The Get Healthy Tampa Bay Podcast

E96: Exploring Low-Dose Radiation Therapy for Osteoarthritis with Dr. Rahul Bhandari

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I'm thrilled to welcome Dr. Rahul Bhandari, a board-certified radiation oncologist based in Clearwater. In this episode, we explore the fascinating world of low-dose radiation therapy and its potential to treat osteoarthritis and other inflammatory conditions. Dr. Bhandari explains how this innovative approach works to reduce inflammation and relieve pain without the side effects of traditional treatments like NSAIDs or steroids. We dive into the history of low-dose radiation, its success in Europe, and how it's becoming a game-changer in the U.S. for patients who have exhausted other options. Tune in to hear inspiring success stories, understand the science behind this treatment, and learn who can benefit from this revolutionary therapy!

Dr. Rahul P. Bhandari is a board-certified Radiation Oncologist, with more than 10 years of experience. He has a strong history in Academic Research in Radiation Oncology, publishing peer-reviewed papers at Georgetown University, Northwestern University, the University of Mississippi, and the VA Sonny Montgomery Hospital. Dr. Bhandari earned his undergraduate degree from George Washington University before going on to receive his medical degree through the University’s Medical Center early selection program. Dr. Bhandari completed his Radiation Oncology Residency at the University of Mississippi Medical Center, where he served as Chief Resident his last two years. After Residency, he joined VA Sonny Montgomery Hospital system, where he helped establish the Stereotactic Body Radiation Therapy (SBRT) Program for Veterans in Jackson, MS.  He then practiced with Tampa Bay Radiation Oncology and the Cyberknife Center before joining Clearwater Radiation Oncology.   

He is now leading the way in the Tampa area with a new breakthrough treatment for benign inflammatory conditions, such as for osteoarthritis.

0:28 - Introduction: Meet Dr. Rahul Bhandari
1:01 - Dr. Bhandari’s Journey into Radiation Oncology
3:06 - Understanding Low-Dose Radiation Therapy
4:58 - The Difference Between High-Dose and Low-Dose Radiation
7:04 - Why Osteoarthritis Is Difficult to Treat
11:37 - The Role of Inflammation in Osteoarthritis
13:45 - The Benefits of Low-Dose Radiation in Treating Inflammation
16:06 - Keeping Radiation Local: How Technology Works
20:17 - Ideal Candidates for Low-Dose Radiation Therapy
29:14 - Success Stories and the Growing Popularity of Low-Dose Radiation

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Kerry:

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller and today we have a very special guest, Dr. Rahul Bhandari. Welcome to the podcast.

Rahul:

Hello, pleasure.

Kerry:

Yeah, so you are local in Clearwater in the obviously the Tampa Bay area, and I know we've had some Discussions on the suffering of hurricanes, but we both survived and are okay. And I think, you know, what you have to bring today is pretty exciting. So I'm excited to hear about, you know, who you are and what you do. So why don't you tell us a little bit about that and then we'll dive into our topic.

Rahul:

Yes, absolutely. I'm a practicing board certified radiation oncologist based in the Clearwater Pinellas County and surrounding Tampa areas. Primary practice is based. in cancer treatments. so that, does take up 90 percent of our, clinic based practice. I, yeah, in terms of radiation ecology, in medical school, there's not any exposure I would say not much, but really, really not any. Maybe there's one sub chapter on radiation therapy under the cancer section of our medical school training. But otherwise, there's no exposure. It's really, if you catch the bug, then you have to pursue it yourself. So personally, I Caught the bug fourth year medical school. I knew I wanted to get into the oncology world and practice oncology care, but wasn't sure what discipline, surgery, medical oncology was even really, privy to radiation, but got exposed to it and I jumped right in. And, and the radiation world. It's very very much so academic based. So that that's where I started getting into the academic side of things, research side of things. I went to George Washington University in D. C. Medical school. They did not have radiation program there, but Georgetown our neighbors did. So I jumped right in there, they welcomed me with open arms, spent time there. And then I went to Northwestern university radiation center after and spent a year there publishing and rotating through their clinics there. And then I went to residency And went from there, but it is everything for me. It wakes me up, gets me excited. I love what I do.

