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Stem-Cell Therapy - Pre-Harvest and Post Surgical Discharge Inx
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Stem-cell Therapy - Pre-Harvest and Post Surgical Discharge Instructions

At the beginning of 2020, we were privileged to introduced a revolutionary new Regenerative Medicine Program at Highland Veterinary Clinic. We are proud to employ certified technicians and veterinarians who can offer in-clinic, same day activated stem cell therapy to our patients who would benefit from this progressive medical therapy.  Today we performed a health risk assessment, physical exam, diagnostic planning, and followed a  plan of care as your partner in %patientname%’s regenerative veterinary care.  We are recommending that the next steps or home-care tasks listed under "plan" be followed in the immediate term by the %clientlastname% family:

How Does it Work?

This ability arises from repair cells that are found throughout our body. In the case of injury or disease repair cells are mobilized to damaged areas to attempt to fix the problem.

Due to injury and/or age sometimes our own repair abilities can use a jump-start. By using the pet’s own repair cells isolated from fat tissue in the body, this repair ability can be applied to areas of need

What Conditions Can We Treat With Stem Cells?

Our typical stem-cell patient has

We know a lot about these conditions, and over 95% of these patients get better, with Ardent’s Stem Cell Therapy. Stem cell therapy can be used alone or in conjunction with surgical repair.

Ardent may provide us with the resources to treat other cases on a “compassionate use” basis. There is less known about these conditions, but clinics and Ardent are gathering data AND seeing some exciting results. Some of those conditions are:

Please talk to us if you have questions about any of these conditions or would like to submit your pet’s case for what is called “a compassionate use trial.” Think of these treatments as off-label use for the Stem Cell therapies that we perform at Highland Veterinary Clinic.

Highland Veterinary Clinic Also Offers PureVet PRP as Part of Treatment

PRP or Platelet Rich Plasma is a convenient same day treatment that harnesses the healing abilities of the patient’s blood platelets. Veterinarians utilize the treatment in conjunction with common surgeries or as a part of treatment plans to combat injury and disease.

What is PRP?

The concentrated platelets found in PRP contain mass quantities of bio-active proteins, including growth factors and signaling proteins that are vital to initiate and accelerate tissue repair and regeneration.

Ardent’s PRP Kit can be used to treat injured joints, tendons, or used in its gel form.

PRP can be used to aid in the treatment of many ailments--not just joint disease, but we use PRP systemically as part of same day stem cell harvest and therapy

What are the Advantage of HVC's Stem Cell Therapy?

Our vet family techs and practitioners at Highland Vet Clinic always ask: if this were my best friend—what kind of therapies are within reach which will enrich our lives together? How can I improve my pet’s quality of life? Stem cells treat the source of the pet patient’s medical problem by becoming new tissue and replacing damaged tissue. Other treatments, such as NSAIDs, can only attempt to reduce symptoms present with chronic inflammatory diseases. Our activated stem cell treatment is very low risk because it uses your pet’s own stem cells! With Ardent Animal Health's technology, in a recent study conducted by four independent veterinarians, over 95% of animals treated show improvement. For pet owners, there are four main advantages to Ardent's regenerative medicine program at Highland Veterinary Clinic:

1.) The cellular processing is all done in our office, so no worry about losing or damaging the sample during shipment.

2.) Ardent Animal Health allows Gregg J. Gormley, DVM and any of our future certified vets and technician teams to complete the entire procedure in one day, making it very convenient for you and your pet. While all companies are equally safe, Ardent has the highest reported success rate (>95%). When comparing side by side, we chose Ardent because of the superiority in technology and on-site training with support.

3.) Harvesting your pet’s stem cells from adipose tissue (fat) is less invasive, creates no ethical quandaries, and provides higher stem cell yields.

4.) You can choose to have your pet’s stem cells banked in cryo-storage! If your pet needs treatment again (the benefits of an average osteoarthritis treatment lasts an average 18-24 months), Ardent can retrieve your pet’s stem cells and send them for future treatments—no more minor surgery to harvest adipose tissue.

Preparing for Stem Cell Therapy

We perform a specialized blood test one week prior to stem cell therapy. This testing ensures that your patient does not have a cancerous condition or other conditions which would need to be addressed or treated prior to stem cell therapy, and ensures that your pet is healthy enough to undergo 30-40mins of anesthesia for collection and administration of the therapy. We are utilizing a brand new screen by VDI labs to also monitor the need and effectiveness of the therapy by screening your dog’s Vitamin D and Hylauronic Acid levels, or your Cat’s Vitamin B12 and Vitamin D levels. This will help with therapy and ensure the greatest most lasting success.

