Veterinary Articles and Case Examples

Veterinary Regenerative Medicine Overview

Posted on in Non-surgical Therapy, Regenerative Medicine, Uncategorized Comments Off on Veterinary Regenerative Medicine Overview

 

Overview of Veterinary Regenerative Medicine

(Tendon and Joint Injections of Hyaluronic Acid,

Stem Cells, and/or Platelet Rich Plasma)

 

coming off a fram contact

Even though it is still young, the field of regenerative medicine is showing great promise for treating many musculoskeletal conditions that we couldn’t before.  Already we are seeing great successes.  As with every new field of science, it is also rapidly changing.  Each year, protocols and techniques evolve as we learn more.

Regenerative medicine involves isolating the body’s own tissue repair mechanisms and then placing them in high concentration at the site of injury.  The goal is to accelerate healing and generate new healthy tissue.  Below is a brief overview of the regenerative medicine options available for treating musculoskeletal issues in dogs.

 Hyaluronic Acid Joint Injections

Duffy after regionals

Hyaluronic acid (HA) is a key component of healthy joint fluid and cartilage, and is depleted in arthritic joints, which leads to worsening arthritis, which causes it to be more depleted, which worsens the arthritis…. There are effective oral and subcutaneous injection products that help boost HA levels, but direct injections into the joint achieve the highest level of HA replenishment.

HA can be used on its own for early or mild arthritis, or combined with steroids for more advanced and/or painful conditions.  Although we frequently use HA injections for severely arthritic joints, the best effects are seen when it is given earlier in the disease process.

Although HA injections into the joint are helpful, especially when combined with steroids, the effects don’t last as long as they do with PRP injections.

 PRP (platelet rich plasma)

he joy twoPlatelets are the body’s front line soldiers for repairing damaged tissue.  They clot the wound to stop bleeding, then release a number of growth factors to initiate the healing process.  By collecting a sample of blood from your dog, concentrating down the platelet fraction and then re-injecting this platelet rich plasma (PRP) where it is needed, we see a number of positive effects.

PRP accelerates healing and decreases inflammation associated pain.  It also magnifies the benefits of stem cells when the two are mixed together.

When injected into arthritic joints, it gives pain relief for 80% of patients (which is the same as either HA or stem cell injections) that lasts about 9 months (which is much longer than HA injections, and almost as much as stem cell injections).  The pain relief provided is as good as, if not better, than that provided by combining HA with steroids.

When injected into injured tendons, PRP appears to accelerate repair.  In the dog world, most of the research on tendon injury remains unpublished, and involves shoulder injuries.  To see a specific example of how well PRP combined with stem cells works, click here.

Compared to stem cells PRP is a less invasive and less expensive technique (about 1/3 the cost of stem cell injections).  Depending on the joint being injected, the entire process can happen with only mild sedation, or even no sedation in some dogs.

 Stem Cells

 

These cells were collected from the bone marrow and the stem cells are being concentrated for injection

These cells were collected from the bone marrow and the stem cells are being concentrated for injection

Stem cells were one of the first regenerative medicine tools to be used.  Mesenchymal stem cells are very different than embryonic stem cells.  We only use mesenchymal stem cells.  Our bodies constantly undergo some degree of damage and repair, and stem cells are a big part of that repair.  They can be found in many tissues, and once stimulated, will begin to grow new healthy tissue.  They are found in high levels in the marrow and periosteum of bone, and play a big role in fracture repair (along with platelets).

In veterinary medicine, we commonly harvest stem cells from two locations: fat or bone marrow.  Fat derived stem cells  are typically sent to an outside lab for processing which often means a second anesthesia for your pet, but bone marrow origin  stem cells can be processed and re-implanted immediately.

When MSCs were first injected into joints, we were hopeful that they would regrow healthy cartilage and reverse arthritis.  Unfortunately, they do not.  They do however provide good pain control in most patients for 11 months on average (see PRP above).

