Beginnings of physiotherapy past stem cell implantation

It has now been 2 weeks since Yarpen had the stem cells injected. We have finished the initial after-care period, and he is now allowed a little more movement. We have had 5 (of 6) laser sessions, with one left for next week. I am now starting to really accept the improvement I’m seeing. His energy levels are through the roof compared to before. I guess only now that he has improved I am fully appreciating the state he was in before… It was easy to miss it, as the deterioration was so gradual. He is more active, happier, wants to play both with the puppy and me, picks up toys and enjoys his life again. I would say that the stem cell therapy turned us to the point we were about 2-3 years ago.

At the moment the cells are still multiplying and implanting, so even though it’s incredibly tempting to just start on muscle building exercises, we need to be very careful. The main muscle building will be achieved during under-water treadmill sessions, but I am not entirely sure when we will be starting this, we will follow our vet’s advice on this. We have however seen our physiotherapist.

DISCLAIMER

Please, do not attempt any of the exercises I am writing about in this and other posts without consulting a professional first. Physiotherapy is a great, great tool, but it’s not just about teaching a dog new tricks/movements. The main point are for the dog to be asked only what he can achieve at his current level and making sure that the movement is carried out by proper muscles, at appropriate speed. Pushing things not only won’t achieve any results, but can in fact make the dog worse.

As we are still letting the joint settle, we are not doing anything which would put too much strain on it. The first exercise we did during our session was a “simple” posture correction, with the use of platforms/steps. As Yarpen’s right hip is worse, he tends to stand with his right foot closer under the body. This makes his body asymmetrical, with muscles being inappropriately activated even when he is just standing. Further, we are working on slow and mindful movement. For example I am going to try and slow down his backing away (only a few steps at a time), so he is very aware how far each foot is moving. We are also working on his front paw targeting by using pods. I am now starting to teach him the basics of lateral movement as well. He’s never done that before, but is catching on very well. The final exercise we have started before the procedure is nose target to hip and toes. It activates his core muscles. Before the procedure he was able to reach the target on a lure. As we have now taken a few steps back in difficulty of exercises, I have decided to work a little on replacing the lure with a hand target. It’s not easy, as even though Yarpen has a pretty good maintained target (his nose touching my hand), by chance we have never worked on a moving target. This means that I am asking for far less movement, e.g. instead of asking him to target his hip with his nose, I only “pull” his head on a hand target to about 90 degrees each side. At the same time, as I take the lure out he is far more level headed (rather than just trying to get to the lure).

Stem cell therapy – progress

When I wrote the first entry on stem cell therapy for Yarpen’s HD, the plan was that we would probably wait with injection till after Christmas. Luckily, his cells were growing extremely well (which was a nice surprise considering his history of weird ailments!), and we managed to have the procedure done on 23rd Dec. He had the cells injected directly into his hips joints, as well as into the spine around the affected area. This was followed straight away by the first (of 6) laser treatments, with a grade 4 laser

The standard expectation for the improvement is that the dog will show an immediate improvement, followed by a slight dip (still way over the initial status), and a stabilisation which will last for several months to couple of years, depending on various factors.

We are now a week in, with 2 more laser treatments. At the moment Yarpen’s walks are limited to 10min on lead, 3x a day. As such, I can’t really say just yet how much better he is, but I can definitely see a change in his behaviour at home. He is actually naughty… he’s eaten a gingerbread ornament from Christmas tree, something that even Falka didn’t attempt! He’s also now fully expecting that sofa is his dominion (after all, there is the pesky puppy on the floor…) and in general, he’s back to his cheeky old self.

I am very, very happy with the result, as even though it might wear off in time, it gives us the chance to build some of his muscles back with hydro- and physiotherapy. This is such a change compared to the previous status, where due to chronic pain, we couldn’t even attempt the exercises… I am very keen to start him on the new regime when we get an all clear from the vet, especially that his boredom is turning him into a slightly annoying monkey!

Yarpen and his hip dysplasia

While this blog has been mostly about Falka, this post will be all about Yarpen. Though it won’t be as fun as the other posts… As I write it, Yarpen is curled up, spaced out on Tramadol, with an incision in his belly and bald patches on his hips. But let’s start from the beginning….

Yarpen was bought as a pet foremost, but also I had hopes he would become a stud dog. When he was 3 years old, I had his hips and elbows Xrayed to see where we stood. I expected good results, as other than not being particularly jumpy, he didn’t have any problems that I could see. Well, a HD D score was a very brutal wakeup call… Unfortunately, I don’t have copies of his original Xrays, but I do know that his right hip was worse than left. We followed the specialists advice and modified the exercise a little, but other than that, made sure that he had enough of it to build up muscle mass to hold up the joints. Of course, breeding was out of question.

Fast forward 3 years, I started noticing first signs of the dreaded disease. It started very gently, with a shorter gait on the back right leg. Then it moved on to reluctance to pee while standing on right leg. So, we started physiotherapy. It was absolutely amazing and I could see progress pretty much straight away. However, due to progressing osteo-arthritis (OA) we had to limit Yarpen’s exercise further. And this becomes a very slippery slope…  The more pain the dog experiences, the less they want to move. But, with a severely deformed joint, it is the muscles that need to hold the joint up. With no exercise, the muscles start to shrink, other body parts are taking more load than they should and the consequences spread from the affected joint to the whole muscular-skeletal system.

