In the veterinary hospital, a major component revolving around the integration of a new therapy is time. How long is the treatment going to take? How many personnel will need to be scheduled to administer the therapy? How long does the patient need to be under sedation (if needed)? How long does the patient need to be in recovery?
The old saying “time is money” certainly has its place in the veterinary hospital. If a procedure requires several technicians and takes numerous hours to perform for treating one patient, that may not be an efficient use of the hospital’s or technician’s time. In the early years of regenerative medicine, many of the therapies required numerous anesthetic episodes and several hours of both the technician’s and doctor’s time. The procedures required a dog to be anesthetized to collect the sample and then return in a separate hospital visit to be administered the therapy. The collection of the tissue and administration required the doctor to be scheduled for two surgical procedures as well as the attending technician(s). In total, the time to perform this therapy could easily approach 2 hours of doctor and technician time combined, which would then necessitate a higher fee for the single therapy to cover the overhead costs. For many customers, the combination of the numerous office visits and cost of the procedures would be prohibitive, making this therapy less appealing.
Today, these therapies have become extremely efficient only requiring a single office visit with processing and administration taking less than 30 minutes. For Platelet Rich Plasma (PRP) the process takes even less time (typically 15 minutes from start to finish) with most of the procedure being performed by the attending technician(s). The steps for processing PRP are quite simple, making it a therapy that can be easily cross-trained for the supporting staff. The doctor’s time is only required for the administration of the therapy, which takes less than 2-3 minutes (depending on the number of areas being injected). With this minimal time requirement, providing regenerative therapies can easily be scheduled in-between other procedures, exams or surgeries.
To hear a first-hand account of how the Companion Regenerative Therapies System benefited a general practice and their schedule:
Stay tuned for our next blog post where we “bust” another regenerative medicine myth!
Spinal cord injuries can have a devastating impact on a patient’s life. For the canine patient, spinal cord injuries are surprisingly common, accounting for approximately 2% of all cases that are presented to the veterinarian*. The most common forms of injuries arise from acute disc herniation, spinal trauma, fibrocartilaginous embolic myelopathy and chronic diseases including degenerative myelopathy and spinal stenosis. While the initial injury to the spine is a major concern, it’s the secondary effects of that trauma that have long lasting effects including impaired blood flow which can lead to “stroke-like” events.
Spinal tissue has poor regenerative properties, which can provide a challenge to the attending veterinarian when choosing a treatment program for their patient. Depending on the severity of the injury, some patients can make a significant recovery with a comprehensive rehabilitation program. Some patients, however, may remain unresponsive to physical rehabilitation and require further intervention. Below is an overview to a case study originally reported in Veterinary Practice News (February 2016) by David R. Mason, B. Vet. Med, DACVS, DECVS, of Las Vegas Veterinary Specialty Center. This case study focuses on a young, 5-year-old Labrador Retriever named Duncan with Fibrocartilaginous Embolic Myelopathy (FCE).
FCE is a condition in which a fragment of disc material is somehow forced into the spinal vasculature. This migration of disc material causes a “stroke-like” event, cutting off blood flow to the surrounding spinal tissue. This event can cause partial or complete paralysis to the patient. FCE is most commonly reported in large and giant breeds, but is also prevalent in sheep dogs and miniature schnauzers. The most common treatment protocol for patients with FCE is based around aggressive supportive care and physical therapy.
Duncan’s owners reported that he was in the back yard when he vocalized and then was found unable to move his back limbs. After undergoing a thorough evaluation at Las Vegas Veterinary Specialty Center (LVVSC), it was determined that Duncan was suffering from FCE. Subsequently, Duncan was enrolled in a 16-month rehabilitation program, but his condition did not improve and he remained non-ambulatory in his back limbs. Knowing that additional treatment options were limited for Duncan, Dr. Mason elected to treat Duncan with a combination of Platelet Rich Plasma (PRP) and Bone Marrow Aspirate Concentrate (BMAC). Duncan was treated with an epidural injection of PRP/BMAC solution which was produced using the Companion Regenerative Therapies System. After injection, Duncan recovered from anesthesia without incident and returned to his dedicated rehabilitation program.