However, when injected into damaged tendons, stem cells do regrow normal tissue, as well as resorb scar tissue and mineralization.  It is an excellent tool for tendon repair, and combined with PRP is the treatment of choice.  It can also be used to accelerate the healing of broken bones.

 Summary

Regenerative medicine is fast becoming a key tool for addressing and decreasing the progression of arthritic pain and for treating damage tendons, especially for shoulder and groin injuries.  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.

Click on this case study to see an example of how stem cells were used to treat a tendon injury.

 Summary of different regenerative medicine options:

Indications
Pro’s
Con’s
HA +/- steroids
  • Pain control and prevent further degeneration of arthritic joints
  • Less expensive than PRP and stem cells
  • Less invasive than stem cells
  • Better alternative than daily anti-inflammatories
  • Effects do not last as long as either PRP or stem cells
PRP
  • Pain control and prevent further degeneration of arthritic joints
  • Facilitate healing of mildly damaged tendons
  • Less expensive than stem cells (about 1/3 the cost)
  • Effects on arthritis last much longer than HA, and almost as long as stem cells (9 months)
  • Better alternative than daily anti-inflammatories
  • Does not fully heal badly damaged tendons as well as stem cells do
Stem Cells
  • Pain control and prevent further degeneration of arthritic joints
  • Facilitate healing of badly damaged tendons
  • Can regenerate and heal badly damaged tendons
  • Provides joint pain relief for 11 months on average
  • Better alternative than daily anti-inflammatories
  • More expensive than HA or PRP
  • Collection process requires a general anesthetic

 


Case Report: Bode the SPCA dog’s tarsal arthrodesis

Posted on in Broken bone, Case Reports, Radiographs 3 Comments

Case Report: Bode the SPCA dog’s tarsal arthrodesis

 

Bode cast4

Bode sporting a dapper blue collar with matching leash and cast.
Photo Credit: Soundingsoul Photography

 

Bode is a sweet dog. He was turned over to the SPCA after it was learned that he had been limping around on a dislocated tarsus (ankle) for over a month.  His story spread across social media, with people from all over donating money to his cause.

 

 

Together with donations from local veterinary teams, he was able to undergo the treatment he needed – first to address his infected wound and painful abscessing teeth, then to fix the tarsus itself.

SPCA Bode luxated tarsus AP

Front view of dislocated tarsus.

 

 

 

 

 

Because the tarsus had been dislocated for so long, the joint cartilage was dead.  That meant there was no hope of saving the joint without leaving Bode a legacy of chronic arthritis and ongoing pain.  Instead, the decision was made to perform a tarsal arthrodesis, or to fuse the joint.  It would mean that Bode would always have a hitch when he walked, but that he would also be forever pain free in that joint.

SPCA Bode tarsal luxation lat view

Side view of dislocated tarsus.

 

 

 

 

 

 

 

 

 

 

 

 

 

These radiographs were taken when Bode was first diagnosed. The first one is a front view, and the second one is a side view of the dislocated tarsus.

 

 

SPCA Bode luxated tarsus AP graphics

Front view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

 

 

 

 

 

 

 

 

 

For clarity, I’ve added fancy graphics.  These are the same two radiographs, but with the joint surfaces highlighted.  The red line traces along the end of the tibia, and the green line traces the joint surface of the talus, one of the ankle bones.

 

The first part of the surgery involved breaking down the extensive scar tissue that had formed after a month of no treatment.  Only then could the two bones be put back together.  Once that was completed, a fair amount of bone and scar tissue had to be chiselled from the tibia to make a flat surface.  It is along this surface that the stabilizing implant would be placed.

Side view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

Side view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

 

 

 

 

 

 

 

 

 

Once that was done, all the joint cartilage was removed and small holes were drilled into the underlying bone to stimulate repair.  A hole was also drilled in the top of the tibia and a cancellous bone graft was collected – a harvest of marrow rich in the cells needed to grow new bone – and placed in the joint spaces.  Once that was complete, the stabilizing metal implant was applied.

