Telemedicine Patient Diaries: Ankles, Backs, and Necks!
As you all likely know by now, many physicians including those at Regenexx now offer both in-office and telemedicine visits. For the latter, the patient is seen in the comfort of their own home through their phone, tablet, or computer. Yesterday was a telemedicine day for me where I got a chance to catch up with some patients who I have featured on the blog before. So let’s get into how those patients are doing.
Tracy is a patient in her early forties who spent years working in Nepal who I had seen several years back. At that time she was down to only walking a few hundred steps a day due to severe subtalar arthritis. This means that the joint BELOW the main ankle joint was arthritic (see image here). She was initially treated in the licensed Grand Cayman clinic with image-guided injections of her own stem cells which were grown to greater numbers in culture. The goal was to help the joint and to tighten down loose outside and inside ankle ligaments. She initially had a rough recovery, but as we continued to work on the ligaments in Colorado she gradually got back to more and more walking. The last time we met she was up to a few thousand steps per day.
One of the new things we began focusing on in January of this year was the fact that her MRI demonstrated a problem with the sinus tarsi ligaments shown in the diagram above. As you can see, this is a complex network of ligaments on the left that stabilize this subtalar joint on the right. However, these ligaments are the red-headed stepchild of the ankle, in that most physicians barely know that they’re there and even fewer have any solutions if they’re lax and allowing too much motion at the subtalar joint.
We tried to inject this area under ultrasound, however, the visualization of these ligaments is poor using that technology. Hence, we quickly switched to fluoroscopy (real-time x-ray) as that allowed us to more accurately target those ligaments. The images of that injection highlighting these ligaments is shown here.
So how is she doing? Our platelet based injections to tighten these ligaments and stabilize the subtalar joint has her now walking 6-7,000 steps a day! She’s going to start mixing in hiking and then short runs. Suffice it to say that while it’s been a long recovery, Tracy has gone from a wheelchair to a normal human being due to precise diagnosis and treatment. In addition, today’s telemedicine visit from her home gave her the next steps in the plan to get her back to more significant activity.
Rob is a patient I saw last year from California who had a severe neck issue with a large disc bulge. That bulge was very impressive, so he was offered surgery. I felt that stabilizing his neck with platelet based ligament, joint, and epidural injections around the nerves could save him a big surgery. Sure enough, he did well and after the procedure has had no neck pain or numbness in his hand. He obviously never got the surgery.
He’s in an area that’s shut down so exercise has gone down because his gym is closed so he’s been riding his bike more using a Camel Back. That’s irritated things in his neck a bit, so I gave him advice on what to do at home to see if this would go away, if not, we’ll bring him back out for a touch up in his neck. Again, all of this happened from his home gym while he was half-way across the country. Because we have a secure two-way video link, he could show me his camelback and I could walk him through a quick exam.
Ricardo’s Low Back
Ricardo has been a tough patient. He regrettably had all sorts of injections into his discs including birth tissues and exosomes before I evaluated his low back at our Cayman clinic. Just before that visit he was getting much worse and after our precise injections into his L5-s1 disc in Cayman, I was able to diagnose that all of those prior injections into his L4-L5 disc had caused a severe bone reaction in the vertebra. Basically, his L4 bone was falling apart and the MRI indicated that this could be an infection. Hence, our focus shifted from whether his L5-S1 disc procedure had worked to clean up mode for another doctor who had, in my opinion, irresponsibly injected a kitchen sink of things into his L4-L5 disc.
This is from our telemedicine visit today:
Note that I was easily able to go over Ricardo’s new MRIs with him, even though he’s in New Jersey. His crazy disc injections with untested birth tissues and exosomes had caused an L4 vertebra bone cyst as shown on the right. That’s now resolving after about 8 months, as shown on the left.
The best news was that the L5-S1 disc bulge that we injected in Grand Cayman with his own specially cultured, hypoxic stem cells showed dramatic improvement as shown below:
Noe that the yellow dashed circles show a mid-line disc protrusion at L5-S1 on the left and then the resolution of that bulge on the right due to the hypoxic stem cells we injected into the bulge. How did that work? The disc bulges due to weak fibers and the injection helps heal those damaged fibers, so the bulge size reduces.
The upshot? This is just a smattering of the telemedicine patients I saw on one day this week. As you can see, we’re fully able to get all of our new patients seen from the comfort of their own home or to keep our existing patients going on their treatment plans even during the shutdown! Hence, if you’re seeing a Regenexx physician or had plans to see one before the shutdown, please reach out to the national call center today to make sure you keep your diagnosis and treatment moving forward! This is now the “new normal” folks, so it’s time to keep staying at home, or social distancing when we’re out and about, but not time to let our bodies break down without plans to get them fixed!