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West Chester Veterinary Rehabilitation Specialty Center Issue 5, February 2012 Focus Rehab on Welcome Stem Cell Therapy This issue of our newsletter features the role of the Adipose Stem Cell Procedure* in conjunction with rehabilitative therapy treatment. We can extend the length and quality of life of our animal companions through the use of stem cell regenerative therapy. The therapy is most effective for animals suffering from osteoarthritis, hip dysplasia and ligament injuries, but can also be used in muscle repair. The treatment uses the animal’s own stem cells to heal its body. Continued research for other applications is ongoing and is an exciting new field of veterinary medicine. Contents Stem Cell Therapy Case Study—Cisco West Chester Veterinary Rehabilitation Specialty Center 1141 West Chester Pike West Chester PA 19382 Email: [email protected] westchestervetmedcenter.com HOURS: By Appointment Call: 610-696-8712 In patients suffering from osteoarthritis, muscle or other soft tissue injuries, stem cell therapy helps to decrease pain allowing the patient to participate in a comprehensive rehab program more comfortably. Rehabilitation is an essential part of rebuilding the muscle mass and regaining lost range of motion. At our Center we use the MediVet In-House Stem Cell Procedure. * Adipose tissue is body fat. Adult stem cells are cells which are found in normal body tissues and organs including fat, bone marrow, blood, skin, etc. As adult cells they have the ability to heal only their tissue of origin. However, these cells can be transformed into stem cells which have the ability to heal tissues other than their own kind. Stem Cells have the ability to differentiate into cell types such as cartilage, bone and muscle. Endothelium, pancreatic cells, bone, myocardium (heart muscle), liver and neural cells can also be induced given the right conditions in an animal’s body. Changes can be seen in vivo when adult stem cells are transplanted into a tissue environment different than their own origin. Before stem cell therapy can begin, the patient must be thoroughly evaluated to determine his or her health status. Stem cell therapy should not be performed on patients suffering from cancer or active infections. (Continued on next page) Stem Cell Therapy (contd.) (Continued from front page) Pre-screening for patients being considered for stem cell therapy should include all of the following diagnostic procedures: induction of growth factors and cytokines from cells of any organism (see photo below). When adipose-derived stem cells are removed from fat tissue using a patented enzyme most of the cells are in a latent, non-dividing state. Complete blood count (CBC) Comprehensive chemistry panel Urinalysis Chest Radiographs Abdominal ultrasound Cardiology work-up Tick panel Adipose tissue is harvested from intra-abdominal falciform fat (photo above). Other areas of fat storage is also utilized in both dogs and cats. Fat is an excellent source of stem cells because it can be harvested in abundance and yields a much larger stem cell count when compared to bone marrow. To be activated within the body there is a repair mechanism cascade that must be activated in order for the stem cells to circulate through the body and begin differentiation into new tissues.The 3 color light stimulates the cells to initiate repair from the moment the cells are injected into the animal’s body. Compared to other sources, adult stem cells found in the collected adipose tissue can range in the millions per unit of measure. Stem cells have the ability to repair ligaments, tendons, cartilage, and even other body tissues once injected into an injured or arthritic tissue and/or joint. They are also administered intravenously to provide improved availability of the stem cells through-out the body. The benefit of the MediVet technology is the ability to do the entire procedure from fat collection to stem cell administration on the same day. Because the fat is autologous, there is very little chance of an adverse tissue reaction. There are infinite possibilities for the indications in adult stem cell therapy and we have just touched the surface. Research on benefits for neurologic and muscle repair are currently ongoing as well as continued studies on the benefits in osteoarthritis and ligamentous repair. Focus Once harvested, fat is processed using proprietary reagents, patented enzymes, filtered, washed with an antibiotic and centrifuged multiple times (photo above). Exposure to a special 3-color LED light initiates photobiostimulation which results in enhanced cell proliferation, differentiation and on Rehab is a publication of the West Chester Veterinary Rehabilitation Specialty Center 1141 West Chester Pike, West Chester PA 19382, Tel: 610-696-8712 Email: [email protected], Web: www.westchestervetmedcenter.com DISCLAIMER All activities discussed in this newsletter are conducted under