Kerry:

Cool. Yeah, definitely want to be doing things that you let light you up. I was excited to see that you're like GW and Georgetown connections as you know, I did training in Baltimore and actually my brothers went to Georgetown undergrad. So it was neat for sure. DC is a fun area. So tell me about what is, you know, low dose radiation therapy and why have I never heard of it?

Rahul:

Yeah, yeah, absolutely. The primary reason what I'm here to discuss is low dose radiation therapy. You know like I said, primarily our practice is based on treating cancers, which, which we are prescribed high dose radiation therapy. So don't want to get in, too much details and bore folks. But in terms of just radiation, you know, for example, head and neck cancer, prostate cancer, those types of malignancies are receiving around 7 to 8000 plus units of radiation. And they are getting about 200 units of radiation daily. And for example, head a neck cancer, they will come for 35 total treatments. So over seven weeks, they'll get 200 units a day to equal 7000 units to that primary malignancy. In contrast osteoarthritis or really any inflammatory disease ending with itis is what we can treat now effectively. So for example, osteoarthritis, tendonitis, bursitis, synovitis appendoconulitis, you know, tennis elbow, golf elbow, things like that anything with local inflammatory process, we prescribe low dose radiation therapy, which means in contrast. We're giving about 4 percent of the total radiation dose to the joint space of interest. So joint osteoarthritis patient will get half a unit of radiation per treatment opposed to the, if you remember the 200 units per treatment. So, entirety, a joint will receive 300 units over six total treatments. So half a unit, they'll get 300 units which is what a cancer patient plus minus gets in one sitting to their cancer and the 35 total times. So that's why it's considered very low dose therapy. It's about 4 percent of a cancer dose.

Kerry:

And that's throughout the whole course of the treatment,

Rahul:

That's correct. Yes. So that in radiation and just in terms of biologically and all that we treat with a certain low dose per fraction obviously depends on the cancer histology site, etc. All the fractionations dose per treatment are different. Total dose will be different, but we're treating at a small dose at a time. And really, it's giving the chance to the body to repair overnight. That's correct. So because we're, you know, high dose is going to the cancer cell some of the normal surrounding normal tissues do get exposed to some radiation dose. Now we know what each organ they have their own tolerances so we make sure we don't surpass those limits, but we have to go slowly because six hours later after radiation is given those normal tissues repair. But if we gave the full dose in one sitting, it's critical issue yeah, that would cause a lot of damage and normal tissues wouldn't repair. So that's what we're essentially doing. And and so low dose, they, you know, through animal models and clinical research and all that. I'll get into how long, you know, this has been around. Actually, it's pretty miraculous surprising, but animal, animal models, this half a unit of radiation, you know, was the exact dose that caused anti inflammatory response. And so there is the multifaceted mechanism in terms of how it affects the local inflammation in the area. And that's what we're essentially treating, decreasing the inflammation. But Any higher dose over one unit would cause a pro inflammatory response, which we do see when we treat cancers on local sites. You know, we will cause inflammation as the dose builds up in the local area, but really this ended up being the magic dose through multiple studies over decades of this magic unit caused anti inflammatory, but it was that sensitive fine line where if you went a little over per fraction per dose per day it would cause Pro inflammation. So that's how we landed on this dose of half a unit per treatment.

Kerry:

That's very specific for sure. So Dr. Bhandari, osteoarthritis, right, is becoming increasingly common affecting millions and millions of people. Can you explain why osteoarthritis is such a difficult condition to treat with the current methods that we have?

Rahul:

Yes. You know, as we know, and it, it's a perpetual growing problem every decade. If you look at the statistics, it is the second most debilitating chronic condition. It is the highest burdening, financially burdening chronic condition in the US and then you, you look at. What's associated with osteo, you know, higher depression rates, cardiovascular rates, obesity rates lack of mobility, you know, everything where you need your joints to move and help with the rest of your health care and body, you know, fine tuning it, you're kind of sacrificed. So it does provide a big burden on the health care system and then, you know, economics as well. But if you look at osteoarthritis, it is. The leading chronic condition when you get into where we don't have effective therapies yet for this chronic condition that yeah, are longer lasting or really getting down to the bottom of it. I do want to say before, you know, I go further. I am a big proponent, especially as a cancer doctor of preventative measures, the holistic approach, start at the root cause, You know tackling that to begin with in the global healthcare world, you know, obesity rates and all that. But when we're having patients already diagnosed and they're sitting in the primary care physician's chair and they've been told orthopedics chair, rheumatologist chair, we have no options left for you at this point, which is a common news that is delivered to them at certain stage of their osteo, which is true. We really, if you get down to it there, there is a stepwise approach in the U S. It's conservative measures. You come to the PCP's office, you complain of joint pain, they say, let's try conservative measures, weight loss, rehab such, you come back a few months later, didn't work, let's try orthotics. Things like that. Maybe even try pushing NSAIDs at that point which we know long term NSAID use cardiovascular fest g I bleeds. You know, that's a whole sequelae as well. if that doesn't work they'll suggest injections, steroid injections, different hyaluronic acid injections that as such and then as we know, osteoarthritis, a progressive debilitating disease over years, Unless, you know, if we get down to the root, if you do see weight loss and all that and are serious to rehab, there is a way to turn around, but a debilitating disease, there's a certain point patient walks in the doctor's office and they are told and that's really how I'm getting my patients given this news of I have nothing left for you. There is no other options replacement is the only option. And then, you know half of them are good candidates because of their age and comorbidities as such. But that is really where we're at and we're also learning simultaneously what the underlying mechanism is where, you know, 1st we know it's cartilage destruction, joint space, narrowing bone destruction, nearby sclerosis. We're now noticing that it is multifaceted as to there's also changes in the synovium and in the ligaments in the bones, obviously around in the whole joint capsule in entirety, we are realizing it's multifaceted. So one treatment here and there wouldn't, might not handle it. And then even steroids, which is the standard of care here. Eventually, we know you can only get so many injections. A, B, we know that it can cause cartilage destruction down the road, so it's almost going against it. And so I would say to end it, right now our therapy is outside replacement, which is, you know, change, replacing the actual structure, because it becomes a structural problem too. Outside that, it, our therapies are masking therapies. It is just to mask the pain or the symptoms and with that hopefully increased function, but it's not getting down to trying to tackle or treat what is causing the pain. What is causing the dysfunction? And so we know half of this structural. You know, the joint space narrowing loss of that but the other half is the inflammatory response that is occurring and is building through the years because the joint space isn't getting better over time. It is becoming more destructive. The space is narrowing and the immune system is just trying to handle it through the years. And in fact, it's almost working against it and causing accelerated destruction

Kerry:

Mm hmm. A couple of things. A couple of comments. One is I'm a obesity medicine specialist and I totally agree, getting at the root cause and working, you know, on whatever nutritional foundation and things to do but sometimes, you know, we see that they may have weight so much in excess that they cannot move around to say, okay, you need to move more, right? So, you know, These kind of things are important, so as I see people losing weight with me, one of the best things they say is that they're able to, you know, move more, feel better. So that's good. But sometimes, you know, they may need something like this to help them be able to do that and even have success in losing weight. So that's, that's definitely a great thing to have an option for. And then, You mentioned NSAIDs, just so everybody who's listening knows what that is, but non steroidal anti inflammatory. So things like ibuprofen, Advil, Motrin, Naproxen you know, there's Diclofenac, all sorts of ones. And yes, like we definitely turn toward those to help patients. And, like you said, there's a cardiovascular risk, there's a kidney risk, there is a GI bleed risk, and some people just can't take them. And then, obviously, you know, sometimes people would maybe move toward another medicine, might be like an opiate, and that's definitely not something we want to go doing either, right? And then you mentioned the steroidal component as well, and definitely, you know, that standard of care which is, we don't want to do systemic steroids, but at least the local injections can help, and you only can do every, you know, three months or so, you know, having these, this alternative idea is fantastic, I think. And then, like you said, a lot of people are being told, like, you got to get it replaced, but like you mentioned a lot of people think of or osteoarthritis as like a structural problem, like bone on bone. And I don't think we do hear as much, even though we give the anti inflammatories, that it is an inflammation So it's almost surprising to hear that, I think for the general public of that, some sort of radiation therapy, which is focusing on the inflammation can actually improve this problem. And I know we can talk about the other problems that this helps in a minute, but I just think that's so interesting that they may not think that, right. So, Yeah,

