Hi, everyone, and welcome to another webinar. Tonight, we are lucky enough to have John Waterhouse with us to talk about osteoarthritis. Doctor John Waterhouse graduated in 2004 from the University of Sydney in Australia.
In 2010, John moved to the USA to undertake a fellowship in pain management and rehabilitation medicine in Colorado Springs. He also completed an externship in diagnostic musculoskeletal ultrasound. John is a certified canine rehab practitioner through the University of Tennessee.
John, welcome and it's over to you. Thank you very much, and I always love coming and talking for you guys, especially Anthony Chadwick and the, the rest of the team there at Webinar vet, because what you do is so important. I just changing my microphone so we make sure we can hear me.
What you do is so important, getting education out there. And so when, with the webinar vet team reached out to me, they said, can you do a talk about what's new in arthritis and treatments in arthritis, and that's what today's webinar is going to be all about. So A little bit of more about my background, there was an introduction.
I am a licenced Australian veterinarian, I did come out in 2011 to do a fellowship in pain management in Colorado Springs under the tutelage of Doctor Jamie Gaynor. As was said, I went to the University of Tennessee and undertook my rehab certification on my CCRP, and then went back in 2014 and built a rehab facility for six orthopaedic veterinarians in Colorado. In 2015, my wife, Doctor Celia Waterhouse, who was the brains, I'm just the brawns of the relationship, said, why don't we take everything that we've learned and build the veterinary teaching academy.
So since 2015, we've been doing monthly webinars and information programmes, spreading the news about sports medicine and rehabilitation around the world. We also launched back in after COVID, 2 years ago, canine rehab On Demand, and we'll actually talk about that at the end, because that's a new programme that's coming out next month, that's very exciting. I'm also a speaker and author of many publications and that on sports medicine, rehabilitation and laser therapy.
So that's just a little bit about myself, . Tonight I thought we'd talk about how to gain an understanding of what new pharmaceuticals and new traceuticals have come out in the last 2 to 3 years. Different companies, countries I know that we have different audiences here, so you have some things we'll talk about in the UK and Europe that have just hit the US market, and we have a few things here in the US market that are now looking to get into the UK and Europe.
So I thought I'd stop the line probably 2 to 3 years. Because it takes that time for different regulatory companies, coal countries to get new products. We're gonna look at what, non-surgical treatment therapeutics to help patients.
I'm not looking at surgical options, but this is non-surgical options that we'll be talking about tonight. We'll also look at new approaches that provide additional treatment options for you, the practitioners, so you can have more options, tools in your toolbox to help your clients when they come in with osteoarthritic or degenerative joint patients. We're gonna look at new options that actually work, I'm gonna talk about studies and because studies are very important that these products and supplements that we're talking about have studies to back them up, and then we're going to look at what protocols can be used for combination of supplements and interarticular injections can be used for the benefit of your patients.
Now a disclaimer, some of the, What we're talking about tonight, I don't don't have any affiliations with the companies. There's one supplement we'll talk about, Myos that we actually have in our store, in our canine rehab on demand pro platform, but there is no affiliate fee with any of these programmes or products at the moment, but I just wanted to bring that disclaimer up before we get into it. OK.
Get your pens and paper ready because we're gonna talk a lot about a lot of different things in the next hour. So we're gonna look at what is called the multimodal approach, and this is my wheel of how I treat my patients. So we look at pain control, weight control, diets, so EPA rich diets, physical rehabilitation, daily exercise, and supplements.
So all the different spokes of the will that I address when dealing with a patient or a client that has degenerative joint disease. So when we look at pain control, let's talk about what new pharmaceuticals have come online in the recent 2 to 3 years. So the first one is Galyrant.
Galyrant really has been a game changer here in the United States. I'm pretty sure that you would have it now in the UK, but this is shifted how we think about treating degenerative joint disease and osteoarthritis. So galirant is a newish class of non-steroidal anti-inflammatory, and it's active ingredient is gayrant.
So I'm just putting my glasses on, so I can read this. It's a non-COX inhibiting prostaglandin receptor antagonist and. Really this is a great mechanism of action because it blocks the EP4 receptor that's responsible for transmitting pain and inflammation associated with osteoarthritis and we'll talk about the next drug as well that is one of these blocking mechanisms.
So trials, that was really important that patients were given 15 times the recommended dose and that's 2 milligrammes per pound per day for 9 months, and they saw no changes in liver function, kidney function, coagulation parameters, appetite, there was slight GI disturbances, some of the, test subjects had loose stools, but that was the only side effects. And so if we classify this as a non-steroidal like drug, and we know all the adverse side effects that come along with non-steroidal anti-inflammatories, this is a great adjunct now to what we can do for our patients. Cool, let me go back and tell you a little bit more.
This drug is also safe for puppies and geriatrics. So puppies from 6 months of age can start to take it. So we now have a non-steroidal type of drug that we can now give to puppies if they injure themselves or have ostolytic like OCD lesions, things like that that traditionally we weren't giving any type of non-steroidal anti-inflammatory, Medications now we have something that we can prescribe and also for our older patients, just because it is liver and kidney I won't say protective but doesn't have any adverse effects, we can now give it to those geriatric patients that may have liver or kidney disease.
Injectables, this is really where the new forefront of treatment of osteoarthritis is coming in, and the intra-articular injections, we're gonna talk about, really, I'm very excited where we're going to be able to go in the next decade with these new, Pharmaceutical applications that we have for degenerative joint disease patients. So the first one is, Calencia or Libria. These are drugs that you and the UK have had for, I think 3 to 4 years.
