Tuesday, November 28, 2017

Platelet-Rich Plasma Treatment (PRP) for Partial Cranial Cruciate Ligament (CCL) Tears: Would I Do It Again?

So it's been over a year and a half since Cookies PRP treatment for her partial cruciate ligament tear(s).

Back then, we had a long, hard debate about what we should do. There was the TPLO surgery, which is the first thing most veterinarians recommend. While the traditional suture repair worked well for Jasmine, I didn't believe it could withstand Cookie's enthusiasm. TTA and TTO are not available around here. We were intrigued by the Simitri Stable in Stride (hinge technique) and would have considered it in spite of it being so new, but it was not available for Cookie's size. Cookie was too young and too active to include conservative management in the decision process.

Is that some impressive muscle definition or what?

I have become a proponent of regenerative therapy.

Even back when I was researching options for Jasmine's partial cruciate tears, I was looking into regenerative therapy. Stem cell treatment was a relatively new thing for dogs, but it resonated with me. I believe that helping the body to heal itself is always better than altering it.

Through Jasmine's treatments, I have developed a relationship with Vet-Stem who pioneered veterinary regenerative therapy. Naturally, I contacted them this time as well.

The advantage if PRP treatment is that it costs less and it is one-time procedure from collection to application. It doesn't even require anesthesia; sedation is sufficient. The collection is a simple blood draw, rather than surgically fetching fat tissue, so it is less invasive.

Could it work for a damaged cruciate ligament, though?

My friend at Vet-Stem said there was a decent chance PRP would do the job in helping the ligament to regenerate.

What were the pros?

  • minimally invasive (blood draw and joint injection)
  • no anesthesia, just sedation
  • no alteration of anatomy
  • substantially lower risk of complications
  • substantially shorter recovery
  • surgery remained an option

What were the cons?

  • there was no guarantee it would have worked or lasted

Even if it didn't work, it would still have reduced the inflammation and made the joints happier for the time being.

We decided to give it a try.

I described our decision process here.
I described the procedure here.
Here is an article describing Cookie's progress post therapy.
Here is Cookie's update three months post therapy.
Here is Cookie's update half a year post therapy.

Cookie has been doing great.

She is happy, active, and nobody can see anything wrong with her legs. Naturally, the only way to actually "see" the ligament and how it healed would have been an MRI or arthroscopy. I don't see much sense in putting Cookie through all that seeing there is nothing that would indicate her knees are giving a hard time.

There is no visible limping of favoring of the limb(s).

Granted, that's not empirically exact data because up to 25% of favoring wouldn't be even visible to plain sight. There are more objective indicators, though. For example, walking on the underwater treadmill, any favoring becomes more exaggerated.

Overall muscle mass on the hind legs as well as whether the circumference is even on both legs indicate whether the legs are being used the way they should be. As well as any shift of weight-bearing from the back end to the front would result in broadening of the shoulder area and diminishing muscle mass on the hind end overall. Cookie's muscles are quite impressive. Strong, pliable, with excellent definition and equal on both legs.

There are not secondary aches and pains that could have resulted from compensation.

As far as anybody, including Cookie's physical therapist and local veterinarian, can tell, she is doing a-okay.

She is a very happy, very active girl. She requires a minimum of three hours of activity outside daily and tolerates it well.

So when Dr. Rae of Fergus Veterinary Hospital, who did the treatment for Cookie, emailed me for the latest update and asked me whether I'm happy with the results and would do it again, I was excited to report that yes, I would.

I would absolutely do it again.

