Veterinary Articles and Case Examples

Extracorporeal Shockwave Therapy

Posted on in Non-surgical Therapy, Uncategorized Comments Off on Extracorporeal Shockwave Therapy

Extracorporeal shockwave therapy being applied to an arthritic kneeExtracorporeal Shockwave Therapy 

Extracorporeal shockwave therapy doesn’t involve electric shocks. Shockwaves are sudden vibrations. The body is built to absorb shockwaves from activities such as running and jumping. These shockwaves trigger the release of growth factors that promote the development of bone, tendon and ligament. This is part of the reason why athletes have greater bone density than less active individuals.

Growth factors not only promote tissue growth; they are also powerful anti-inflammatories. This anti-inflammatory action can help relieve arthritis pain.

Arthritis, Bursitis, Fasciitis

Extracorporeal shockwave therapy helps relieve the pain of chronic arthritis and other inflammatory conditions. Typically, it is recommended that extracorporeal shockwave therapy be applied a total of once a week for 3 weeks. If the treatment is going to work, benefit should be seen after the first treatment. After the completion of 3 treatments, improved comfort typically lasts for 3 months, after which only a single treatment is needed to provide comfort for each additional 3 month period.

Patients need to have a small area over the affected structure shaved before treatment. Generally, no sedation is required. Minor bruising of the affected area sometimes occurs. Chronic, long standing conditions tend to respond better than recent conditions.

Tendon and Ligament Repair, Resorption of Tendon Calcifications

Treatment protocols vary depending on the nature and severity of the tendon lesion, but extracorporeal shockwave therapy has been shown to be effective in the treatment of damaged tendon and the resorption of tendon calcifications.

Typical protocols involve 3 treatments spaced 2-3 weeks apart, coupled with an appropriate rehabilitation program.

Accelerating bone repair after surgery

Extracorporeal shockwave therapy has been shown to accelerate healing of bone following cruciate surgery, as well as stimulate the healing of bone following fracture repair. Speeding the rate of bone repair can help reduce the chance of complications following cruciate repair or other surgery.

If you would like your pet to receive extracorporeal shockwave therapy, contact information can be found here. If you have further questions, please email info@pointseastwest.com


PennHIP Radiographs – improving hip dysplasia diagnosis

Posted on in Dog Hip Dysplasia, Radiographs Comments Off on PennHIP Radiographs – improving hip dysplasia diagnosis

Diagnosing Canine hip dysplasia using PennHIP

 

Canine hip dysplasia is a well recognized genetic condition in dogs that can cause hip arthritis, chronic pain, and sometimes requires surgery. Over the last fifty years, breed organizations and kennel clubs have attempted to remove the disease from the population through selective breeding. Despite this effort, little progress has been made. This may be in part due to the under utilization of the PennHIP radiographic technique.

Normal dog with hip joints PennHIP compressed

Normal dog with hip joints PennHIP compressed

 

 

OFA (Orthopedic Foundation for Animals) Radiographs

Selecting dogs that are considered “hip dysplasia free”, those considered unlikely to pass the condition onto their offspring, has largely been based on their OFA radiograph findings – by x-raying the appearance of the hips while the dog is lying on its back with its legs in full extension.  Unfortunately, research has shown that OFA radiographs are a poor test for screening against hip dysplasia.

OFA radiographs are a poor test because although they select for dogs with good hip conformation, they does not test for soft tissue laxity, a key component in the development of hip dysplasia. As a result, many dogs that pass their OFA radiographs have now been shown to have lax hips This is likely the reason that efforts to eliminate the disease have not worked. Research has found that breeding dogs with passing OFA radiographs results in hip dysplasia in anywhere from 19% to 73% of the offspring.

PennHIP (Pennsylvania Hip Improvement Program) Radiographs

PennHIP radiographic testing was introduced over 20 years ago, and tests both hip conformation (as does OFA) as well as tissue laxity. It is a more sensitive test than OFA radiographs, meaning that it will detect cases of hip dysplasia that otherwise would be missed. In order to breed hip dysplasia out of the gene pool, it is key that all dogs potentially carrying the condition are detected, and therefore the test needs to be as sensitive as possible.

 

Normal dog with hip joints PennHIP distracted - the joint space has been highlighted blue. Notice how little difference there is between the hip compression and distraction view. This indicates a stable hip joint.

Normal dog with hip joints PennHIP distracted – the joint space has been highlighted blue. Notice how little difference there is between the hip compression and distraction view. This indicates a stable hip joint.

Which is better?

Side by side comparison of OFA and PennHIP radiographs found that none of the dogs that failed their PennHIP radiographs, passed their OFA radiographs, but many dogs that passed their OFA radiographs, failed their PennHIP radiographs. In fact, two of the dogs with “excellent” OFA ratings had some of the worst PennHIP scores, indicating a high probability of developing hip arthritis secondary to tissue laxity later in life.