veterinary supervision only. The West Chester Veterinary Rehabilitation Specialty Center is not liable, under any circumstances, for any loss of life or bodily injury claimed to be as a result of the reader's use of information contained in this newsletter. Stem Cell Case Study — Cisco Signalment Radiographs Our Rehab Team Dr. Stephanie Finley, CCRT Cisco: 12-year-old neutered male Golden Retriever Presenting Complaint Cisco had progressive hind limb weakness and stiffness, difficulty rising, unable to do stairs, and decreased stamina on walks. Both stifles had surgical repair of torn cruciate ligaments via tibial-plateau-leveling osteotomy (TPLO). Improvement with NSAIDs was noted, but not significant. Pelvis: Good hip coverage, no osteophytes noted Stifles: Osteoarthritis Virginia Maryland Regional College of Veterinary Medicine, Blacksburg, VA Certified Canine Rehabilitation Therapist (CCRT),Canine Rehabilitation Institute, Wellington, FL Dr. Charles Schenck Medications Rimadyl 100mg BID Tramadol 100mg BID Physical Exam Stiff and forward shifted gait Significant decreased stifle (65) and hock (85) flexion during passive range of motion (PROM) Treatment Interventions Stem Cell Therapy: Stem cells harvested from Cisco’s falciform fat (see photo below) were “activated” with platelet rich plasma (PRP) and photobiostimulation. These activated cells were then injected into both of Cisco's stifles (0.5 ml per joint) and then the remaining 0.5 ml of the stem cells was given intravenously. Graduate Texas A&M International Veterinary Acupuncture Society (IVAS) certified veterinary acupuncturist 30 years of clinical experience Michelle Lazarski,PT,CCRP Crepitus of both stifles and hocks Pain score 2+/4 Muscle atrophy both hind limbs Able to walk about 30 feet * Normal flexion for stifle and hock is 40-500 Diagnostics Graduate Boston University B.S. Physical Therapy More than 25 years clinical experience Certified Canine Rehabilitation Practitioner, University of Tennessee College of Veterinary Medicine Cheryl Englert CBC, chemistry panel, urinalysis, chest radiographs, abdominal ultrasound, cardiology work-up including echocardiogram and joint radiographs (Continued on back page) Next Issue: Acupuncture Graduate Penn State University B.S. Animal Production 5 years veterinary experience Stem Cell Case Study — Cisco (contd.) Treatment Plan Cisco’s treatment consisted of a multi-modal approach. Cold laser therapy was integral in decreasing pain, but also in increasing circulation and therefore potency of the injected stem cells. Home instruction of an exercise program to help Cisco rebuild muscle mass once he was more comfortable was also important. Aquatic Therapy: Swimming therapy was initiated in the clinic prior to stem cell injection. Cisco continued therapy for several weeks after injection and then was released to a home swim program. Rehab Goals Decrease pain Increase pain-free PROM for stifles and hocks to functional limits Improve symmetrical weight bearing in stance and gait to 0/4 lameness score Increase muscle strength/girth of hind limbs Increase function for longer walks, uneven terrain, stairs Educate owner with a safe, appropriate and progressive home program Modalities Cold Laser: Cold laser was applied to stifles, hocks, areas of muscle spasms and tenderness to decrease inflammation, pain and promote tissue healing. It also increases the viability of the stem cells and improves their circulation throughout the body. Ice/cold pack to the stifles was used with signs of soreness or after exercise to decrease inflammation. Soft Tissue Massage: Areas targeted were quadriceps, hamstrings and cervical/ scapular muscles. Massage aids in circulation, decreases muscle spasm and promotes tissue healing and relaxation. PROM/Flexibility: After laser therapy and massage, gentle slow PROM (in pain free range) for hip extension, stifle and hock flexion was performed. Joint Mobilization Techniques: Joint mobilization techniques can be effective to help restore joint mobility, and aid in synovial fluid distribution. Approximations of the stifles and hocks as well as hock glides were performed. Therapeutic Exercise: Focus was on hind limb strengthening and ROM. Exercises that stimulated isometric contractions of the hind limbs to minimize joint impact while engaging the muscles including a “paws up” position and gentle weight shifting were stressed. Caveletti walking and sit to stand exercises were performed to increase active ROM and improve muscle strength. Outcome Within three weeks of the stem cell injection, Cisco was able to climb the stairs with little to no assistance and walk up to 60 feet. At one month post stem cell therapy he could rise without help on grass or carpeted surfaces. His appetite was good and he was able to stand throughout his meal. The owner reported that Cisco was about 90 percent back to his old self. He was following his owner around the yard and trotting after a ball for a short distance.