We have just got them in the United States in the last 9 or 12 months. So Lenny, I was really excited about trialling with, and we'll talk about my 20-year old cat that just passed back in January of this year, and I was really excited, but the drug never came out in time for her. And then, Librella is, and I never know how to pronounce it correctly, but that has come out in the last 9 months as well, and we're seeing, very promising things here in the United States, but if you're in the UK you've already had this for the last couple of years.
So this is a therapy that involves monoclonal antibody specific design to target and neutralise nerve growth factors. So really it's an anti nerve growth factor compound. And this is great because it binds the nerve growth factor and prevents these antibodies interacting the receptor sites, a lot like gay rant that they are the receptor sites that are responsible for the transmission of pain.
So if we can block those receptor sites, we're not transmitting those pain signals then from the degenerative or inflamed joints. So this inhibition blocks the pain signals as I said, and this, That we know that the nerve growth factor is responsible for heightening in sensitivity in the the joint and has some influences in the plasticity of the joint. So if we can neutralise this or down regulate it, we can down regulate the intensity of the signal that is being transmitted to the brain when it comes to degenerative joint disease.
So What does this mean? So this targeted approach means that therapies now can provide targeted pain relief without the side effects associated with a non-steroidal anti-inflammatory drug. And so this is now the new gateway, as I said, we now have gayrant, we now have this class of drug that is going to change how we treat our geriatric patients.
So the premise of the action is that it blocks the transmission of pain and inflammation. And this is a complex web of neurons, axons and how all the nervous system works, and we're just starting to learn about it and get more information about how these monoclonal antibodies interfere with the transmission of pain, but in the early stages we're seeing very promising results. We are seeing some side effects.
So probably 80% of, dogs in my research do really well on this, and about 10% have adverse side effects. And there's that wishwash overlap, about 10%, that shows some diarrhoea, some anxiety, some other side effects. But on a whole, we're seeing very good results in about 80% of the population.
So People have asked me also, well, what is nerve growth factor for, and nerve growth factor is really essential in the development stage, in the foetal stage of developing nerve sensory neurons and development of that stage. But as we age, it almost has a negative feedback or could have a protective feedback back in the prehistoric days, but now we're seeing that this, Causes the interaction with the tropolatin receptor kind a receptor, and this has been found to play a pretty critical part in not reception and nerve system plasticity and pain conditions. So we actually find it's almost like I say it's like, Turning up the volume on the radio in your car, this nerve growth factor can help stimulate and lift up or increase the peripheral sensitivity of pain associated with eugenic joint disease.
And so we're seeing that these, anti-nerve growth factors are now dampening down, as I said before, and helping modulate or Block the transmission of that pain signal. So current evidence indicates that the anti nerve growth factor therapy has positive analgesic effects. Additionally, the effects of single injection appears to last for 4 to 6 weeks, and the magnitude of effects appears to be the same or greater than that experienced with a non-steroidal anti-inflammatory.
So we're seeing we're having a 4 to 6 week, Therapeutic window for every injection, and this is important that we work out because I know that not every, patient reads the book, I like to say. So knowing that you have a 4 to 6 window with windows, you can be telling your clients about that between injections is important because some will come on earlier, some will, it'll last longer. But we now have a therapeutic window that we can say to our clients, this is going to give relief between 4 to 6 weeks.
The next, interarticular drug is Arthromedvet. And this is, I'm I'm really excited about because I was introduced to this in its original trials back, well, 13 years ago with Doctor Jamie Gaynor, we brought this in from Europe because it was an equine, pharmaceutical, and we were the first to do the drug trials and we'll actually talk about Doctor Gaynor's Case study in a little bit, but Artemed VET is an inert biocompatible, non-resourceable, injectable, trans flat, Gri, hydrophilic gel, sorry, tongue tied on that one. And so, It's a cross-linked protein of both, A poly I can never say this word, it always gets me, a polyacrylamide hydrogel that adheres and becomes inherently involved in the synovial lining of the joint.
So we know that every joint is encapsulated with the synovial lining, and I like to think it's like a water plastic balloon and all the good mechanical bits are inside the balloon, and it's inside that lining of the balloon that is the synovial fluid or the synovium. And so we know that, The synovival integrates and with the Arthromed vet, we see that it takes 4 to 6 weeks to be incorporated into that synovial lining for the synovial lining now to be up regulated, hypertrophied and producing more synovial fluid into the joint. And so people have also asked me, well what can Arthro Medvet be used for?
And the conditions that respond well to treatment are synovitis, capsulitis, osteoarthritis, subconral bone cysts, and meniscal tears. So everything that's inside that bag, Of the joint responds very well when we increase the synovial fluid, and enhance the environment of the joint, because we know that as we age, when we're 20 or when we're 50, we have half the amount of hyaluronic acid in the joint than we had when we were 20. And we've all known when we do joint taps, you get a really great joint, you get the synovial fluid out, you spring it, and it's like gooey, mucousy, springy, soft, viscous material.
But as we have degenerative joint disease, and we tap those joints, we pull out, it's almost water and it feels. Gritty. So if we can get back to that nice gooey, synovial stringy, fluid, now we're getting more lubrication, the joint down regulation of the inflammatory processes that happening in the joint, and this is what we see that's happening with Arthur Medivet.
