Posts Tagged ‘evidence based medicine’

Stem cells: A beneficial therapy or a waste of money?

May 8, 2011

 

Stem cell therapy (aka regenerative medicine) is becoming all the rage in veterinary medicine.  Initially used only to treat damaged horse parts (tendons, ligaments, and joints) the repertoire of stem cells has expanded to treating dogs, primarily for management of arthritis symptoms.  Even a few kitties are getting in on the act as regenerative medicine is investigated as a means of restoring health to their aged kidneys.

Here’s a rundown on the logistics of stem cell therapy. The process begins with the veterinarian harvesting fat or bone marrow samples from the affected individual.  These samples are then sent off to a specialized “stem cell company” for processing. Recently, one company, MediVet America, has provided the option for vets to propagate stem cells within their own hospital setting. Once harvested the stem cells are injected into the patient’s affected body part(s) and/or are administered intravenously.  Extra cells can also be “banked” for future use. And all of this for a price of $2,000 to $3,000, on average.

In theory, these stem cells have the potential to differentiate into bone, cartilage, and many soft tissue types.  Why do I emphasize, “in theory”? To date, there is no proof that the stem cells, once injected into the body, do actually become the cells we are hoping for.  Perhaps any observed benefit is a result of biochemical alterations of the cells already present rather than regeneration of new and improved cells. 

Not only is there a paucity of information about what actually happens to the cells after they are injected, there is a surprising lack of evidence-based data that supports any benefit of stem cell therapy.  In this regard, it appears that the stem cell therapy cart has pulled way ahead of the horse- unusual in the world of “western medicine” where veterinarians are typically reluctant to embrace a particular therapy without it having survived the scrutiny of evidence-based medicine.  Yet many western trained practitioners readily offer forth stem cell therapy to their clients based on anecdotal information (individual client impressions, vignettes told by other veterinarians, marketing materials from stem cell laboratories). 

According to a recent article in the Journal of the American Veterinary Medical Association (JAVMA), Dr. Robert Harman, CEO of Vet-Stem Inc reports that his company has processed stem cells from fat samples for approximately 8,000 patients.  Approximately half the patients are horses, the other half comprised of dogs and a few cats.  In the same article, Dr. Sean Owens, director of the Regenerative medicine Laboratory at the University of California- Davis School of Veterinary Medicine states, “We’ve moved forward so quickly that what we need to do now is put the science underneath.”

Dr. Brennan A. McKenzie is the president-elect of the Evidence-Based Veterinary Medicine Association. As stated in the same JAVMA article, “Dr. McKenzie thinks the use of stem cells is a promising avenue for therapy but that the evidence of efficacy and safety is inadequate to justify the expensive treatment in most cases.  He would prefer for clinics to offer stem cells as a truly experimental treatment in formal clinical trials.”

The North American Veterinary Regenerative Medicine Association has recently been organized with hopes of acting as a clearinghouse of information on the use of stem cells in veterinary medicine.  Their first official meeting will be in June with the intention of forming standing committees to address things such as clinical trials and regulatory affairs.

Given the paucity of research supporting stem cell therapy, is there any downside to opting for this form of therapy for your dog or horse?  While there is always risk associated with general anesthesia (usually required for harvesting fat or bone marrow samples as well as injecting the stem cells into the exactly appropriate spot), thusfar, there have been no reports of adverse effects caused by the stem cells themselves. If my own doggie had significant arthritis pain and nothing else in my medical arsenal (supplements, acupuncture, underwater treadmill therapy, nonsteroidal anti-inflammatory medications) made a difference, might I try stem cell therapy?  You betcha. Is there risk of expenditure of two to three grand without a return on investment?  You betcha.

Has one of your four-legged family members received stem cell therapy?  If so, I welcome your feedback.

Best wishes for good health,             

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Fish Oil (Omega-3 Fatty Acids): a Proven Treatment for Canine Arthritis

January 30, 2010

 I had the good fortune of receiving my veterinary school training at Cornell University.  Part of what made this education so fabulous was that the senior faculty spent a great deal of “face time” with their students.  I have fond memories of a seasoned clinician patiently holding a Dachshund for me while teaching this novice how to collect a blood sample from the jugular vein.  Another taught this city slicker how to collect a milk sample for mastitis testing from the teat of a cow.   A major “take home point” my classmates and I received from these icons in veterinary medicine was, “First, do no harm.”  In other words, before subjecting our patients to diagnostic testing or treatment, we should strive to be as confident as possible that the potential for benefit was far greater than the potential for harm.  “First do no harm” has always been my mantra and is the main reason I try to rely on “evidence based medicine” (facts substantiated by research) rather than anecdotal information to support what I do. 

Unfortunately, there is a paucity of evidence based medicine pertaining to the use of many commonly used supplements, nutraceuticals, and herbs for dogs and cats.  This is the reason a big smile appeared on my face when I opened a recent edition of the Journal of the American Veterinary Medical Association.  It contained two studies on the effects of omega-3 fatty acids (fish oil) for the treatment of osteoarthritis (also known as arthritis or degenerative joint disease) in dogs.  The study designs were excellent in that many dogs were included, there was a control group (some dogs received a placebo rather than the fatty acids), and the observers were “blinded”- neither the veterinarians nor the dogs’ families knew if the dogs were receiving the fatty acids or the placebo.  

Fish Oil (Omega-3 Fatty Acids)Here’s what the studies showed.  Compared to the placebo group, the dogs receiving omega-3 fatty acids had a significantly improved ability to rise from a resting position and play by six weeks after beginning supplementation, and improved ability to walk by 12 weeks.  Additionally, compared to the control group, dogs receiving the fish oil had improved weight bearing on the affected limbs as assessed by force-plate analysis (an extremely humane testing method).  No significant adverse side effects from the fish oil supplementation were reported. 

If you’ve spent any significant amount of time with dogs (especially large dogs), guaranteed you’ve known at least a few with arthritis.  It is estimated to affect up to twenty percent of dogs over one year of age. Dogs with arthritis resemble people with arthritis- they are often stiff and slow to rise when they first get up in the morning, as well as after vigorous exercise.  There are many ways to treat this common canine malady including nonsteroidal anti-inflammatory medications (the equivalent of ibuprofen for humans), acupuncture, rehabilitation therapy, and supplements that increase the production of normal joint fluid.  The effectiveness of all of these modalities, including fish oil, will vary from individual to individual.  The beauty of fish oil is that, likely the only potential significant risk is for you- your dog may develop fish breath! 

I love the fact that veterinarians now have evidence based support for recommending fish oil as a treatment for their canine patients with arthritis, and in doing so, they can abide by the mantra of, “First do no harm.”  If you suspect your dog has arthritis (if you have a large breed dog over eight years of age, chances are that you do), talk with your veterinarian about the pros and cons of all the treatment options.  And the next time you are dining on fish, don’t be surprised if your dog’s nose appears right beside your dinner plate.  Chances are, your dog clearly recognizes the benefits of fish oil supplementation!  Now, pass the salmon please. 

Wishing you and your four-legged family members abundant good health.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller. 

Order  a copy of Speaking for Spot personally signed by Dr. Kay – http://www.speakingforspot.com/purchase.html

Join our email list – http://speakingforspot.com/joinemaillist.html

Look for us on Twitter – http://twitter.com/speakingforspot

Become a Fan of Speaking for Spot on Facebook

Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross

Please share this blog with your dog-loving family and friends:

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine