September 14, 2015

(Dan Hey folks, thanks for joining me today on Doc Talk, I’m Dr. Dan Thomson, and we’re gonna have a great show. Dr. Jim Lillich is here and we’re gonna talk about degenerative joint disease in horses. Thanks for joining us today. Hope you enjoy the show and we’ll see you right after these messages.

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(Dan) Folks welcome to Doc Talk. Jim, thanks for being here. (Jim) Thanks for having me. (Dan) Folks, this is Dr. Jim Lillich and he is an Associate Professor here at the College of Veterinary Medicine at Kansas State University. He is an equine surgeon and does a lot of research on things that all equine, all bones… (Jim) Anything that has to do with making them go faster. (Dan) That’s right. That’s what Dr. Lillich will be doing and we’re tickled to death to have ’em on the show cause he’s a wealth of information about horses and about lameness and about different things. But today we’re gonna talk about degenerative joint disease. Otherwise known as DJD. (Jim) Yea, and it’s a topic that…one of the biggest things that slows us down from using our horses throughout their life span is…and what we call wastage in the industry is lameness, or damage to joints, bones and tendons, ligaments, etc. Also feed into that it’s musculoskeletal system, but for sure the joint takes the beating because cartilage doesn’t heal. And there’s just so much misinformation out there about this problem and you just kind of want to get the definitions right so you know where you’re coming from and when you talk about a degenerative condition, that means that the entire joint is paying a penalty, is damaged, it’s diseased. So, not only is it the bone and cartilage, but it’s also the joint capsule or the other soft tissues around it. So, the entire package, the entire joint is not right. So, it’s hard tissue and soft tissue. And you know we’ve just focused in on just well, we’re gonna treat the cartilage because it doesn’t heal and we want to save the cartilage. But once that goes, bones start to go bad and joint capsules thicken up and the clinical signs when you get to that bad part of it are no different than you and I. We walk with a limp, we have a reduced range of motion, and we’re not able to use the leg like it was designed to work. So, a lot of research has been out there, just pointing out modifying the symptoms of the disease, but not trying to fix the disease. Or certainly not trying to prevent the disease. So, when it comes to veterinary medicine in particular horses, we really have pushed the forefront of research because of what our performance animals are worth. (Dan) So, when we’re looking at degenerative joint disease, just kind of give me a snapshot of what’s going on inside that joint. (Jim) So, the joint is starting to collapse because the cartilage is between the two bones, right? (Dan) Yep. (Jim) So, that’s the smooth gliding surface that allows the body to work effortlessly. When that starts to be damaged then you get some inflammation with that so, there’s fluid. Then the cartilage starts to wear in ways it wasn’t supposed to wear. That in turn allows the bone to see mechanical forces that probably it shouldn’t be seeing. So, it gets stiffer, it gets harder. Then when that becomes a feed fuller process, Mother Nature wants to slow down that motion of that joint, so she starts packing fibrosis and fibrous tissue around it. In which case you can loose range of motion, and the joint can no longer work like it once was designed to. And then you’re at the end of the road, you’re at the end stage. And with you and me, they can replace joints. They don’t do that with horses. (Dan) Not yet anyway. (Jim) Not yet anyway. Right. So, some small animals species you can or you wind up amputating the leg to make the pain go away. And that’s just not possible. (Dan) No, no. Let’s take a break here And when we come back, let’s start getting into some of the therapies and things with DJD. (Jim) OK, very good. (Dan) You’re watching Doc Talk. Dr. Jim Lillich, Dr. Dan Thomson. We’ll be right back.