So we know that through studies, we don't need to use much. So each syringe has about 1 mL. And so we know with large shoulder joints and large dogs, you can put a mill, but most breeds, smaller breed dogs, you put half a mL.
So you're probably getting two treatments out of one syringe into both shoulder joints on a medium sized dog. And so, and that's with everything. So, large breed dogs, we try and put a mill, but it can also be hard to get a mill into a degenerative joint disease, arthritic shoulder joint, or an elbow joint, but in other joints like the hips and the stifle, we're using using 0.5 mil to 1 mL in our patients.
So here's a great study that was done and it shows that Artemedvet was incorporated into the synovium approximately 2 to 4 weeks post injection. And this is going to be important when we talk about the next product that I'm gonna tell you about, because we can have an overlap of these two interarticulate joint injections. So pre-incorporation into the synovium is lines that the synovium is waiting to absorb, so it takes a while for it to move across the membrane and get absorbed into that synovium layer to cause upregulation.
The majority of Artemed bet was seen in the sub men. The subintema layer of the soium, sorry, that's my dyslexia turning out, these big words get me every once in a while, and, I usually pre-record, so being live is just that next level of excitement, and so I apologise if I misspell some words or mispronounce some words, but on his, The pathology revealed that there was angiogenesis and collagen depositions were found in the synovium layers. So we're seeing that things are changing in the synovium when we introduce Arthromed vet to these degenerative joint disease environments.
The synovitis, hyperplasia and hypertrophy was also seen on histopathology examination. This was about after 4 weeks. And so we know 4 weeks is that golden window, so I like to say, some people will say, you see effects after 2 weeks, I like to tell my clients, you see effects after 4 weeks.
It's better to give our clients, I what would I say? More realistic and conservative opinions then, and then they're really excited when they see things happen at 2 weeks and say no, it's gonna happen at 2 weeks and they don't see anything to 4 weeks and they're disappointed in the treatment. So I would like to say err on the side of caution and say, OK, you're gonna see things about 4 weeks, but some dogs may, you may see signs sooner.
Study #2, this was done on 20 Labrador retrievers with evidence of moderate to severe elbow dysplasia. We know that there are very few things we can do for elbow dysplasia, and this was diagnosed on radiography, computer tomography and the elbows were scoped. And clinically they were lame when they were enrolled, and they injected 1 mL of Artemedvet into the worst of the two elbow joints to see what would happen.
In 75% of the patients there were significant improvements during the 1st 4 weeks. Gait analysis showed significant improvement in weight-bearing pressure. Between the baseline and 4 weeks of time, and we'll talk about the next study number 3 where there was a little bit more research done.
But this is great. 75% of patients responded with significant improvement. The majority findings of the study is that it is safe to use in dogs and significantly improve lameness, function and pain parameters indicating effective, Cinematic treatment of osteoarthritis associated with elbow dysplasia in these dogs, so game breaking because it is an inert substance that we're putting into the joint.
So study number 3, and this was a follow-on study from the work that I originally did with Doctor Jamie Gaynor, where that he looked at 50 dogs and 102 individual procedures, so that's doing both joints or multiple joints in the patient. And Doctor Gaynor likes data, so he looked at and measured lameness at walk, lameness at try, pain on palpation, range of motion, and general functional disability, and we also had what was called a gate right mat, that was a 30 ft mat with thousands of sensors, so it could not just do force plate but look at motion, weight shifting, everything in movement, so it gives you more data. And he did measurements at 0, 30, 60, 90, 180, 360 and 390 days.
And this is what, this is the old box, what it was called, it, it's called it was called Cinnamid for the canines and R3Med vet for the equines, and now it all has just been rebranded to Arthromed vet. But what was impressive that in all we saw in lameness at walk an improvement of 82.5%.
Lameness at Trot, an improvement of 75.8%, almost 76%, pain on power of patient and an 80% improvement, range of motion in the joints and 80% improvement. And general functional disability, we saw an 80, almost 89% improvement in the the function of those jobs after.
Treatment with automated vet. So the majority of the cases show once like case number, case study number 2 was a 75% improvement in the joint. And so we saw that there was a positive shift in result between 0 to 30 days, 1 to 40 to 4 weeks, and between 4 weeks and 90 days we had our biggest improvement.
So it showed that the treatment became more effective over time. And 60 or 67% of the dogs treated were able to reduce or discontinue other pharmaceutical pain medications. Now spring is another pharmaceutical interarticular joint injection that's come to the market in the United States probably 2 or 3 years ago.
And this is a total shift of how we're thinking of treating inarticular joint injection. So spring is a naturally derived another inert injectable bio material. It's called osteo cushioning technology, so here's the, the box of it, and I want you to remember osteo cushioning technology because it helps reinforce the joint affected by osteoarthritis.
So spring is made up of two proteins, elastin and collagen, and a carbohydrate perena. And it's they're large molecules, so I want to think we're injecting a large molecule rubber-like substance into the joint. And what it's doing is acting as when we have degenerative joint disease, we have two bones grinding on bones.
This is a spacer that goes in between the two bones, so now they're grinding on an elastic rubber material. And so, this instantly gives pain relief, but it's like putting a rubber soft, Material in, it's like having sneakers, you put orthotics in your shoes and you've now got a squishy material, the same type of thing is with spring. So spring is bioparticles that acts as micro cushioning mass of material that integrates into the synovial fluid and surrounding space to provide a soft, lubricating elastic cushion.