Rahul:

and even get, you know, that with animal models, they got down to the gritty nitty gritty of what cells radiate low dose radiations actually affecting and killing away. And specifically, there are 4 mechanisms. There's the anti inflammatory mechanism. It reduces the production of anti pro inflammatory cytokines, interleukin 1 and tNF tumor necrosis factor, those cells go away. So as it reduces production and recruitment of pro inflammatory cells, and then it modulates the actual immune cells that are already there, such as macrophages, lymphocytes, mast cells. So it also kills away those cells in the meantime. And then it also has shown properties of cartilage and bone production. So osteoblastic Mineralization and then prohibition of osteoclast cells. And then the last thing is it has endothelial proliferation to help with the healing process. So it is tackling, like you said, and what I tell my patients, you know, I, I'm not doing anything or affecting the actual structure here, but in your case symptomatically and subjectively, because we don't know in terms of symptoms, I can see a radiograph, an X ray. I can't really tell. It might not line up with the actual presentation. Sometimes it looks bad, and they're not with pain. Sometimes it doesn't look so bad, and they have 10 out of 10 pain. It's hard to pinpoint for x rays per se, but I said one thing I am, will, will help with is the inflammatory process, the pain signals that are released there, the destruction, the destructive cells, you know, delaying those, or at least eliminating those. So you can get back to working. And to go off on what you said, that's one of the One thing I was in my consulates and follow ups with is if you go through this treatment, I would, I am a big proponent of physical rehab because to sustain this, maintain this relief, if you have such, you have to build the structures again around it that have been dormant and, you know, the body diverses resources very well. It weakens the muscles that are being used as such, you know, so let's get back to it. let's get you moving again. Let's work on these other things. It is again a multifaceted approach there too.

Kerry:

So with all these generation and destruction of the certain cells, is it localized to what area is getting the radiation treatment?

Rahul:

Yes. Yeah. Great question. So radiation, the way it works, it's very, it's local therapy. And so the way I describe is surgeons, they use blades and knives. We use lasers. But if surgeon goes in and cuts in a specific area, that's what they're addressing. And if you have side effects, it's just in that area that they're poking at. And same thing with Us, we're giving external beam radiation, but very local with our technology, you know, where, if we're treating a little circle, we're only off by a millimeters, you know, that circle will get radiated and the dose fall off is so steep that the surrounding tissues don't get exposed to much radiation. So osteoarthritis, all that, just treating, for example, the knee, just a knee joint capsule with a margin of a few centimeters, but nothing else in the body gets affected by radiation. And while we're extra, Okay, with going through with this, despite all the data is because when we're treating joints, there's no critical organs nearby near the knee you know, elbow all that jazz, all the critical organs are in the central part of the body and we can displace the knee or whatnot away and just treat that locally so nothing otherwise gets exposed. And what do we have here is just tissue, muscle, tendons, bones that are highly resilient to radiation doses and that heal pretty nicely. So yeah, very local therapy. And if you have side effects and radiation, it will be in the area we're addressing.

Kerry:

Can you explain kind of how you keep it local, how that works?

Rahul:

Yes. So what we use in either cancer or osteo or benign conditions is called image guidance radiation therapy, meaning what we'll do with any patient coming in eating radiation, we'll do a planning CT scan and it's usually in house at the radiation center, but it's a low dose type of CT scan with donut shaped machine, the whole ordeal still. But we, we scan CT scan the area of interest that CT is what we use to plan the radiation. So we really have drawing tools where we draw the organs and cancer area of interest and then physicists, dosimetrists, planning therapists, all that. It's a huge team in the radiation ecology practice. It's a lot of individuals involved, but it does go through three, four eyes terms of planning, et cetera, et cetera. But they basically shape the machine or angle the machine That which can move in 3 60 access most common way of delivering radiation is called linear accelerator. We're literally accelerating particles and causing ionizing radiation, but you can shape the beam and angle as such to just focus on that area of interest. And we're able to see how the dose of the deposited, you know, he's he's machine learning to now, and as coming to play all that, but with our tech, we're able to see where the dose is going. All then how much of the normal surrounding tissues are getting and that's how we say we're okay. Feel safe. We're not so safe with treatments And so when we put the patient on the machine, we use that planning CT that we did pre treatment and we fuse it with the position the patient is in that day. And that's how we can move the patient to line up perfectly with the planning CT. So they're basically a mark on mark and you know, they have marks on the body as well with line up with lasers, but that's how we assure it's image guidance because before we press treat every day, we make sure we're in the same position every time. Okay.