 

 

Side view taken immediately after tarsal arthrodesis surgery showing application of a specially designed plate for tarsal arthodesis.

Side view taken immediately after tarsal arthrodesis surgery showing application of a specially designed plate for tarsal arthodesis.

 

 

 

 

 

 

 

 

This radiograph was taken immediately after surgery.  It is a side view with a special “banana plate” applied to the tarsus with nine screws.  If you look at the top of the tibia, you can see the hole through which the bone graft was collected.

Post surgical side view of tarsal arthrodesis with graphics higlighting old joint space and bone graft collection site.

Post surgical side view of tarsal arthrodesis with graphics higlighting old joint space and bone graft collection site.

 

 

 

 

 

 

Here is the same radiograph again with more fancy graphics – the purple area represents where the remnants of the old joint space used to be.  The cancellous bone graft selection site is highlighted in red

For the next 8 weeks, Bode moved into the house of an SPCA representative.  He wore a cast to support the implant while healing began and was under strict exercise restriction.

Side view of tarsal arthrodesis taken 8 weeks after surgery.

Side view of tarsal arthrodesis taken 8 weeks after surgery.

 

 

These last two radiographs were taken approximately eight weeks after arthrodesis surgery, and show good healing.  The joint space is no longer visible.  The healing bone is not yet at full strength, but it has starting to share some of the work so Bode no longer needs a cast.  He is still restricted to leash walks, and isn’t out of the woods yet, but he is on his way to a full recovery.

Front view of tarsal arthrodesis taken 8 weeks after surgery.

Front view of tarsal arthrodesis taken 8 weeks after surgery.

 

 

 

 

 

 

The muscles in Bode’s leg are very weak and severely atrophied, so he has been prescribed a comprehensive rehabilitation program to speed his recovery.  It will teach him that he can use the leg without pain, build muscle mass, and speed his return to an active lifestyle.

Thank-you to all those who stepped up to help this wonderful dog.

 

 


Tubal ligation or vasectomy for dogs

Posted on in Canine Cruciate Ligament Rupture, Dog Hip Dysplasia, Prevention, Puppy Care 8 Comments

When to spay or neuter my dog?

(Part 2)

Should I spay or neuter my dog, or get a tubal ligation or vasectomy instead?

 

This is a continuation of the 1st blog that looks at the issue of finding to best age for spaying or neutering your dog.  If you haven’t read part one, then you may wish to before forging ahead.

In part one, I alluded to new information that recently became available about possible risks associated with spaying or neutering your dog – research that was done at the UC Davis Veterinary Collage in California and is available online here.

PWD runningThe paper reviewed the medical records of 759 golden retrievers, and compared the incidence of hip dysplasia (HD) and cranial cruciate ligament tear (CrCL), as well as the incidence of several malignant cancers including lymphsarcoma (LSA), hemangiosarcoma (HSA), and mast cell tumours (MCT).

The study found some troubling results.  We don’t yet know if these findings can only be applied to golden retrievers or to other breeds as well, but until further research answers that question, the safer approach is to consider that other breeds might yield similar results. The visla club did an informal survey that would not stand up to rigorous scientific scrutiny, but none-the-less found an increase in cancer in spayed/neutered vislas compared to intact ones.

For purposes of this study, early neutered males are defined as males neutered before 12 months of age.

Summary of results:

 

Hip Dysplasia

  • The incidence of HD in early-neutered males was 10.3%, more than double the incidence in in-tact or late-neutered males.
  • The incidence of HD in spayed vs in-tact females was the same

 

Cruciate Ligament Rupture

  • The incidence of CrCL rupture in early-neutered males was 5.1%.
  • In early-spayed females, it was 7.7%.
  • CrCL rupture was not diagnosed in any of the in-tact animals studied, and in only 1 of 72 late neutered males.