For the osteoarthritic joint, so it's putting a spacer or something for the bones to rub against instead of rubbing against each other. So a single injection of 2 CCs is injected into the joint. So you want to have about 65 to 80% of the synovial space filled with spring.
So this is the volume, there were 2 the jelly, so it stops that concussion force of the bone on bone. So let me go back and talk about, so when we talk about incorporating different treatments, so what we're looking at seeing is we use Arthromedvet first. We inject those joints, we wait 4 to 6 weeks because we know it takes 4 to 6 weeks for the Arthromed vet to start kicking in.
At about 4 to 6 weeks, usually around 6 weeks because we want that synovium to be protected, we then can inject spring, and spring is male giving the cushioning while Arte Medvet changes the environment of the synovium of the joint, and we're seeing great piggyback effects of injecting those two inarticular substances. So this is a new product that's come out in the United States, and Cinnovitin OA. And this is a radioactive tin injection, and you might be saying, what?
And so cynovitin OA works by using a radioisotope called tin 117M to target and treat inflammation in the joint affected by osteoarthritis, so we're injecting a radio, Isotope into the joint. So you might say what does this do? So the Antarctica injection, the compound is injected directly into the affected joint, ensuring that the radioisotope is localised and minimised to that joint.
We don't want it spreading around the body, we want it to keep in that joint. The radioisotope emits a low level radiation in a very short tissue penetrating range. So it just radiates the joint in soft tissue, but after treatment, when the patient goes home, they're not allowed to sit on the lap of the patient for a couple of weeks.
The anti-inflammatory action is that the radiation selectively targets and destroys infla inflammatory cells within the joint, reducing inflammation that causes pain and swelling associated with osteoarthritis. So by reducing inflammation, CinnavitinA provides significant pain relief in the treated joint. The effects of treatment can last up to one year, providing long-term pain relief from symptoms with a single joint injection, and this was developed for elbow dysplasia.
And so in the United States at the moment, from what I believe it's only regulated by the or approved the FDA for use in the elbow joint. Clinics that are, Partaking of using this inarticular joint then have to go for an additional radiation licence, there's a whole lot of procedural hoops that they have to jump through to add on to your nuclear medicine or your radiation licence because you already have an X-ray machine, but it is something that's new, very promising with what. It's doing in the data that it's showing, a couple of clinics here locally.
Oh, Doctor Jamie Gaynor is about to undertake a study of this, because we know with our elbow dysplastic dogs, there's very little, options out there, and this could be a game changer for them, as well as with the two previous intra-articular bioinert, injections we talked about. And so minimal side effects due to its target nature, the treatment is, has minimal side effects compared to systemic medications like non-steroidal anti-inflammatories, other things that we see that we have to really throw everything in the kitchen sink when we have a dysplastic elbow dog. So this is another game changer, when I say game changer, this will revolutionise what we're looking at with regenerative medicine.
And this is PRP or platelet rich plasma. And so A lot of people still aren't doing regenerative medicine out there in private practise, so I thought I'd just spend the next few slides going through and talking about the benefits of PRP and why and then why this will be a huge game changer. PRP is used in dogs, and it, it comes from their own blood supply.
And so this minimises the chances of rejection or allergenic reactions, so we will pull 10 to 20 milli. Litres of blood, we spin it down in a centrifuge, we put it into a separating apparatus, usually a bag with different philtres and at the end you'll have the the PRP . Component that we inject back in the joint, and so PRP then is full of all the growth factors, and these growth factors can help reduce joint pain and discomfort.
Associated with degenerative joint disease, but also, PRP can help enhance our healing and repair of soft tissues including ligaments, tendons and joints. So very, a lot is used in shoulders, a lot of used in CCL ligaments, Achilles, any soft tissue structure that has very poor blood supply, PRP has been shown to help speed up the healing rate and also slow down or eliminate all soft tissue scarring that we see, especially with tendon ligament issues. It also has the anti-inflammatory property that can help decrease swelling and improve joint function.
It's minimally invasive because all we're doing is a simple blood draw, we're spinning it down, we're extracting the PRP and then we're injecting it back into those the affected joint or joints, so there's no surgery procedure required, unlike with stem cells. Quick recovery, typically, the minimal death. Time is a couple of weeks, when we're doing PRP injections.
When I say a couple of weeks, we don't want to, if they're a competition dog or working dog, we don't want them out running around madly overstressing that joint, the soft tissue structure that we've injected. We want to keep them calm, and just do light exercises to allow that regenerative medicine, all the inflammatory cells, all the stem cells, everything to come and do its job. PRP has also been shown to help lessen the dependency or anti-inflammatory medications we're changing the environment joint.
We're changing that inflammatory cascade so we can down regulate the pain associated with degenerative joint disease, and we can now pull back on pharmaceuticals and nutraceutical supplementation. Its versatility can be used in acute injuries or also chronic injuries like degenerative joint disease. PRP has a great safety profile with low or very low complication rates.
We can see if multiple joints are injected at one time. Sometimes we can see flares, inflammatory flares, but usually that's very rare, but it's also something you need to tell your clients and warn them about. And we also see that may slow down the progression of degenerative joint disease, so, people are looking at doing studies now to not wait till we have our older geriatric patients but start using this in younger dogs that have, The potential to have elbow dysplasia, hip dysplasia, working dogs, dogs that are injured, introducing PRP treatments earlier on to help protect that environment in the joint, and we're seeing we're slow or they're theorising and the early papers are coming out that we can actually now slow down the progression of degenerative joint disease and give them greater quality of life.
