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There have been tremendous advances in both human and veterinary
medicine in recent years. Just about every procedure available
for humans is now available for our companion animals. Of course,
not every general practitioner is going to have an MRI (magnetic
resonance imaging) or CT (computed tomography) scanner, but the
purpose of this article is to let you know about some of the new
high tech tools available to help treat your favorite four-legged
friends.
Having said that, one of the most
basic surgeries performed is the spay. Increasingly, instead
of the traditional open surgery laparoscopic spaying is being
performed. Instead of an incision several inches long, one or
two small ones only a few millimeters in length are made to enable
passage of the instruments. The advantages of this technique
are considerably less pain and surgical stress for the patient –
surgery is faster and so is recovery and healing. Retained
testicles can also be removed using the same technique. Once the
rigid endoscope is in the practice, the days of “opening ‘er up
for a good look” will also be gone. Through the same
endoscope the veterinarian can do a full abdominal or thoracic
exploration. Through a single port she can take full thickness
biopsies of liver, spleen, kidneys, pancreas or intestines with no
need to grossly handle and manipulate the organs, or for an incision
from sternum to pubis. The same equipment can be used for
intestinal surgery – removing part of the intestines and suturing
the cut ends back together, removing stones from the bladder and
other procedures. In the chest it can be used to remove the
sack around the heart or to take lung biopsies if needed, without
breaking ribs to enter the chest wall. It can also be used to
examine the nose. Our dogs frequently get foreign bodies
caught in their noses and using the endoscope you can find, grasp
and remove them. Long nosed dogs are at increased risk of
nasal cancers and again the endoscope can be used to remove or
obtain biopsy samples from growths in the nose. Exploration of the
ear is also improved using endoscopy. Because the procedures are far
less invasive, what once were major surgeries requiring prolonged
hospitalization can now be done as out-patient surgery with the dog
going home the same day.
Arthroscopy is another popular
endoscopic procedure. There are five times as many ACL
surgeries done in dogs as there are in people. They are the
number one procedure in terms of veterinary revenue. With
arthroscopy the stifle can be examined thoroughly without cutting
through muscles, tendons and blood vessels as used to be necessary.
Recovery is faster too; the dog will be bearing weight on the
affected leg one to four weeks sooner than with traditional surgery.
Muscle loss is reduced, and there is less catching up to do in
rehabilitation. With arthroscopy you can insert implants and
prosthetic ligaments, repair the joint, do vascular surgery and
perform cartilage grafting.
Another technology that is
appearing in general practitioners’ back rooms is digital
radiography. Instead of having to develop X-rays you get the
image in about 4 seconds. You can reshoot, take other views
and reach a diagnosis during one session. Regions of interest
can be magnified, contrast and brightness adjusted, and if there is
still doubt you can e-mail the image to an expert colleague for
input. The image can be stored on a CD, and a copy given to
the owner. Chemicals and film no longer need to be bought and
stored, which is a saving for the veterinarian too, and frees up a
room for other diagnostic equipment. With digital X-rays
veterinarians are taking more X-rays. No where is this more
important than in the mouth. Like the proverbial iceberg,
9/10ths of the pathology is taking place under the surface of the
gum, and now we are seeing it.
In the future we may reach a point
at which surgery will be performed without sutures, and the future
is coming fast. Ligasure is an electrosurgical vessel sealer
which cuts and fuses vessel walls permanently. There is no
swelling and bleeding two big pluses when working in the mouth and
throat. Both carbon dioxide lasers and radiofrequency equipment are
being used in place of the traditional scalpel. They reduce
bleeding and post surgical pain. The radiofrequency equipment
works at lower heat and is faster than the laser, and preferred for
working in joints.
Nuclear medicine is also making
great strides. Injected, inhaled or ingested radionucleotides
can be followed through the body to look for tumors and other
abnormalities. At the same time radiopharmaceuticals are being
developed to target specific loci for tailored therapy.
Along the same lines, stem cell
therapy may very well be the biggest new field. Stem cells are
grown from adipose (fat) tissue from the animal being treated.
The vet removes the fat from the animal (so far dogs and horses) and
it is over-nighted to Vet-Stem in San Diego California – currently
the only veterinary stem cell company. Connective tissue is
removed enzymatically. The remaining substance is spun in a
centrifuge; the stem cells sink to the bottom while fat floats to
the top and is discarded. The concentrated stem cells are
over-nighted back to the veterinarian who then injects them into the
damaged site. Stem cells promote immediate regeneration.
They have been used to treat tendon, ligament and joint injuries and
disease. By modulating the immune system, stem cells reduce
inflammation and immune cell reaction which can cause more damage.
They promote the creation of new blood vessels too, and in the
future will likely be used to treat heart and peripheral vascular
disease. When treatment is given early, scarring can be
avoided, and even later existing scar tissue will be reduced.
In horses more than 90% show some improvement and at least 75%
return to their previous performance level. So far in dogs the
primary use has been for dogs with severe arthritis – ones that no
other treatment has been able to help. In this group 80% or
more show a marked improvement in range or motion, reduction of pain
and lameness and an improvement in their quality of life.
Imagine what could be done if treatment was initiated early on in
the disease process. Because the stem cells come from the
animal’s own body, side-effects are minimal. Currently the
biggest draw back is cost which averages out at $2000 for the
procedure. As with everything else though, cost will likely
drop as the use of stem cell therapy is brought to a wider number of
animals.
We have seen the future, and it is
now. It bodes well for our animal’s comfort and our own
peace of mind.
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