Saturday, April 26, 2008

Exoskeleton-this is wild

Watch this video, it will blow your mind. While this is being developed for the military(a lot of scientific advances are) it could have huge implications in medicine. Imagine taking those with spinal injuries, ALS, MS and severe arthritis and being able to walk and function with only minimal exertion. I have to admit I had flashbacks to Robo-cop and darth Vader but it is truly amazing.
I'm sure the expense is astronomical but like much of technology the price will come down as the product comes on line and more advances are made. Think about the implications for Equine medicine in generations to come where the lame horse or laminitic horse could move about effortlessly. I don't think we will be around to see it but we can surely see it coming.

Dr Mary Thomas runs the Boston Marathon

This past week Dr Mary left us and went to run the Boston Marathon. The amazing thing about it is that she has been coughing like a chain smoker for the last month. She got checked out by the doctors and ran anyway finishing in the top third in her class. While Dr Dick and I fight the pull of the outgoing tide by dieting and hitting the weights.....Mary effortlessly stays in unbelievable shape. Here are some pics from the race.....congrats Mary.

Funny Political Video-"The front fell off"

This is a great Aussie political satire that shows how politicians are viewed the world over.
Think of this every time you see an upcoming political interview this presidential season.

Wednesday, April 23, 2008

Laminitis-the roll of Hyperinsulinemia



The AAEP journal Equine Veterinary Education frequently publishes highlights of clinically relevant papers and this months edition does just that. There are several very interesting abstracts presented including the following.
"Induction of Laminitis by prolonged hyperinsulinemia in clinically normal ponies" by K.E.Asplin et al.
The purpose of the study was to determine what are the effects of prolonged insulin administration
on hoof wall integrity. High serum insulin states exist in the horse such as in Metabolic Syndrome and the associated insulin resistance. In this study 9 clinically normal ponies were divided into 2 groups, 1. treated n=5 ,2. control n=4. The treated group was given insulin over a 72 hour period via a euglycemic-hyperinsulinemic clamp technique which keeps the blood glucose level normal in the face of increased insulin. there was no gastrointestinal disease and no systemic illness during the study, ruling out those causes of laminitis. In the treatment group all of the ponies developed clinical and histological laminitis (Obel grade 2) in all 4 feet.
This is significant because it indicates the role of insulin in laminitis, independent of hyperglycemia or colonic fermentation. Perhaps we should be looking at serum insulin during times of crisis or stress as our indicator of potential laminitis.

Friday, April 11, 2008

Tildren-comments and more questions

I have had quite a few responses to a post on "Gallium Nitrate and Tildren". The main point of my post was the pushing of Gallium nitrate on the public as a scientific treatment for navicular disease, which still has no scientific backing today. This one came in recently. "Isn't the primary effect of Tildren to inhibit bone resorption? A related effect would be, yes, to reduce the Calcium in the blood, if this were coming from excess bone remodelling. It's not to treat the blood Calcium , but to reduce damage to the bone...which increases blood Calcium. I'm absolutely sure you know this already, but your comment is leading and misleading. You must be a fan of Richard Dawkins". I'll try to address those questions here. Tildren (tiludronate) was also mentioned as a recent treatment for Navicular disease (also tarsal arthritis and thoracolumbar pain ) American Journal of Veterinary Research, March 2007, Vol. 68, No. 3, Pages 329-337. Tildren is a drug developed to treat hypercalcemia associated with certain malignancies. This is caused by production of substances that mimic parathyroid hormone and causes activation of osteoclasts and excessive bone resorption. Since in some cases of Navicular disease there is significant bone damage, it is postulated that Tildren can reduce the osteoclastic activity and prevent this change. In the limited number of studies done thus far it is difficult to rationalize the results seen. In a group treated for thoracolumabar pain (15 tildren/14 placebo) there was an improvement noted 60 days later in the treated group. What is the original inciting injury in these cases? (The same question applies to navicular disease) . If there is a lesion present before the study why does preventing further bone resorption eliminate the original source of pain or are they saying that excessive osteoclastic activity is the primary disease entity in these cases. I recently spoke with a surgeon that co-authored one of the papers on the use of Tildren and it was his opinion that in cases where the MRI showed a fluid signal in the navicular bone ie. bone loss, then they used Tildren and thought there was clinical improvement. I can't dispute his findings and he is a top drawer surgeon, so I have to go with his opinion. However, I still scientifically question if there are other effects from this drug causing the relief seen in these cases. Is it just that by stopping further bone loss ,the inciting causes are reversed. How does this address the soft tissue changes, flexor tendon lesions, coffin joint synovitis, impar ligament changes and conformational issues frequently seen with navicular disease. Does Tildren have some anti-inflammatory or pain relieving properties. There have been many drugs and treatments proposed for Navicular disease/syndrome over the years , many never stood up under the light of scientific scrutiny. Tildren may prove to be a very effective treatment and then again it may not. I think the light still needs to be shown on it a little more.
So where do I stand.....Gallium is still a hoax, Tildren may be helpful ( if you have a Board Certified Specialist tell you so) and I had no idea who Richard Dawkins was until this email ( not much in common there)