Senior Care Advocates Fetch New Allies

Just 12 years ago, when the Food and Drug Administration approved the first non-steroidal anti inflammatory drug specifically for canine use, about 20 percent of general practitioners’ patients were geriatric. Now it’s 25 percent.

The NSAID pain-manage-ment option was a great recognition of the needs of senior pets, but the research hasn’t stopped. Today, veterinarians are using new medications and surgical techniques to improve the quality and lifespan of aging pets.

Research unveiling proce-dural and medicinal benefits for companion animals has been accomplished largely because canines serve as a medical model for human medicine. One procedure gaining acceptance in the profession is adipose-
derived regenerative cell therapy, or fatty stem cell therapy. To date, more than 1,170 veterinarians are using it on canine, feline and equine patients, most of whom are at an advanced age.

“Science has made it possible for pets to live to be geriatric,” says Robin Downing, DVM, of Windsor Veterinary Clinic and the Windsor Center for Animal Pain Management in Windsor, Colo. “It’s always been veterinary medicine’s desire to advance medical capabilities for animals, but we’ve accomplished more during my career than I ever imagined possible as a new graduate.”

Dr. Downing uses the fatty stem cell procedure and expects it to advance over time. The procedure is FDA-approved only for the treatment of osteoarthritis in animals, but she says that someday it might be used to prevent hip dysplasia and other degenerative anomalies such as liver, kidney or cardiac diseases.

“This procedure provides a non-invasive option for animals that otherwise would need hip or joint replacement, which is more costly and requires physical therapy to recover,” Downing says. “Fat is harvested from the patient’s body and processed through Vet-Stem (of San Diego). The company prepares the cells for IV and joint injection. These cells regenerate tissue.”

She says fatty stem cell therapy, which is performed on animals that have few other options, is nothing short of a miracle. Clients pay about $3,000, compared to the average hip-replacement cost of $5,000.

“The ever-increasing human-animal bond has spurred manufacturers to recognize that senior care is a lifestyle and veterinarians need to do more than just deal with pain,” Downing says. “This procedure is one more option in veterinarians’ toolbox.”

Ongoing Research

In other osteoarthritis advances, an implant, the bioscaffold, has been developed for canine patients. The device is implanted in or near diseased tissue and provides a structural matrix for local repair cells such as stem cells or fiberblasts to attach and heal tissue by physiological mechanisms.

TR BioSurgical LLC. of Chandler, Ariz., the device’s manufacturer, evaluated it in a clinical trial and says the product will “profoundly change the management of osteoarthritis.”

“The bioscaffold implant has no similarities to cell-based approaches like stem cells,” says Jeff Kellerman, DVM, vice president of research and development at TR BioSurgical. “The implant has no cells, drugs or biological growth factors and serves as a scaffold for existing cells to infiltrate and establish physiological tissue repair.”

The product is available through the Comparative Orthopedic Research and Evaluation Network. (Click here for more information.)

Another researcher, Darryl Millis, DVM, Dipl. ACVS, CCRP, is looking into a multimodal approach to companion animal pain, a problem that largely affects senior pets.

“People are realizing that NSAIDs are good, but they are far from perfect and they’re far from safe,” says Dr. Millis, a professor of orthopedic surgery at the University of Tennessee. “NSAIDs don’t improve the situation, and that is the direction most research is heading: repairing and not simply masking the problem.”

Millis’ research, sponsored in part by Morris Animal Foundation, includes applying a mild electric current to the affected area to prevent pain signals from traveling to the brain. He also is examining acupuncture, shockwave therapy and low-level laser therapy.

“We are looking at these procedures objectively to see how they affect the pain pathways,” he says.

 At least 40 percent of the pet population is overweight or obese, which leads to many problems. Veterinarians should tell clients the exact amount of food to provide their dog based on many factors, including the type of food being fed. One brand can contain 100 calories per cup and another can have 600.
~ Sean Delaney, DVM, Dipl. ACVN, president of the American College of Veterinary Nutrition

Studying the Heart

Mike Martin, DVM, MRCVS, reported at the American College of Veterinary Internal Medicine forum in June that Levosimendan (L), a calcium-sensitizing inodilator, is under development for the treatment of canine heart failure. Dr. Martin, the lead author,  presented findings from a double-blinded clinical study of 155 dogs that demonstrated the addition of L to standard background cardiac therapy.

