Returning for a second week, we're so happy to be welcoming back Cameron Black BVMS MVetSci PhD MRCVS In Conversation with VetzPetz' Naomi Oikonomou.
Hi Cameron, what a year it's been! Can you tell us a little about what you’re currently doing?
Hi Naomi! I'm back in the UK after a break in SA, spending some quality time with family, it’s rare to have the time to do that which I’m grateful for. During lockdown I spent a lot of time working trying to clear some publications that I never really had the time to prioritise whilst in the clinic.
So, what’s next?
I’m in the process of setting up a new regenerative medicine and osteoarthritis service, also enjoying spending time involved in CPD and building connections within the profession.
Wow, making every minute count by the sounds of it! For anyone not yet familiar with the work you do can you give us a brief summary of your veterinary journey so far?
After qualifying and working as a GP and OOH vet for a wee while I was drawn into research, turns out that would keep hold of me for several years, work was always focussed on the clinical translation of core research within stem cells, biomaterials and tissue engineering. I spent time at the University of Edinburgh and then at the Bone and Joint Research Group based at University of Southampton. Following that I wanted to move back into practice and see if it was possible to genuinely translate across from the realm of basic science into clinical application and joined the team at Fitzpatrick Referrals, helping deliver biological therapies in support of conventional orthopaedic surgery and to our lovely osteoarthritis patients.
You formed part of the hugely successful regenerative medicine service at Fitzpatrick Referrals. Although greatly rewarding this must have also been quite mentally draining, especially with how full-on and emotionally motivated a lot of the work is. What for you personally, powers you through?
Yes, it was certainly a busy role and I didn’t have half the work of some of the team! Importantly, it was tremendously rewarding, we were managing variable and complex cases on a daily basis and thankfully, with the personnel and physical facilities to provide the best care we could. Working in that sort of environment provides a clinician with a canvas and toolset to which is so rarely available, being part of developing treatments and providing care to the animals under our care and by extension, the families as well, that really helps to keep you going in and amongst the waves. So yes, full-on, but rewarding.
Is there any one case that really stands out for you in particular?
Ah there are those cases that just make you smile to think about! It certainly doesn’t happen in every dog but when you see that change, it’s so heartening. I can think of a lovely older black lab, part of a 2 dog and 2 vet family. They’d seen their girl slowing down over the year as would be expected from the breed and age, in the months leading up to meeting them, their dog had further declined and was only able to walk out to go to the bathroom and not a lot more. They were walking buddies with another dog I had worked with and were encouraged by what they had seen, so they came for a visit. After consideration of other modalities, including surgical, medical and rehabilitation options, we settled on a program of intra-articular autologous stem cells with supportive care.
Within one month I was sent videos of a rejuvenated black lab trotting in fields and along the river paths after previously having been restricted to short walks only and tiring quickly! The family told me it was as though she was years younger and relayed being very happy. It really meant a lot to me that one, an unequivocal success with lots of smiles.
Such an incredible story. In recent years, what do you believe to have been the biggest forward leaps in veterinary clinical research.
Do you mean OA research? That’s a huge question and my little window on the world can’t really do it justice. However, speaking from a perspective of translational research, I would suggest that expanding upon the cellular and molecular underpinnings of the disease process as gleaned from in vivo research and how it is leading to intelligent targeted therapy development will undoubtedly change lives, both human and animals.
We know ever more clearly the 'hows' and 'whys', and through the shared development of treatments now being discussed in human and veterinary literature, the rate of treatment improvement has soared. We have gone from seeing OA as a no-hope “manage as best we can” disease to a known dynamic process with may avenues of attenuation and importantly, outcomes leading to improved quality of life
How did you first hear about Antinol and what in particular sparked your interest with regards to Antinol?
I was approached by Milly and Dave from VetzPetz, who brought Antinol to my attention to see if we could use it in our OA cases. As everyones knows it’s not exactly unusual to have a new product punted at you particularly in the supplement world. To their credit the Antinol team were able to demonstrate a good base of supportive information related to product safety and efficacy, this made a decision to suggest its use far more comfortable in a consult context. The world of supplementation can be ambiguous, it was important for me to be able to point colleagues and owners towards the research for sure.
Management of OA and chronic musculoskeletal disease is a multi-armed treatment beast, it is so important to look at all the options and include as many complementary interventions as is reasonable and possible. Lipid supplementation is one of those arms and within that Antinol was promoted as an evolution within the lipid supplement space. Nothing new in itself but I did respect the peer reviewed data submitted in support of Antinol, that was probably the “foot in the door” to using it more widely.
How have you incorporated it into your work?
As supplementary as part of the management strategy in OA/mobility cases. This may be as a standalone supplement or in concert with other combination supplement products. Anecdotally it was not infrequently reported by a family that they noticed a benefit to using Antinol in combination with other supplements vs either product alone.
Cases in which NSAID use is contra-indicated and where anti-inflammatory properties are sought. There is data suggesting a pain relieving aspect when given as a sole agent and it may be possible to gain further when used with the newer “non-traditional” NSAIDs on or coming to market. In cases receiving stem cell application it has become accepted protocol both in human and veterinary medicine to restrict NSAID and steroid use for a period leading up to and following cell delivery. This is a much larger conversation, however this is still a time when the animal will be experiencing pain and discomfort and certainly a time during which anti-inflammatory support is desirable.
Would you recommend its use?
In brief, yes, I would. It became an easy product to incorporate as part of a strategic management plan for the OA patient. Honestly, it isn’t always a game changer, but the more I was suggesting it to owners I was more often than not receiving very positive feedback. In some cases, families wished to trial supplementation alone, and I was receiving clear positive updates from those only receiving Antinol. As the case numbers and feedback increase so too does my happiness to recommend Antinol.
Your personal research interests include phenotypic characterisation of canine stem cell populations and optimising the cell-scaffold environment to enhance the therapeutic effect . Chloe our RVN was talking about a stem cell case where you use Antinol, she was excited to understand the connection and why that might be an appropriate use.
To maintain a healthy joint the body is in a balanced state between renewal and degradation. I think of a forest or meadow, cleared by fire and then new vibrant growth. In the osteoarthiritc joint the embers of the fire keep burning and the new shoots struggle to grow. When stem cells are applied into the joint they produce a raft of anti-inflammatory and “moderating” signals, helping to restore the natural balance of tissue renewal. Omega oils such as those in Antinol form part of the cell membranes of new cells, and contribute to the production of the moderating signals. Further they are also involved in the formation of cartilage matrix, if we thought of cartilage like a carpet covering our joints, then lipids help form some of the fibres in that woven covering. I confess I do not know the exact degree to which this effect is synergistic however the contributing effect of both elements has been described extensively in the literature. I was also interested in providing pain relief to my cases in the period around injection, as described in the question above
What approach do you take with most OA cases?
Firstly, have an open mind, an OA presentation is an opportunity to improve the quality of patient life with just a little planning and care. All animals should go through a work-up as if we were investigating any cause of lameness or impact to mobility, it is important not to make assumptions either about the condition or about client expectations; history examination, all options, treat.
Confirm the cause, identify underlying pathology and treat as is most appropriate, sometimes that can be a simple change, other times we could put a multifaceted program in place.
Always consider and discuss all the options, the vet should guide this conversation as the healthcare professional, offering all options as is best possible. So often we have expertise in one area and may end up with a bias towards treating within that area. There are lots of approaches and as a profession we should be happy to form a treatment web, not just a single strand.
Once we are confident that surgery is not indicated, then options include intra-articular therapy, medical management of pain with supportive nutrition, physical therapy, exercise and lifestyle modification. Changes take time so it’s important to track progress as best you can, again there are many tools out there to help. This is an important step as it helps keep the families engaged, improving compliance and certainly contributes to improved outcomes.
Thank you so much for your time Cameron, we really appreciate it and look forward to hearing more on all your up and coming projects.
If you're a vet with an OA clinic looking to gather a resource of information for your pet owners, Cameron has also kindly written up a summary of specialist advice on OA for pet owners.
Do you have a story to tell or insights to share? Get in touch! You can email me firstname.lastname@example.org