For most of us dog owners, there isn’t anything we wouldn’t do for our pets. But what do you do when your dog is old and arthritic, and yet still has joy in his life?
Cash was my neardie Beardie. He was fourteen years old and had been a Frisbee fiend and ball retriever all his life. Over the years he had several crashes and injuries but never complained. Then suddenly at the age of twelve he started to limp. The limp got worse, his back became arched and his speed of movement deteriorated rapidly. Our vet told us that Cash had Osteoarthritis which is the most common cause of chronic pain in dogs.
There was not much they could do other than the traditional veterinary treatment of NSAIDs which does not always make a significant improvement in advanced cases.
This was the case with Cash. The drugs appeared to have little effect and after much thought and consideration we decided to take him to an animal vet and chiropractor. It was a long trip but we made it once every couple of weeks for several months. The treatments helped Cash reduce the stress (temporarily) on his spine, but could do nothing to help the arthritis. His limping became worse.
We found another vet and chiropractor closer to home who also dealt in homeopathic medicine. Anything was worth a try. Cash was already receiving glucosamine, and the new vet suggested we try adding devil’s claw, bromelaine and MSM. Some improvement in his apparent amount of pain and stress, but his mobility was still decreasing. Throughout it all Cash remained top dog in the household dishing out discipline as required - all balls and frisbees were still his.
During these months, my husband and I had been taking our Beardies Stilton and Mickey to agility lessons, and someone recommended a physiotherapist for Cash. I started asking around and found out that several dogs I knew were patients of the physiotherapist and that not only did she work on animals but humans too. I called and got Cash an appointment with Carrie Smith.
At that time, Cash was still mobile, and although he was showing some consistent lameness at a walk, he was able to negotiate stairs, jump on the couch, and play with the rest of the gang. Carrie’s notes from that time showed he had 90 degrees of elbow flexion bilaterally, with pain at the end range of flexion, thickening through the elbow joints and increased tone in the triceps.
Ultrasound, electronic muscle stimulation, exercises, acupuncture and intramuscular stimulation (IMS) were all part of Carrie’s sessions. This helped Cash considerably. He was moving better and overall seemed a happier dog. The summer and winter came and went. We breathed a sigh of relief. Cash still had a great appetite, and although he couldn’t chase balls and frisbees, he still wanted them.
As an aside - I meantime had become a patient of Carrie’s. My diagnosis was tennis elbow, and I can assure you I have never played a game of tennis in my life. Beardie groomer’s elbow had struck me hard and I wasn’t able to lift a coffee cup, never mind a fifty pound dog. I picked Carrie as my torturer of choice - unfortunately two different clinics so Cash and I could not attend sessions together. The only disappointment – Carrie does not give herd discounts. In fact, although the doggie patients get liver treats, I had to complain bitterly until finally one day I was offered a donut to shut me up.
Cash loves to travel, and life in our motor home suits him. Few stairs and lots of rest are a recipe for an arthritic dog. The summer of 2008 however was different. Even in the motor home it was obvious that the pain levels were up and his desire to move wasn’t truly there. He started to bunny hop and “accidents” started to happen. We could tell that he was embarrassed. By the end of the summer he had lost most of his mobility through his hips and had become very roached through his spine.
Carrie was concerned over the bunny hopping. The muscles in Cash’s rear were deteriorating and his front end was now severely afflicted with arthritis. Thickening of the elbows was blatantly evident. To top that off we could hear his hips grinding.
Carrie notes reminded us that Cash could barely walk. He would struggle to bring his two front legs forward, and could only bunny hop with his hind legs. He had no discernable hip extension and a severe amount of crepitus in the hips. Walking was extremely difficult, he had to lie down to eat, he was no longer playing with the other dogs and stairs were out of the question.
My husband and I decided once again to contact our vet and proceeded to ask to see an orthopaedic specialist. Perhaps there was something surgical that could be done? The vet was sympathetic to our cause but not encouraging. We got our appointment.
A few weeks later Cash hobbled into the vet’s office and the orthopaedic specialist examined him. He discussed Cash’s condition and offered no hope. His age was against him. Hip replacement surgery could only be done one hip at a time with six months in between. Lots of exercise would be the key to recovery – not really possible. We grilled him – “What about removing the ball from the rear hip joints?” No, this couldn’t be done because the hip joints were too diseased and there was not enough muscle bulk left to offer support for a femoral head excision. The muscles in question could not be built up because the front end was too far gone to allow the type of conditioning needed. His recommendation was to take him for physiotherapy with – you guessed it – Carrie Smith. Oops! We had been doing it backwards.
We were at an impasse – euthanasia was looking more and more like Cash’s fate. Then suddenly - a ray of hope! The orthopaedic surgeon had heard from a client of a vet doing stem cell regeneration therapy. He would look into it for us. It would be expensive. Several phone calls and a couple of weeks later and Cash went to meet Dr. Cherie White of the Princess Animal Hospital in Kingston, Ontario.
To many the words “stem cell therapy” brings up unpleasant thoughts, visions and questions of morality. In fact, up until this year 2008 there was a ban on shipping stem cells across the border; thus this procedure was new in Canada.
Stem cells? Well, in the veterinary field it is starting to become more popular and doesn’t have the same ethical issues that it does in the human field. Stem cells are actually harvested from the patient’s own fat cells and re-injected back into the joints. (Hey, this sounds pretty good! You mean they can suck out my fat and help my knee joint at the same time? Sign me up!).
