Originally published in the January 2009 edition of Dressage Today, reprinted with permission. Subscribe at DressageToday.com.
There have been many advances in the last few years regarding treatment options for healing and regenerating damaged tissues. One of the most interesting and cutting edge procedures available in veterinary medicine today is stem cell therapy. Stem cells may be derived from bone marrow or from adipose (fat) tissue. It is harvested from the horse’s own body, processed and re-injected into the damaged area. There are now a few companies that provide this service. The process has a two-step approach:
- A small incision in the gluteal region (the area next to the tail head on
the rump) is made just under the skin. We collect fat and send it to Vet-Stem in Poway, California, for processing. The stem cells and growth factors are harvested and concentrated. The syringe is then returned the next day for injection into the site. - Next, a veterinarian uses ultrasound, radiographs or MRI to direct the stem cells into the area of need. Stem cell companies can also bank extra cells for future injections, if needed and if enough stem cells were harvested.
Benefits: The cells harvested and injected will turn into the type of cell needed in the area where it was injected. This helps provide the body with the necessary building blocks to repair the damaged tissue instead of waiting for the body to try to repair that area on its own. Other growth factors are also injected with the stem cells to help promote healing and inflammation relief in the area.
Rehabilitation: All of this new technology, however, will not work without a plan of rehabilitation. As with human medicine, physical therapy is an important part to healing the damaged areas and limiting the amount of scar tissue and adhesions that may form. This scar tissue can weaken an area in the long run and limit the flexibility of the tendon or ligaments in question, causing continued pain and lameness. The unfortunate reality of rehabilitation in horses is that we cannot tell them to stay off the leg for a while. This means that, initially, while we are trying to reduce the pain and inflammation of the area, we have to keep in mind that they will still be walking on the injured limb. Stall rest and anti-inflammatories are the initial key to the comfort of the horse.
Once the pain and inflammation have subsided, then hand-walking begins. It is important to start hand-walking early to prevent adhesions from forming. Starting slowly and increasing the time spent and the walking surface are important. Over the next few weeks to months, depending on the type and location of the injury, frequent assessments are made to determine if the horse is sound enough and the injury healed enough to move on to the next level. Each level consists of introducing increased time of a type of exercise (hand-walking, walking under saddle, trotting, cantering) and type of footing (hard ground, soft ground, sand, straight lines only or adding turns).
If a setback occurs, then you will have to reassess the program and take a step back until the horse is sound enough to move forward. This can be a long process depending on the severity of the injury. Not all injuries can be cured. Some are severe and may never result in a sound horse; however, trying to get the horse as comfortable as possible is a realistic goal. Time and patience are a necessity, but the rewards of a sound horse are priceless.
Cost: The cost of the procedure from the harvest to the injection typically starts at $2,500. This is without any additional fees for imaging or diagnostics. Many insurance companies are starting to cover these expenses.
Results: Although we cannot say for sure whether the stem cells worked, past case experiences tell us that this lesion would most likely not have healed with conservative therapy alone. Jesse’s positive clinical response to stem cell therapy is what we use to gauge this treatment as a success.