So the big thing is that Vetstem in the United States has now brought out PRP in a bottle, and that got launched this year. And I believe this is going to be a game changer because now we no longer need to go through the process of collecting the blood, spinning it down. Putting in the centrifuge, all the cost of a sedation and anaesthetic, just to get the blood draw out to then do the interarticular injection.
You still need to sedate for the joint injections, but now PRP is in a bottle, and so we can order it, we can have it sitting on a shelf, and we can now be using PRP on, patients very easily, you don't have to go through the cost and the expense and the time of doing all those procedures it takes all your morning, to do, to spin down, get the sample ready to re-inject, you now have it in a bottle. And so we see that PRP is recommended 0.5 mL into small joints and then up to 2 mLs in large joints, large breed dogs into shoulders stifle joints.
And so it's just a volume you'll feel when the, you're injecting in, you'll feel reverse pressure when you have, I say filled that space, and so, but they're general volumes that you see and you're getting About 4 to 5 treatment doses per vial or per bottle. I have the slides here for stem cells because, and I know I'm going fast because there's so much information and I wanted to leave some time for questions, but stem cells, so vet stem in the next 1 to 2 years we'll have stem cells in a bottle. And this will be an even more revolutionary for regenerative medicine than just PR.
PRP is huge, like I can't explain how huge that is, now that we have in a bottle, but when we have stem cells in a bottle, we no longer need to do surgery to collect either the falciform ligament or the shoulder pad ligament because we have gone in on multiple patients and the falciform ligand gets removed to time of Spain. They whip it out, because it makes it easier to get access to, The uterus, but when you go in then to collect mesenchymal fat, And it's gone, you go, where else can we go? So we now, if a female patient is spayed, we will potentially look for the fast form ligament, also, or look for the ligament behind the fat pad behind the shoulder, because also you don't have, we had incident of dehisance from the wound, the dog chewed out the stitches, it's very hard for them to get there and if they do, it's not a life threatening emergency.
But if we have stem cells in, A bottle, we no longer need to do a surgical procedure to extract the stem cells or bone marrow, where they now come in a bottle, and this will revolutionary, will revolutionise how we deal with regenerative joint disease, both, And soft tissue and. I, I, I'm speechless in what it's going to do to change the landscape for how we train and treat our patients. Nutriceuticals, so let's talk about supplements that have come on the market.
So muscle growth supplement. And so this is my, and this is the supplement that I said that we have in our store. And this is a bioactive composition derived from fertilised chicken eggs, and it increases muscle mass size, lean body mass size and strength in our patients.
And so, how does this work? And so it works by down-regulating the inbiquitum pathway to slow muscle degeneration. And upregulations the MTOR pathway to promote muscle synthesis.
And this is done by lowering the myostatin level in the blood to promote muscle growth. Because we know as we age our myostatin levels go up in the in our blood. And so this has a negative feedback on our ability to produce muscle.
So we get, as we age we lose muscle, our geriatrics lose muscle, through sarcopenia or chexia if they've got a disease, and so, Sarcopeia is because mystatins level get too high, it has a negative feedback. But if we can trick the body once again another compound that covers the receptor site and lowers makes the receptors believe the myostatin levels are lowered in the blood, we can then put on muscle, and this is what it does. So here's 3 studies that they did, and it showed that fordotropin, that's the actual ingredient in, increases the rate of muscle protein synthesis, inhibits an increase in mystatin, that's what I mean, it drops the level of myostatin in the blood, inhibits muscle disute atrophy after eight weeks after surgery.
So this was a great study they went in and they looked at muscle atrophy after TPLO surgery, and they had control, and they had their patients on MOS and they showed that the patients on mice had very little to no muscle atrophy in the, Surgical leg compared to the control that had muscle atrophy because they hadn't used their limb after surgery. So this is game changing for how we teach, treating our post-surgical but also our geriatrics because we can build muscle, we can retain. Muscle for our degen myopathy patients, invertible disc disease patients, we can put on muscles, keep those joints hard because also the surrounding soft tissue structure, if we build it, we can protect those joints, stop that movement, stop that dysplasia.
And it's been shown to reduce load scores and improve mobility in dogs with OA. So MyOS also now came out with a green lip muscle formula. So here's the, the veterinary strength MyOS formula.
Here's the MOS that you, that your clients can buy online. And now they have, I don't have it on my shelf, the green lip muscle, but they also have a feline version as well that just came out. And I had my, 20 year old cat on it, and I saw that, With the cachexia and sarcopenia, her temporal muscles wasted away.
She got that gaunt look, they, everything filled out. And when your temporal muscles fill out, you go, OK, something's going on here. She built muscles, she looked better, she could then move freer.
I say and we'll talk about some, rehabilitation modalities as well. Well, next, but I Benjamin buttoned her about 5 years. She could then walk up and down stairs again that she hadn't done for 5 years.
Jump up and down onto my desk. So when you see these things with your own pet, you see these studies coming out, you, I, I go, OK, this is going to be a game changer, how we deal with our post-surgical, Geriatric patients and our patients suffering from degenerative joint disease. So let's talk about physical rehabilitation modalities and equipment that has come out as well.
So I put this in. Class one, or laser is nothing new. Laser has been around for decades now, but now we have the introduction of Class one lasers that you can send home with your clients.
And these aren't just red light lasers like somewhere out there. These are, so here's a 25 watt class one laser that is shown to have the same therapeutic effects as a class 3 laser, 3B laser. So lasers work through a system of photobiomodulation and has been shown to be great for treatment of soft tissue trauma and tendon ligaments, increasing blood supply to that area helps promote strength and soft tissue healing, increases wound and tissue healing times by about 30%.
Because we're bringing more blood supply to the area, we're getting rid of all that inflammation, that edoema, that bruising, stimulate stem cells to come to that area as well. Increase the speed, quality and tissue strength and repair, and we had a great study that was done by, oh I just got a mental blank now, but it showed the tendons in an equine of the Achilles tendon rupture, before and after and done laser therapy on it, and it was, 99% healed with very little to no scar tissue, evident on soft tissue ultrasound after being lasered compared to a control that you saw the disused or disrupted fibre patterns and the scar tissue that means a weaker tendon after healing. And so we know the power of laser therapy when it comes to soft tissue, but also degenerative joint disease.
Decreases musculoskeletal pain and inflammation because it releases endorphins, it helps block the P nerve or P wave function, relieves stiffness and pain in joints and muscles, assists muscles and nerve regeneration, treats osteoarthritis by relieving pain, increasing range of motion, reducing swelling, and decreases edoema in the area. But what does these little things, and I say this is going to be game changing because a class one, the new research papers come out that it does the same job as a class 3B that we would potentially have in our clinic. And this we can send home to help our clients accelerate tissue healing repair after surgery.
So that's faster wound healing, analgesia decreases inflammation and helps with vaso. Diation, so we're getting rid of that edoema, that bruising. And so, but this is also a practise building product.
So one of these, a 10 watt, I think is about $1500 the 25 watts is about $3000 but I know clinics that are renting them out to their clients for $400 a week. And so the animal has a tullo surgery, they send them home with the laser, they laser that area 3 to 4 times a day, helps speed up, That's tissue heal healing, minimise adverse side effects. The clients are doing something, they feel like they're invested, and the clinic's getting a good return.
If you're at $400 a week and you buy the 10 watts, I, I can't say because for What I can say, what Rules in America about talking about being able to make money, but you can do the math, $400 a week, $1500 divide this device, I know a clinic that has, 10 to 30 of these that they rent out to their clients after surgery. So this is also a practise building application. But also the probe works in red light spectrum and blue light spectrum.
Our class 4 lasers work in infrared, class 3B lasers can work in infrared too, but this is just in red and blue light, so very minimal to no chance that your clients can, injure themselves, with their eye by looking at this light, but we know that we're getting superficial, heat. And vascular changes on probably 1 centimetre deep. It's not deep penetrating like an infrared does, 3 to 4 centimetres, but we're doing things on the surface and we know most of the joints, elbows, hips and smaller dogs, other joints, shoulder joints when we can get in there, stifles when we can open them up, we can be actually getting the laser light in there and making a real difference.
Ulster electromagnetic field therapy. I'm just looking at my watch. I got 15 minutes ago, so I'll speed through these.
This is really game changing. This was technology developed by NASA, and so for astronauts in space, what do they do when they break a bone in space, they found that you needed gravity to. Be able to heal.
So they've found pimp decreases swelling and inflammation associated with soft tissue trauma and surgical wounds, accelerates bone healing times following bone fractures, relieves pain associated with osteoarthritis, improves recovery times associated with eugenerative joint disease, and accelerates healing and recovery times following tendons and ligament damage. So it's been really great. There was a study done where they removed 1 centimetre from the ulnar of a rabbit, both sides, they put the pimp device, Here's thesisi loop that everyone knows about.
On there, ran it for 21 days. After 21 days, they re-addigraphed and on the side that was getting pimp treatment, the bone had regrown in, and on the control side you still had the defect with the callus forming around. So this is really great for our non-union fractures, things like that, but also soft tissue, healing.
It's so it enhances the body's natural healing process, corrects cellular dysfunction through the body, so it really it recharges the cell to be all that they can be, and stimulates and exercises those cells to be recharged, gives the patient more energy naturally, so I've used it on myself and you feel more, invigorated, reduces inflammation and pain and helps you recover from injuries faster. So there's 4 main players, the CC loop, so here is the CC loop, you then have KVP cure in the UK, you have recovery, this is a human product, and then you have response systems that's here in the United States. So in the wands, you have both the CC loop, this is the, Recovery RX different sizes, and then the KVura.
The CC loop costs about $300 for 150 treatments at 15 minutes, and you can't recharge it and that's done. Recovery RX has just come out, this is about, I think 50 $55 a loop and it does 174 hours or 120, 20 hours of treatment, and it can be turned off, you can put it on the, For allodynia or wind up in our patients, they put it on the collars and let them run. You can strap them over the surgical side with vet wrap and let them run.
This is now a really cost effective way to do electromagnetic field therapy, compared to what was traditionally out there was the Assisi. Asisi lip is very good, Fantastic product, but now there's more of a cost effective that you can be incorporating with all your surgeries, sending home to help speed up healing. Bedding system, a Clip also has the lounge.
This is the, the cat version or the small dog version lounge which I had my cat sitting on, and every time I walk past, I'd press the button and give her a treatment. This lounge is about $1500 the large dog bed in the photo on the right-hand side is about $3000. The response system we had in, consultation rooms, so when patients would come, they'd lie down, we would give them a treatment at the same time.