By day 14, Duncan’s owners reported an increase in energy and after continuing his rehabilitation, Duncan is now able to take several steps without the assistance of a sling or cart. Although Duncan’s condition may not return fully to pre-injury form, this case provides a positive outlook to treating spinal conditions with regenerative medicine.
To read more about Duncan’s story, click here.
* https://cvm.ncsu.edu/research/labs/clinical-sciences/canine-spinal-cord-injury/
Intra-Articular (IA) injections are common place in human and equine medicine, whether being used for diagnostic or therapeutic procedures. In particular, IA injections have been a vital component of the successful treatment of osteoarthritis (OA). While similar benefits can be achieved for dogs with OA, the use of IA injections in the small animal practice is less common.
Why is this? Historically, IA injections weren’t a common procedure for OA treatment due to a lack of products available for small animal species and there was an educational void surrounding the use of those products. Additionally, there is a decreased comfort level in performing IA injections in smaller animals since the joint spaces are much smaller than that of the large hooved patients and the procedure is not as common place.
In today’s blog, we will discuss the uses of intra-articular Injections, products that are commonly used for IA treatments and educational opportunities that can equip the small animal practitioner with the skills necessary to perform these procedures.
Intra-articular injections can be used in a multi-modal approach for treating osteoarthritis or can be used for a variety of other indications including:
- Patients with residual post-operative intra-articular symptoms (effusion, discomfort, lameness)
- Supplementation/ alternative treatment to oral meds
- Post-surgical lavage
- Arthrocentesis for differentiating OA from inflammatory joint diseases
- Joint blocking for lameness workups
Which products are commonly used in IA injections?
- Regenerative Medicine Products
As discussed in our previous posts, regenerative medicine, which includes Platelet Rich Plasma (PRP) and Stem Cell therapies, utilizes the body’s own cells to heal and regenerate tissue. With minimal side-effects and treatment benefits lasting upwards of 9-12 months, regenerative medicine treatments are ideal for patients with mild to moderate osteoarthritis.
- Hyaluronic Acid (HA)
Hyaluronic Acid is a naturally occurring polysaccharide in the extracellular matrix of the body. HA has been synthetically manufactured for the treatment of OA in dogs, horses and humans. When injected, HA binds to receptors on the chondrocytes which induces cellular proliferation and extracellular matrix production. Typical treatment schedules require a series of loading phase (weekly administration) injections and re-administration every 3-6 months. Efficacy of HA injections varies depending on the molecular weight of the HA and can adversely affect tissue if injected outside of the joint capsule.
- Corticosteroids
Commonly used in human medicine, intra-articular injections of corticosteroids are recommended in several guidelines for the treatment of patients with OA but remain controversial. Corticosteroids prevent the formation of prostaglandins and are a powerful modulator of inflammatory pathways. However, it is not recommended for long term use (no more than 4 administrations/ year total) and can have negative side effects to the cartilage in the joint.
Now that we know what intra-articular injections can be used for and what can be administered using them, we’re ready to inject, right? For some that may be the next step. But for most of us, IA injections can seem daunting, especially if we’ve never done one before (or perhaps haven’t done them since the equine rotation back in vet school). The good news is that now there is a wealth of educational resources available to gain proficiency at IA injections, including the Companion Regenerative University events. Companion Regenerative University is a one-day live seminar where attendees learn the background to regenerative medicine and get the hands-on practice of performing intra-articular injections. To learn more about this course or to see when and where upcoming courses are taking place, click here.
Stay tuned for our next post where we will take a closer look at a case study involving a patient with a Fibrocartilaginous Embolism who got his step back thanks to regenerative medicine.
