Fringe Therapy? Fringe Benefits?

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1 Fringe Therapy? Fringe Benefits? James S. Gaynor, DVM, MS Diplomate, American College of Veterinary Anesthesiia and Analgesia Diplomate, American Academy of Pain Management Breckenridge, CO Client Inquiries and Demands Many products brought to us by clients and distributors Little, if any research Apparent efficacy Supporting documentation Products Glucosamine supplements Hyaluronic acid Microlactin Elk antler Devices: Targeted Pulsed Electromagnetic Field Therapy Therapeutic laser Oral Structure Modifying Supplements Glucosamine Condroitin Not FDA approved - nutraceuticals Little scientific data for most products Glycoflex III Inconclusive data SynoviG3 - None Cosequin apparent efficacy- What makes it different? Dasuquin - Different Recommend products which have efficacy! Glycoflex III Perna canaliculus* Methylsulfonylmethane (MSM) Glucosamine HCl* DMG Vitamins E, C Grape seed extract Glutathione Selenium Manganese* *Documented efficacy Glycoflex III reduce the severity of cartilage breakdown and synovitis to have an anti-inflammatory effect to reduce cartilage breakdown 85% of vets rated GF products as good or excellent in reducing joint symptoms No published data of actual efficacy PPVG2015 1

2 SynoviG3 Cosequin Glucosamine HCl* Low molecular weight chondroitin* Manganese* No emerging data No testimonials Company provides no back up *Documented efficacy in the target species 1. Cosequin Has In It What It Says Adebowale A et al. Journal of the American Nutraceutical Association 2000; 3: Cosequin is Different Glucosamine Low molecular weight chondroitinactually absorbed by GI tract Manganese- acts as a catalyst PPVG2015 2

3 Efficacy of the 3 Ingredients Actual Cartilage Benefit Lippiello L et al. Clinical Orthopaedics and Related Research 2000;381: Lippiello L et al. Canine Practice 1999; 24: Cosequin s Preventative Effect 5. Beneficial Effect with NSAIDs Chymopapain Carpal injection Double blinded Placebo controlled Cosequin administration prior to joint insult had a protective effect against synovitis and bone remodeling Canapp SO Jr., McLaughlin RM Jr., Hoskinson JJ, et al. Scintigraphic eval- uation of dogs with acute synovitis after treatment with glucosamine hydrochloride and chondroitin sulfate. AJVR1999;60(12): Lippiello L, et al Veterinary Therapeutics 2002; 2(3): Clinical Impressions 3,080 vets 28,898 joints Dasuquin Glucosamine LMW Chondroitin ASU Avocado Soybean Unsaponafiables Anderson et al, Preventative Veterinary Medicine 1999; 38: PPVG2015 3

4 Dasuquin Combination inhibits expression & production of many inflammatory and degradative mediators Dasuquin Effects extend across species Canine Feline Equine Human cells OA & nutrition: from nutraceuticals to functional foods: a systematic review of the scientific evidence Good evidence Avocado/soybean unsaponifiables Moderate evidence MSM and SKI306X (plant extract mixture) Limited evidence Duhuo jisheng Wan (Chinese plant extract), cetyl myristoleate, lipids from green-lipped mussels, and Harpagophytum procumbens extract Hyaluronic acid Most abundant lubricant in body Injectable formulation - FDA approved in humans and horses Not all oral formulations are created equal Oral Hyaluronic Acid High molecular weight HA Proven results? Apparent efficacy Testimonials No published data PPVG2015 4

5 What is MicroLactin?! Milk - derived protein! Hyper-immunized cows! Anti-inflammatory effect! Inhibits neutrophil migration Orthopedic Score (0-100, mean ± sem) Improvement in Orthopedic Disability Index in Dogs, n=18 Placebo, n=17 p<0.001 CanEVA Elk Velvet Antler 55 0 Time, weeks Overall improvement noted in % of therapeutic group 35% of placebo group Elk Velvet Antler (EVA) Contains Glucosamine Chrondroitin Hyaluronic acid Omega 3 & 6 Calcium Phosphorus Growth factors Magnesium Copper Zinc Selenium Collagen The Canadian Veterinary Journal A reprint of: Clinical evaluation of a powder of quality elk velvet antler for the treatment of osteoarthrosis in dogs Maxim Moreau, Jacques Dupuis, Norbert H. Bonneau, Manon Lécuyer 2004, Volume 45, No. 2, pages PPVG2015 5