 

Lymphosarcoma

  • Early-neutered males had nearly three times the occurrence of LSA when compared to intact males.
  • No LSA was detected in late neutered males
  • There was no statistically significant difference in the incidence of LSA in spayed vs intact females

 

Hemangiosarcoma

  • Late-neutered females had a 7.4% incidence of HSA, over four times that of intact females (1.6%), and in early-neutered females (1.8%)
  • No differences were found between intact and neutered male dogs in the incidence of HSA

 

Mast Cell Tumour

  • MCT did not occur in the intact females but was diagnosed in 2.3% of early-neutered females and 5.7% of late-neutered females
  • Neutering did not affect the incidence of MCT in male golden retrievers

 

Now what?

 

That’s a good question… and no clear answer is going to come out of these murky waters.  I tried to make things simpler by making a chart (see below).

 Female dogs:

early spay

late spay

intact

Mast Cell Tumour 2.3% chance 5.7% chance less risk
Hemangiosarcoma 4x increase no increase no increase
Lymphosarcoma no effect no effect no effect
Mammary Tumour very low risk low risk very high risk
Cruciate Rupture 7.7% chance under 1% chance under 1% chance
Hip Dysplasia no effect no effect no effect
Urinary Incontinence high risk very high risk(?) low risk
Aggression/Roaming NA NA NA

 

Male dogs:

early neutering

late neutering

intact

Mast Cell Tumour no effect no effect no effect
Hemangiosarcoma no effect no effect no effect
Lymphosarcoma 3x incidence no effect no effect
Mammary Tumour NA NA NA
Cruciate Rupture 5.1% chance under 2% chance under 2% chance
Hip Dysplasia 10.3% chance under 5% chance 5.1% chance
Urinary Incontinence NA NA NA
Aggression/Roaming decreased risk unknown high risk
Reactivity/Fearfulness decreased risk unknown high risk

 

BC Yukon regional championshipsI would also like to add these thoughts into the mix:

  • Intact males are more likely (in my opinion) to be attacked by other male dogs (intact or neutered). I’ve personally known many intact male patients that developed significant inter-dog fear and/or aggression issues secondary for being repeatedly attacked.  These issues greatly impacted quality of life.  

 

  • Pyometra is a common and potentially life threatening infection of the uterus that occurs almost exclusively in intact females.  One Swedish study found that 24% of intact females will get a uterine infection by 10 years of age.

 

  •  Testicular tumours only affect intact dogs and are common in dogs older than 10 years of age.

 

  • For male dogs, the issue seems to be balancing the risk of health issues against behaviour issues – a rock and a hard place.  For females, the choices seem even less clear, with health issues being raised not matter what you decide.

 

  • The only way to guarantee that your dog will not contribute to the pet overpopulation problem is to have him/her neutered/spayed.  One lapsed moment with a dog in heat can lead to 8 unwanted puppies – and even if you find a home for those 8 puppies, that just means that 8 other puppies somewhere else don’t get a home and have to be euthanized.

 

Tubal ligation or vasectomy for dogs

 

If, based on the above information, you decide that you want to keep your dog sexually intact, then getting a tubal ligation or vasectomy is the only way to guarantee that you do not contribute to the overpopulation problem.  Tubal ligation or vasectomy for dogs is the same procedure as it is for people; the vas deferens in males, or the fallopian tube in females, is severed and tied off.  This will render your pet incapable of producing puppies, yet still maintain the same sexual hormone levels as an intact dog.  The procedure is about the same complexity as a spay or neuter. However, by leaving the uterus behind, female dogs are still at risk for pyometra. Therefore, a hysterectomy, in which the entire uterus is removed but the ovaries are left behind, might be a better option.

For owners wishing to keep their dog sexually intact, the only way to guarantee that no unwanted puppies are produced is to have a vasectomy or tubal ligation/hysterectomy.