Another limitation of OFA radiographs is that scoring is based on subjective evaluation. This means that the same radiographs may get a different score depending on who is reviewing them, or even if the same radiologist reviews them on different days (with a different mood, fatigue level etc.). This problem is reduced with PennHIP radiographs because the results are based on measurements and the calculation of a distraction index, which is less likely to show variation between radiologists.

OFA radiographs require the dog to be at least 2 years of age before testing, whereas PennHIP radiographs have been shown to be accurate in predicting the onset of hip dysplasia as early as 4 months of age, allowing for earlier testing.

Conservative estimates based on mathematical models indicate that for a breeder of Labrador retrievers hoping to eliminate hip dysplasia from their line, using the PennHIP system will accomplish that goal 4 times faster than by relying on OFA radiographs.

Although some dogs receiving OFA radiographs may not need sedation, sedation is mandatory for PennHIP radiographs in order to relax the muscles enough to properly appreciate the degree of connective tissue laxity.

Hip dysplasia PennHIP compression view - notice how the dog's left hip joint space (right side of picture) has an irregular width

Hip dysplasia PennHIP compression view -notice how the dog’s left hip joint space (right side of picture) has an irregular width

 

Who should Consider PennHIP?

Any breeder who is serious about producing a line of dogs free from hip dysplasia should employ a PennHIP screening program. Pet owners and dog handlers who want to invest in a dog suited to an active life style, working, or competition, should also consider only purchasing PennHIP cleared dogs. Dogs can be tested for hip dysplasia using the PennHIP method as early as 4 months of age.

If you have any further questions about PennHIP testing in BC, please email info@pointseastwest.com

 

Hip dysplasia distraction view - notice how much wider the joint becomes once it is distracted, compared to the normal dog.

Hip dysplasia PennHIP distraction view – notice how much wider the joint becomes once it is distracted, compared to the normal dog.


Stem Cell treatment of partially torn biceps tendon

Posted on in Non-surgical Therapy, Regenerative Medicine, Uncategorized Comments Off on Stem Cell treatment of partially torn biceps tendon

Case Report:

Stem Cell treatment of partially torn biceps tendon.

Introduction:

biceps stretch

With a damaged biceps tendon, shoulder flexion like this is very painful.

Biceps tendon injury is a common cause of shoulder pain in dogs.  In veterinary medicine, the traditional treatment has been surgical – the tendon is cut from its attachment point so that it no longer is a source of pain.  The problem is that once cut, the tendon is no longer a source of stability for the shoulder and now there is an increased chance of other injuries occurring, including rotator cuff injuries or damage to the supraspinatus tendon. SURGICALLY CUTTING THE BICEPS TENDON SHOULD ONLY BE USED AS A LAST RESORT AFTER ALL OTHER TREATMENTS HAVE FAILED!

Rehabilitation therapy (the veterinary equivalent of physiotherapy) offers a new option for treating this condition and is successful in most minor cases where the amount of tendon tearing is not too great.  However, some cases fail to respond to rehabilitation, and unfortunately many of those cases then proceed straight to surgery.

Now there is another option for biceps (and many other) tendon injuries if rehabilitation therapy alone is not enough to fix the problem.  We are now able to use stem cells to regenerate new healthy tendon, as well as to resorb scarred or calcified tendon tissue.  Click here to learn more about regenerative medicine options and uses.

Case Example:PEW blog BT injury pre-MSC

Damaged Biceps Tendon Damaged Biceps Tendon Damaged Biceps Tendon

Damaged Biceps Tendon with graphics

This is an ultrasound of a damaged biceps tendon that I examined last summer.  I know, looking at ultrasound images can be confusing, much like trying to read television static, so I added fancy graphics.  Healthy tendon should have an even level of “whiteness” on ultrasound, with easily distinguished fibers running along its length.  Damaged tendon has mixed colouring of light and dark tissue, with disruptions of these fibers.

The blue lines show the outline of the bones.  See how the tendon (in red) crosses from the forelimb on the right to the shoulder blade on the left?  It spans across the shoulder joint, which provides stability and is why we want to preserve it if at all possible.

The tendon itself is outlined in red.  As you can see, there is quite a bit of colour variation and fibre disruption evident.  This is a badly damaged biceps tendon.  We tried fixing the tendon using rehabilitation therapy techniques, but unfortunately those techniques didn’t work in this case.  Without some other treatment, this dog would never return to full and pain free activity again.


PEW blog BT injury 3m post-MSC

PEW blog BT injury 3m post-MSC edited copy

Here is the same tendon 3 months after injection with stems cells collected from the dog’s bone marrow and injected into the damaged tendon.  See the difference?

This tendon has a much better level of “whiteness”, uniform colouring and good fiber definition.  We anticipate that this dog will return to full activity on the shoulder.

If you would like to have your pet assessed and possibly treated using these techniques, please contact one of the hospitals where Dr. Lane works.


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