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Dr. Rosie Gilbert and Dr. Kristy-Ann Brock introduce us to some of the most exciting therapies for chronic joint pain, including Class IV Laser, Platelet-Rich-Plasma, and Stem Cell.

  Sunday, March 19th, 2017

  2:00pm

  DoveLewis Emergency Animal Hospital  |  Community Room (upstairs)

 

Dr. Brock, Daniela, and Dr. Gilbert  

What We Learned

It was a chilly, sunny, end-of-winter kind of day here in Portland as our audience gathered to hear from Kristy-Ann Brock, DVM, CCRP, and ACT Alumni, Rosie Gilbert, DVM, of Viking Veterinary Care.

They have been steadily expanding their arsenal of regenerative modalities to combat a variety of inflammatory processes, including arthritis (degenerative joint disease), wounds, ligament injuries, and even feline gingivostomatitis.  They kindly agreed to share their knowledge and experience, along with some fantastic cases.

 

“Regenerative medicine is the bold collection of techniques and technologies that aim to restore our physiology to something that resembles its original condition.”

Nature, December 2016

 

Inflammation is the enemy

Osteoarthritis (aka degenerative joint disease) is the most common cause of chronic pain in dogs and cats (probably humans, too).  Symptoms of arthritis are not always obvious – not all pets will limp or cry – and can range anywhere from poor grooming (especially in cats) to reduced appetite and aggressive or defensive behavior, such as biting or scratching. 

AVMA TV: Arthritis and Your Pet

 

The take home message is, first, arthritis has no cure, and second, no single therapy is right for all individuals.  Keeping our pets comfortable requires a plan that suits both the patient and the pet owner, and must be guided by a veterinarian with a broad knowledge of treatment methods, including medication, regenerative therapies, and referral opportunities for anything that’s not available in their practice. 

It’s also important to lay the groundwork before initiating regenerative therapy; the patient must be a good candidate in every way possible to maximize the chance for success.  Dr. Brock suggests addressing the following areas first:

Weight Control

Make all efforts to gain or maintain a healthy weight for the pet so their body has the best balance to start with.

NSAIDs

These drugs are affordable, available in many formulations such as carprofen and Metacam, and are generally well tolerated by both dogs and cats.  Explore these options to provide short-term relief and improve mobility.

Pain Medication

If NSAIDs are not enough on their own, or the patient does not tolerate them, there are other drugs available with minimal or mild side effects, such as gabapentin or tramadol.

 Adequan Injections

When treating for chronic arthritis, Adequan injections are a great non-invasive way to boost the body’s ability to produce joint fluid.

Supplements

Dietary supplements such as Omega-3 fatty acids, Duralactin, and glucosamine-condroitin, are known to improve joint fluid production and mobility.

Physical Therapy

Joint pain can cause patients to compensate with a less painful limb, which results in atrophy of the painful area, and can increase the risk of injury or degeneration of the stronger limb.  Physical therapy helps maintain flexibility, balance, and prevents or restores muscle loss.

Traditional Chinese Veterinary Medicine (TCVM)

Consultation with a TCVM practitioner adds options for herbal, acupuncture, and homeopathic modalities to help prevent and combat inflammation.

Massage

There’s no question that massage can relieve muscle tension, pain, and stiffness – it’s not only helpful against inflammation, but most pets love it!

Environmental changes

Evaluate the pet’s environment to make getting around a little easier.  For example, make sure a cat’s litter box is accessible.  Reducing impact and strain on the joints helps prevent further breakdown in cartilage and bone.

 

Class IV Laser

Laser

Laser therapy works by using specific wavelengths of light to penetrate deep tissues and stimulate cells to produce helpful biological components, such as growth factors and nitric oxide, which communicate both inside and outside damaged cells to accelerate healing.  Gentle heat is a natural byproduct of this process, which relaxes the tissues and improves circulation

It is not uncommon for a patient to seem sore directly after the first therapy because of the increased circulation, however, as the process matures, patients generally improve rapidly.

 

Companion Laser Therapy Medical Animation 

 

Frequency

Treatment schedules vary based on the severity of the condition, and the pet’s response to initial therapy.  Many patients begin on a weekly or bi-weekly schedule, which may be tapered down and eventually discontinued as their condition improves or resolves. 

Cost

Laser therapy is now offered in many general practices.  After initial exam and general workup, including cancer screening, laser treatment can be administered during a short visit for $40-60.

Contraindications

Laser therapy is strongly discouraged for patients with cancer, as the therapy can accelerate cancerous growth.  Dr. Brock and Dr. Gilbert recommend a thorough work up prior to laser therapy, including bloodwork and radiographs, to avoid treating a possible cancer patient with this modality.

  Read more about laser therapy.

 

Platelet-Rich-Plasma (PRP)

PRP

This modality can significantly reduce inflammation and stimulate healing in cases of osteoarthritis, wounds, ligament tears, and even feline gingivostomatitis.  The procedure consists of taking a sample of the patient’s own blood (8-20mL for cats and 30-60mL for dogs) and producing from it a fluid rich with platelets and growth factors.  

Using a completely in-house system at Viking Veterinary Care, patients can receive treatment within approximately 2 hours of drawing the blood sample.  Injections are given as close to the affected tissue as possible, and patients are discouraged from strenuous exercise for a few days afterwards to prevent the PRP from dissipating too quickly.