6 Dogs The Canadian Veterinary Journal 2004, Volume 45, No. 2, pages EVA Treated Dogs Improves their weight bearing and executed the stride in a comfortable manner. Could be attributed to: Increased muscular strength or Decrease in joint inflammation or A combination Investigators speculated that palpation of muscle mass revealed a significant reduction of atrophy, suggesting a myotropic effect, rather than simple anti-inflammatory effect How PEMF works Pulsed electromagnetic fields induce signaling microcurrents in tissue Signal characteristics important Duration, Frequency, Power Targeted signals Speed body s own mechanisms No known side effects No adverse effects Targeted PEMF Proprietary signals (tpemf) A priori targeting of electrochemical activity Decreased power, increased efficacy compared to PEMF Treats through dressings, clothing, casts, etc. 34 Specific effects of tpemf " Targeting Calcium/Calmodulin Binding (Ca/CaM) " Anti-inflammatory cascade " Signal configuration couples to Ca 2+ binding tpemf Mechanism of Action PEMF induced current Ca 2+ + CaM Voltage dependent Ca 2+ CaM PEMF increases Ca 2+ binding to CaM (in milliseconds) Ca 2+ CaM + cnos NO Ca 2+ CaM binds to cnos, which catalyzes NO release (in seconds) Anti-inflammatory: increased Blood and Lymph Flow Pain/Edema Decrease (in seconds) NO cgmp Growth Factors (in hours/days) VEGF Angiogenesis (in hours/days) FGF Collagen/Granulation (in days) TGF-β Remodeling (in days/weeks) 36 PPVG2015 6

7 Evidence for PEMF effect on Ca/CaM & NO Independent study results in the literature Increased vasodilatation via NOS/cGMP Miura et al. (1993) Increased osteoblast proliferation via NO Diniz et al. (2002) Increased neuronal regeneration via NO Kim et al. (2002) Inhibition of endothelin-1 (vasoconstrictor) via NO Morimoto et al. (2005) Increased NO in nasal/sinus mucosa Yariktas et al. (2005) Down-regulation of inos in monocytes Reale et al. (2006) Rapid intracellular (NO) signaling in osteoblasts Schnoke et al. (2007) Study of tpemf in Post-Surgical Pain Randomized, controlled trial, post primary breast augmentation Showed significant reduction in pain and pain medication use Heden and Pilla, 2008 Aesth Plast Surg. 32: tpemf in Post-Surgical Pain Randomized, controlled trial, post primary breast reduction Mean VAS (Normalized to Start VAS) Start Normalized to *P = *P = *P = Time Post Op (hours) 2.4X decrease in pain medication in active group 39 Rohde, 2009 BEMS Mean Maximum VAS Osteoarthritis Study Results PEMF Treatment Days 33 patients Working people with OA In OA clinic TX: bid 15 minutes. group showed an immediate (within 2-3 treatments) 45% decrease in pain and slowly over time showed a 55% decrease in pain. Ankle sprains in College Athletes 4 tpemf improves pain tolerance and edema in acute inflammation Mean Change in Edema Volume (ml) *P=.03 n=193 n=202 * Edema Pain Tolerance p=.003 p= Effect of PEMF therapy on edema volume from grades I and II lateral ankle sprains. Mean edema decrease from Day 1 to Day 3 post study entry in the PRF treated group was >7x that in the sham treated group. Treated animals had no discernible pain (sham treatment group had 50% increase) and 40% less swelling. Comparable to NSAIDs with nitric oxide donors. Carageenan injection model adapted from Johnson et al., BEMS, San Diego, 2008 PPVG2015 7

8 PEMF significantly accelerates tendon healing in standard model (Achilles tendon repair) PEMF accelerates surgical wound healing p=.001 P = Tensile Strength Tensile Strength Tendon strength at 21 days. arm is 60% stronger, meaning that healing was accelerated over sham group Strauch et al., JHS 2006 cohort heals 58% faster than sham treatment group, based on tensile strength at 21 days Strauch et al PRS. 120: Laser Science Laser Classification An acronym for Light Amplification by Stimulated Emission of Radiation Class 1 Laser Printers CD Players Class 2 Low Power Diffuse output PPVG2015 8

9 Laser Classification Class IV Lasers in Medicine Class 3a Class 3b LLLT Lasers Laser Pointers LLLT <500 mw Surgical Lasers: Used to cut, coagulate and evaporate tissues. This type of laser replaces the scalpel. Therapeutic Lasers:! Used for the stimulation of cell function. The biological effect is photochemical not thermal, unlike surgical lasers.! PHOTOBIOMODULATION Important Parameters The right wavelength for absorption The right depth of penetration The higher the power The lower the treatment time! The right amount of light or dosage Cellular Mechanism of Action Chromophores Components of various cells and sub-cellular organelles which absorb light. The stimulation of chromophores on mitochondrial membranes incites the production of ATP. This: Increases cellular energy levels Enhances pain relief Accelerates cellular healing Photobiomodulation & Pain Increase in beta endorphins Blocked depolarization of C-fiber afferent nerves PPVG2015 9

10 Photobiomodulation & Healing Therapeutic Laser Canine Applications Increased Leukocyte Activity Increased Macrophage Activity Increased Vascular Regeneration Increased Fibroblast Proliferation Early Cell Regeneration Increased Tensile Strength Enhanced Cell Differentiation Accelerated Wound Healing REDUCED HEALING TIME Data Physiologic Human OA pain Healing Veterinary - Pending Take Home Message Clients and veterinarians have access to many products/ services May or may not documented efficacy Our duty to determine Steer clients in the correct direction Do the right thing for our patients For Consultation Further Information Don t Forget to Try the On Line Consultation Service % off for 1 month PPVGCE2015 PPVG