Discontinue The Following Medications and Therapies

Some drugs and treatments have immune-modulating behaviors or known interactions with protein receptors important for proper immune function.  Which may impact the efficacy of regenerative cell therapy.  The following is a list of drugs and therapies that Ardent Animal Health recommends an animal NOT be administered for a limited time during regenerative cell therapy.  In addition, NSAIDs should be discontinued for 48hrs prior to surgery only if there is a concern for bleeding.  The exception is Galliprant, which must be discontinued for two weeks prior and two weeks post stem cell therapy.

Discontinue or do not perform less than two weeks prior to AND two weeks post therapy:
 immune-modulating drugs, Cyclosporine A, Ciclosporin, Atopica, glucocorticoids (Prednisone, Prednisolone, Hydrocortisone, Dexamethasone, Budesonide), Galliprant, Monoclonal Antibiodies (Apoquel, Cytopoint, Solensia), Amitriptyline, Tacrolimus, Vaccines, Shockwave Therapy.

Discontinue for at least two weeks post surgery: Heat Therapy

Discontinue two days before and after therapy: Tramadol, Prozac, Cerenia.  Perform Dental Cleanings BEFORE adipose collection if same day, or wait a minimum two days post injection.

Discontinue until week five of recovery after clearance has been granted: Aquatic Center Activities, Aquatic Therapies

Ok elsewhere, but not recommended for injection site for two weeks post injection: Adequan, Arnica 12.

Ok elsewhere, but not recommended at injection site for 4-6wks post injection: Cold-Laser Physical Therapy.

Medications and Therapies you May Continue During The Procedure

Approved Medications: We've been asked about the following medications, which are approved as support for stem cell therapy.  They have been put on Ardent's "Approved List" do not need to be discontinued unless there is some other concern (risk of bleeding).

NSAIDs and the following pain medications: Carpofen, Meloxicam, Deramaxx, Previcox, Torbutrol/Butorphenol Tartrate, Fentanyl, Gabapentin, Bupivicane.

Other Supportive Drugs: Trazodone, Alprazolam, Antibiotics, Zyrtec, Proin.

Supplements: Denamarin, Probiotics, Prebiotics, Glucosamine + Chondroitin, Fish Oil, Other Oral Joint Supplements, Chinese Herbs,

What Happens On the Big Day

In dogs or cats, the extraction is less invasive than a spay and in horses, a standing lipo technique can be utilized.

First, we induce your pet under general anesthetic. Then, we will make a small incision and collect 2-4 tablespoons of fat (either in the belly or behind the shoulder blades). Ardent provides on-site training for each clinic that brings on Stem Cell treatments; the process ensures your pet’s cells will be isolated and activated with the same-day advantage in a proper manner.

The fat is collected in about 20 minutes. Processing the sample is done carefully by one of HVC’s highly trained Vet techs specially certified after careful training by Ardent Animal Health. In the thousands of animals treated, Ardent has not observed any significant negative side-effects from in-clinic activated stem cell therapy.

The surgical time requiring anesthesia is typically less than 30 minutes. The cells are isolated, activated and re-administered on site so that your companion animal can begin to improve right away.

A minor surgical drain or an absorbable bio-sponge is placed inside to prevent bruising and fluid accumulation. Most patients will not even have sutures or staples to remove.

Most pet owners choose to bank their pet’s remaining stem cells in the Ardent Animal Health Kentucky Cryo-storage unit. This means that surgery won’t be required for these patients in the future should they need further treatments!

Recovery and Rehabilitation Instructions: Post-Stem Cell Harvest and Therapy:

Generally, surgical incisions take 10 – 14 days to heal.  During this time-period, %patientname%’s incision should look exactly like it does today when you take %patientsexobjprol% home.  We’d like you to schedule a several follow up appointment for a surgical and physical rechecks:

      - 3 Days: A Brief Visit to Remove the Drain From the Harvest Site

      - 10 Days: A Short Visit to Recheck Incision Site, and Document Passive Range of Motion

         (PROM) Progress, and Read Bank Harvest Success Report if Applicable.