Shockwave therapy, this has changed dramatically in the last 2 to 3 years. So, I've gone back. Oh, I've done something with my slides, here we go.
So shock wave therapy, electromagnetic pulse is sent through, A conducer coil that generates a magnetic field which causes a magnetic pulse that hits a, Artistic or a sound wave, I can't say a acoustic impulse creates, that sends in a physical shock, and if anyone has ever felt the traditional shockwave treatment, it really hurt and we had to sedate our patients. Well, that's made change, we've we've got new technology that's no longer painful, and so this magnetic field method of shockwave generates an intense water-based reaction to that and, It delivers a small amount of energy to a focal area that stimulates healing. So two big players out there, you have Pfizo Wave and Pulsed.
Everyone knows Pulsevet, that's a traditional, it's been out for decades, and that was painful, we'd have to sedate the patient with an with anaesthesia. Shock wave the joint, wake them up. Then Pfizer wave came out that uses more technology like an ultrasound.
And so Pfizer wave, it's non-painful, you don't feel it, and you can go and do this on the joint while the patient is conscious. So now the clients can be there, you can walk them in, it doesn't hurt at all, and they can now get the benefits of shockwave therapy. Pulsevet is folded along, a different cushioning now probe, so it takes some out of that, it's still, you can feel it.
So it's like a slight rubber band but not being whacked, where you actually went, ow, that hurts, and your patients, most patients will tolerate this very nicely, if not a mild sedation will help them, but this is a game changer when it comes to shockwave therapy. Supportive devices, we need to change how we think about, patients all the way through their life from puppy to geriatrics, and incorporating a really good betting system is, I'm now talking to all my clients about it. And here are two of the big players, big Barker dog beds and underdog orthopaedic beds.
So big barker dog beds this gene. I spent 3 years developing the foam combination of different layers so that you wouldn't have transmission of force contact to the floor. We, I call it the elbow test.
I tell my clients to all go home, get on your hands and knees, put your elbows on their bed, run your elbows, and if you can feel the floor, the bed is not supportive, especially for giant and large breed dogs. And so here's force place analysis of the dogs and an artistic diagram on the right-hand side showing what it does. So it's the bed is designed, so there's very minimal to no contact between the, the heart.
Bony provinces of the dog and the floor. And so on the right on the left-hand side you see the force plate analysis and you see very little to no contact where normal dog beds, you see those hotspots there, elbow and hip joints and stifle joint contact. And so here's just a quick photo of the different layers of foam, that make up the big Barker dog bed.
Underdog orthopaedic bed is a total different spin on bedding system. This is almost like water bed technology where you have fingers that move to help support, and it is a great, bed for neurological patients, patients suffering, intervertebral disc disease, Degenerative myopathy, anything that's gonna develop a pressure necrosis or pressure sores, this betting system is fantastic. And so I use this extensively with my cat, and it just changed her comfort levels.
And so it's a low surface tension and it's like fingers that move in 7 degrees and it really, and 6 degrees it really does work and all different, fingers are connected, so it takes pressure goes up and down to support different areas that need supporting. And here's just a visualisation of how all those different fingers move and they actually move to open up, support those different areas. So this is a great betting system for recovering patients in hospital because that they can bite it.
So it's an air mattress. So I don't send it home with young puppies to tear up, but this is great for a, later stage, clients and patients. And here's their force plate analysis showing the support that the the bed offers with force plate analysis.
And here is just some other diagrammatics showing the difference in comfort zones for between wooden floors, memory, Boam and then the underdog bed at the bottom. Rule of thumb with beds always oversize the bed. So here's my German Shepherd, and you can see then the medium size compared to the large size bed.
You want to give them plenty of space to be able to relax, spray, spread out, and so this is just a diagrammatic photo because clients always ask what size bed should you get? And I always say, go up, the bigger is better. So, home rehabilitation programme.
So we launched, and this I think is going to be a game changer for what we we do. We've been working on this now for 7 years, and we launched it a year ago, K9 rehab on demand, and we're bringing version 2.0 in the next 2 months.
And so what we do is we have a 12 week rehabilitation programme where we give education. I've been training vets around the world for the last 7 years, we give access to this training. We also have a 12 week rehab programme with all the sheets and exercises and videos to go along with that.
They get exercise charts, they get a 12 week nutraceutical planning guide, what supplements, when and where they should be taking in a 12 week. They also get a modality guide, so which modalities pieces of equipment that they need to be coming to you for to get additional help. Here are just a list of some of the programmes we have and we're adding programmes all the time, but we have about 14 programmes up at the moment.
If you want to go have a look, go to canine RehabOdemand.com. And so we also do version 2.0s coming out in the next two months where you're able to break these apart into individual components and sell them at the front of house.
We have orthopaedic surgeons that are selling our 12 week programme, every client goes home with this, so instead of Rimodel and cage rest, they go home with a 12 week programme and this up services the clients, the clients are doing things at home, they feel invested, and we're seeing less complication rates. Also, when. You break it up, you could send home just the education so your clients can learn about hip dysplasia, elbow dysplasia, invertible disc disease.
They can come back, you don't have to spend the time explaining it in the consultation room. This talks about the init what causes the disease all through treatment programmes, supplements, surgical, non-surgical options for some diseases, and what we have modalities. So they can be educated, they can come and have a conversation with you about it.
So I know we're right on time, I've gone very fast, thank you for, sticking up with me. If you have questions, I'm here to help answer questions as well, if at support at veterinary Teaching academy.com, or you can send the questions through to, the fantastic people at Webinar vet and Let's open up to see if any questions have come through.