Dr. Gilbert’s Great Dane, “Bart,” presented with severe arthritis pain in his rear legs and received treatment with PRP.  To her great surprise, he was up on his feet the very next day, playing in the yard with mobility that Dr. Gilbert had not seen in him for years. 

Frequency

Most patients need 2-3 treatments to show marked improvement, with 1 treatment about every 2 weeks.  For chronic cases, improvement lasts 4-8 weeks or more.

Cost

After the initial evaluation and general workup, Platelet-Rich-Plasma treatments can be administered for $200-300.  If sedation or anesthesia is necessary for the patient to tolerate injections, this may increase depending on the patient.

Contraindications

Contraindications of Platelet-Rich-Plasma treatment are best evaluated based on the individual patient’s overall risks.  For example, if the pet has a heart condition, the stress of repeated visits or blood collection must be considered.  

Patients who respond well to PRP may also be good candidates for our next topic, stem cell therapy.

  Read more about PRP.

 

Stem Cell Therapy

This form of regenerative therapy has perhaps the greatest potential for treating a huge range of conditions.  Stem cells are the body’s chameleons – they are essentially “blank” templates that can be gathered together and turned into many kinds of tissue, including skin, adipose (fat), muscle, bone, heart, liver, cartilage, neuron, and pancreas.

Not only do these cells accept all sorts of new identities, but they can signal to other free stem cells to collect in a particular area, effectively “calling” more stem cells to the damaged tissue.

Stem cell is a widely-accepted therapy for many inflammatory conditions, including arthritis and hip dysplasia, as well as accelerating regrowth in bone fractures, wounds, and ligament repairs.  Clinicians are also noticing concurrent improvement in conditions like feline asthma, irritable bowel disease, septic disease, kidney disease, and nerve damage.  Research into the application of stem cell therapy for these conditions is ongoing:

  Intravenous adipose-derived mesenchymal stem cell therapy for the treatment of feline asthma: a pilot study

  Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats

 

The process for stem cell therapy includes an anesthetic procedure, so complete pre-surgical work-up is essential.  Stem cells may be harvested from many tissues, but adipose (fat) tissue is the most generous with viable stem cells (50-1000 times more than bone marrow).

Sample tissue is processed in-house while the patient undergoes any additional anesthetic StemCellprocedures that may be convenient at the time, such as mass removal or dental cleaning.  Stem cell fluid is generally ready by the time the patient is in recovery, still sedated and comfortable after anesthesia.  Injection sites are prepped and sterilized as needed and fluid is injected in problem areas.  Any unused stem cell fluid may then be injected intravenously to provide the body with as much of this valuable material as possible.

If there is a surplus of stem cells after IV injection, this may be stored for a fee at a cryogenic facility for future use.  Stem cells can also be harvested ahead of time during a routine procedure, such as spay or neuter, and banked.  This is a great way for pet owners to make sure stem cells are available at a time when their pet may need the therapy but are not good candidates for anesthesia due to age or other conditions.

Frequency

After treatment, patients should be rechecked on a regular monthly schedule.  Benefits of stem cell treatment generally last for 6 months, and may be repeated with another collection of fat tissue, or using banked stem cells.

Cost

Stem cell therapy is the most expensive of the three regenerative treatments we discussed.  After evaluation, pre-op workup, and anesthesia, this procedure runs around $2500.  However, considering the expense of continuous medication and other more frequent therapies, it is well worth the cost for the right patient.

Contraindications

The effect of stem cell therapy on cancer is still unknown.  Some studies suggest stem cell therapy might help fight cancer, others hint that it may, like laser therapy, accelerate cancer growth.

Until the connection between stem cell therapy and cancer is better understood, Dr. Gilbert recommends screening carefully prior to treatment, and avoiding stem cell therapy if cancer is diagnosed.

  Read more about stem cell therapy. 

 

Beau the Bold

For the stem cell case study, Dr. Gilbert presented “Beau,” an 8-year-old Great Dane who suffered from joint pain so severe, it could take him several minutes to lay down.  

 

Vets using stem cell therapy to treat pets in pain

KGW Portland recently covered the story of Dr. Gilbert and "Beau."

http://www.kgw.com/news/local/animal/stem-cell-therapy-helping-pets-in-pain/322208230

 

Minerva the Magnificent

Minerva

Saving the best for last, Dr. Brock shared one of her most challenging – and rewarding – cases, which involved physical therapy, multiple regenerative therapies, and a lot of uncertainty. 

“Minerva,” a spicy little orange tabby, was rescued and presented to Willamette Veterinary Hospital for emergency treatment of dehydration, rear-end paralysis of unknown origin, and a bladder literally fit to burst. 

With the help of very generous and dedicated medical staff, support from the local community, and the help of rescue groups Core Paws and Cat’s Cradle Rescue, Dr. Brock managed to restore this little kitty’s bladder control, and even some mobility to her rear legs.  Instead of losing her chance at life, “Minerva” now enjoys a loving forever home with her dignity intact.

 

 

 

ACT extends a sincere thanks to Dr. Brock and Dr. Gilbert for their time and expertise.

Attendees qualified for 2 CE credits from the Oregon Veterinary Medical Examining Board.

Check back soon for the full video presentation.