      - 3-4 Weeks: To Evaluate Medications, Increased PROM, Walking, and Heat Therapy

      - 5-6 Weeks: to Evaluate Aquatic or further Physiotherapy Needs

      - 8-10 Weeks: to Evaluate/Adjust Therapy Laser Programs

There is no examination fee for any of the aforementioned re-checks, nor is there an exam fee to troubleshoot any suture site reactions while %patientname% is in recovery over the next 12 weeks.  If your pet requires sedation for handling or suture removal, this may occur for an additional feel.  Please call if %patientname% exhibits the following:

WATER: Normally an orthopedic patient’s water intake does not need to be monitored much upon arriving home because we have assured that the intake is normal in the hospital.  However, %patientname% should drink normal amounts of water to encourage proper hydration and ensure no complications are occurring due to anesthesia or medication regimen.

FEEDING:  Your pet's normal diet may be fed the morning after surgery—we normally do not release orthopedic patients until after normal appetite is assessed the day the patient is expected to be discharged.

INCISION CARE: Look at the incision daily and notify us if you notice increased swelling or redness, discharge, or missing sutures.  An Elizabethan collar may be necessary to prevent your pet from licking or chewing the incision.  We recommend bathing your pet prior to surgery, we do not recommend struggling in the bath with a patient post-surgically. If an area of the body must be cleaned, definitely avoid direct application of soap and water to the surgery site.

Rehabilitation and Physical therapy Protocols Suggested for Regenerative Therapy patients

We want to take the time to thank you for trusting Ardent Animal Health and Highland Veterinary Clinic to help ease the pain and suffering of your pet. It is imperative that you take the time to follow a good rehabilitation program to ensure that your pet fully heals.

Please refrain from allowing your pet to run, jump or play during the first FOUR weeks following treatment, even if they feel significantly better--please use interventions to provide confinement of space, redirection, and other activities (such as puzzles, chew toys, or Kongs)

Due to the unique nature of each case, a standardized protocol for rehabilitation following injection of adipose-derived regenerative cell therapy is not applicable in each situation. Instead, there are some simple principles that can be applied to a protocol that is personalized by you for every patient. There are a few things that should be kept in mind when designing a rehabilitation program for each pet; including severity of the condition, the number of joints that were involved in the surgery, age of the animal, and other current medical conditions of the pet.  Patients can be classified as mildly to moderately affected or even severely affected.  Your veterinarian will design a program based on their needs.  The following activities may be recommended for your pet during recheck evaluations based on their unique condition immediately post surgery:

Passive Range of Motion (PROM): Beginning the day after regenerative cell injection, the affected joint(s) should be exercised through a comfortable range of motion. It is important that the bones both above and below the affected joint are supported so not to add unwanted stress and strain to the joint. The joint is carefully flexed until only mild discomfort is felt by the animal. This discomfort may be exhibited as tensing of the limb, slight resistance, or turning of the head in recognition of movement. This flexing movement should NOT cause pain so that the animal sounds out or struggles to pull away. The joint is then carefully extended until the point of mild discomfort. Passive range of motion (PROM) needs to be performed 2-3 times per day for 5-10 repetitions. It may also be helpful to add stretching to the range of motion exercises. The joint should be held in either flexion or extension for 5-10 seconds. As days go on, a greater range should be achieved during stretching. The most important thing to remember is not to cause pain in the joint by placing too much stress on it.

• Hip: Lay one hand across the back, right above the hip joint. With the other hand, grasp just above the knee.  Gently and slowly flex the leg forward, towards their head, until you feel slight resistance. Hold this for 5 – 10 seconds. Gently and slowly flex the leg in the other direction, towards their tail, until you feel some slight resistance. Hold this for 5 – 10 seconds.

• Knee: Grasp the leg by placing one hand slightly above and one below the knee. Slowly start bending the knee outward, making the leg as straight as possible, until you feel slight resistance. Hold this position for 5 – 10 seconds. Bring the knee back, towards to body, until you feel resistance. Again, hold this pose for 5 – 10 seconds.

• Elbow: Grasp the leg by placing one hand slight above and one below the elbow. Flex the elbow forward, toward the head, until you feel resistance. Hold this for 5 – 10 seconds. Start extending the elbow backwards, with one hand located above the elbow on the back of the leg and the other hand located below the elbow on the front of the leg, until you feel slight resistance. Hold this position for 5 – 10 seconds.