According to the literature, the animal must undergo a detailed physical examination in order to determine if they are a candidate for stem cell therapy. The animal has to be otherwise in good health with no underlying pathologies such as cancer or organ diseases. There are several sites in the body where the fat cells can be harvested from, including bone marrow and subcutaneous adipose tissue. Adipose tissue is usually collected from the abdominal, inguinal or thoracic wall. Adipose tissue provides mesenchymal stem cells (AD-MSC) which are the preferred type of cell as they are simple to isolate, are easily cryopreserved, and provide larger numbers of viable stem cells than bone marrow does.
After answering a questionnaire on the quality of Cash’s life, his abilities, and his disabilities, and checking his overall health, Dr. White agreed Cash was a good candidate.
Day One: Step one was to surgically remove some fat tissue from Cash. According to Dr. White, the best place to get the sample (about two tablespoons) is around the shoulder blade, however failing that, the pad of fat in front of his liver, in between his rib cage will do, although this area of fat tends not to produce as many stem cells. The surgery required that Cash be put under for a short period of time.
Once removed, the fat tissue sample was FedEx-ed to VetStem in California as an overnight delivery.
Day Two: Vet-Stem processes the fat sample and concentrates the regenerative cells. The cells are shipped priority overnight in ready-to-inject syringes. This is accomplished within 48 hours after collection of a fat sample.
The number of syringes received back is proportional to the amount of stem cells recovered. We were hoping for the maximum of five: one for each hip, each elbow, and one to be injected intravenously. VetStem banks anything over five for future use. Once shipped you have 48 hours of useful life in the injections - time is critical.
Day Three: I mentioned earlier that this process has just been approved in Canada. The stem cells arrived at Toronto FedEx on schedule but then disaster struck. Canadian Customs would not clear the package. STEM CELLS - oh no those, dreaded words. Phone calls were made but no luck. Cash and I were on standby to rush to Kingston. Twenty-four hours passed. Customs had not released the package. More phone calls. Canadian Customs finally released the package but now it is too late to get them to Kingston.
Day Four: FedEx ships the stem cells to Kingston. Cash and I arrive at the vet’s at 10:00 am. The stem cells arrive at the FedEx Kingston warehouse just before noon. Dr. White is proactive and sends a technician to retrieve them- and yes we have the maximum five! Thirty-six hours have now passed. Cash is put under again and is given the injections. I pick Cash up around 5:30 pm; he’s wobbly but determined he is going with me!
We had been advised by Dr. White that it would take about 4 weeks to see any results. By the end of the first week we were convinced that Cash was moving a little easier and seemed more relaxed. Week two seemed the same as week one, and maybe it was just imagination after all. Week three and Cash was attempting to wander around the garden and was actually taking steps instead of bunny hops. At the end of week three we took Cash to physiotherapy where we all agreed he had regained some mobility.
Week four and Cash knocked at the patio window twice during the week with his front feet to be let in. More importantly he could get down the back steps – although not totally in control, he was not waiting for me to carry him down.
Week seven and Carrie was amazed at his progress.
If you believe that dogs instinctively know if you’re in pain then perhaps it explains another huge change.
My sister has a male Giant Schnauzer named Jigs. For more than a year now, whenever Jigs would come to visit he would fetish on Cash. By fetish I mean that he would stand over Cash and whimper, drool on him, etc. You could pull Jigs away, but as soon as your back was turned he would be right back hanging over Cash. My father came up with the explanation that Jigs knew that Cash was in pain and was trying to figure out how to help/comfort him.
My sister and Giant Schnauzer crew arrived at New Years – 8 weeks into Cash’s adventure. Jigs came rushing in and went immediately over to Cash. But this time, he sniffed Cash, stayed with him for a few minutes and then went and found my Beardies to play with. He left Cash alone for the rest of the visit. Did this mean that Jigs no longer considered that Cash needed comforting. I like to think so.
Week ten passed and Cash’s condition had improved dramatically. On physical examination, he continued to have a severe amount of crepitus in the hips, but he had gained at least ten degrees of hip extension bilaterally. Although his hips and right front elbow had seen remarkable improvement, the left front elbow had some improvement but not to the same degree as the other joints. The length of his stride increased and he could go up and down stairs with much more control than we had seen in a long time. He once again demonstrated his old ability to sit like a Meerkat and paw at you to get attention. He no longer panted in pain. These were very significant improvements for Cash and absolutely changed the quality of his life.
When first waking up, or when the weather was damp, we noticed that the tendency to bunny hop was still there. With the dramatic improvement in his hips and right front, the impairment of the left front was really noticeable. Cash tended to favour the left front so much that he walked on the diagonal and used his tail as a rudder.
Our understanding was that the stem cell patient will see improvement over a 12-week period. Because Cash was almost at that point we decided to use one of the banked injections to see if we could improve the left front some more. This left one injection for future use should his time remaining on earth permit.
Cash was the second dog in Canada to receive stem cell therapy. Maybe we asked for miracles, but Cash told us it was not his time to go. The cost of the whole procedure was approximately $3,000 Canadian – still having my dog at my side – PRICELESS.
Oxford Mills, Ontario
Addendum: We used the banked injection which was given as a general dose and not specific to the joint. In our opinion we saw a minor improvement. We also underwent the same trauma from customs and panicked delivery.
Cash’s age was against him at the start of this adventure and at the end of April 2009 we decided it was time. My greatest regret was that stem cell treatment was not available earlier in Cash’s life, and I would still recommend stem cell therapy to anyone with a dog suffering from arthritis.