Related articles:
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot?
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking Too Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 
To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process 
Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis 
Cookie's Iliopsoas Injury Treatment: Trazodone  
Cookie's Iliopsoas Injury Treatment: Other Medications 
Cookie's Iliopsoas Injury Treatment: Laser, Hydrotherapy, and Chiropractic 
Cookie's Recovery from Iliopsoas Injury: ToeGrips 
It Never Rains ... Cookie's New Injury 
Mixed Emotions: When What You Should Do Might Not Be What You Should Do for Your Dog 
Cookie's New Injury Update 
Cookie's Iliopsoas Injury: The Symptoms 
Cookie's Iliopsoas Injury: Battling the Zoomies 
Cookie's Muscle Injuries: What Else Is Going On?
Theory and Actual Decisions for an Actual Dog Aren't the Same Thing: Cookie's Knee Injury
Does Your Vet Listen to You? Cookie's Post-Sedation Complications
Would I Ever Treat a Symptom Directly? 
Platelet-Rich Plasma (PRP) Treatment for Cookie's Bad Knee(s)
Platelet-Rich Plasma (PRP) for Cookie's Bad Cruciate Update 
Injury or Surgery Recovery: Mishaps versus Setbacks 
See Something, Do Something: Cookie's Lumpectomy 
Cookie's Lumpectomy Update 
Using Pressure Pads to Evaluate Lameness in Dogs: My Observations
Cookie's Musculoskeletal Challenges: What Supplements Am I Using?
Cookie's Musculoskeletal Challenges: Restricted Activity and Weight Management
Cookie's PRP Treatment for Partial Cruciate Tear: Update
Has Your Dog's Physical Therapist Taken Dog Training Classes? 
Cookie's PRP Treatment for Partial Cruciate Tear Update and Considering the Future
Cookie's PRP Treatment for Partial Cruciate (CCL/ACL) Tear and Leg Circumference
Cookie's Wellness Exam
Ticked Off at the Tick Situation: What Do You Use for Tick Prevention?
Ticked Off at the Tick Situation: The Verdict Is In (for Now)
Cookie's Annual Heartworm and Tick-Borne Diseases Test
One Yelp, No Yelp. But Two?
One Yelp, No Yelp - Update
Cookie's Rabies Booster
Is Your Dog Struggling with Weight in spite of Diet and Exercise? Cookie Is Hypothyroid (Part I)
What Does the Thyroid Do? Cookie is Hypothyroid (Part II)
Thyroid Replacement Therapy: Cookie is Hypothyroid (Part III)

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did your dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you.

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  1. I am so glad to hear that you are happy with your choices and would do it again!! I am always asking so many questions about should I or not when it comes to my pets health. Sometimes it's not an option if out of my ability to pay which is why I always tell people pets are a lifetime commitment and deserve the best health care possible! This is also why I am not adopting any more right now. Anyway, I am so thankful for all you have shared.

    1. I agonize over every choice I make. I research, and ask everybody, and research ... I'm very thankful every time I manage to make the right choice.

  2. SO very glad she is doing so very very well! It's always tough to make those decisions. It's wonderful when they do well and the decision proves to have been a good one and all is well again. YAY!!

    1. Thank you. I always lean first toward choices that leave the smallest footprint. That way, if something doesn't work, one can always resort to surgery or something more invasive. But it is awesome when the non-invasive option works.

  3. Interesting. I didn't even know about this existed! It sure sounds like a great alternative to surgery.

    1. I've been on top of regenerative therapies ever since we first researched all options for Jasmine's knees. It is what I look to first when there is a problem to see whether it could tackle it. It is my number one option to consider.

  4. This is so interesting. I watched a TV show on Animal Planet last year with a vet who used stem cells to help a cat with kidney disease. I'm so glad this worked for Cookie.

    1. Yes, we used stem cells for Jasmine as well. PRP cheaper and easier, that's why we tried that this time. Regenerative therapies are awesome.

  5. I've never heard of this treatment, but so pleased that it seems to be working Jasmine, you must be so pleased. I agree its better to try and prevent that change.

    1. PRP can be used for that, it's being used for arthritis and other things. It is great stuff.

  6. I'm so glad your treatment for Jasmine worked and was non-invasive. I had not heard of PRP before. Luckily, when Chipper tore his ACL a few times, my vet just prescribed rest since he only weighed 32 pounds. Larger dogs usually need surgery according to what I have read. Chipper recovered from each tear with a few weeks of rest. Of course he was an old dog, so he wasn't very active.

    1. Conservative management works for some dogs, yes. The way that generally works, if one can keep the joint stable enough, that scar tissue envelopes it and it gets stabilized that way.

      With the PRP, the goal is to regenerate the ligament itself. Of course, it is a bit of a lottery, but it did work out for Cookie.