Yarpen is now over 8 years old. According to our physiotherapist, I managed to keep him in optimum condition, with him still being able to jump on a grooming table or in the bath. But, he is extremely fragile to contusions… Over the last 3 months he has had several strains on both hips, requiring heavy medication and rest. Of course, the rest = no exercise, which leads to further muscle loss… His last strain was probably the worst, as I couldn’t even pinpoint what cause it. He didn’t slip, Falka didn’t jump on him, he didn’t get hit by anything… and yet one day he woke up with trouble to get up and refused to put weight on the right leg. At this point I realised that we need to do SOMETHING, or this will be the beginning of the end.

Our options were:

  1. Continue with medication, strict rest to heal up and then physiotherapy.
  2. Surgical procedure
  3. Stem cell therapy

Option 1 was what we did up until now, and it seemed to stop working. The outcomes of option 2 are not really well guaranteed, and considering the recovery time is about 6 months per one hip, it would mean that for the rest of his life he would be in pain. Plus, as he weighs just a little less than me, this would not be practically possible, as my husband works a lot, and I wouldn’t be physically capable to carry him in and out for toilet. So, we have decided to go for the stem cell therapy. The one major drawback to it is that this is the only treatment not covered by our insurance, which means Christmas (and whole next year by the looks of it!) will be tight, but hey, it’s just money….

We have had the first stage of the process done yesterday. Yarpen was measured and examined in any way possible. Of course, he had an Xray done. Not only on his hips, but also his back, as he started showing symptoms of back problems too.

His hips look like this:

yarpen-hips-dec-16

You will notice the horrible socket of the right hip, with severe OA. Note also the shape of the femoral head, it should be like a ball. Yarpen’s resemble more a pyramid than a ball… The neck of the bone is also malformed, instead of clear narrowing under the head, the bone just started building up. If you look close enough, you will also see a difference in the thickness of muscle on both sides.

His back Xray showed that he started to have changes in his spine. Because of abnormal movement, his disk started to calcify, with some changes on the walls of vertebrae. This will need addressing too.

spine

A thermal-image camera showed clear signs of inflammation in his pelvis, radiating through his lumbar region (white – hot, going through yellow, orange, red to green and blue being cold). There is also some muscle inflammation in the thoracic region, as shown in the thermal signal and in physical examination, but this appears to be only muscular. The lack of heat signal on his glutes shows a muscle mass loss.

heat-back

A weight-spread analysis showed that he is now walking evenly, with one back leg carrying only 12% of the body mass. This is of course compensated by the front legs, which carry more than they should.

The hip joint fluid, instead of being clear and viscous, is watery, filled with blood and leukocytes, showing clear signs of inflammation. In both joints….

The diagnostics left us in no doubt – Yarpen is in pain.

What we are going to do about this now. First, he had a blood sample collected, from which a platelet rich plasma was extracted. This was then injected into his hip joints, which will hopefully stimulate the “clean-up” process of the inflammation. We hope to see no blood in the fluid next time we sample it. We also collected a sample of his adipose tissue (fatty cells) from his belly. This required a general anaesthetic and a small incision. These cells will be sent out to a lab and grown for a couple of weeks. After Christmas, these cells will be injected in his hips and spinal column to regenerate the deteriorating cartilage. All this will be followed by a series of laser treatments and physiotherapy. We are hoping to do this soon after Christmas. And it should give us in excess of 18 months of vastly improved life… We’ll see what will happen when we get there!

Writing what I think about breeding against HD would take a whole book, so I will state it only very concisely. Hip dysplasia IS genetic. Whether it causes problems or not is affected by environment to a certain degree. But there MUST be an underlying genetic predisposition for this to happen. Selecting against HD is not easy, but it is absolutely doable. I am a quantitative geneticist, working on traits exactly like HD in my day job, and it just boggles my mind how many breeders prefer to hide behind the “you can get a good pup after dysplastic parents, and a dysplastic pup after good parents”. Yes, the same goes for conformation champions, and somehow this doesn’t negate the drive you have for breeding for the next rosette! Some dogs may be more affected than others, some will have horrendous Xrays and seemingly no issues, other will go limp with slight strain. But, there is nothing worse than seeing your dog wanting to walk, wanting to work with you, and not being able too. So I implore you, please, test your breeding dogs, and for puppy buyers, PLEASE make sure you don’t make the same mistake as me, don’t buy pup after untested parents! The fact that the pups parents appear to be fine at the age of 3-5 does NOT mean that they are free of dysplasia.

Yarpen’s score is HD D. This table shows the translation of the score to the systems in other countrieshd-scores

The median score for the Russian Black Terriers in the UK up to 2014 was 25. According to this, an average RBT in the UK has hips similar to Yarpen. I feel absolutely sick to my stomach to think that so many of our dogs will suffer from this horrible disease…