LASER Surgery and LASER Therapy
These are two distinctly different modalities that require completely different state-of -the -art equipment and separate training
Laser Surgery
Without getting into technical details, here is what you need to know: We were one of the first facilities in Tampa to buy a Laser surgery machine. It is used in any and all surgeries in the place of the old fashioned scalpel. If you have ever cut your finger with a sharp knife by accident, you will know the feeling. Immediately it creates an intense burning/stinging sensation that by the next day develops into a throbbing sensation. The swelling gets so bad that you cannot bend your finger properly and it feels like you are constantly bumping into things creating intense pangs of pain, lasting sometimes many days.
Well that is the same "healing process" that happens after all surgeries with a scalpel. NONE of that occurs with laser surgery.
If the patient was awake, they would feel an intense burning sensation for about one second, but after that you feel NOTHING. Of course they are always asleep during that initial cutting stage, so they wake up, not experiencing any pain. In fact we have more problems with them being hyperactive after the surgeries than we used to, all because they do not know they have had any incisions done.
We have seen with our own eyes many many examples of almost miraculous recoveries. Most noticeable after a declaw surgery. The old fashioned technique is barbaric, involves tourniquets to cut of the blood supply and leaves the patients in excruciating pain for about two weeks.Doing it my way, the kitten is usually batting a paper ball around the next day, as if nothing happened.
There is no question, the only humane choice for doing surgery is with Laser, and we refuse to ever go back to the old ways.
Aesculight Surgical Lasers
The CO2 lasers remain the Gold Standard of surgical lasers because of unique wavelength and precision. Tens of thousands of CO2 lasers are used daily across North America in various specialties at veterinary and human medical facilities.
Aesculight is the only American-based veterinary CO2 laser manufacturer. We design and build the next generation of surgical lasers that feature higher power, improved beam delivery, new patented laser tube technology and most advanced control features. Along with the best technology, quality and reliability, we offer efficient technical support and the best service in the Industry.
To learn more about Aesculight Veterinary Laser click here
Laser Therapy
Because many years ago, physicians were so impressed with the dramatic pain reduction during laser surgeries, they created laser therapy machines. These use the same energy emitted as the bigger surgical machines, but at a much lower intensity, so that it does not cut or burn the skin.
As soon as Class IV lasers were approved for veterinary use the USA, we obtained one. Previous lasers were so weak that they could only be used for lesions and conditions on the surface of the skin. Class IV allows penetration 4 to 6 inches into tissue, which creates wonderful opportunities to treat arthritis inside knees and hips, even for large animals like horses.
It also allows us to treat inside the abdomen and chest cavity for frustrating conditions that previously we could only contain, that were treated palliatively with corticosteroids and pain medication and prayer.Well I don't need to tell you that long term steroids, or even non-steroidal anti-inflammatory (NSAIDS) can be devastating to patients intestines, livers and kidneys. You also know about the heartbreaking stories of addiction and abuse in humans exposed to long term opoid and narcotic pain medications.
We have to worry about none of these and in fact we have noticed that in the majority of cases the laser therapy not only treated the pain, but caused long standing, chronic conditions, to start healing and even sometimes gets cured after a course of therapies.
I don't want to brag, but I strongly believe that the greatest break-throughs in future medical care, is going to be made in laser therapy. I bet it puts the discovery of Pennicillin to shame.No wonder just about every sports franchise and every professional athlete is gettinf access to it these days.
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Here is an article written by a Veterinary Rehabilitation Specialist:
LASER THERAPY AS A MODALITY IN CANINE
REHAB
Kristin Kirkby, DVM, MS, CCRT, DACVS
Seattle Veterinary Specialists
Kirkland, WA
LASER PHYSICS
Lasers were first used surgically to cut or seal tissue. It
is only recently that therapeutic (also known as cold
laser or low-level) lasers have gained wide recognition in
veterinary medicine. Lasers, along with the sun, ordinary
light bulbs, x-ray machines, and microwave ovens, emit
electromagnetic radiation. Energy from these sources
travels at the speed of light in packets known as
photons. Photons travel in waves, and the type of
radiation is distinguished by its wavelength.
Electromagnetic radiation is typically described as a
spectrum from very short (gamma rays, 1000?1 fm) to
long (radio waves, 1000?1 m) wavelengths. Laser
radiation falls within the center of this spectrum, with
wavelengths in the visible light (400?800 nm) and
infrared (1000?-0.8 μm) range.
Laser is an acronym for “light amplification by
stimulated emission of radiation.” In this process,
electromagnetic energy is harnessed into an intense,
coherent, monochromatic beam of light. The properties
of monochromaticity (all waves are same length/ color)
and coherence (all waves in phase) are characteristics
of all lasers.
A laser is made using a material (gas, liquid, solid) that
when stimulated by an external energy source such,
such as electricity, will release photons of a single color
or wavelength. For example, a helium-neon (HeNe) laser
will emit only wavelengths of approximately 633 nm,
which fall within the visible light spectrum and produce
the color red. Gallium arsenide (GaAs) lasers emit
wavelengths of 904 nm, and are thus invisible within the
infrared portion of the spectrum. Wavelength is inversely
proportional to energy. This can be appreciated by
recognizing differences between harmless radio waves
(long wavelength, low energy) and gamma rays that are
used in cancer radiation therapy (short wavelength, very
high energy). Wavelengths between 300 and 400 nm
represent UVA and UVB rays. These rays possess
dangerous ionizing properties that cause sunburn. The
wavelength of therapeutic lasers all fall between 400 and
10,600 nm, with the previously mentioned HeNe and
GaAs lasers being the most frequently studied and
employed clinically.
Therapeutic lasers are commonly referred to as “low
level lasers” or “cold lasers” in contrast to high-powered
lasers that are used to cut tissue. True low level lasers
have a power output less than 500 milliwatts (mW) and
cannot cut tissue. Power output is significant, because a
laser with a higher wattage will reach the desired dose
more quickly. Among low level lasers, power output
(watts, W) varies greatly, anywhere from 3.5 mW to 500
mW. Recently, therapeutic lasers with power output
greater than 500 mW (typically around 10 W) have been
introduced to the veterinary field. While these lasers are
able to treat a large surface area and reach deep
penetration quickly, they produce discernable heat and
have the capacity cause considerable tissue heating and
risk burning skin.
There are several other parameters that can differ
between lasers. Lasers can be continuous or pulsed.
When a laser is pulsed, the power output will reach a
peak and return to zero at varying frequencies (Hz), or
duty cycles. Therefore, the amount of power delivered
will be the average power output.
Power density, or intensity, is the amount of power
concentrated on a given area and is measured in W/cm2.
If the laser beam is spread over a larger area (larger
spot size), the amount of energy at each point becomes
less, compared to concentrating the energy at a single,
small point. This will be influenced by the beam diameter
(mm) and spot size (cm2) that are specific to each laser.
Some lasers allow for adjustment of beam diameter and
spot size.
Lasers can also be polarized or non-polarized and
collimated or non-collimated. Some researchers will
argue that polarization and collimation are important;
however, there are several reports of biostimulation
using non-polarized and non-collimated light.
Lasers are divided into four classes with additional
subclasses (1, 1M, 2, 2M, 3R, 3B, and 4). A common
misconception is that these classes distinguish the
efficacy or quality of the laser. Rather, laser class is
determined by the ability to cause eye injury and is
based on power output. Class 1-3A lasers, including
supermarket scanners, laser pointers and remote
controls, are considered safe. Class 3B lasers pose a
risk of eye injury, and eye protection is recommended.
Any laser with greater than 500 mW of power falls into
class 4, which is considered to be an acute hazard to the
skin and eyes from direct and scattered radiation.
Dosage (also known as energy density or fluence)
appears to be the most important laser parameter in
clinical application. Lasers that are available
commercially and marketed for medical or veterinary use
will likely come with recommended doses for various
conditions pre-programmed into the unit or listed in the
instruction manual. While the optimal treatment dose has
not been established for any condition recommended
doses generally fall between 2 and 10 J/cm2.
Dosage is measured in J/cm2 and can be calculated
using the following formula when treating superficial
targets:
Dose = P x t
A
P= laser’s output power (W)
t= treatment time (seconds)
A= area treated (cm2)
1 J= 1 W/s
The depth of laser penetration depends primarily on
the wavelength of the laser, with longer wavelength
resulting in deeper penetration. A GaAs laser (904 nm)
can reach tissue depths of 3 to 5 cm, while a HeNe (633
nm) will have more superficial penetration, near 1cm.
Photons emitted by a laser interact with tissue in four
ways: reflection, transmission, scatter and absorption.
Factors that may influence the depth of penetration
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include hair coat, skin coloration, and tissue
composition. Much of the radiation energy may be
absorbed by hair, dark pigmented skin, and highly
vascular tissue such as muscle. However, unlike sound
waves, light can penetrate bone. Reflection of light off of
the tissue surface can decrease absorption, thus, when
targeting deep tissue, the laser should be held in contact
with the skin.
