Thursday, December 13, 2012

Cookie's Platelet Rich Plasma Therapy

by Dr. Keith Niesenbaum, VMD

My dog Cookie has been greeting clients and patients at the animal hospital for years.  


She has been known to come into the exam rooms to say hello, or wander around into the waiting room, just to keep tabs on the comings and goings of all of our visitors. She has become quite comfortable in this daily routine over the past 14 years, and pretty much has the staff wrapped around her little paw, with each and every one jumping to her beck and call. 

Last year it became apparent that she was starting to slow down.  

She was stiff upon rising and eventually started to limp off and on. When older dogs present this way, with a gradual onset of lameness and pain, the most common cause is degenerative arthritis.

Normal wear and tear on the joints, sometimes aggravated by underlying orthopedic conditions or injuries, damages the cartilage,  and joints become painful and stiff.  Routinely, I start these patients on a supplement to support joint health, and then add an anti-inflammatory (NSAID) as needed, to decrease pain and swelling. Usually, the response is pretty dramatic and the dogs are doing much better in 48-72 hours after starting the medications.

When this is not the case, I recommend radiographs to make sure that our diagnosis is correct.

Of course, Cookie didn’t respond.  

I added a prescription diet that is designed to decrease inflammation and started her on Adequan injections ... still no improvement. Finally, I took radiographs, suspecting some sort of shoulder problem, based on the way she was walking. The bad news was, I had the wrong joint, her shoulders looked great.


The good news was that the diagnosis was correct, she had arthritis in both of her elbows, and it was just too severe to respond to the medication and supplements that she was on.

Now, that I had a diagnosis and was able to locate the problem to a specific anatomical location, there were some other treatment options available.

I  considered stem cell therapy which I have used on several patients with good results. 

This was not suitable for Cookie , as she had recently had a splenectomy to treat a mass, and while it was benign, cancer is a contra indication for stem cell therapy and I preferred to be cautious.

Instead, I decided to use platelet therapy to treat her condition.  

I have started to use platelet injections (PRP) as an alternative to stem cell therapy in patients where stem cell therapy is not a viable option. The PRP has a high concentration of platelets, and platelet factors, that exert strong, local anti inflammatory properties.

I drew a blood sample and using a filtration system designed by Pall Corporation, concentrated the platelets and the platelet factors. Then, under sedation, these are injected into the affected joints.  There was enough product left to freeze for later treatments.

While Cookie's joints were quite sore the next day or so (I’ve since added a local anesthetic to my joint injections to prevent this post treatment tenderness), she gradually started to improve during the first week.

I stopped the NSAID as it wasn’t helping anyway and I was worried about potential side effects.  

She continues to eat the joint diet and take the supplements. Although she isn’t crazy about it, we continued her Adequan injections every 3 weeks. She also gets regular therapy with a class 4 laser  to decrease pain and inflammation.

We have seen great improvement.

This multi modal approach gives Cookie the best chance for long term successful management of her chronic degenerative joint disease.  

We have seen minimal to no side effects with these treatments either alone or in combination and by tailoring our therapy to each individual situation, we are restoring function and improving the quality of life for our patients and their families.

***

Dr. Keith Niesenbaum is the owner and medical director of Crawford Dog and Cat Hospital. After graduating from the University of Pennsylvania, School of Veterinary Medicine in 1984, he spent 4 years practicing in New Jersey, while his wife, Anne, finished up her OB/GYN residency. 

They relocated to Long Island in 1988 where he started Animal Bedside Care, a Veterinary House Call Service, which is now an integral part of Crawford's services.

The Crawford Dog and Cat Hospital's team is committed to educating clients in how to keep their pets healthy year round, with good nutrition and exercise.  Crawford Dog and Cat Hospital stays on top of the latest advances in veterinarian technology and above all, remembers that all animals and pets need to be treated with loving care in every check-up, procedure, or surgery. 

Check out their blog or connect with Dr. Keith on Facebook or Twitter.

1 comment

  1. Just to keep everyone up to date, this post was written in real time, meaning that there is no end to the story yet. We are about 8 weeks out and Cookie is starting to show some signs of lameness from her elbows again so I am planning to inject her next week. I'll post her progress on our facebook page www.facebook.com/crawforddogandcat so those that are interested can follow her progress.

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