(Dan) Hey folks, welcome back to Doc Talk. I’m Dr. Dan Thomson here with my friend and colleague Dr. Jim Lillich, who’s an equine surgeon and a specialist when it comes to equine performance medicine in horses. And otherwise, we wouldn’t call it equine performance medicine. (Jim) No. (Dan) But anyway, what we’re talking about is degenerative joint disease. And it’s something that cripples horses, that cripples humans, but there’s some old therapies, old treatments that we used to try and probably don’t work as well as what they wanted. But what are some of the things that we focus on? (Jim) I think that there can be a potentially happy medium between that. The old therapy was you rest, you use some ice, you co apt it and you elevate it. We really can’t do that. But horsemanship, good horsemanship will go a long ways to get a lot of the inflammation out of an acute injury. (Dan) OK. (Jim) And then after that we can use other medications, non steroid anti-inflammatories, very popular drug that is still being used. Reduce the inflammation, allow the swelling to come down, allow some of the what we call edema, the fluid to away, so the animal can use the leg better. Just like us, use the knee just a little bit better. We want to walk and we need to use it because that begins the rehabilitation process. (Dan) What are some of the non-steroidals that are most common? (Jim) Most common, you know, certainly phenylbutazone has been around for a very long time. There’s a ketoprofen, which is an ibuprofen type drug. The new COX-2 inhibitors in horses, actually are pretty beneficial, they’re a little more pricey, but anecdotal information will tell you that previcox, which is specific COX-2, which is a newer generation anti-inflammatory, a better one, less hard on the gut. Works in horses. Again, it’s gonna be pricey. (Dan) And it’s something that we don’t use in food animals. I think that’s the most important thing we need to get out there as well. And work with your veterinarian. (Jim) Right, exactly. (Dan) They’ll help you. (Jim) Banamine, would be the final drug in the arsenal. You can’t really stack ’em. You know you can’t give multiple different drugs to see if you can get a better benefit. And then certainly steroids have been around for a very long period of time. These are corticosteroids, they are very anti-inflammatories. Other disease, or rather symptom modifying drugs would be hyaluronic acid, of HA, or even adequan and some of those come in feed supplements as well. I couldn’t tell you exactly the scientific basis, why an oral supplement might make the animal better, might make us better. But some animals respond to it. So you can’t necessarily discount it, but they’re expensive. My personal preference is to use it directly into the joint that’s injured. Because if I can get a medication I can inject, then I can reduce my total body exposure to the drug and I’m doing, really targeting the area that I want to treat. But it takes expertise and you have to get with your veterinarian in order to give those medications into the joint. That’s a sterile procedure. (Dan) And there’s even…a lot of veterinarians that don’t do that. (Jim) Right, exactly. (Dan) I mean you have to find someone that’s well versed, that does a lot of joint injections and things to that nature. (Jim) And allow it to go you know, horses are going to make their living for people, performing. Whether it’s in the feedlot, or at the rodeo, or on the race track, or having a trail ride and enjoying Kansas. (Dan) Yep. (Jim) So, the worse thing is what you would want them to have is a poor quality life, because of that injury. (Dan) You got it. We’re gonna take a break. When we come back, we’re gonna talk a little bit about some new research and new technology that’s going on to treat degenerative joint disease with Dr. Jim Lillich.

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(Dan) Hey folks, welcome back to Doc Talk. I’m Dr. Dan Thomson here with Dr. Jim Lillich and we’re at Kansas State University’s College of Veterinary Medicine and today we’re talking about the management, the diagnosis, the management and the therapy of degenerative joint disease in horses. Something that’s crippling to horses, it decreases performance, it decreases quality of life, and we’ve gone through some of the old therapies that mask the symptoms, but now we’re starting to get into maybe some things that are gonna change how we start to manage this disease and maybe even cure it. (Jim) Well, I think we can do far better than what we’ve done before. All the drugs that we mentioned are very important to help reestablish a normal environment in the joint, or get it as normal as possible. And basically slow the progression of the degeneration cause it’s gonna happen. It’s just a part of aging in some regards. We’re better at knowing how to rehabilitate a horse. And a good horseman, for lack of better terminology, somebody that knows that particular individual, knows how to train, knows how to keep the animal functional, that goes a long way. So, veterinarians typically haven’t necessarily always gotten involved in that part of it. But they’re now getting much more involved in it because rehabilitation is a huge profession, as well as some of the newer therapies. And these would be what we call biologics, which would be stem cell therapies. (Dan) Yep. (Jim) Condition medias, condition serums. Basically allowing Mother Nature to better direct and almost perfect the wound healing process and maybe and part of wound healing is actually, the final stage of it is remodeling. So, we’re gonna take something that we might not need, like a scar, and then turn it into something that was more normal, that might take years. Well, hopefully the newer generation therapies that are coming up, go hand-in-hand with the earlier therapies that we talked about and then focus in on rehabilitation. And we wouldn’t get a drug toxicity from a stem cell therapy. We wouldn’t get a drug toxicity from a conditioned serum if we gave it in the joint. It’s probably just healthier for the body if we can really get to the bottom of what exactly is happening when we use these biologics. Then I think we can go even further into the process of helping that animal out, or even us. (Dan) We’ve got about a minute before we have to go break. Can you help me and just, let’s just talk a little bit about some of the things you’re doing on rehabilitation with horses. (Jim) Well, in the old days put ’em in a stall, they’re broken. Right? Just put ’em in a stall. Horses are gregarious, they love their buddies. So, sticking ’em in a stall can almost do more harm than good. If it’s a devastating injury and you now it’s catastrophic, they’re gonna have to stay in a stall because they need to heal. But if it’s an injury that can be… where they can get out and actually have a modified training regimen, that’s probably the most beneficial thing that we can do. We don’t run ’em hard, we don’t run ’em long. We do small things to keep the body active. And it’s no different than you and I getting rehabilitation after a major joint surgery or something along that lines. You need a good physical therapist. (Dan) Good. (Jim) So, that’s the approach nowadays with most of our sports medicine in veterinary medicine across the country. (Dan) Well, let’s take a break. When we come back, I want to wrap up with the stem cell because it is something that is hot, not only in humans, medicine, but animal medicine, and something we need too. (Jim) I agree. (Dan) Thanks for watching Doc Talk. We’ll be back here in a minute.

(Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Jim Lillich, who’s an equine surgeon and sports medicine expert for horses. I’m just intrigued, the more you hear about stem cell therapy and things to treat arthritis and joint disease it’s pretty fascinating stuff. And to think about being able to do that in our horses, save a lot of lives. (Jim) I think it’s an exciting science on several…from basic all the way up to applied clinical science. So, we’ve thought for some time that you can take certain cells from the body and they could potentially become a tissue, if you were able to harvest them, concentrate them, expand their numbers, and then reinject them into injured tissues or organs, that you would actually potentially regenerate that…or allow that organ to regenerate. I think that that was simplistic when we first approached it. And it wasn’t necessarily the case. What we believe is happening now, is that the cells that we put in there are great at directing traffic for wound healing. So, instead of waiting on cells to come in to have that done, which the body has to do by sending in new blood vessels to heal an injury, you automatically have that right there. So, you’re kind of jumping some or skipping some steps and you’re speeding it up. And if we can speed that up and get the good stuff going before some of the scar tissue happens, then quite possibly we’ll maximize that animals’ ability, or even our ability to heal an injury. And I’m talking in particular about the musculoskeletal system, damage to the bone, the joint, the tendons, sometimes they’re still in that category as well. But if you can do that then you don’t have to go through some of these harsher… (Dan) What are you putting in there? (Jim) It’s basically cells. So, you can harvest the stem cell from fat, from muscle. It goes into the laboratory. We now are better off at finding which particular cells will expand. And you have to put the in the right cocktail, the right bath in order to grow them quickly, and you can expand them very, very quickly. Instead of, two weeks was the old time, now it’s like two days. (Dan) So you take ’em from the animal… (Jim) From the animal. (Dan) Put ’em in there, they grow up in a couple of days. (Jim) Expand their numbers and then they get injected right back into the injured tissue. Or in some institutes actually inject into the vascular space. We know less about that probably because we don’t know exactly where they’re all going when they got to the sites of injury. There’s evidence to say, yes they do and that’s to say, they just go general body. And that makes sense as well. Do they stay in going to the tissue? Don’t know. But that is the science behind it. And I think you’re gonna see a lot more coming in the next years. (Dan) Cool. (Jim) It’s gonna be really interesting. (Dan) Well, I sure appreciate you being on the show. (Jim) It’s great being here. (Dan) And we’re gonna have you back. Folks, Dr. Jim Lillich here at the Kansas State University College of Veterinary Medicine. If you want to know more about what Dr. Jim and I do here at K-State you can find us on the web at www.vet.ksu.edu. Remember always work with your local veterinarian. You’ve been watching Doc Talk today. I’m glad that you joined us. I hope you enjoy the new back drop. I’m Dr. Dan Thomson and I’ll see you down the road.

Closed Captioning brought to you by AgriLabs, the Perfect Pairing of Performance and Value.

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