When targeting deep tissue (anything other than a
superficial wound), the following formula has been
recommended.
t= D x A x (1 + d)
P
d= depth of target tissue (cm)
PHOTOBIOMODULATION
Photobiomodulation is the application of light in order
to modify a biologic process. Depending on the
wavelength, power and other factors, light can cause
beneficial or harmful effects in cells and tissue.
Therapeutic lasers can be used to stimulate favorable
effects in tissue, including enhanced wound healing and
modulation of pain. The exact mechanism of tissue
healing has yet to be fully elucidated; but, there is
growing evidence to support lasers influencing each
phase of wound healing. Laser energy is absorbed by
chromophores, such as cytochrome c oxidase, in the
mitochondria. This results in increased cellular
metabolism and ATP production and stimulation of DNA
and RNA formation. These events are followed by an
increased expression of growth factors, cytokines, and
genes related to cell proliferation and migration.
The precise role of laser therapy in the inflammatory
phase is debatable. Some studies have shown
enhancement of the inflammatory response and
increased production of growth factors such as
transforming growth factor-β (TGF-β). Immune system
up-regulation has also been demonstrated. Others have
demonstrated acceleration of the inflammatory phase,
with rapid progression into the proliferative phase of
healing. Furthermore, laser therapy has been shown to
reduce inflammatory mediators, such as cyclooxygenase-
2 (COX-2) and prostaglandin E (PGE), and
decrease inflammatory cells and edema.
An increase in vascular activation (hyperemia) has
been seen within the first 36 hours following laser
treatment to open wounds. This may be due to a local,
sub-sensory increase in temperature, which can
influence cell membranes and ion exchange and,
ultimately, vascular tone.
While laser therapy does appear to influence the
inflammatory phase, it is clear from a large number of
studies that the proliferative phase of wound healing is
greatly enhanced by low-level lasers. Research
conducted on cell cultures has found that various
wavelengths and doses are effective at increasing
fibroblast proliferation, but HeNe laser (633 nm) at a
dose of 5 J/cm2 appears to stimulate the greatest
amount of cell proliferation and migration.
The final phase of wound healing is maturation or
remodeling of scar tissue. Lasers influence this phase by
enhancing the organization of collagen fibers within
wounds. Furthermore, there are reports of using laser
therapy (particularly 585 nm) to treat hypertrophic scars
in humans.
Lasers are used routinely in veterinary rehabilitation to
relieve pain. The mechanism of pain relief is thought to
be due to several mechanisms, including increased
secretion of serotonin, increased release of endogenous
opiates, and blockage of afferent C fiber depolarization.
Based on the aforementioned properties of laser, the
indications for use in veterinary medicine are numerous,
but primarily include enhancement of cutaneous wound
and tissue healing and amelioration of acute and chronic
pain. Because laser is recognized to enhance
neovascularization, irradiation of tumors or wounds that
may contain cancer cells is contraindicated.
Furthermore, lasers pose a known risk to the eye, so
irradiation of or near the eye should not be performed.
Additional contraindications include irradiation over a
pregnant uterus and open growth plates.
Finally, it is important to note that a therapeutic
window exists for photobiostimulation. At sub-therapeutic
doses, cells will not be stimulated and no reactions will
occur; at extremely high doses, detrimental effects can
be seen. Interestingly, it is believed that low-level lasers,
at any dose, have minimal effect on normal, uninjured
tissue. The modulatory effects may also be wavelength
specific and vary with other laser parameters such as
polarization or pulse frequency.
CONCLUSION
In conclusion, therapeutic lasers are gaining
acceptance in veterinary medicine as an adjunctive tool
in wound healing and pain management. Therefore, it is
important for practitioners to increase their knowledge in
this area in order to make informed recommendations for
such therapy. While a plethora of anecdotal reports,
case reports and experimental evidence exist in support
of therapeutic lasers, large clinical studies are currently
lacking. It is anticipated that clinical veterinary studies
will emerge in the near future that enhance our
understanding of the usefulness of this modality.
REFERENCES
1. Tunér J, Hode L, Nobel A. The Laser Therapy
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2. Prentice WE. Therapeutic Modalities for Sports
Medicine and Athletic Training. New York: McGraw-
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3. Corazza AV, Jorge J, Kurachi C, et al.
Photobiomodulation on the angiogenesis of skin
wounds in rats using different light sources.
Photomed Laser Surg. 2007;25:102-106.
4. Mendez TM, Pinheiro AL, Pacheco MT, et al. Dose
and wavelength of laser light have influence on the
repair of cutaneous wounds. J Clin Laser Med Surg.
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5. Woodruff LD, Bounkeo JM, Brannon WM, et al. The
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6. Yu W, Naim JO, Lanzafame RJ. Expression of
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Additional references available from the author upon
request.