Kerry:

Mm hmm. You don't use casting or anything like that?

Rahul:

We use immobilization devices. Absolutely. And so it depends on the site. If we're treating lung, we'll bring their arms up and have them hold a little device on top of them to bring their shoulders out of the field. If we're treating their pelvis, we'll put them in something called a back lock. It's basically a bean bag that shapes to the shape of the patient's body. So that's their bag, every treatment, and that's what they'll be positioned. And so there are different ways externally and internally to show we're in the right area.

Kerry:

Okay. Who would be an ideal candidate for low dose radiation therapy?

Rahul:

Yes.

Kerry:

stage of osteoarthritis or other inflammatory conditions, would

Rahul:

So

Kerry:

they

Rahul:

yeah. So let me quick, let me give a historical background of where this is coming from. So, you know, the first osteoarthritis patient was actually treated in the 1890s. And it was a big part of the standard of care here here in the U. S. For many, many years however, when opioids came into play in the U. S. Radiation therapy got pushed away and it was not a thing anymore. Opioids were the magic do all eventually. However, in Europe, they kept pushing on all the first world countries there, Italy, Germany, UK, Germany, being the biggest country pushing this and during this time. So, for the last 70 years, they have been giving low dose radiation for their osteoarthritis patients about third of their population ends up getting low dose radiation therapy. And so their protocol is conservative measures. You try that for a few months, but if you try that for a few months and it hasn't worked, they'll, most patients will get pushed right to low dose radiation. Steroid injections is not even a thing there because this works, this actually is more effective works mechanism wise and has no side effects really are low low side effects compared to steroids. So it's not even there. Even, you know, opioid is not a as big of a thing as here as such. So that's where it falls. And then if it doesn't work or it comes back after a couple of years of such and replacements, the only option left, then they'll get replaced because this is not a contraindication for replacement. You can get go get replaced, you know, a couple months or a few years after this. You know, it's a great insertion to hopefully avoid replacement or delay it, you know, for a long time. But here what's being pushed now, Astra is our national radiation ecology society in the USA. They are over this year, they're pushing benign diseases and low dose radiation therapy for such such as osteoarthritis. So they're implementing their own protocol, but really the way I've linked with the local physicians, PCPs, rheumatologists, as such. If the patient has tried conservative measures and there's a discussion of even NSAIDs at that point or steroid injections, let's have them try low dose. Radiation therapy because of how effective it is been, you know, shown and not many side effects, but that's kind of where I'm falling into place or where it's moving towards just like the Europe. However, right now, I've been doing this for a little more than a year now. But in the beginning, especially within the community, the patients who I was getting were the ones where they've tried everything. They're opioid dependent. They've been told that the only thing's left to replacement, you know, they're literally, there's nothing left for them. So those initially were the patients I was seeing to see if I can help them at least, and but now it's the protocol is getting pushed ahead. Now room tallest PCPs are sending patients earlier on in the course, because even per literature is shown the earlier radiation therapy is given the disease process, the better the outcomes.

Kerry:

So, is it helpful for like rheumatoid arthritis? You mentioned rheumatoid, I mean, sorry, rheumatologist, so I'm just wondering.

Rahul:

So, so, no. So psoriatic arthritis, ru rheumatoid arthritis, because those are more autoimmune and you know, the brain and the central system is more so leading the way in attack mode. This radiation wouldn't work because it's just local therapy. That's the big thing here. It's just affecting some, a local process, a local tumor, a local inflammatory process. That that's what I would say. Those such autoimmune diseases need those systemic therapies or pills or injections, you know, more systemic intervention to tackle the autoimmune part. But no, this as of now, it's not indicated and hasn't shown to work on those conditions

Kerry:

Okay, what other any conditions or patients in addition to that, that wouldn't be the best option for,

Rahul:

really if you've had a replacement. You are automatically not a candidate because the structure is gone to begin with. Secondly metals in there and our particles, radiation particles will bounce right off. And yeah, really, it's not gonna work. And then the other contraindication is the spine. We don't treat any spine osteoarthritis as such. Technically, we can. It is very low dose. We give much higher doses to the cord and, you know, masses there, etcetera, without many side effects. But the whole favorable thing, like I mentioned, was we're staying away from the central part of the body here, and we're sticking to that for now, you know, so that and really, like I said, it's hard to determine For looking at x rays there you have severe arthritis, etc. So it is if you're you've tried everything you have symptoms that I will give it a try and even per my experience I've had patients coming in for 40 plus years of dealing with it. They've tried everything out of pocket and this did end up finally working for them, you know, and they're, they're, if you look at their x rays, they looked horrific, you know, Oh boy, is this even a good candidate, but they have nothing left. Let's try. And it worked and there's some patients where it doesn't look so bad and it just, it won't, it won't work.