Standing Exercises: Animals that suffer from severe osteoarthritis are usually very weak and have difficulty standing for longer than a couple of minutes. It is common to see shaking and weakness in the limbs while standing. The goal is to increase both the strength and endurance of the postural muscles. This can be done by offering support to the animal with a sling while they are in a standing position. The feet should be placed in a square standing position. The animal should stand for as long as it is able to, when weakness becomes evident or the animal starts to sit, using the sling as a

support tool, gently pull the animal back to a standing position. These exercises should be done for 5 minutes, 2 – 3 times per day until the animal is able to stand on its own for 5 minutes.

Assisted Sit‐to‐Stand

• Place your pet in a proper sitting position—this means with your pet sitting squarely with the rear legs evenly tucked underneath their body.

• Slowly start to bring the rear end up using a sling and/or using one hand to lift up from the pelvis.

• Start off by holding your pet in this position for 15‐30 seconds as tolerated. Allow your pet to support a portion of their body weight, increasing the amount daily.

• Help your pet return to the proper sitting position once again.

• The time that this exercise is held will be increased over the recovery period up to 3 minutes, depending on how well it is tolerated.

Your pet is our utmost priority. These exercises, especially in the beginning, will be very tiring.

Always perform these exercises with your pet’s tolerance level in mind‐ pushing too hard can do

more harm than good. The main goal is to increase the number of repetitions of each exercise as

well as the amount of time exercises are held and to decrease the amount of assistance provided by

you.  Ice Therapy: After any exercises or stretching, an ice pack may be applied to the affected joint(s) for up to 20 – 30 minutes.  A piece of cloth should be applied between the ice pack and the animal’s skin to increase comfort.

Leash Walks: Slow, confined leash walks may begin the day after regenerative cell injections. During the first week, leash walks should be no longer than 5 minutes, 2 – 3 times per day. For the animals suffering from severe osteoarthritis, 2 – 5 minutes is appropriate while those suffering from mild to moderate should aim for 3 – 5 minutes. If pain, lameness, and swelling are starting to improve at the end of the first week, then leash walks can be increased to 10 minutes for mild to moderate and 5 – 10 for severe.  At the end of the week, if improvement is continued, walks can be increased by 5 minutes each week. If the animal exhibits pain or lameness, then adjust the walks and talk to us about adjusting pain medication so that your pet is comfortable.

Physiotherapy: This is recommended for those animals who do not return to optimal physical function, or are not expected to return to optimal function following the operation. These patients are usually those pets who were suffering from severe osteoarthritis or obesity prior to therapy. The goals of physiotherapy are to improve comfort, mobility, activity level, cardiovascular fitness and muscle tone and strength to support joints. These activities are strongly encouraged within the first 2 -4 weeks. These activities include:

• Walking on a treadmill under the supervision of a veterinary physical therapist or veterinarian, or

   soft soils/sand for 5 minutes, 2 times a day

• Walking up incline or decline ramps for 5 repetitions, 2 times a day

• Performing Sit-to-Stand exercise, 5 repetitions, 2 times per day

• Raising food bowls to shoulder level

• Carpeting slippery floors

Contraindicated Concurrent Therapies:

• Intra-articular Steroids- 45 days before and after

• Systemic corticosteroid use- unless definitively needed for life limiting diseases

• Shockwave therapy- 4-6 weeks after

• Power plate- 4 to 6 weeks after

• Swimming (due to rapid joint motion) - 4 to 6 weeks after

• Therapy Laser at the site of the stem cell injection, 4-6 weeks after regenerative cell therapy

Acceptable Concurrent Therapies:

• Non-Steroidal Anti-Inflammatories (NSAIDs)

• Hyaluronic Acid (HA)

• Glucosamine and/or chondroitin sulfate, avocado –soybean unsaponifiable, omega-3 fatty acids

• Acupuncture

• Systemic antibiotics

• TENS (Transcutaneous Electrical Nerve Stimulation)

• PSGAG (Polysulfated glycosaminoglyeans) Adequan

Some findings may have been discussed in less detail than others today.  As always, if you have a question about your pet’s visit or recommendations today please feel free to call 812-867-6652 so we can help direct you to information or further clarification at your request.

VETERINARY NEWS AND PREVENTATIVE CARE RESOURCES:

Veterinary Care Centers and Information for Dogs, Cats, and Other Animals

Ardent Veterinary Animal Health--HVC's Partner in our Regenerative Medicine Programs

Vetri-flex, Mobility Flex, Cholodin. and Senilife

www.highlandvet.net - (812) 867- 6651