Thank you, Doctor John. That was an amazing presentation. We have a few questions.
Before we read them, I would like to remind everyone, if you have any questions, please use the Q&A box for Doctor John to answer them. So, the first question is Is there any evidence that supports online claims from some cat owners that Salencia first injection caused death in their cat within a week, or is this unsupported? I have very little experience as it's only been out in the market now here in the United States for in the last year with these, with these products.
I was really excited to try and get a sample dose or dose of it when my own 20 year old cats try it on her and see that from the literature, I see that some animals have adverse effects to it, like, we're seeing with the the canines, 80% respond really well and then there's 10% that have adverse response. I don't know anything about, The claims of it causing death or is that a Google witch hunt or, you know, Rimodel causes death in brown Labradors, and we know that that was from a study that was done and these dogs had underlying disease, early. On, but the Labrador Retriever community jumped on board with that said, No, Riador kills Labradors, or C over and kills Labradors, we can't give it.
And that was they didn't read the studies, and yes, it killed one of the dogs in the trial, but it had underlying liver disease and other things early on. So, I can't answer your question because I haven't done enough research on it and see, but I know that there is concern, because there's a first generation drug and that some animals don't do well, but the majority of animals have a very good response to this, we've just got to, check. I will do some more research on this, but I think that there's more online claims, that causes death than reality, because if it was in reality, then, the company wouldn't be having it out there and promoting it as it was.
So hopefully that answers your question, on that. But yeah, I don't have that much experience with it, but what I've read, it works very well, but there are some side effects to it. Has it been causing deaths?
I can't say. Thank you, Doctor John. Another, another question says, do cats put holes in the underdog system and can this be fixed?
Yes, they can put holes if they're, they're clawing on it. I would keep the claw, I would trim the nails, on my cat just because that was my greatest fear. It comes with a, a great, material, it's quite, pliable.
I've been talking with the the manufacturers about trying to make something more resilient for cats, but also the, The canvas that the fingers are made out is quite rubbery, quite resistant, but they also give you a repair kit, with, with the system, so if it does puncture, you just use soapy water, look for the bubbles and put on that repair kit, like you're repairing an inner tube or a an air mattress. But I. Found that I would then layer a, thin, microfiber or a sheepskin on top of it.
So, it would give the support, it would move, but also, I'm in a cold climate, like the UK. It just gave a little added, level of warmth, and then I put the, The actual Assisi loop bed underneath it as well. So she had the bed because the bed's actually very hard, and dogs and cats don't tolerate it well.
So I found I put a dog bed or a cat bed on top of the Assisi loop, and then they'll lay down on it. And then every time I walk past, I press the button. But I didn't have any problems with her, but I was scared with sharp nails.
Yes, so I would then just trim her nails, check her nails once a week, making sure that they weren't sharp. Perfect. Thank you.
And another one says, with the cold laser, does this mean not using class 4 lasers? At present I use class 4 lasers every 1 to 2 months in the clinic. Well, no, but this is something, so Class 4 laser is a, it's a, it's own category, it's fantastic what it does.
With the, and I have to, cave it then talking about Class 4 lasers, I'm now on the board of companion lasers, because I believe in the product so much. Class 4 laser is fantastic, but it can only be used in the clinic. We can't send that home with our clients because of the potential for, light spectrum damage to or our eyes or their eyes.
I talk about this device being a game changer because we can send it home with our clients. Our clients can be doing laser therapy at home. It won't penetrate as deeply as a class 4 laser because we know that the infrared long wavelength penetrates a lot deeper into the soft tissue than the fast blue light or the red light is a lot slower than the blue, but not as long and powerful as the infrared.
And so this is, Something that I'm talking about that now we as a profession can be you sending home with our clients, building revenue for our practise, but also giving, Speeding up healing times, things like that with our clients post-surgically. A lot of orthopaedic clinics, a lot of clinics that do a lot of surgery, or if you're seeing a lot of invertible disc disease, things like that, this is great to send home with the clients because they can be doing laser therapy multiple times a day, where they can't get into you to see at the clinic, multiple times a day or multiple times a week, it becomes hard for them. To.
And so this now gives us a new option that we can be sending home with our clients to do something at home that helps their pet while they're waiting to come in and see you then for the class 4 laser treatment. So it's not there to replace Class 4 laser treatments, it's just an adjunct that now that your clients could be doing at home with their own pets on off days between when they come to see you for the deeper penetrating class 4 treatment. Thank you so much, John.
That sounds great. And thank you everyone for joining the light. I just, I just saw a quick question, are there are there class one ladders better than others?
Yes, there are, we've been using multi radiance, is the one that I've been using. This is a multi-radiance, 25 watt device, they're on the higher end, but they have the studies and the technical, Experience and the servicing to backup, there are cheaper ones out there, but they're more just, red light, not LED lights, so they will do tissue healing, but they're not anything that's, and they're not as powerful as the multi radiance devices. I have no affiliation with the company, but they're the ones that I use because they have the studies and they also have been around long enough and they have the human versions, and this is their, veterinary version.
OK, sorry to interrupt. It's OK. Thank you so much for answering all the questions, John, and thank you everyone for joining the live webinar this evening.
We hope you have enjoyed the session and just for you to know, the recording will be available within 48 hours. So yeah, see you in another webinar. Bye bye.