Kerry:

can you think of any particular examples of a success story?

Rahul:

Yeah. my first patient actually sent to me from a rheumatologist she was one of his longest coming patients, but really, you know, every appointment was crying, with tears just basically because she, there was nothing left for her and she was not going to get replaced. She had osteoarthritis of a couple of digits in her right hand, and she underwent a surgery there. Now she has shortened digits and deformed hand, and she was just so upset about that. So operation was not an option. So it was more of, let me just live with it and not even opioids. Don't want to deal with it. So she was sent to me. I treated both her hands and she had deformed hands. Couldn't close her fist. Couldn't grip as such. I treated both her hands and she, after three months. gripping biggest smile to the point where the rheumatologist called and said, that was just amazing because every visit with her was just so hard because I couldn't add nothing left for her to the point where we also published a case report on her as well together because it was such a great success story. And then she ended up getting her niece treated as well down the road. She was dealing with that for decades as well. And Walking around all happy like that. Other success stories are a gentleman just wants to play pickleball and every year, every last few years just not getting back to it. Treat his ankles, arthritis of his ankles, wearing orthotics, A few months later comes in, doesn't need orthotics. His swelling actually went down, which is a mixed bag. Sometimes anatomically, you can see swelling go down or changes in the joint, but sometimes you don't. But in this case, swelling did go down. He has significant swelling, didn't need the orthotic, went back to pickleball, happy as ever. And I'll tell you even because it's so new in the U. S., but not new at all in terms of the medical interventions because it's it's a new at the U. S. It is voodoo in the beginning of radiation therapy for what, you know? So even admittedly so, I was skeptical too, just being trained in cancer and all that, just that's our world but when I dove into literature and I teamed up with radiation oncologists in the UK who has 14 centers dedicated just to, for radiation therapy that's all he does. So he helped me, got me to build my program here, and he's one of the gentlemen teaming up with the big university, Rad Onc, here in the U. S., who are implementing the protocols in the U. S. now, in terms of making standard of care here. But yeah, that was one. And then another simple, something such as guitar players. They just want to play guitar. They can't oppose their thumbs or grip and such, or they can only play for a couple of minutes. Just getting them back to playing guitar. Amazing. So even I started getting confidence when my own data, my experience was lining up with the publications you know, it's like this does work. And when I speak to other PCPs, I say, you know, when orthopedics came into the clinic many years ago and said, Hey, I'm going to put metal in there. I'm just going to replace that. I'm pretty sure people didn't run towards it, but it became standard of care rightfully so. But it's rocky waters. But the fact that it's working, our patients have become our biggest proponents, you know, telling other patients their own physicians. They're just at the end. Like I said, it causes mentation and cause can cause depression and all that, you know, mobility. So just seeing something like that, pick them up, feel like they have control over their life. It's significant. It's kind of why I'm pushing it more now.

Kerry:

Yeah. Well, are you facing any challenges getting it more widely accepted here?

Rahul:

absolutely. Just because of the radiation stigma and, you know, even when I have cancer patients come, they have legitimate concerns and, but most of their prompted questions or concerns are related to old radiation techniques and old machines and in the news and the scares of the old times of treatment, but our machines, technology, software, et cetera, techniques are so improved and they're getting better every year where we are getting away with middle side effects from radiation and better outcomes. But really that was that has been the barrier still is in terms of, saying, hey, radiation, let's try that, you know, but it is becoming more popular because it is working. And, you know, the 1 things I was when I started the program, I was wondering, does insurance even cover this, you know to my surprise. I would say 90 percent plus of insurance have always covered this. There's a whole section in most insurance companies where it says low dose radiation therapy for benign conditions, osteoarthritis, it's always been there. Just never utilized, tapped into, and you know, even in terms of economics, it's significantly lower than replacements or et cetera, et cetera. You know, decrease hospitalizations. You know, there's so many papers out there, too.