Dogs were evaluated for quality of life, appetite, exercise intolerance, cough and restlessness.

Martin’s presentation showed that dogs receiving L had a significantly better owner-reported symptom score and an improved joint owner-investigator score. They also required less background cardiac therapy adjustment and cardiac morbidity than dogs receiving the placebo.

Elsewhere, Virbac Animal Health of Fort Worth, Texas, and Europe-based Orion Corp. have partnered to produce a drug to fight cardiovascular disease in dogs. The companies are seeking FDA approval, with the hope of marketing the product within two years.

“There are some nice options coming down the road for senior pets,” says Nancy Bathurst, VMD, clinical development manager at Virbac. “The cardiovascular product isn’t the only product in the works. We’ll be releasing an addition to the Rebound Solution line of products that will serve as a complete and balanced formula for dogs and cats, fortified with critical nutrients to speed the recovery of compromised patients.”

Improved Nutrition

Veterinary nutritionists and diet experts say older animals require higher levels of protein, but the threat of renal disease has to be taken into account.

“Protein supports the immune system and keeps kidneys healthy,” says Grace Long, DVM, of Nestlé Purina PetCare of St. Louis. “A senior animal shouldn’t have high dietary protein in the case of current renal disease. Since senior pets struggle with muscle loss, veterinarians need to examine at-risk clients to make sure the animal’s body isn’t robbing itself of protein.”

Purina is one of the sponsors of the updated American Assn. of Feline Practitioners (AAFP) Senior Care Guidelines. Dr. Long says the company is happy to see nutrition recommendations in the revised version.

“About one-third of senior cats get thinner and thinner for no apparent reason,” she says. “The guidelines separate this group from the cats that carry extra weight.”

Not all veterinary nutritionists believe that advanced age means diet should be automatically altered. Sean Delaney, DVM, Dipl. ACVN, president of the American College of Veterinary Nutrition, says that older pets typically need a diet change but that a pet and owner who are OK with the current diet shouldn’t be made to switch.

“A real concern for aging pets is weight gain and caloric intake changes,” says Dr. Delaney, chief nutrition officer for Natura Pet Products of Santa Clara, Calif. “At least 40 percent of the pet population is overweight or obese, which leads to many problems. Veterinarians should tell clients the exact amount of food to provide their dog based on many factors, including the type of food being fed. One brand can contain 100 calories per cup and another can have 600.”

More Advice

The last release of the Senior Care Guidelines was 10 years ago, and because much changed in the profession, the AAFP board decided to publish revisions.

“Feline senior care guidelines were way overdue,” says Jeanne Pittari, DVM, Dipl. ABVP, co-chairwoman of the feline guidelines group.

Dr. Pittari advises that veterinarians get clients involved in caring for senior cats by telling them that frequent vomiting isn’t normal and that such animals be brought to the office so the stomach upset can be investigated.

“Recommend that owners weigh senior cats at home if they are facing low-weight issues,” Pittari says. “If owners can document weight loss, they’re more likely to bring the pet in earlier.”

Seeing Better

Ader Enterprises of San Diego has researched lenticular sclerosis, in which the nucleus of the lens becomes denser, harder and cloudy. The density change that occurs in all older animals can be reduced, according to the company, by two to three weeks of application of PetVision Pro, a carboxymethylcellulose sodium product. It is eight times stronger than an over-the-counter version.

“This product is not a replacement for cataract surgery but has been helpful in establishing improved vision in dogs whose owners did not wish to pursue surgery,” says Richard Palmquist, DVM, vice president of the American Holistic Veterinary Medical Assn.

“The material is intriguing and in need of further investigation,” he says. “We are hoping to interest researchers and ophthalmologists in further developing the evidence for its use.” <HOME>

This article first appeared in the August 2009 issue of Veteirnary Practice News