’ve had it, but where your overall goals are.

Host: Next question, Dr. Herman. What areas of the body can you use the orthobiologics in? Is it just knees, hips? What parts?

Dr. Donella Herman: So for the, for the registry, for our fat derived cells, we have five joints that we’re allowed to use that in and so that is the shoulder, the wrist, the hip, the knee, and the ankle. We can use the bone marrow and those joints as well, but we can also expand the bone marrow option to other joints. So, you know, the CMC joint or the joint of the base of the thumb, toe joints we can use it for, for things like that. The other options we have are also for muscle and tendon injuries. So if somebody has an Achilles injury and, and it’s something that we’re going to try to treat without surgery, we can use the bone marrow cells or rotator cuff tears even have responded nicely to bone marrow cells in the past. For the PRP, it’s kind of the same thing. We can either do joints or we can do tendons. We treat some hamstring injuries, Achilles injuries, things like that.

Host: What sort of time is needed? I know that you’re talking about different treatment options, but in general, are there some times to consider for recovery and healing?

Dr. Donella Herman: Usually when we inject into a joint, regardless of the product, we usually tell people, it, it takes a couple of weeks. We don’t want you to be too active for a couple of weeks. You can still do your activities of daily living. We don’t anticipate that you’re going to need crutches or, or a sling or anything like that. When we get into the ligaments and the tendons, because we’re injecting into that area, we want to be able to rest it afterwards. And so when people have either a ligament or a tendon, we generally ask them that, you know, we’re going to have some limitations probably for the first six weeks. If you’re a higher level athlete, it may, it may take you 10 weeks to get back to that higher level activity. But if you’re, if you’re somebody who has repetitive work at your job, it’s usually about six to eight weeks to return.

Host: Are there some risks or side effects to consider as part of orthobiologics?

Dr. Donella Herman: Absolutely and, and that’s something we also want to be forward about is that one of the risks is that this may not give you complete relief of symptoms. And so that’s a big expectation conversation that we have. But anytime we do an injection, risks of bleeding and infection are kind of the biggest ones. We make sure that we take all the safety precautions. We need to ensure that, that we don’t don’t have any of those injuries. You know, we do a lot of our injections under ultrasound guidance so we make sure that we’re going exactly where we need to go. We can see the injured area and we can ensure that you’re getting the product in the location it needs to be.

Host: Next question, Dr. Herman.  I know that Sanford is a very sprawling health organization with lots of different places to come into. Do I have to be a current Sanford patient to see somebody about this?

Dr. Donella Herman: You know, you can do a self-referral if your insurance allows for it, otherwise you can get a referral from your primary care provider. We’ve been trying to talk to the, the providers in the region and kind of let them know how to get people filtered into the appropriate place. A lot of times, if, if you see another provider and they feel it’s, it’s an appropriate option for you, they’ll, they’ll kind of push you in that direction or lead you to my clinic. But otherwise, if you have questions or concerns, you can just make an appointment in my clinic and we can kind of talk about what your options may or may not be

Host: Dr. Herman. I know that people with joint pain or joint issues, like everybody, and, and I’m sure you see them on a daily basis, people that are already sort of educated, I’m using the air quotes, by going to Google and searching. So people are searching this stuff and they see pop-up ads about these other places doing types of things, what should they be wary of when they see these things and why should they choose Sanford Health?

Dr. Donella Herman: That’s a great question and I always-people get nervous when, when they say, oh, they they’ve researched this on Google. I love it when my patients tell me that. I do. I know that means that they are, they’re truly interested in improving their own health, they’ve taken the time to do research. So for me, that’s a really positive thing when they’ve kind of looked into things. I think if you’re looking and, and they’re making promises that they can build new cartilage, that you’ll have a brand new joint or a brand new tendon when they’re done that, they’re going to get rid of a hundred percent of your pain, that you’re going to be able to climb Mount Everest. You know, I think, I think being aware that, you know, we don’t have all the information of what we’re doing. We’re generally just trying to provide a better environment for healing with these products. And if that means our body can somehow make some cartilage and put it in an empty spot in your knee then great but we don’t know that that’s actually happening. What we know is happening is that we’re creating a better environment within the knee so we have less pain and improved function. So if people were making you promises that if you get this, you’ll never need a knee replacement, or you’re going to feel a hundred percent better, I would be a little leery of that. And the other thing is the cost. You know, we really, we really shouldn’t be making a lot of money on these. So if they’re promising you, the world, and all you have to do is spend $10,000, okay, there, they may be looking to make a profit more than anything. The third thing is, is, is are they looking to see what they’re injecting? You know, are they able to tell you we are injecting live cells? Can they tell you how many? Can they tell you are these a safe product? Are we sure that there’s nothing infectious involved? Those are the, those are other questions that I think are important to ask because those safety concerns are, are the ones that really put people at risk if people are, if other entities aren’t taking those additional safety measures.

Host: Dr. Herman, I’m listening to this program, and I’m really excited about this and I think this might be just what I need, but I live in a community not near a Sioux falls. What are some of those questions they might want to ask my primary care provider about this If I bring this up through a regular clinic visit?

Dr. Donella Herman: I think just asking them questions about all the conservative measures that they’ve tried, and then obviously asking your primary care physician, you know, what they know about orthobiologics. We’re, we’re really making an effort to try to educate primary care physicians within our group because, because we know that they’re the frontline, we know they’re kind of the boots on the ground treating these early. And so I, if it, hopefully we’ve gotten to your primary care physician by the time you have these questions, but if you ask your primary care physician and they don’t have the answers, you know, we have a team within orthobiologics that is available. So, so you can either contact our clinic or ask your primary care physician too, to see if you may be a candidate.

Host: Dr. Herman, last question I wanted to ask you. Let’s say you’re riding an elevator and you’ve got 30 seconds to tell somebody why orthobiologics is important to somebody with joint pain. What would you say to them?

Dr. Donella Herman: I think it’s important because it’s a new option and it’s a, it’s an option that can either delay surgery or give people opportunity for, for healing and better function when maybe surgery isn’t an option for them.

Host: Dr. Herman, it was a pleasure talking to you today. We thank you so much for all of your information and insight into this topic of regenerative medicine and orthobiologics. For Sanford Health News, I’m Alan Helgeson.

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What is orthobiologics?

Posted In Expert Q&A, General, General Surgery, Healthy Living, Innovations, Orthopedics, Research, Rural Health, Sioux Falls, Sports Medicine, Veterans, Workplace Health

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