Kerry:

Yeah, you just answered several of my questions, right? One, does insurance cover it? Two, what is the cost effectiveness of it? It sounds like obviously it's going to prevent possibly a replacement and it's going to really cut down on the costs of, you know, burden to healthcare and everything. Could you explain a little bit more on what possible side effects might be?

Rahul:

Yes. So if I was telling patients, you know, if you expect any side effects, it would be local. Like I was saying, where we provide local therapy. So, for example, if I'm treating the knee, what do you have to worry about? They're like, muscles, ligaments, all that. But in terms of side effects outside and probably the most common, if anything, the side effect would be is skin changes radiation no matter what is we're coming from external source and go and then going inside, but the skin is in the way. So hence why high dose you'll see skin redness, darkening hyperpigmentation really how I put into layman terms for my patients in terms of what radiation therapy is, is I say, We're outside getting exposed to radiation every day in the sun. The sun is a big generator of radiation. We just harness that power and put them into millimeter beams. Why? For the same reason, if you're in the sun every day or for hours, you'll redden, darken, eventually get cancer if you do it for many, many years. Same thing here, but we're able to just weight the radiation beams and energies where we can say 100 percent here, not so much there. But radiation is going through and through. So in terms of side effects, Two things I would say is we can cause inflammation before taking it away. So that's one side effect, meaning you could have a couple of points increased in pain. Before you have decreased in pain. I do say that because of mechanism, but I haven't noticed it. And even per reports about one to 2 percent of patients might report it. The biggest thing is skin redness. And the note on that is there's a, there was a big study done on low dose radiotherapy just to see side effects down the road. A couple of years later, they looked at thousand plus joints treated and brought them back a couple of years later, asking about side effects, if any, and All of them, but one said no side effects. The one patient of the thousand plus said I little skin redness that went away, meaning possible, but really even from my personal experience, no side effects yet. And I don't expect any, it's just so low dose. There's nothing critical there. One caveat, any radiation exposure. There's always a chance of secondary malignancy. So I would say that is probably the most concerning. The one side effect on the radar, bigger concern in younger patients. So why I wouldn't treat less than 50 year olds with osteoarthritis. Some institutions won't treat less than 60. You know, it's just the younger you are, you know, longer you'll live higher chance of developing secondary malignancy. They ran reports on, 50, 60 plus year olds, low dose radiotherapy. They're. Non significant correlation with secondary malignancies there again, because not near critical organs as such what you would have to worry about, you know, they did a study of shoulder osteoarthritis and breast cancer incidents down the road from caused by radiation load you know, secondary malignancy and there is no correlation. That would be probably the most sensitive best way to see breast radiation therapy around the chest lymphomas can cause breast cancer down the road. But in this case, there's no correlation. So I would say side effects that might see skin redness. But that's about it. That's what I've noticed. And I haven't even noticed yet any skin changes myself over the last year.

Kerry:

Okay. you mentioned some other inflammatory conditions that you often use it for? Could you mention a couple

Rahul:

So, yes, I do treat anything solely with itis. So, tendonitis, bursitis, synovitis and then plantar fasciitis we'll treat. We, we treat inflammatory process too. Dupuytren's contracture. We'll treat that as well. So those are really all the main condition, anything with itis. So tennis, elbow, elbow, golf, elbow, you know which is pathology of the tendons and all that itis. So we'll effectively treat that too. One cool thing, you know, even when I present and talk to other patients as seminars I'll bring up a slide of Hussein Ball, who had plantar fasciitis. Was not even able to walk, got low dose radiotherapy to the sole of his feet and won two gold medals after, you know, it just worked so well for him. And I would say, yeah, even our fasciitis patients, it's working wonders because those are such patients too who are left with nothing. You know, they'll be shaving off the calluses on Dupuytren contracture hands or, you know, as such, but that's it's symptomatic orthotics, et cetera. But it it's working wonders too again because it's tackling the inflammatory process at the root cause of it.

Kerry:

I was going to ask about the Usain Bolt thing. So I'm glad you brought it

Rahul:

Yes.

Kerry:

Super cool. Because yeah, plantar fasciitis is definitely one of those more difficult to treat things if you kind of are doing all the things and it's still just very persistent. So this is very This is exciting. I can't wait to, you know, see if I can help people with sending them to you. Is there anything else you'd like to share with any, with us?

