For Tobo

Stem-cell therapy helps an army captain repay a post-war debt of gratitude.

Dr. Chuck Miller performs surgery on Tobo, an 8-year-old German shepherd dog with hip dysplasia and degenerative joint disease. Dr. Miller harvested fat to perform stem-cell therapy on Tobo.

The Herald-Sun/Christine T. Nguyen

Like many service members returning from war, Army Capt. Sam Wilson brought back from Iraq mental images and experiences that made home life a struggle. The love of his wife and pets helped ease his transition, but still there were flashes of anger that sent him searching for solutions.

One solution was named Tobo.

The German shepherd came into his life after his wife, Kris, suggested he answer an ad in the paper. “I think she just knew I needed that companionship,” recalled Wilson, now a statistician for a clinical research organization.

“You know how you can have lots of pets but there’s always one that holds a special place for you? Tobo is that one for me.”

So after watching Tobo, now 8, lose mobility and suffer through the pain of hip dysplasia, arthritic inflammation and degenerative joint disease, Wilson was excited to get a phone call last fall from the family’s veterinarian, Chuck Miller, DVM, a partner at Triangle Veterinary Hospital in Durham, N.C.

Prime Candidate

Dr. Miller, who in June will mark his 20th anniversary as a veterinarian by continuing to practice at a clinic that has been around since 1942, saw Tobo as a prime candidate for a new procedure he was just adding to his pain-management arsenal.

Regenerative medicine, and specifically stem-cell therapy, had been on Dr. Miller’s radar for several years. He’d discussed it more than once with his wife, Dr. Jennifer Swanson, an emergency medicine physician, but Miller thought the cost of the procedure put it out of reach for his practice and his clients.

“When I found out MediVet had developed technology that lowered the price point and made it possible to perform a minimally invasive stem-cell procedure onsite, I was interested,” Miller said.

Building on knowledge gained from human medicine, especially related to athletic injuries, some veterinarians for years have used stem cells harvested from a patient’s adipose tissue to speed healing and relieve pain from osteoarthritis and other joint ailments. Miller first learned about its use at equine practices.

He likes that the technology developed by MediVet America of Nicholasville, Ky., doesn’t require the clinic to send harvested cells to an outside lab to be cultured. By using LED technology and incorporating platelet-rich plasma into the procedure, Miller is able to harvest and “activate” 400 million to 600 million stromal cells—more than enough for an effective procedure—just by extracting a little more than a tablespoon of a patient’s fat.

A single trained veterinary technician can take the harvested adipose tissue and break it down with an enzyme wash before using a centrifuge to separate out the stem cells for activation under an LED light. Proponents say the mixture of platelet-rich plasma and photostimulation causes a proliferation of activated stem cells, which when injected into the area of treatment reduce inflammation and pain. As the cells divide, they can also replace lost tissue such as bone and cartilage.

For Miller and Triangle Veterinary Hospital, the initial outlay was about $12,000 for a centrifuge, a warm-water bath, an LED setup and enough large- and small-animal kits to perform eight stem-cell procedures, for which the clinic is charging $2,000 each.

The Staff Prepares

To prepare, Miller and two part-time doctors went through two days of training by MediVet representative Jason Richardson, who also helped five staff veterinary technicians gain certification on the procedure.

When approached by Miller, Wilson and his wife were eager for Tobo to be one of the first two Triangle patients to undergo stem-cell treatment.

“Sam and Kris are incredibly compassionate people who love animals, so for them to have a pet in pain, well, they feel the pain, too,” Miller said. “Plus, they are scientific people, so the procedure wasn’t foreign to them.”

Miller was careful not to pitch the procedure as a fountain of youth.

“I told them the results had been encouraging”—MediVet reports seeing positive clinical improvement in 95 percent of arthritic cases nationwide—“but not all cases will see improvement. Because it’s minimally invasive and has few side effects, I told them I thought it was worth a try.”

On Nov. 11, which appropriately enough was Veterans Day, Miller performed the procedure on Tobo and on Tucker, a 7-year-old Labrador retriever belonging to Jarrod Lichty of Leesburg, Va. 

“The first time can be frightening,” Miller said. “There are a lot of steps, some of them technical. It was important for me to get the team together beforehand and walk through things, step by step, so we were prepared for anything.”

Miller also highly recommends having a company representative on hand to answer questions and offer insights during a first procedure. “It was great having Jason there,” he said.

Both procedures went smoothly, Miller said. To anesthetize the patient and harvest cells takes about 45 minutes, he said, with the separation and activation of stem cells consuming about four hours. Finally, resedation and joint injection takes about 30 minutes.

As for recovery, Miller said he takes patients off all non-steroidal anti-inflammatories at least a week before surgery and doesn’t start them back up for at least a few days after. “We don’t want to down-regulate the inflammatory response. We want the cells rapidly dividing, with high turnover rates.”

To mitigate post-operative pain, Miller uses a range of therapeutic modalities, including hot and cold compresses, as well as limiting exercise.

Steady Improvement

Two months after his procedure, Tucker has shown remarkable relief from the pain of severe osteochondrosis in his elbows, knees and shoulders, Miller said. He’s off his meds and regularly runs or walks a mile to the beach, swims for 20 minutes, then walks or runs the mile back home.

As for Tobo, there was an almost immediate burst of puppy-like behavior, attributable to the platelet-rich plasma, then hints of the lethargy that marked her days before the surgery. Over the past month or so, however, Wilson has seen signs of steady improvement.

“After six or seven weeks, she started playing with her buddies (the other three dogs in the household),” Wilson said. “She even tried to get on the couch again.”

Miller described himself as “very, very encouraged,” adding that he’s “more excited than ever about the possibilities of regenerative medicine.”

Wilson is thrilled just to improve the quality of life for a special friend who has helped get him through a difficult time in his own experience.

“It means a lot,” he said, “to be able to repay the love Tobo has given to me when I’ve needed it the most.” 

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