Rahul:

No, I mean again, thanks for having me the biggest mission, I guess is getting this news out there, especially seeing the results and how it is changing lives. I mean, I don't want to sound, you know, cliche or anything, but it actually is, which is incredible of seeing patients with no options and having them leave feeling better at least then they came in, you know, get them back on their feet as such. That's the biggest thing. I am trying to push this treatment out there. It is there. It is covered by insurances as such, you know so that that's the biggest proponent. I'm just agreeing. This grassroot showing up at doors, meeting physicians. And you know, I'm getting, I am seeing recurring referrals on patients because they're, some of these specialists are happy. Oh my, I've been telling them they have nothing left. I can actually tell them let's have something we can try that has worked. So that's been great. And even to the point where I'm treating, Some family relatives, even patients are our biggest proponents. Like I said, their relatives from the north, Pennsylvania, New York are coming down, staying with them for two weeks. That's how long the treatment is two weeks. And staying with them and getting treated and going back home. As people are finding out about it, they are loving it for sure. And what I guess we'll say just in terms of the treatment experience, For the patient, you know what, what it would look like for them under our care. So it is done over, like I said, six days, six treatments. And is the course is over two weeks. So we, we give this treatment every other day. It's Monday, Wednesday, Friday, Monday, Wednesday, Friday, usually most radiation centers are not open on weekends or holidays. So we don't treat it during those days, but otherwise it is over two weeks. It's about 10 minutes of visit. Every treatment's the same for them. They'll be laying usually flat on our hardtop CT top table. They'll see a radiation machine moving above their actual joint and just there making clicking noises. That's how they know it's on. Some patients will come out of the room and say, did I even get radiated? I didn't feel anything. And I'll say, I assure you it was on, but it is contactless, painless. Yeah, no complaints. It's usually in and out. And then I'll usually bring the patient back a month after that their last treatment. And that follow up is really just to make sure that didn't develop any side effects or have any issues and to see if they had any relief by this point, I would say it's a mixed bag in terms of timing and relief. I've had patients before they're even fifth or sixth treatment has been completed where they say I have zero pain now. I've had patients the month later, nothing. But three months later, I'm feeling good now. And even per literature, really, I would say three months is the real hard evaluation point, giving time for the inflammatory process to do its thing, the body to handle it, what we just did. So three months is a good evaluation point. You have to see if this worked or not. And then reports also, I will say one big question is how long will this last? You know, is this a temporary relief, et cetera, et cetera. There's great reports and, you know, I'm a little more than a year, so I'll be publishing my own eventually, but reports were pretty consistent, which is when they bring these back patients back two years later, if they saw relief at three months, at least 50 percent were still saying, I feel great. If not, depending on the joint of course it was different. The numbers were different, big or small joint. But even up to somewhere 70, 90% were saying, I feel great still two years later, even some three years later, or 50 to 70% were saying I feel great. So it shows, it's proven to have a sustained response too, it looks like.

Kerry:

That is super exciting. Wow. This is really, this is really cool. I feel like it's not cutting edge because it's been around for so long, but it's great to see it used in other areas too. So thank you for sharing this. Where can people find you? I mean, we kind of said, but where can they find you? They want to work with you or follow you or something like that.

Rahul:

Yes. So we're right in Clearwater. My website is clearwaterradiation. com. There's more information on our website. We're very approachable. We're very personable clinic. Feel free to call us, message us. You will most likely get me directly. Requested or not. If you have questions, I'll talk to you directly. We are like that there. And you know one thing, if you Testament is if folks can read her reviews, you know, patient testimonials of even their own experience, just arthritis patients, you know and how, how it's worked for them. But very available approachable and just part of the community love what we're doing and just kind of move that needle forward, you know, for patients. Like, I know you're doing kind of trying to stay on top of it.

Kerry:

Yeah. Well, thank you so much, Dr. Bhandar for being on the podcast today and sharing your expertise and your time with us. I really appreciate it. This was really exciting to hear about. So

Rahul:

Thank you for

Kerry:

to working with you.

Rahul:

Absolutely. Likewise. Thank you for having me.

Kerry:

All right. Stay tuned everybody next week for another awesome episode. And thank you for listening.

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Dr. Kerry Reller

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